Adjustment to cancer - coping or personal transition?

Psychosocial Impact of Penile Cancer: An Unmet Need

Penile cancer is a rare cancer, where patients not only need to deal with the anxiety around a cancer diagnosis, but also manage the consequences of treatment on their self-esteem, body image, and intimate relationships. Many find it embarrassing and difficult to talk to family and friends. Due to this, changes in urination and other physical effects of treatment, many will withdraw from social activities too. Patients need psychosocial support and more needs to be done to address this unmet need. Holistic and multidisciplinary approaches in clinic, with access to counseling, may help patients adjust to their new situation.

Negative Disease-Related Stigma 3-months After Hemorrhagic Stroke is related to Functional Outcome and Female Sex

OBJECTIVES

The objective of this study was to determine factors associated with negative disease-related stigma after hemorrhagic stroke.

MATERIALS AND METHODS

Patients with non-traumatic hemorrhage (ICH or SAH) admitted between January 2015 and February 2021 were assessed by telephone 3-months after discharge using the Quality of Life in Neurological Disorders (Neuro-QoL) Negative Disease-Related Stigma Short Form inventory. We evaluated the relationship between disease-related stigma (T-score>50) and pre-stroke demographics, admission data, and poor functional outcome (3-month mRS score 3-5 and Barthel Index <100).

RESULTS

We included 89 patients (56 ICH and 33 SAH). The median age was 63 (IQR 50-69), 43% were female, and 67% graduated college. Admission median GCS score was 15 (IQR 13-15) and APACHE II score was 12 (IQR 9-17). 31% had disease-related stigma. On univariate analysis, disease-related stigma was associated with female sex, non-completion of college, GCS score, APACHE II score, and 3-month mRS score (all p<0.05). On multivariate analysis, disease-related stigma was associated with female sex (OR = 3.72, 95% CI = 1.23-11.25, p = 0.02) and 3-month Barthel Index<100 (OR = 3.46, 95% CI = 1.13-10.64, p = 0.03) on one model, and female sex (OR = 3.75, 95% CI = 1.21-11.58, p = 0.02) and 3-month mRS score 3-5 (OR = 4.23, 95% CI = 1.21-14.75, p = 0.02) on a second model.

CONCLUSION

Functional outcome and female sex are associated with disease-related stigma 3-months after hemorrhagic stroke. Because stigma may negatively affect recovery, there is a need to understand the relationship between these factors to mitigate stroke-related stigma.

The Association of Resilience with Psychosocial Outcomes in Teenagers and Young Adults with Cancer

Purpose: There is limited research on the psychological impact of cancer for teenagers and young adults (TYAs) and the role of protective factors such as resilience. This study investigated associations between resilience and psychosocial outcomes in this group. Methods: Data were collected from TYAs (aged 16-24) who attended the TYA cancer clinic at Guy's Hospital between 2013 and 2021. Participants (N = 63) completed psychosocial questionnaires within 4 weeks of their treatment start date (T1) and again between 9 and 15 months later (T2). We used separate multivariable linear regression models to analyze associations of resilience (Brief Resilience Questionnaire) with outcomes measured at T2, including symptoms of depression (Patient Health Questionnaire [PHQ]-9), anxiety (Generalized Anxiety Disorder [GAD]-7), and subjective quality of life. Models were adjusted for age, gender, ethnicity, and T1 outcome assessments. Results: Higher resilience at T1 was associated with increased anxiety (β = 1.68; bootstrapped confidence interval [95% CI -0.28 to 3.19]), depression (β = 1.24; [-0.85 to 2.90]), and quality of life (5.76; [-0.88 to 15.60]). In contrast, an increase in resilience over time was associated with decreases in the same period in anxiety (β = -3.16; [-5.22 to -1.47]) and depression (β = -2.36, [-4.41 to -0.58]), and an increase in quality of life (β = 9.82, [-0.24 to 21.13]). Conclusion: Increases in resilience during cancer treatment were associated with reduced symptoms of depression and anxiety in TYAs. We discuss factors likely to influence these outcomes, the implications for psychosocial interventions in this population, and identify further research to explore the impact of other factors such as diagnosis and treatment type.

How a Medically Tailored Meal Intervention with Intensive Nutrition Counseling Created Active Coping with Behavior Change for Vulnerable Patients with Lung Cancer

Purpose

The purpose of this study was to assess participants' perceptions and experiences while participating in a Food is Medicine medically tailored meal plus nutrition counseling intervention to create a theoretical explanation about how the intervention worked.

Methods

This interpretive qualitative study included the use of semi-structured interviews with active intervention participants. Purposeful sampling included vulnerable (uninsured, rural zip code residency, racial/ethnic minority, 65 years old, and/or low-income) individuals with lung cancer treated at four cancer centers across the United States. Interviews were recorded, transcribed verbatim, and analyzed using conventional content analysis with principles of grounded theory.

Results

Twenty individuals participated. Data analysis resulted in a theoretical explanation of the intervention's mechanism of action. The explanatory process includes 3 linked and propositional categories leading to patient resilience: engaging in treatment, adjusting to diagnosis, and active coping. The medically tailored meals plus intensive nutrition counseling engaged participants throughout treatment, which helped participants adjust to their diagnosis, leading to active coping through intentional self-care, behavior change, and improved quality of life.

Conclusions

These findings provide evidence that a food is medicine intervention may buffer some of the adversity related to the diagnosis of lung cancer and create a pathway for participants to experience post-traumatic growth, develop resilience, and change behaviors to actively cope with lung cancer. Medically tailored meals plus intensive nutrition counseling informed by motivational interviewing supported individuals' adjustment to their diagnosis and resulted in perceived positive behavior change.

Quality of life, distress and psychological adjustment in patients with colon cancer

PURPOSE

The purpose of this study was to investigate the relationships between distress, psychological adjustment, and quality of life in patients with colon cancer.

METHOD

This study employed a cross-sectional design and included 104 colon cancer patients treated at AHEPA Hospital, Thessaloniki, Greece. The assessment tools used encompassed the Distress Thermometer, MINI-MAC scale, and FACT-C to evaluate distress, psychological adjustment, and quality of life. Statistical analysis, conducted in SPSS software, encompassed correlation tests and linear regression to explore the interplay between these variables in colon cancer patients.

RESULTS

Correlation tests revealed that patients' quality of life is positively correlated with a fighting spirit (r = 0.719, p < 0.001), cognitive avoidance (r = 0.634, p < 0.001), and fatalism (r = 0.518, p < 0.001), and negatively with helplessness and hopelessness (r = -0.756, p < 0.001), and anxious preoccupation (r = -0.679, p < 0.001). OLS regression findings verified these results partially for a significance level of 5% but indicated no statistically significant effect of cognitive avoidance and fatalism on quality of life, which was further found unaffected by total distress.

CONCLUSIONS

The intricate links between quality of life, distress, and psychological adjustment in colon cancer patients call for deeper investigation. A personalized approach in psycho-oncology care is essential for comprehensive treatment. These findings highlight the significance of addressing the psychological and emotional needs of colon cancer patients, as observed in the study's results.

A Better Me? An Interpretative Phenomenological Analysis of the Experiences of Female Cancer Survivors' Heightened Preoccupation With 'Healthy Eating'

The end of treatment is known to be a particularly challenging time for many cancer survivors as they transition to coping with their condition independently. They may engage in health behaviours, such as implementing drastic dietary changes to manage the side effects of treatment they have undergone or as a way to assuage their anxiety. Understanding cancer survivors' heightened preoccupation with healthy eating is therefore fundamental to our understanding of the psychological phenomenology of cancer. This study explored how people who have developed a heightened preoccupation with healthy eating after a cancer diagnosis make sense of this change. Eight participants were recruited through social media. They each engaged in a semi-structured interview over Zoom concerning their changed relationship with food following cancer. Their accounts were then analysed using interpretative phenomenological analysis (IPA). The article focuses on four group experiential themes arising from the analysis: Open and Enlightened About Food, Becoming a Better Me?, Developing a New Passion for Nutrition, and Becoming Consumed by Food. The themes that arose from the analysis speak to the experience of becoming a 'better' person from having lived through cancer and developed a new relationship with food. Instead of seeing illness as a loss, several of the participants reported a positive shift linked to having developed an interest in healthy eating, something which became central to their identity. However, others experienced their new engagement with healthy eating as a preoccupation that engulfed them. These findings are discussed in light of existing theory and research, and their clinical implications are outlined. Areas for future research are also suggested.

Multimedia-based hormone therapy information program for patients with prostate cancer: the result of a randomized pilot study

Few studies have explored the feasibility and efficacy of a multimedia information intervention for patients with prostate cancer who are undergoing hormone therapy. Thus, the purpose of the study was to assess the feasibility, acceptability, and the preliminary results of a multimedia-based hormone therapy information program (HTIP) on positive thinking and quality of life (QOL; primary outcomes) as well as social support and self-efficacy (secondary outcomes) of patients with prostate cancer. Patients with prostate cancer who were receiving hormone therapy were recruited from hospitals. After completing the pre-test questionnaire, patients were randomly divided into the multimedia information group (MIG; n = 40) and the control group (CG; n = 40). Patients in the MIG received a multimedia-based HTIP once a week for 6 weeks. Data were collected at 8 and 12 weeks after the pre-test. Measurement variables included positive thinking, QOL, social support, self-efficacy, and satisfaction with the program. The recruitment rate and retention rate were calculated for assessment of feasibility. The study had a 96.3% retention rate, and patients in the MIG were satisfied with the program. Preliminary results showed that, compared with those in the CG, patients in the MIG tended to exhibit higher positive thinking, prostate cancer-specific QOL, and social support at 8 weeks and 12 weeks after pre-test; however, the effect did not reach a statistically significant level. A multimedia-based HTIP is considered feasible and acceptable in patients with prostate cancer who underwent hormone therapy. Further research with a larger sample size, patients with high homogeneity in early-stage disease and long-term follow-up is needed to assess the efficacy of the intervention program.Trial registration: ClinicalTrials.gov (NCT04693910); Registered 05/01/2021.

The mutual determination of self-efficacy to cope with cancer and cancer-related coping over time: a prospective study in women with breast cancer

OBJECTIVE

The aim of this study was to examine the longitudinal impact of self-efficacy to cope with cancer on the cancer-related coping reactions of breast cancer patients and vice versa.

DESIGN AND MAIN OUTCOMES MEASURES

Data from the BOUNCE Project (https://www.bounce-project.eu/) were used to address the hypotheses. Participants (N = 403) were enrolled in the study a few weeks after surgery or biopsy. Coping self-efficacy was assessed at baseline and six months later (M6). Cancer-related coping was assessed three (M3) and nine months (M9) after baseline. The analyses were performed using structural equation modeling with Mplus 8.6.

RESULTS

Baseline coping self-efficacy predicted all M3 coping reactions, while M6 coping self-efficacy also predicted changes in all but one M9 coping reaction. Moreover, one of the M3 coping reactions, that is, hopelessness/helplessness, predicted the changes in M6 coping self-efficacy. The relation between coping self-efficacy and one coping reaction (i.e. cognitive avoidance) was rather weak. Stability paths from M3 to M9 coping reactions were moderate to high.

CONCLUSION

The relationship between self-efficacy to cope with cancer and cancer-related coping is complex. New theoretical models are needed to more accurately describe the diverse aspects of this association.

Gender Differences in Psychosocial Outcomes and Coping Strategies of Patients with Colorectal Cancer: A Systematic Review

(1) Background: Gender is an important factor impacting cancer experience. This review mainly aimed to summarize colorectal cancer (CRC) patients' gender differences in psychosocial outcomes and coping strategies. (2) Methods: Relevant studies were searched for in four electronic databases from 2007 to July 2023. And manual searching was performed on the included studies' reference lists to identify additional eligible studies. (3) Results: A total of 37 eligible articles were included in this review. These studies were conducted in 19 countries, and they targeted CRC patients at various treatment stages. Significant results showed that female patients tended to have more psychological distress, complex social functioning, and less sexual distress and to choose more positive coping strategies than male patients. But there was no gender difference in psychosocial outcomes and/or coping strategies in some studies, which implied that gender similarity also existed. (4) Conclusions: The findings support the fact that there are both gender differences and similarities in CRC patients' psychosocial outcomes and coping strategies. A perspective beyond the simple masculine-feminine binary improved our in-depth understanding of gender tendency. Importantly, taking gender tendency into account is critical for medical staff to provide more personalized support and communication interventions.

Improving personalised care and support planning for people living with treatable-but-not-curable cancer

People living with treatable-but-not-curable (TbnC) cancer encounter cancer-related needs. While the NHS long-term plan commits to offering a Holistic Needs Assessment (HNA) and care plan to all people diagnosed with cancer, the content, delivery and timing of this intervention differs across practice. Understanding how people make sense of their cancer experience can support personalised care. A conceptual framework based on personal narratives of living with and beyond cancer (across different cancer types and all stages of the disease trajectory), identified three interlinked themes: Adversity, Restoration and Compatibility, resulting in the ARC framework.Our aim was to use the ARC framework to underpin the HNA to improve the experience of personalised care and support planning for people living with TbnC cancer. We used clinical work experience to operationalise the ARC framework and develop the intervention, called the ARC HNA, and service-level structure, called the ARC clinic. We sought expert input on the proposed content and structure from patients and clinicians through involvement and engagement activities. Delivered alongside standard care, the ARC HNA was piloted with patients on the TbnC cancer (myeloma and metastatic breast, prostate or lung) pathway, who were 6-24 months into their treatment. Iterations were made to the content, delivery and timing of the intervention based on user feedback.Fifty-one patients received the intervention. An average of 12 new concerns were identified per patient, and 96% of patients achieved at least one of their goals. Patients valued the space for reflection and follow-up, and clinicians valued the collaborative approach to meeting patients' supportive care needs. Compared with routine initial HNA and care plan completion rates of 13%, ARC clinic achieved 90% with all care plans shared with general practitioners. The ARC clinic adopts a novel and proactive approach to delivering HNAs and care plans in a meaningful and personalised way.

Prehabilitation in the lung cancer pathway: a scoping review

BACKGROUND

Lung cancer is the third most common type of cancer in the UK. Treatment outcomes are poor and UK deaths from lung cancer are higher than any other cancer. Prehabilitation has shown to be an important means of preparing patients both physically and psychologically for cancer treatment. However, little is understood about the context and mechanisms of prehabilitation that can impact physiological and psychological wellbeing. Our aim was to review and summarise primary research on prehabilitation in the lung cancer pathway using a realist approach.

METHODS

A scoping review of empirical primary research was conducted. Five online medical databases from 2016 - February 2023 were searched. All articles reporting on prehabilitation in lung cancer were included in the review. For this review, prehabilitation was defined as either a uni-modal or multi-modal intervention including exercise, nutrition and/or psychosocial support within a home, community or hospital based setting. A realist framework of context, mechanism and outcome was used to assist with the interpretation of findings.

RESULTS

In total, 31 studies were included in the review, of which, three were published study protocols. Over 95% of studies featured an exercise component as part of a prehabilitation programme. Twenty-six of the studies had a surgical focus. Only two studies reported using theory to underpin the design of this complex intervention. There was large heterogeneity across all studies as well as a lack of clinical trials to provide definitive evidence on the programme design, setting, type of intervention, patient criteria, delivery, duration and outcome measures used.

CONCLUSION

A standardised prehabilitation programme for lung cancer patients does not yet exist. Future lung cancer prehabilitation programmes should take into account patient led values, needs, goals, support structures and beliefs, as these factors can affect the delivery and engagement of interventions. Future research should consider using a conceptual framework to conceptualise the living with and beyond cancer experience to help shape and inform personalised prehabilitation services.

Is personalised prehabilitation feasible to implement for patients undergoing oncological treatment for lung cancer at a London teaching hospital? Protocol of a feasibility trial

INTRODUCTION

There is significant potential to improve outcomes for patients with lung cancer in terms of quality of life and survival. There is some evidence that prehabilitation can help, but, to date, this has only been tested in surgical populations, despite 70%-80% of patients with lung cancer in the UK receiving non-surgical treatment. The physiological and psychological benefits of prehabilitation seen in surgical patients could be extrapolated to those receiving non-surgical treatment, particularly in such a poor prognosis group. With patients and healthcare professionals, we have co-designed a personalised and evidence-based prehabilitation programme. This draws on a conceptual framework that aligns with patient values and needs as well as functional goals. We aim to investigate whether this programme is feasible to implement and evaluate in clinical practice.

METHODS AND ANALYSIS

An open-label, single-group feasibility study incorporating quantitative assessments, a qualitative free text questionnaire and reflective field notes. Thirty participants will be recruited over an eight-month period from a single London teaching hospital. All recruited participants will receive a personalised prehabilitation programme during their oncological treatment. This includes a one-hour face-to-face appointment prior to, at week three and at week six of their treatment regimen as well as a weekly telephone call. Interventions including nutrition, physical activity and psychological well-being are stratified according to a patient's priorities, level of readiness and expressed needs. The primary outcome will be feasibility of the personalised prehabilitation programme in clinical practice by investigating areas of uncertainty regarding patient recruitment, attrition, treatment fidelity, intervention adherence and acceptability of study outcome measures. Secondary outcomes will include quality of life, functional capacity and grip strength.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Health Research Authority (reference number 22/PR/0390). Results of this study will be disseminated through publication in peer-reviewed articles, presentations at scientific conferences and in collaboration with patient and public involvement representatives.

TRIAL REGISTRATION NUMBER

NCT05318807.

The experience of interval scans for adults living with primary malignant brain tumors

PURPOSE

People with primary malignant brain tumors (PMBT) undergo anti-tumor treatment and are followed up with MRI interval scans. There are potential burdens and benefits to interval scanning, yet high-quality evidence to suggest whether scans are beneficial or alter outcomes of importance for patients is lacking. We aimed to gain an in-depth understanding of how adults living with PMBTs experience and cope with interval scanning.

METHODS

Twelve patients diagnosed with WHO grade III or IV PMBT from two sites in the UK took part. Using a semi-structured interview guide, they were asked about their experiences of interval scans. A constructivist grounded theory approach was used to analyze data.

RESULTS

Although most participants found interval scans uncomfortable, they accepted that scans were something that they had to do and were using various coping methods to get through the MRI scan. All participants said that the wait between their scan and results was the most difficult part. Despite the difficulties they experienced, all participants said that they would rather have interval scans than wait for a change in their symptoms. Most of the time, scans provided relief, gave participants some certainty in an uncertain situation, and a short-term sense of control over their lives.

CONCLUSION

The present study shows that interval scanning is important and highly valued by patients living with PMBT. Although interval scans are anxiety provoking, they appear to help people living with PMBT cope with the uncertainty of their condition.

Multimodal prehabilitation service for patients with colorectal cancer: the challenges of implementation

Prehabilitation has been shown to improve outcomes for patients undergoing major surgery; benefits include reductions in length of hospital stay and postoperative complications. Multimodal prehabilitation programmes lead to improved patient engagement and experience. This report describes implementation of a personalised multimodal prehabilitation programme for patients awaiting colorectal cancer surgery. We aim to highlight the successes, challenges and future direction of our programme.Patients listed for colorectal cancer surgery were referred for initial prehabilitation assessment. The prehabilitation group were assessed by specialist physiotherapists, dieticians and psychologists. An individualised programme was developed for each patient, aiming to optimise preoperative functional capacity and enhance physical and psychological resilience. Clinical primary outcome measures were recorded and compared with contemporaneous controls. For those undergoing prehabilitation, a set of secondary functional, nutritional and psychological outcomes were recorded at initial assessment and on completion of the programme.61 patients were enrolled in the programme from December 2021 to October 2022. 12 patients were excluded as they received less than 14 days prehabilitation or had incomplete data. The remaining 49 patients received a median duration of 24 days prehabilitation (range 15-91 days). The results show statistically significant improvements in the following functional outcome measures after prehabilitation: Rockwood scores, maximal inspiratory pressures, International Physical Activity Questionnaire Score and Functional Assessment of Chronic Illness - Fatigue Score. There was a lower postoperative complication rate in the prehabilitation group when compared with a control group (50% vs 67%).This quality improvement project has 3 Plan-Do-Study-Act (PDSA) cycles. PDSA 1 demonstrates prehabilitation can be successfully imbedded within a colorectal surgical unit and that patients are grateful for the service. PDSA 2 provides the project's first complete data set and demonstrates functional improvements in patients undergoing prehabilitation. The third PDSA cycle is ongoing and aims to refine the prehabilitation interventions and improve clinical outcomes for patients undergoing colorectal cancer surgery.

The Exploration of the Eating Experience in Adults with Celiac Disease: A Phenomenological Qualitative Study

BACKGROUND

The adjustment to a strict gluten-free diet for adults diagnosed with celiac disease (CD) may lead to changes in the eating experience affecting the physical, social, and emotional states.

OBJECTIVE

Through the application of the Social Cognitive Transition Model of Adjustment, the aim of the study was to explore the adjustment in the eating experience in adults recently diagnosed with CD and transitioning to a gluten-free diet.

DESIGN

This was a qualitative phenomenological study conducted using semistructured interviews.

PARTICIPANTS AND SETTING

Seventeen adults from the midwestern United States who were diagnosed with CD between 6 months and 5 years before the study were recruited using social media CD sites and snowball sampling. Participants completed a semistructured interview on Zoom and the Celiac Disease Adherence Test and CeliacQ-7 questionnaires from May to November 2020.

STATISTICA ANALYSES PERFORMED

Two trained qualitative researchers engaged in four steps to reduce and contextualize the data: horizontilization, reduction and elimination, clustering and thematizing, and composition of textural description. During analysis, the Social Cognitive Transition Model of Adjustment was incorporated for organization of themes and text description.

RESULTS

There was moderate to high dietary adherence in 14 of 17 participants and quality of life scores ranged from 19 to 43 (median = 33). Five themes emerged aligning with Social Cognitive Transition Model of Adjustment, describing the adjustment in pre- and postdiagnosis eating experience and the coping and behaviors enacted during adjustment to a gluten-free diet.

CONCLUSIONS

In individuals with CD, moving beyond problem solving and identifying psychosocial and emotional attributes in the adoption of a gluten-free diet need to be considered to promote maintenance of quality of life and dietary adherence.

Post-traumatic growth in caregivers of children hospitalized in the PICU due to traffic accident: a qualitative study

BACKGROUND

Globally, tens of millions of children are hospitalized every year for non-fatal traffic accident injuries, being confronted with an injured child can be extremely stressful for parents. Understandably, a significant level of psychological distress may ensue. Traumatic losses may lead parents to find new insights in life and develop a greater sense of spirituality and strength.

METHOD

Semi-structured interviews were conducted with caregivers of children who were hospitalized in the pediatric intensive care unit (PICU) with traffic accident injuries at children's hospitals in China between January and June 2022. Caregivers were selected using a purposive sampling method until no new data were generated (n = 24).

RESULTS

We identified eleven sub-themes and four higher-order themes based on these sub-themes: (1) changes in their life philosophy, (2) personal strength enhancement, (3) relationship improvements, and (4) effective responses. The findings of our research contribute to a better understanding of the psychological status of the caregivers of children injured by traffic accidents.

CONCLUSION

Professionals should guide caregivers from a positive perspective, stimulate their strengths and potential, increase personnel support and communication, promote positive coping, formulate targeted management countermeasures to improve the PTG level of caregivers, and develop strategies to maintain stable mental health and well-being.

Undergoing radical treatment for prostate cancer and its impact on wellbeing: A qualitative study exploring men's experiences

INTRODUCTION

Quality of life in prostate cancer survivorship is becoming increasingly important, with mental and social wellbeing recognised as key components. However, limited global evaluation of psychosocial challenges experienced after treatment exists. Therefore, we aimed to explore the lived experiences of men who underwent radical treatment, and its psychosocial impact.

MATERIAL AND METHODS

This qualitative study was conducted using 19 men who had undergone radical treatment (prostatectomy or radiotherapy) for their cancer. Semi-structured interviews were conducted exploring lived experiences of men after treatment. A Structured thematic analysis of collected data was undertaken, with an inductive co-construction of themes through the lens of the biopsychosocial model. Themes generated were considered within a psychological, social, and physical wellbeing framework.

RESULTS

An initial knowledge gap meant mental wellbeing was strongly impacted initially leading to a 'Diagnostic Blow and the Search for Clarity'. Doubt over individuals' future resulted in 'An Uncertain Future' in many men. Once treatment was completed a 'Reflective journey' began, with men considering their outcomes and decisions made. Social wellbeing was also impacted with many identifying the 'Emotional Repercussions' on their relationships and the impact their diagnosis had on their partner and family. Many subsequently sought to increase their support through 'The Social Network and Advocacy', while physical changes led to an increased need for 'Social Planning'. Finally, physical wellbeing was highlighted by a continual acknowledgement of the 'Natural process of ageing' leading to a reluctancy to seek help, whilst simultaneously attempting to improve existing health via 'The Health Kick'.

CONCLUSIONS

Radical treatments have a considerable impact on mental and social wellbeing of individuals. Anxiety after diagnosis and significant uncertainty over individual futures exist, with physical complications of treatment leading to social repercussions. Future research should aim to identify forms of support to improve quality of life of these men.

The psychosocial experiences of human papillomavirus (HPV) positive oropharyngeal cancer patients following (chemo)radiotherapy: A systematic review and meta-ethnography

OBJECTIVE

The UK incidence of oropharyngeal cancer has risen sharply over the last 30 years with an increase in human papillomavirus (HPV) associated diagnoses, most prevalent in younger, working age populations. This meta-ethnography explores the psychosocial needs of HPV+ve oropharyngeal cancer patients during early recovery following (chemo)radiotherapy.

METHODS

Meta-ethnography methods were used, based on the approach of Noblit and Hare. Systematic searches for relevant qualitative studies were conducted in five electronic databases (MEDLINE, PubMed, CINAHL, PsycINFO and Cochrane database) between 2010 and 2021, followed by citation searching.

RESULTS

Twenty-three papers exploring the psychosocial needs of HPV+ve oropharyngeal cancer patients after treatment were included. Findings were synthesised to develop five constructs: 'gaps in continuity of support from healthcare professionals' reflecting unmet needs; 'changes to self-identity' revealing the comprehensive disruption of this disease and treatment; 'unrealistic expectations of recovery' highlighting the difficulty of preparing for the impact of treatment; 'finding ways to cope' describing the distinct complexity of this experience; and 'adjusting to life after the end of treatment' exploring how coping strategies helped patients to regain control of their lives.

CONCLUSIONS

Completing (chemo)radiotherapy signalled a transition from hospital-based care to home-based support, challenging patients to address the constructs identified. An unexpectedly difficult and complex recovery meant that despite a favourable prognosis, poor psychosocial well-being may threaten a successful outcome. The provision of tailored support is essential to facilitate positive adjustment.

Post-stroke emotionalism (PSE): a qualitative longitudinal study exploring individuals' experience with PSE

PURPOSE

Post-stroke emotionalism (PSE) is a common consequence of stroke characterised by episodes of crying or laughing. There is only one published qualitative study exploring the experience of emotionalism to date. This study aimed to explore individual's experience of PSE and develop a theoretical client-derived framework to shape future psychological interventions.

MATERIALS AND METHODS

A primary analysis of the qualitative pseudonymised pre-collected semi-structured interview data of the TEARS study was completed. Participants were recruited from nine acute stroke units in Scotland with participants commencing the study at baseline (two-weeks) and they either continued or dropped out. Interviews were completed at two-weeks, six-months and 12-months post-stroke.

RESULTS

Data was analysed from 52 participants at two-weeks, 25 participants at six-months and 23 participants at 12-months. Three major themes were identified: "In the moment," describing characteristics and triggers, "Ways of coping," highlighted a variation of coping strategies including avoidance or acceptance and "Impact," outlining the longer-term effects of PSE such as individuals' beliefs.

CONCLUSION

The results indicate specific psychological aspects of PSE which could be viable targets in psychological interventions such as increasing adaptive coping strategies and challenging negatively held beliefs.IMPLICATIONS FOR REHABILITATIONEmotionalism can cause emotional consequences such as distress, embarrassment and fear.Helping individuals to develop insight into triggers for emotionalism could be beneficial to help gain understanding and awareness whereby post-stroke emotionalism (PSE) has the potential to be anticipated and adapted to psychologically.Potential adaptive responses such as acceptance or control and better anticipation of episodes of emotionalism could help to reduce the emotional consequences of PSE.

Changes in Depression and Sleep Quality and Associated Factors in Women Receiving Chemotherapy for Ovarian Cancer: An Observational Study

BACKGROUND

Although women with ovarian cancer experience depression and poor sleep quality, little is known about how various factors, particularly self-efficacy, might be associated with these conditions.

OBJECTIVES

The aim of this study was to examine the prevalence of and changes in depression and sleep quality and the factors associated with these conditions in a cohort of women with ovarian cancer before, during, and after chemotherapy.

METHODS

A prospective repeated-measures design was adopted in this study. Participants were women with ovarian cancer who were expected to receive 4 to 6 cycles of chemotherapy and were recruited at a medical center in Taiwan. The participants were asked to complete a questionnaire that included the Symptom Distress Scale, Center for Epidemiologic Studies Depression Scale, General Self-efficacy Scale, and Pittsburgh Sleep Quality Index. The data were collected before, during, and after the course of chemotherapy.

RESULTS

Overall, 24.6% to 36.9% of women were at risk for depression; 75.4% to 80.0% of women had poor sleep quality. There were no significant changes in depressive symptoms and sleep quality throughout the course of chemotherapy. More severe depressive symptoms were associated with higher levels of symptom distress and lower self-efficacy. Poorer sleep quality was associated with higher levels of symptom distress.

CONCLUSIONS

Among participants, more depressive symptoms and poorer sleep quality were associated with higher levels of symptom distress or lower self-efficacy.

IMPLICATIONS FOR PRACTICE

Healthcare providers should continuously assess depression and sleep quality in women with ovarian cancer. These symptoms may be improved by strengthening self-efficacy and relieving symptom distress.

Social support, anxiety, and depression in patients with prostate cancer: complete mediation of self-efficacy

BACKGROUND

Social support and self-efficacy are important factors to improve negative emotions such as depression and anxiety in patients with prostate cancer after surgery; however, little is known about the relationship between them. The objective of the study was to comprehensively explore the relationship between social support, self-efficacy, and anxiety and depression.

METHOD

A cross-sectional design and a convenience sampling method were used to recruit patients with prostate cancer from a comprehensive hospital in Zhejiang Province. Structured scales were used for data collection, including the Social Support Rating Scale, Strategies Used by People to Promote Health, and the hospital anxiety and depression scale.

RESULTS

The result showed that anxiety and depression were negatively correlated with self-efficacy (r =  - 0. 434, P < 0. 01) and social support (r =  - 0. 212, P < 0. 01), while self-efficacy and social support were positively correlated (r = 0. 356, P < 0. 01). A structural equation model showed that the effect value of social support on self-efficacy was (β = 0.386, p < 0.01) and the effect value of self-efficacy on negative emotions was (β =  - 0.497, p < 0.01). Self-efficacy fully mediated the effect between social support and negative emotions with a 100% mediation rate.

CONCLUSION

Social support and self-efficacy did contribute to the improvement of depression and anxiety in patients with radical prostatectomy, and they were associated with a full mediating effect of self-efficacy. Providing social support that matches the coping needs of the stressor can maximize the role of social support. Therefore, it is necessary to identify the patient's stressor and coping needs in advance, which will help us to provide matching social support, so as to alleviate patients' bad emotions more effectively and improve their prognosis.

'Still living with it even though it's gone': Using interpretive phenomenological analysis to explore shared experiences of living with and beyond breast, prostate, and colorectal cancer

PURPOSE

Living with and beyond cancer is an increasingly common experience. While research is uncovering valuable individual experiences of those living with and beyond cancer, it has been argued that this idiographic approach is limited in outlook, reach and impact. This study contributes to the understanding of what it means to live with and beyond cancer by complementing idiographic knowledge with multiple perspectives from a group of participants who are living with and beyond cancer, to explore how individual experiences may be relevant to others.

METHOD

Semi-structured interviews were conducted with people who had received treatment for breast (n = 6), prostate (n = 6) or colorectal cancer (n = 6). Data were analysed using interpretive phenomenological analysis. The early findings were then shared with a wider group of people who had received treatment for breast, prostate or colorectal cancer (n = 26) in six focus groups, to explore whether they had similar experiences.

RESULTS

While individual accounts of living with and beyond cancer detail unique features specific to each person's experience, focus group discussions illustrated how participant life worlds interact and overlap. The findings identified thematic similarities within and between individual and group levels and across cancer types. Three super-ordinate themes describe the shared experience of living with and beyond cancer: i) the cancer shock, ii) managing cancer and getting through and iii) getting over cancer.

CONCLUSIONS

A multiple perspective approach informs our understanding of shared experiences of living with and beyond cancer. This knowledge can be used to direct, design, and deliver relevant supportive cancer care.

Experiences of Self-Criticism and Self-Compassion in People Diagnosed With Cancer: A Multimethod Qualitative Study

Objective: Self-criticism is a self-condemning and self-compassion a supportive style of self-to-self relating. These concepts have increasingly been studied in people with cancer, but mainly with quantitative studies. This study is the first to explore how adult cancer patients experience self-criticism and self-compassion in the context of their illness. Design: A multimethod qualitative study design was used, combining individual and group semi-structured interviews. Participants were 26 people with cancer who familiarized themselves with the topic by doing various self-compassion exercises for 2 weeks prior to the interview. Individual and group interviews were analyzed together using thematic analysis. Results: Four themes regarding self-criticism were identified: (1) being harsh or strict with yourself, (2) feeling guilty or angry, (3) feeling useless or like a burden, (4) feeling ashamed and not wanting to show weakness. Six themes regarding self-compassion were identified: (1) being mild to yourself, (2) guarding your boundaries, (3) accepting the illness and limitations, (4) maintaining a positive perspective, (5) connecting to others, and (6) taking responsibility for your health. Conclusion: Our findings offer insights into practical and daily life experiences of self-criticism and self-compassion of people with cancer, which can aid the further development of theory, scales and interventions.

What Matters Most? Predictors of Quality of Life and Life Satisfaction Among Young Breast Cancer Survivors

BACKGROUND

Younger breast cancer survivors face unique challenges, and research is needed to better understand how to optimize their quality of life (QoL) and satisfaction with life (SwL).

OBJECTIVE

The aim of this study was to examine a biopsychosocial model of QoL and SwL in young breast cancer survivors. Biological, psychological, and social/practical factors were hypothesized to be associated with both distressing and adaptive reactions during survivorship, which in turn were hypothesized to be associated with QoL and SwL.

METHODS

Young (age = 19-45 years at diagnosis) breast cancer survivors (N = 284) completed an online survey assessing demographic and biopsychosocial factors, QoL, and SwL. Latent variables were created for adaptive and distressing reactions, and structural equation modeling was used to test the hypothesized relationships.

RESULTS

The model fit the data (χ2(100) = 332.92, P < .001, comparative fit index = 0.86, root mean square error of approximation = 0.09, standardized root mean square residual = 0.05) and accounted for large proportions of variance in QoL (R2 = 0.86) and SwL (R2 = 0.62). Social support, parenting concerns, and fertility concerns each significantly predicted adjustment. Adaptive reactions positively predicted SwL (β = 0.58, P < .001) but not QoL. Distressing reactions negatively predicted SwL (β = -0.26, P < .01) and QoL (β = -0.87, P < .001).

CONCLUSIONS

Adjustment in survivorship mediated the association of social support, parenting concerns, and fertility concerns on QoL and SwL in young breast cancer survivors.

IMPLICATIONS FOR PRACTICE

To support the psychological adjustment of young breast cancer survivors, attention should be given to survivors' social context including survivors' available social support and their concerns about fertility and parenting.

Transitioning the eating experience in survivors of head and neck cancer

PURPOSE

Applying the Social Cognitive Transition (SCT) Model of Adjustment as an interpretive framework, this mixed-methods case series explored how head and neck cancer (HNC) survivors participate in the dimensions of the eating experience (described as physiological, psychological, social, cultural).

METHODS

This was a sub-study of a primary study, "The Natural History and Impact of Taste Change in Oncology Care." Qualitative interviews and quantitative data (questionnaires and exams) were intersected to examine and describe the complexities of transitioning the eating experience after treatment for HNC. Triangulation of qualitative and quantitative data within and across cases was examined to produce rich descriptions of the changes and transitions in the eating experience.

RESULTS

Four case studies were detailed. All reported some taste and/or smell changes. Each case described worry about weight loss and the decreased ability to engage and finding meaning in the eating experience. Each expressed coping strategies that drew upon the social and cultural dimensions of their prior eating experience that brought meaning and purpose to the post-treatment eating experience.

CONCLUSIONS

This case series explored the impact of taste and oral function and the participant's pre- and post-treatment mental model of the eating experience. Application of the SCT Model of Adjustment to the eating experience in adults with HNC provided a deeper insight into how cognitive adaptation and coping strategies supported transition in identity related to the eating experience following cancer therapy.

Cognitive Behavioral Therapy of Patients with Somatic Symptoms-Diagnostic and Therapeutic Difficulties

In every somatic disease we can find a psychological element, just as it is not uncommon for numerous physical symptoms to occur in a mental disease. Nowadays, the patient is no longer just the “owner” of the sick organ but is considered and treated as a “whole”. The interpenetration of somatic manifestations with mental health problems forces patients who experience subjective suffering, including mental suffering, from current symptoms to visit specialists from different fields of medicine, and their treatment does not bring about any improvement. Cognitive behavioral psychotherapy (CBT) is one form of therapy that attempts to respond to the needs of an increasing—in recent years—number of patients who demonstrate somatic disorders of a multifaceted nature. The co-occurrence of physical and mental disorders repeatedly makes it impossible to determine which symptoms were the cause and which were the effect; hence, it is difficult to establish clear boundaries between the categories of these disorders and diseases. The therapist, to whom the patient with somatic diseases is eventually referred, may be faced with a diagnostic dilemma, the solution of which will give direction to further psychotherapeutic work. The common feature of this group of patients is a strong focus on physical ailments, while omitting or almost completely ignoring the psychological factors involved. The purpose of this paper is to present the causally diverse circumstances in which a patient with physical symptoms needs diagnosis and therapeutic support from the perspective of a cognitive behavioral approach.

Calling an Oncological Emergency Telephone to Seek Advice: An Interview Study

BACKGROUND

Cancer treatment is increasingly provided on an outpatient basis, which may challenge patients and caregivers coping with illness and adverse effects at home. A telephone consultation is an accepted type of healthcare provision to support patients and prevent adverse outcomes when their capacity to self-manage is inadequate. Whether this option for help sufficiently supports patients needs further investigation.

OBJECTIVES

The aim of this study was to explore patients' and caregivers' experience of calling an oncological emergency telephone.

METHODS

The study applies a phenomenological hermeneutic approach with 12 semistructured interviews. Patients and caregivers who had called the oncological emergency telephone within the last 2 months were included. The interview texts were analyzed by content analysis.

RESULTS

Patients and caregivers perceive the emergency telephone as a lifeline that they consider calling when the patient's condition changes from what they understand as normal to what they perceive as abnormal. They would rather call "one time too many than one time too few" if their resources are inadequate to ensure their safety. The tone, attitude, and professional competency of healthcare providers affect patients' experience of the call.

CONCLUSIONS

The value of calling the oncological emergency telephone depends on the healthcare providers' professional competences and skills to establish a relationship that makes patients feeling accommodated and taken care of.

IMPLICATIONS FOR PRACTICE

Patients' and caregivers' perceptions of what constitutes a good telephone consultation represent significant knowledge that contributes to a more comprehensive and practice-based understanding of what is required to advise patients and caregivers in an oncological emergency telephone.

Corporeal Posttraumatic Growth As a Result of Breast Cancer: An Interpretative Phenomenological Analysis

Women’s traumatic experience of breast cancer (BC) can result in posttraumatic growth (PTG). Women’s embodied experiences of BC seem particularly pertinent to their experiences of both difficulty and growth. While PTG is usually conceptualized as having five domains, it seems that BC survivors experience a sixth domain—corporeal PTG (CPTG). CPTG was recently defined as a “reclaiming” and renewed connection to the body through increased appreciation of the physical self, a new sense of bodily responsibility, positive health changes, and a new sense of positive identification with the body. This study’s aim was to explore how women experience CPTG due to BC. In-depth interviews were conducted with female BC survivors. Interpretative phenomenological analysis extracted three themes: losing, regaining, and relinquishing ultimate control over the body, reconstructing embodied identity, and a newfound appreciation for the body. Participants spoke of a complicated journey from distress, loss, and fragmentation to a reshaping of their assumptions about their bodies. The findings suggest that the body plays a vital role in women’s traumatic and growth-related experiences of BC. Future research on the embodied experience of BC is recommended as it forms a crucial part of BC recovery.

The factor structure of the posttraumatic growth inventory in cancer patients in Turkey

Posttraumatic growth is a positive psychological change that occurs as a result of tackling vital crises. Although cancer is perceived as a fatal disease, the individual's struggle with many negative conditions during diagnosis and treatment can provide positive change and development. The aim of this study was to examine the factor structure of the posttraumatic growth inventory (PTGI) in Turkish cancer patients. This study included 265 cancer patients receiving treatment at the chemotherapy unit of two university hospitals located in northern Turkey. Percentages, frequencies, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to analyse the data, and Cronbach's α measured internal consistency. EFA yielded a five-factor structure: Spiritual and existential change, change in perception of life and selfness, relating to others, personal strength and new possibilities. Fit indices for CFA were root mean square error of approximation (RMSEA), 0.06; non-normed fit index (NNFI), 0.92; comparative fit index (CFI), 0.90; root mean residuals (RMR), 0.06; and goodness-of-fit index (GFI), 0.90. The overall Cronbach's α of the scale was 0.93. PTGI was determined as a reliable and valid tool for Turkish cancer patients. PTGI, which has a determined validity and reliability rate, can be used by healthcare professionals working with oncology patients to evaluate the positive psychological growth and changes in cancer patients and determine their adoption rate.

Exploring the Positive Thinking of Patients With Prostate Cancer: Self-efficacy as a Mediator

BACKGROUND

Research has explored the effectiveness of positive thinking on individuals, but only a few studies have investigated the factors that influence individual positive thinking, particularly among patients with prostate cancer.

OBJECTIVES

The aim of this study was to understand the factors that affect positive thinking among patients with prostate cancer and the mediating role of self-efficacy.

METHODS

A cross-sectional design and a convenience sampling method were used to recruit patients with prostate cancer from 2 hospitals in Taiwan. Structured scales were used for data collection, including the General Self-efficacy Scale, Expanded Prostate Cancer Index Composite, Positive Thinking Scale, and Social Support Scale.

RESULTS

The total average score for positive thinking among 201 patients was 66.1 (SD, 9.4). The factors that influenced the positive thinking of patients with prostate cancer included self-efficacy, treatment satisfaction, perceived health status, marital status, and appraisal support. The effects of treatment satisfaction and appraisal support on positive thinking were partly achieved through self-efficacy (partial mediation).

CONCLUSIONS

Self-efficacy is a mediator that affects the relationship of treatment satisfaction, appraisal support, and positive thinking.

IMPLICATIONS FOR PRACTICE

In the course of the disease, healthcare providers can help patients with prostate cancer to promote and maintain appropriate positive thinking by improving treatment satisfaction; increasing appraisal support from family, relatives, and friends; strengthening self-efficacy; and modifying unrealistic expectations.

Self-concept, post-traumatic self-appraisals and post-traumatic psychological adjustment: what are the relationships?

BACKGROUND

Cognitive models of post-traumatic psychological adjustment have implicated both self-concept and self-appraisals in post-traumatic stress disorder (PTSD). Two studies investigated the relationship between self-concept and trauma-related self-appraisals, and whether culture influenced this relationship.

METHOD

In Study 1, a student sample (Asian n = 41, British n = 34) who self-identified as having been through a trauma or extremely stressful event completed measures of self-concept, trauma-related self-appraisals and trauma-related distress. Study 2 extended this by asking Asian (n = 47) and British (n = 48) trauma survivors with and without PTSD to complete the same self measures as those administered in Study 1.

RESULTS

Study 1 found that overall for the British group, disruptions in self-concept (i.e. self-discrepancies and trauma-themed self-concept) correlated significantly with negative self, world and self-blame appraisals and depression. However, the same was not found in the Asian group. Study 2 found that pan-culturally those with PTSD had greater self-discrepancies and trauma-defined self-concept than those without PTSD. Additionally, pan-culturally, trauma-defined self-concept correlated significantly with negative self appraisals and depression; ideal self-discrepancies correlated significantly with negative self-appraisals across cultures and depression for the British group; while ought self-discrepancies correlated significantly with negative world appraisals for the Asian group and negative self and self-blame appraisals for the British. Lastly, negative self, world and self-blame appraisals correlated with symptoms of depression.

CONCLUSIONS

Taken together, the findings relay the important associations between appraisals, self-concept and post-traumatic psychological adjustment.

Longitudinal associations between coping strategies, locus of control and health-related quality of life in patients with breast cancer or melanoma

PURPOSE

A diagnosis of breast cancer or melanoma is a traumatic life event that patients have to face. However, their locus-of-control (LOC) beliefs and coping strategies as well as the associations with health-related quality of life (HRQoL) changes over time are still not well known and rarely compared by cancer site.

METHODS

The objective of this longitudinal study was to assess the association of LOC (Cancer Locus-of-Control Scale) and coping (Brief Cope) changes, with change in HRQoL (EORTC QLQ-C30) over time in newly diagnosed breast cancer and melanoma patients at 1, 6, 12, and 24 month post-diagnosis. Mixed models were used to compare LOC and coping longitudinal changes as well as their associations with HRQoL changes in early-stage breast cancer and melanoma patients.

RESULTS

Overall, 215 breast cancer and 78 melanoma patients participated in the study. At baseline, HRQoL levels were often higher for breast cancer compared to melanoma patients. For breast cancer and melanoma patients, negative coping strategies and perceived control over the course of illness were negatively and positively associated with HRQoL changes, respectively. For breast cancer patients only, emotional coping and internal causal attribution were negatively associated with HRQoL changes. For both cancer sites, living with a partner correlated with worse HRQoL.

CONCLUSIONS

Understanding coping strategies and LOC beliefs used by patients soon after their cancer diagnosis and over the course of illness can help identifying psychological and supportive care to modify maladaptive thoughts and beliefs and promote more adaptive behaviors to ultimately improve patients' well-being and HRQoL.

Stroke Survivors on Twitter: Sentiment and Topic Analysis From a Gender Perspective

Background

Stroke is the worldwide leading cause of long-term disabilities. Women experience more activity limitations, worse health-related quality of life, and more poststroke depression than men. Twitter is increasingly used by individuals to broadcast their day-to-day happenings, providing unobtrusive access to samples of spontaneously expressed opinions on all types of topics and emotions.

Objective

This study aimed to consider the raw frequencies of words in the collection of tweets posted by a sample of stroke survivors and to compare the posts by gender of the survivor for 8 basic emotions (anger, fear, anticipation, surprise, joy, sadness, trust and disgust); determine the proportion of each emotion in the collection of tweets and statistically compare each of them by gender of the survivor; extract the main topics (represented as sets of words) that occur in the collection of tweets, relative to each gender; and assign happiness scores to tweets and topics (using a well-established tool) and compare them by gender of the survivor.

Methods

We performed sentiment analysis based on a state-of-the-art lexicon (National Research Council) with syuzhet R package. The emotion scores for men and women were first subjected to an F-test and then to a Wilcoxon rank sum test. We extended the emotional analysis, assigning happiness scores with the hedonometer (a tool specifically designed considering Twitter inputs). We calculated daily happiness average scores for all tweets. We created a term map for an exploratory clustering analysis using VosViewer software. We performed structural topic modelling with stm R package, allowing us to identify main topics by gender. We assigned happiness scores to all the words defining the main identified topics and compared them by gender.

Results

We analyzed 800,424 tweets posted from August 1, 2007 to December 1, 2018, by 479 stroke survivors: Women (n=244) posted 396,898 tweets, and men (n=235) posted 403,526 tweets. The stroke survivor condition and gender as well as membership in at least 3 stroke-specific Twitter lists of active users were manually verified for all 479 participants. Their total number of tweets since 2007 was 5,257,433; therefore, we analyzed the most recent 15.2% of all their tweets. Positive emotions (anticipation, trust, and joy) were significantly higher (P<.001) in women, while negative emotions (disgust, fear, and sadness) were significantly higher (P<.001) in men in the analysis of raw frequencies and proportion of emotions. Happiness mean scores throughout the considered period show higher levels of happiness in women. We calculated the top 20 topics (with percentages and CIs) more likely addressed by gender and found that women’s topics show higher levels of happiness scores.

Conclusions

We applied two different approaches—the Plutchik model and hedonometer tool—to a sample of stroke survivors’ tweets. We conclude that women express positive emotions and happiness much more than men.

Conceptual framework for living with and beyond cancer: A systematic review and narrative synthesis

OBJECTIVE

The concept of living with and beyond cancer is now emerging in policy and literature. Rather than viewing this notion simply as a linear timeline, developing an agreed understanding of the lived experience of people affected by cancer will aid the development of person-centred models of care.

METHODS

A systematic review was conducted. The review question was "What does the term 'living with and beyond cancer' mean to people affected by cancer?" The protocol for the review was preregistered in the PROSPERO database (PROSPERO CRD42017059860). All included studies were qualitative, so narrative synthesis was used to integrate descriptions and definitions of living with and beyond cancer into an empirically based conceptual framework.

RESULTS

Out of 2345 papers that were identified and 180 that were reviewed, a total of 73 papers were included. The synthesis yielded three interlinked themes: Adversity (realising cancer), Restoration (readjusting life with cancer), and Compatibility (reconciling cancer), resulting in the ARC framework.

CONCLUSIONS

Three themes describe the experience of living with and beyond cancer: adversity, restoration, and compatibility. The ARC framework provides an empirically informed grounding for future research and practice in supportive cancer care for this population.

How patients adjust psychologically to the experience of head and neck cancer: A grounded theory

Numerous physical and psychological challenges are recognised as consequences of head and neck cancer and its treatment, but little is known about how patients adjust psychologically to these experiences. This study aimed to develop a theoretical understanding of the processes patients engage in when adjusting to head and neck cancer. Twelve patients participated in semi-structured interviews conducted individually and transcribed verbatim. Data were analysed using grounded theory methodology. Analysis generated a core category of "modifying my relationship to the changes cancer brings," which encompassed 11 processes patients engaged in throughout their adjustment: "survive mode," "instrumental support from others," "making a choice," "developing own understanding," "acceptance," "talking with others," "making changes," "redefining or regaining normality," "managing emotions/distressing thoughts," "putting things into perspective" and "barriers to progress." Contrasting findings are discussed, and a model of psychological adjustment to head and neck cancer is proposed. The study found that patients engage in a series of processes throughout adjustment to head and neck cancer, which broadly map on to the cancer treatment trajectory, though these processes did not appear to be specific to head and neck cancer. The proposed model may be used as a framework to guide psychological interventions.

Lived Experiences of Canadian Women with Metastatic Breast Cancer in Preparation for Their Death: A Qualitative Study. Part I-Preparations and Consequences

Objectives

This study aimed to detail the tasks of death preparation and the consequences of such preparation for women with metastatic breast cancer.

Methods

A phenomenological qualitative approach was used. Five women with metastatic breast cancer were interviewed on two occasions. Themes were analyzed, described, and validated, until saturation was met. Outcomes of thematic analysis related to the impetus, process, and consequences of preparing for one's own death.

Findings

The women prepared for their death by: acknowledging their grief; preparing mentally; seeking information and support; preparing the family; and preparing for the end of life. They also engaged in creating life projects that enhanced their connections with loved ones, and lived full and joyful lives. These activities helped increased their readiness to die in peace.

Conclusions

Preparing for their own death can help women with incurable cancer live full, satisfying lives, and be prepared to face their own death with peace. Helping women express their feelings around their own death and their preparation for death should be a key interdisciplinary psychosocial nursing intervention.

Spiritual Experiences of Women with Breast Cancer in Singapore: a Qualitative Study

Objective:

Although there has been increasing emphasis on the importance of spirituality in patients with cancer, few studies have examined the spiritual experiences of an ethnically diverse sample of Asian women with breast cancer. The objective of this study was to examine the spiritual experiences of Singaporean women with breast cancer in the first year of diagnosis.

Methods:

A qualitative exploratory study design was used and data were gathered using individual semi-structured interviews. Purposive sampling selected the participants and data saturation sample size was reached after interviews with 28 participants. Data were analyzed using Braun and Clarke's thematic approach.

Results:

The participants were aged between 28 and 64 years and included women from the three major ethnic groups. The three themes that emerged from the data included transcendental experiences, meaning and purpose, and changing perspectives.

Conclusions:

This study informs that while spiritual needs are common, Singaporean women in their first year of the breast cancer diagnosis express spirituality in culturally specific ways. The clinical implications of the study emphasize the importance of addressing women's spiritual concerns, with attention to cultural differences so as to render holistic patient-centered care.

Biopsychosocial Correlates of Adjustment to Cancer during Chemotherapy: The Key Role of Health-Related Quality of Life

Background

Patients adjust to cancer in a continuous process that follows the course of the disease. Previous research has considered several illness-related variables and demographics, quality of life, personality, and social factors as predictors of adjustment to cancer, which can be maladaptive (e.g., helplessness-hopelessness and anxious preoccupation) or adaptive (e.g., fighting spirit).

Aims

Assuming a biopsychosocial view, we test an empirical model in which disease stage, patient's age, and gender are viewed as the distal antecedents of positive and negative adjustment to cancer for chemotherapy patients. Health-related quality of life (HRQoL) has a key role, interposing between the distal antecedents and adaptational outcomes. Social support and positive thinking are also included in the model as related to adjustment.

Methods

One-hundred-sixty-two consecutive cancer patients receiving adjuvant or standard chemotherapy participated in the study. Patients completed the Mini-Mental Adjustment to Cancer, the Brief-COPE, the Social Provision Scale, and the SF-12 Health Survey. Partial least squares structural equation modeling (PLS-SEM) was applied for model building and hypotheses testing.

Results

We found a negative association between advanced stage and physical functioning, a strong positive link between physical functioning and mental health, and significant relations between mental health and helpless-hopelessness, anxious preoccupation, and cognitive avoidance. Social support and positive thinking were related to fighting spirit and fatalism. Cancer stage and female gender were indirectly associated with adaptational outcomes through HRQoL. The patient's age had no significant relationships in the model.

Discussion

HRQoL (both physical and mental) is a key factor for preventing maladjustment in chemotherapy patients. Social support and positive thinking coping style fosters fighting spirit and fatalism on health outcomes. Two potential lines of action seem promising: preventing maladaptive and promoting adaptive adjustments working on patient's mental health individually and involving significant others in supportive care, respectively.

Women's stories of living with breast cancer: A systematic review and meta-synthesis of qualitative evidence

RATIONALE

Globally, breast cancer is by far the most frequently occurring cancer amongst women. Whilst the physical consequences of the disease and associated treatments are well documented, a comprehensive picture of how breast cancer is experienced at all stages of disease progression is lacking.

OBJECTIVE

This systematic review aimed to synthesize qualitative studies documenting women's breast cancer narratives into an empirically based explanatory framework.

METHODS

Two investigators independently searched Academic Search Premiere, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycARTICLES, PubMed, Science Direct, SCOPUS, Web of Science and three international dissertation repositories using a pre-specified search strategy to identify qualitative studies on women's breast cancer narratives across all geographic and income-level settings. Of the 7840 studies that were screened for eligibility, included in the review were 180 studies, which were assessed using the Critical Appraisal Skills Programme. Using a 'meta-study' approach, an explanatory model of the breast cancer experience was formulated. Finally, we assessed the confidence in the review findings using the 'Confidence in the Evidence from Reviews of Qualitative Research' (CERQual) guidelines.

RESULTS

Eight core themes were identified: the burden of breast cancer, existential ordeal, illness appraisal, sources of support, being in the healthcare system, the self in relation to others, changes in self-image, and survivor identity. Together, these form the proposed Trajectory of Breast Cancer (TBC) framework.

CONCLUSION

The Trajectory of Breast Cancer explanatory framework offers a theoretically defensible synthesis of women's experiences of breast cancer. This framework provides an empirical basis for future reviewers conducting qualitative and narrative breast cancer research.

John Henryism and Perceived Health among Hemodialysis Patients in a Multiracial Brazilian Population: the PROHEMO

Purpose

John Henryism (JH) is a strong behavioral predisposition to engage in high-effort coping with difficult socioenvironmental stressors. We investigated associations between JH and perceived general health (GH) among maintenance hemodialysis (MHD) patients in a multiracial Brazilian population.

Design

The 12-item John Henryism Acting Coping (JHAC) Scale was completed by 525 patients enrolled in The Prospective Study of the Prognosis of Hemodialysis Patients (PROHEMO) in Salvador (Bahia) Brazil. JH scores could range from 12 to 60. The low and high JH groups were determined by a median split (<52 vs ≥52). The 36-Item Short Form Health Survey was used to determine GH score (range 0-100; higher means better health). Linear regression with extensive adjustments was used to test associations.

Results

Mean age was 48.3±13.7 years; 38.7% were female; 11.4% were White, 29.1% were Black and 59.4% were mixed race. JH was positively associated with higher GH in the whole sample (adjusted difference [AdjDif]=7.14, 95% CI= 2.98, 11.3) and similarly in men and women. A strong positive association between JH and GH was observed in non-Whites but not in Whites; (AdjDif in Blacks =16.4, 95% CI=8.37, 24.4). Also, a strong positive association between JH and GH was observed for patients aged <60 years (AdjDif =9.04, 95% CI = 4.46, 13.6) but not for older patients.

Conclusions

The results indicate that MHD patients engaged in high-effort coping with socioenvironmental stressors as demonstrated by high JH tend to feel more positively about their overall health. This seems to be especially the case for non-White and younger patients.

Anxiety and Depression Disorders in Relation to the Quality of Life of Breast Cancer Patients with Locally Advanced or Disseminated Stage

OBJECTIVE

To evaluate patterns of association between anxiety and depression and the different elements of the construct of quality of life, in patients with locally advanced breast cancer or disseminated stages METHODS: With a single measure over time, HADS and FACIT-B scales were applied in 107 women histologically confirmed to have breast cancer, in stages IIB, IIIA, IIIB, IIIC and IV. Factor analysis and multidimensional scaling methods were used to analyze patterns of association RESULTS: In 84.1% of the patients clinical anxiety was found (95%CI, 75.8-90.5%) and clinical depression in 25.2% (95%CI, 17.3-34.6%). Factor analysis groups items of the two scales in 4 domains which accounted for 59% of the total variance, where 2 items (H11 and B8) showed high values of uniqueness and low factor loadings. Multidimensional scaling suggests five groups, showing proximity between depressive symptoms and physical symptoms, as well as between anxious symptoms and related to functionality and social and family environment CONCLUSIONS: The HADS in patients with neoplastic disease detects a high frequency of depressive and especially anxious symptoms, which makes it advisable to reevaluate their psychometric properties in patients with cancer. The association between depressive symptoms of HADS and physical symptoms of quality of life construct is in favor of the difficulty of diagnosing depressive disorder in patients with cancer, so it may be necessary to develop instruments that allow locating symptoms or clinical characteristics that facilitate this diagnosis.

Constructive, illusory, and distressed posttraumatic growth among survivors of breast cancer: A 7-year growth trajectory study

A total of 84 breast cancer survivors completed a package of psychological inventories in 2009 (Time 1), 2012 (Time 2), and 2016 (Time 3). Latent class growth analysis revealed three posttraumatic growth trajectory patterns: distressed posttraumatic growth ( n = 5, 6.7%), illusory posttraumatic growth ( n = 42, 56.0%), and constructive posttraumatic growth ( n = 28, 37.3%). Women with more frequent use of helplessness–hopelessness coping and lower depression levels at Time 1 were more likely to display an illusory than a constructive posttraumatic growth trajectory pattern. Illusory posttraumatic growth might represent a form of coping rather than authentic positive changes. Researchers and clinicians should understand different patterns of posttraumatic growth.

Patients' experiences and care needs during the diagnostic phase of an integrated brain cancer pathway: A case study

AIMS AND OBJECTIVES

To identify and describe patients' experiences and care needs throughout the diagnostic phase of an integrated brain cancer pathway.

BACKGROUND

A malignant brain tumour is a devastating diagnosis, which may cause psychical symptoms and cognitive deficits. Studies have shown that the shock of the diagnosis, combined with the multiple symptoms, affects patients' ability to understand information and express needs of care and support. Unmet needs have been reported within this group of patients; however, the experiences and care needs of patients going through the diagnostic phase of a standardised integrated brain cancer pathway have not previously been explored.

DESIGN

A case study design was used to provide detailed information of the complex needs of patients being diagnosed with a malignant brain tumour.

METHODS

Research interviews and direct participant observation of four patients during hospital admission, brain surgery and discharge were conducted in a Danish university hospital. Systematic text condensation was used to analyse the data material.

RESULTS

Four major themes were identified: information needs, balancing hope and reality while trying to perceive the unknown reality of brain cancer, not knowing what to expect and participants' perceptions of the relationship with the healthcare providers. The analysis revealed that participants were in risk of having unmet information needs and that contextual factors seemed to cause fragmented care that led to feelings of uncertainty and loss of control.

CONCLUSIONS

Brain tumour patients have complex care needs and experience a particular state of vulnerability during the diagnostic phase. Through personal relationships based on trust with skilled healthcare providers, participants experienced an existential recognition and alleviation of emotional distress.

RELEVANCE TO CLINICAL PRACTICE

Patients receiving a brain tumour diagnosis experience unmet care needs in several areas during their hospital stay. There is a need for interventions from healthcare providers.

The relationship between cancer-related worry and posttraumatic growth in adolescent and young adult cancer survivors

OBJECTIVES

To examine cancer-related worry in adolescent and young adult (AYA) cancer survivors and its relationship with posttraumatic growth over time, as the relationship between these constructs has not been assessed longitudinally in this population.

METHODS

A total of 153 AYA cancer survivors completed measures of cancer-related worry and posttraumatic growth 3 times across approximately 1 year. Descriptive statistics were calculated for cancer-related worry items, and mixed-effects modeling assessed the relationship between cancer-related worry and posttraumatic growth.

RESULTS

Most participants reported at least moderate cancer-related worry in at least 1 area at each assessment (88.2-93.9% across time points). Worry about future health was the most prevalent concern (65.4%-83.7% across time points). Cancer-related worry was positively related to posttraumatic growth in the mixed-effects model. However, post hoc analyses indicated that cancer-related worry and posttraumatic growth were modestly related; there was no evidence that either construct predicted the other over time.

CONCLUSIONS

Cancer-related worry appears to be a common psychosocial outcome in AYA cancer survivors. However, cancer-related worry appears to be only modestly related to the development of posttraumatic growth, implying that these may be independent constructs despite theoretical literature suggesting that posttraumatic growth may stem from posttraumatic distress. Thus, it is necessary to assess AYA survivors for cancer-related worry and posttraumatic growth, and develop interventions to target cancer-related worry and foster posttraumatic growth.