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Hiensch AE, Beckhaus J, Witlox L, Monninkhof EM, Schagen SB, van Vulpen JK, Sweegers MG, Newton RU, Aaronson NK, Galvão DA, Steindorf K, Stuiver MM, Mesters I, Knoop H, Goedendorp MM, Bohus M, Thorsen L, Schulz KH, Schmidt ME, Ulrich CM, Sonke GS, van Harten WH, Winters-Stone KM, Velthuis MJ, Taaffe DR, van Mechelen W, Kersten MJ, Nollet F, Wiskemann J, Buffart LM, May AM. Moderators of exercise effects on self-reported cognitive functioning in cancer survivors: an individual participant data meta-analysis. J Cancer Surviv 2024; 18:1492-1503. [PMID: 37160571 DOI: 10.1007/s11764-023-01392-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE This individual participant data meta-analysis (IPD-MA) assesses exercise effects on self-reported cognitive functioning (CF) and investigates whether effects differ by patient-, intervention-, and exercise-related characteristics. METHODS IPD from 16 exercise RCTs, including 1987 patients across multiple types of non-metastatic cancer, was pooled. A one-stage IPD-MA using linear mixed-effect models was performed to assess exercise effects on self-reported CF (z-score) and to identify whether the effect was moderated by sociodemographic, clinical, intervention- and exercise-related characteristics, or fatigue, depression, anxiety, and self-reported CF levels at start of the intervention (i.e., baseline). Models were adjusted for baseline CF and included a random intercept at study level to account for clustering of patients within studies. A sensitivity analysis was performed in patients who reported cognitive problems at baseline. RESULTS Minimal significant beneficial exercise effects on self-reported CF (β=-0.09 [-0.16; -0.02]) were observed, with slightly larger effects when the intervention was delivered post-treatment (n=745, β=-0.13 [-0.24; -0.02]), and no significant effect during cancer treatment (n=1,162, β=-0.08 [-0.18; 0.02]). Larger effects were observed in interventions of 12 weeks or shorter (β=-0.14 [-0.25; -0.04]) or 24 weeks or longer (β=-0.18 [-0.32; -0.02]), whereas no effects were observed in interventions of 12-24 weeks (β=0.01 [-0.13; 0.15]). Exercise interventions were most beneficial when provided to patients without anxiety symptoms (β=-0.10 [-0.19; -0.02]) or after completion of treatment in patients with cognitive problems (β=-0.19 [-0.31; -0.06]). No other significant moderators were identified. CONCLUSIONS This cross-cancer IPD meta-analysis observed small beneficial exercise effects on self-reported CF when the intervention was delivered post-treatment, especially in patients who reported cognitive problems at baseline. IMPLICATIONS FOR CANCER SURVIVORS This study provides some evidence to support the prescription of exercise to improve cognitive functioning. Sufficiently powered trials are warranted to make more definitive recommendations and include these in the exercise guidelines for cancer survivors.
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Affiliation(s)
- Anouk E Hiensch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Julia Beckhaus
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lenja Witlox
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jonna K van Vulpen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maike G Sweegers
- Division of Psychosocial Research and Epidemiology & Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Martijn M Stuiver
- Division of Psychosocial Research and Epidemiology & Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ilse Mesters
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Martine M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany
- Faculty of Health, University of Antwerp, Antwerp, Belgium
| | - Lene Thorsen
- National Advisory Unit on Late Effects after Cancer, Department of Oncology, Oslo University Hospital, Oslo, Norway
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Karl-Heinz Schulz
- Athleticum - Competence Center for Sports- and Exercise Medicine and Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Cornelia M Ulrich
- Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, USA
| | - Gabe S Sonke
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Kerri M Winters-Stone
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Miranda J Velthuis
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Willem van Mechelen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, location: Vrije Universiteit, Amsterdam, The Netherlands
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Centers, Location University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Joachim Wiskemann
- Working Group Exercise Oncology, Division of Medical Oncology, University Clinic Heidelberg and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Laurien M Buffart
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.
- Department of Physiology, Radboudumc, Nijmegen, The Netherlands.
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Navntoft S, Andreasen J, Petersen KS, Rossau HK, Jørgensen L. Barriers and facilitators to cancer rehabilitation for patients with head and neck or lung cancer-a scoping review mapping structural and healthcare professionals' perspectives. Disabil Rehabil 2024; 46:4617-4629. [PMID: 37961874 DOI: 10.1080/09638288.2023.2280073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Rehabilitation can positively affect quality of life, functional status, and physiological status for patients with head and neck or lung cancer. However, barriers and facilitators regarding access, referral, and participation in rehabilitation have not been outlined in the literature either from a healthcare professional or from a structural perspective. Therefore, the objective of this paper was to identify and map barriers and facilitators from structural and healthcare professionals' perspectives in relation to access, referral, and participation in rehabilitation for patients with head and neck or lung cancer. MATERIALS AND METHODS Two systematic searches were conducted in five databases mapping peer-reviewed research literature. RESULTS In total, 17 studies of 3918 potential sources were included. Seven themes were identified. Four themes concerned access: Understanding Patients' Resources; Collaboration Determining Access; Education, Knowledge, and Evidence Impact Access to Rehabilitation; and Resources Affecting Availability to Rehabilitation Services. Two themes concerned referral: Referral Criteria; and Elements Affecting Referral Pathway. One theme concerned participation: Factors Influencing Participation. CONCLUSION From structural and healthcare professionals' perspectives, barriers and facilitators impact access, referral and participation in rehabilitation. However, the findings on facilitators were limited; only one theme addressed participation and two findings concerned patients with low socioeconomic status.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be mindful that a diverse array of barriers and facilitators may impact the rehabilitation pathway for patients with head, neck, and lung cancer.Engagement by healthcare professionals and structural initiatives are needed to ensure comprehensive access to information concerning rehabilitation options.Local guidelines should be developed to prescribe methods for informing and guiding patients towards suitable rehabilitation options.It is important that healthcare professionals take the individual patient's resources into account when navigating aspects of access, referral, and participation in rehabilitation.
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Affiliation(s)
- Sophie Navntoft
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
| | - Jane Andreasen
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
- Aalborg Centre of Health and Rehabilitation, Aalborg Municipality, Aalborg, Denmark
| | - Kirsten Schultz Petersen
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
| | - Henriette Knold Rossau
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Jørgensen
- Clinic for Surgery and Cancer Treatment & Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Stout NL, Alfano CM, Liu R, Dixit N, Jefford M. Implementing a Clinical Pathway for Needs Assessment and Supportive Care Interventions. JCO Oncol Pract 2024; 20:1173-1181. [PMID: 38709984 DOI: 10.1200/op.23.00482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/02/2024] [Accepted: 04/02/2024] [Indexed: 05/08/2024] Open
Abstract
Despite advances in clinical cancer care, cancer survivors frequently report a range of persisting issues, unmet needs, and concerns that limit their ability to participate in life roles and reduce quality of life. Needs assessment is recognized as an important component of cancer care delivery, ideally beginning during active treatment to connect patients with supportive services that address these issues in a timely manner. Despite the recognized importance of this process, many health care systems have struggled to implement a feasible and sustainable needs assessment and management system. This article uses an implementation science framework to guide pragmatic implementation of a needs assessment clinical system in cancer care. According to this framework, successful implementation requires four steps including (1) choosing a needs assessment tool; (2) carefully considering the provider level, clinic level, and health care system-level strengths and barriers to implementation and creating a pilot system that addresses these factors; (3) making the assessment system actionable by matching needs with clinical workflow; and (4) demonstrating the value of the system to support sustainability.
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Affiliation(s)
- Nicole L Stout
- Department of Hematology Oncology, School of Medicine, West Virginia University Cancer Institute, Morgantown, WV
- Department of Health Policy, Management, and Leadership, School of Public Health, West Virginia University, Morgantown, WV
| | - Catherine M Alfano
- Northwell Health Cancer Institute, New Hyde Park, NY
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Raymond Liu
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Niharika Dixit
- Division of Hematology/Oncology, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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Armoogum J, Harcourt D, Foster C, Llewellyn A, Hepburn J, Prior M, McCabe C. Healthcare professionals' knowledge, understanding and confidence to manage chronic pain after cancer treatment: A UK survey. Eur J Oncol Nurs 2024; 71:102610. [PMID: 38914026 DOI: 10.1016/j.ejon.2024.102610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/03/2024] [Accepted: 05/14/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Healthcare professionals are vital in preparing people living with and beyond cancer about the risks of chronic pain after cancer treatment. To do so, healthcare professionals need to be knowledgeable and confident about chronic pain after cancer treatment, yet little is known about their understanding or confidence of this common long-term and late side effect of cancer treatment. AIM To identify healthcare professionals' knowledge and understanding of chronic pain after cancer treatment and consider how confident they are to inform, listen and signpost people living with and beyond cancer to appropriate information and support. METHOD A cross sectional online survey was distributed to healthcare professionals in the UK via cancer and primary care networks, cancer alliances and social media. The survey consisted of four domains: 1) knowledge and understanding, 2) information and support, 3) confidence and 4) barriers. Quantitative data were analysed with descriptive statistics and free text comments were analysed using qualitative content analysis. RESULTS Healthcare professionals reported limited knowledge and understanding of chronic pain after cancer treatment. Healthcare professionals lacked confidence to talk to people about chronic pain after cancer treatment and viewed their lack of knowledge as a barrier. Additional barriers included 'Limited service provision', 'Conflict between services', 'Not my role' and 'Challenges in diagnosing chronic pain in cancer survivors'. CONCLUSION Chronic pain after cancer can be a significant issue for those living with and beyond cancer, yet healthcare professionals report limited knowledge of it or understanding of the impact. More education is needed to increase healthcare professionals' knowledge and confidence in chronic pain after cancer treatment.
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Affiliation(s)
- J Armoogum
- University of the West of England, Bristol, UK.
| | - D Harcourt
- University of the West of England, Bristol, UK
| | | | - A Llewellyn
- University of the West of England, Bristol, UK
| | | | | | - C McCabe
- University of the West of England, Bristol, UK; Dorothy House Hospice, Winsley, UK
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Bachman SL, Gomes E, Aryal S, Cella D, Clay I, Lyden K, Leach HJ. Do Measures of Real-World Physical Behavior Provide Insights Into the Well-Being and Physical Function of Cancer Survivors? Cross-Sectional Analysis. JMIR Cancer 2024; 10:e53180. [PMID: 39008350 PMCID: PMC11287100 DOI: 10.2196/53180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/26/2024] [Accepted: 04/24/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND As the number of cancer survivors increases, maintaining health-related quality of life in cancer survivorship is a priority. This necessitates accurate and reliable methods to assess how cancer survivors are feeling and functioning. Real-world digital measures derived from wearable sensors offer potential for monitoring well-being and physical function in cancer survivorship, but questions surrounding the clinical utility of these measures remain to be answered. OBJECTIVE In this secondary analysis, we used 2 existing data sets to examine how measures of real-world physical behavior, captured with a wearable accelerometer, were related to aerobic fitness and self-reported well-being and physical function in a sample of individuals who had completed cancer treatment. METHODS Overall, 86 disease-free cancer survivors aged 21-85 years completed self-report assessments of well-being and physical function, as well as a submaximal exercise test that was used to estimate their aerobic fitness, quantified as predicted submaximal oxygen uptake (VO2). A thigh-worn accelerometer was used to monitor participants' real-world physical behavior for 7 days. Accelerometry data were used to calculate average values of the following measures of physical behavior: sedentary time, step counts, time in light and moderate to vigorous physical activity, time and weighted median cadence in stepping bouts over 1 minute, and peak 30-second cadence. RESULTS Spearman correlation analyses indicated that 6 (86%) of the 7 accelerometry-derived measures of real-world physical behavior were not significantly correlated with Functional Assessment of Cancer Therapy-General total well-being or linked Patient-Reported Outcomes Measurement Information System-Physical Function scores (Ps≥.08). In contrast, all but one of the physical behavior measures were significantly correlated with submaximal VO2 (Ps≤.03). Comparing these associations using likelihood ratio tests, we found that step counts, time in stepping bouts over 1 minute, and time in moderate to vigorous activity were more strongly associated with submaximal VO2 than with self-reported well-being or physical function (Ps≤.03). In contrast, cadence in stepping bouts over 1 minute and peak 30-second cadence were not more associated with submaximal VO2 than with the self-reported measures (Ps≥.08). CONCLUSIONS In a sample of disease-free cancer survivors, we found that several measures of real-world physical behavior were more associated with aerobic fitness than with self-reported well-being and physical function. These results highlight the possibility that in individuals who have completed cancer treatment, measures of real-world physical behavior may provide additional information compared with self-reported and performance measures. To advance the appropriate use of digital measures in oncology clinical research, further research evaluating the clinical utility of real-world physical behavior over time in large, representative samples of cancer survivors is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT03781154; https://clinicaltrials.gov/ct2/show/NCT03781154.
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Affiliation(s)
| | - Emma Gomes
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | | | - David Cella
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Ieuan Clay
- VivoSense, Inc, Newport Coast, CA, United States
| | - Kate Lyden
- VivoSense, Inc, Newport Coast, CA, United States
| | - Heather J Leach
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
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Paul V, Inhestern L, Sigmund D, Winzig J, Rutkowski S, Escherich G, Bergelt C. Addressing gaps and enhancing experiences in support services for families of pediatric cancer survivors. Pediatr Res 2024:10.1038/s41390-024-03320-2. [PMID: 38886508 DOI: 10.1038/s41390-024-03320-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Childhood cancer's enduring challenges extend beyond primary therapy. Diverse medical and psychosocial services are available to assist families in follow-up care. This interview study sought to gain a thorough understanding of family motives, satisfaction levels, and barriers to utilization. METHODS The design of this cross-sectional study involves a qualitative content analysis of semi-structured interviews. We interviewed parents of minor cancer survivors within the first 5 years after primary treatment. RESULTS Survivors readily accessed medical support services when necessary. While parents expressed overall satisfaction with the available services, there was a notable gap in their knowledge regarding appropriate psychosocial and family-orientated services. Barriers to access included geographical distances, time constraints, and the absence of childcare options. CONCLUSION There are familial challenges and burdens that fall outside the scope of conventional care services. Tailoring services to family-centered needs, providing more information and easier access to interventions might help to reduce barriers. IMPACT Existing need notwithstanding, families did not frequently utilize psychosocial services as they did medical ones. Identified barriers included lack of awareness, limited availability, long distances, and scheduling conflicts. While many studies primarily focus on adult patients or young adults, the present study examines the gaps and strengths in follow-up care for pediatric cancer survivors and their families. By acknowledging and addressing the unique challenges and strengths of families with pediatric cancer survivors, we can lead to a more tailored and effective follow-up approach that can enhance their overall well-being by minimizing barriers and providing targeted support.
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Affiliation(s)
- Verena Paul
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Désirée Sigmund
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jana Winzig
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Gabriele Escherich
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Tolstrup LK, Dieperink KB, Van Leeuwen M, Möller S, Fechner L, Clausen LH, Mattsson TO. Health-Related Quality of Life in Danish Cancer Survivors Referred to a Late Effects Clinic: A Prospective Cohort Study. Acta Oncol 2024; 63:426-432. [PMID: 38881340 PMCID: PMC11332500 DOI: 10.2340/1651-226x.2024.39937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE The Region of Southern Denmark has recently established four late effects clinics to help cancer survivors suffering from complex and severe late effects. This study aimed to capture and analyze the full range of physical, mental, and psychosocial issues using patient-reported outcomes. Moreover, we aimed to describe demographic data and the type and severity of the late effects. METHODS A prospective cohort study was conducted among cancer survivors referred to a late effects clinic. Before their first appointment, patients completed the European Organization for Research and Treatment of Cancer Quality of Life cancer survivorship core questionnaire (EORTC QLQ-SURV100). We compared mean scores of the EORTC QLQ-SURV100 scales that were comparable to the scales/items from the EORTC QLQ-C30 questionnaire with norm data for the Danish population and EORTC reference values. RESULTS All patients referred to the clinic within its first 2 years were included (n = 247). The mean age was 57 [23-85] years and 74% were females. The most common cancer diagnoses was breast cancer (39%). The five most commonly reported late effects were fatigue (66%), pain (51%), cognitive impairment (53%), sleep problems (42%), and neuropathy (40%). A total of 236 of the patients entering the clinic completed QLQ-SURV100. They reported significantly worse mean scores on all scales compared to the Danish norm population and EORTC reference values for pretreatment cancer patients, p < 0.001. Effect sizes were moderate or large for all scales. INTERPRETATION In this study, we collected demographic data and described the late effects presented by the patents referred to the clinic. Moreover, we captured and analyzed the full range of physical, mental, and psychosocial issues using QLQ-SURV100. Patients referred to the Late Effects Clinic (LEC) had a number of late effects and reported a significantly lower health-related quality of life compared to the general Danish population and patients who have just been diagnosed with cancer, suggesting the aim of helping patients suffering from late effects gain a better quality of life is in dire need.
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Affiliation(s)
- Lærke Kjær Tolstrup
- Department of Oncology, Odense University Hospital, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, Odense Denmark.
| | - Karin B Dieperink
- Department of Oncology, Odense University Hospital, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, Odense Denmark
| | - Marieke Van Leeuwen
- Division of Psychosocial Research & Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense Denmark; Open Patient data Explorative Network, Odense University Hospital, Odense C, Denmark
| | - Linnea Fechner
- Department of Oncology, Odense University Hospital, Odense C, Denmark
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Lara-Morales A, Soto-Ruiz N, Agudelo-Suárez AA, García-Vivar C. Social determinants of health in post-treatment cancer survivors: Scoping review. Eur J Oncol Nurs 2024; 70:102614. [PMID: 38795448 DOI: 10.1016/j.ejon.2024.102614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/10/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE To identify, analyze and describe the available scientific evidence about the influence of social determinants of health on cancer survivors. METHODS A scoping review was outlined according to the steps described by the Joanna Brigs Institute Reviewer's Manual: selection of studies, data mapping, and results grouping, synthesis and report, was conducted. PubMed, CINAHL, Scopus and LILACS databases were searched from 2011 to 2023. RESULTS Out of a total of 1783 papers initially screened, only 19 studies met the inclusion criteria for the scoping review, focusing on the primary social determinants impacting the health of cancer survivors. These studies were categorized into six main themes: a) employment (challenges in work reintegration and work-place difficulties); b) variations among different ethnic groups; c) disparities based on sex; d) barriers and facilitators in accessing health and social security services; e) the role of support networks and social environments; and f) socioeconomic lever (influence of income and socioeconomic status). CONCLUSIONS Understanding the impact of social determinants on the post-treatment quality of life for cancer survivors is crucial. Comprehensive survivorship care should address not just medical needs but also holistic aspects like social support, education, overall well-being, and improvements in physical and social environments. This multifaceted approach ensures the well-rounded support needed for optimal survivorship outcomes.
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Affiliation(s)
- Alfredo Lara-Morales
- Department of Nursing and Obstetrics, Guanajuato University, C. Pedro Lascurain de Retana, Calzada de Guadalupe, 36700, Guanajuato, Gto, Mexico.
| | - Nelia Soto-Ruiz
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. Barañain S/n, 31008, Pamplona, Navarra, Spain; IdiSNA, Navarra Institute for Health Research, Irunlarrea, 3, 31008, Pamplona, Navarra, Spain.
| | - Andrés A Agudelo-Suárez
- Faculty of Dentistry, University of Antioquia, Calle 64 Nº 52-59, 050010, Medellin, Antioquia, Colombia.
| | - Cristina García-Vivar
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. Barañain S/n, 31008, Pamplona, Navarra, Spain; IdiSNA, Navarra Institute for Health Research, Irunlarrea, 3, 31008, Pamplona, Navarra, Spain.
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Birken SA, Peluso AG, Shalowitz DI, Isom S, Wagi CR, Randazzo A, Falk D, Strom C, Bell R, Weaver KE. Primary Care Provider Visits Among Cancer Survivors 5-7 Years Postdiagnosis. JCO Oncol Pract 2024:OP2300699. [PMID: 38776486 DOI: 10.1200/op.23.00699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/11/2024] [Accepted: 04/10/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE Cancer survivors experience better outcomes when primary care providers (PCPs) are engaged in their care. Nearly all survivors have a PCP engaged in their care in the initial 5 years postdiagnosis, but little is known about sustained PCP engagement. We assessed PCP engagement in survivors' care 5-7 years postdiagnosis and characterized survivors most vulnerable to loss to PCP follow-up. METHODS We linked electronic health record ambulatory care and cancer registry data from an National Cancer Institute-Designated Comprehensive Cancer Center to identify eligible survivors (≥18 years; diagnosed with breast, colorectal, or uterine cancer; had an in-network PCP). We used multiple logistic regression to assess associations between survivor demographics, clinical factors, and health care utilization and odds of sustained PCP engagement. RESULTS In 5-7 years postdiagnosis, PCPs were engaged in care for 43% of survivors. Survivors with sustained PCP-engagement were on average 4.6 years older than those without (P < .0001); survivors had 1.36 greater odds of having regular PCP visits for each decade increase in age on cancer diagnosis (P = .0030). Survivors were less likely to be lost to PCP follow-up if diagnosed at an earlier stage with odds at 0.57 and 0.10 for stage I and stage IV, respectively (P = .0005), and had 2.70 greater odds of engagement in care with at least one oncology visit annually 5-7 years postdiagnosis (P < .0001). CONCLUSION Sustained PCP engagement is endorsed as critical by survivors, PCPs, and oncologists. We found most survivors were lost to PCP follow-up 5-7 years postdiagnosis. Our study is among the first to contribute empirical evidence of survivors being lost in transition. Findings from this study demonstrate the need to bridge gaps in long-term care for cancer survivors.
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Affiliation(s)
- Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Alexandra G Peluso
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - David I Shalowitz
- West Michigan Cancer Center, Kalamazoo, MI
- Collaborative on Equity in Rural Cancer Care, Kalamazoo, MI
| | - Scott Isom
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Cheyenne R Wagi
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Aliza Randazzo
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Derek Falk
- Department of Population and Quantitative Health Science, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Carla Strom
- Office of Cancer Health Equity, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Ronny Bell
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, UNC Chapel Hill, Chapel Hill, NC
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
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10
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Gitonga I, Desmond D, Maguire R. Who uses connected health technologies after a cancer diagnosis? evidence from the US Health Information National Trends Survey. J Cancer Surviv 2024:10.1007/s11764-024-01615-1. [PMID: 38744797 DOI: 10.1007/s11764-024-01615-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 05/09/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE As the number of people living with and beyond cancer increases, connected health technologies offer promise to enhance access to care and support, while reducing costs. However, uptake of connected health technologies may vary depending on sociodemographic and health-related variables. This study aimed to investigate demographic and health predictors of connected health technology use among people living with and beyond cancer. METHODS Cross-sectional data from the US Health Information National Trends Survey Version 5 Cycle 4 (H5c4) was used. Regression analysis was used to examine associations between sociodemographic factors and the use of connected health technologies. The sample was restricted to individuals who self-reported a cancer diagnosis or history of cancer. RESULTS In this cycle, 626 respondents self-reported a cancer diagnosis, with 41.1% using connected health technologies (health and wellness apps and/or wearable devices). Most were female (58.9%) and white (82.5%); 43.4% had graduated college or higher education. One third (33.6%) had a household income of $75,000 or more. Respondents who were younger, have higher education, were living as married, had higher incomes, had higher self-rated health and had higher health-related self-efficacy were significantly more likely to use connected health technologies. There were no significant associations between gender, race, stratum, time since diagnosis, history of anxiety or depression, and use of connected health technologies among people living with and beyond cancer. CONCLUSIONS Connected health technology use among people living with and beyond cancer is associated with sociodemographic factors. Future research should examine these demographic disparities as the use of connected health technologies in healthcare continues to gather momentum. IMPLICATIONS FOR CANCER SURVIVORS The study underscores a disparity in connected heath technology usage among people living with and beyond cancer. There is a pressing need for research into adoption barriers and interventions to ensure equitable digital healthcare integration among this population, especially with the heightened adoption of technology post COVID-19 pandemic.
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Affiliation(s)
- Isaiah Gitonga
- Department of Psychology, Maynooth University, Maynooth, Ireland.
- Assisting Living and Learning Institute, Maynooth University, Maynooth, Ireland.
| | - Deirdre Desmond
- Department of Psychology, Maynooth University, Maynooth, Ireland
- Assisting Living and Learning Institute, Maynooth University, Maynooth, Ireland
| | - Rebecca Maguire
- Department of Psychology, Maynooth University, Maynooth, Ireland
- Assisting Living and Learning Institute, Maynooth University, Maynooth, Ireland
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11
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Innominato PF, Macdonald JH, Saxton W, Longshaw L, Granger R, Naja I, Allocca C, Edwards R, Rasheed S, Folkvord F, de Batlle J, Ail R, Motta E, Bale C, Fuller C, Mullard AP, Subbe CP, Griffiths D, Wreglesworth NI, Pecchia L, Fico G, Antonini A. Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study. JMIR Res Protoc 2024; 13:e52957. [PMID: 38687985 PMCID: PMC11094600 DOI: 10.2196/52957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Healthy lifestyle interventions have a positive impact on multiple disease trajectories, including cancer-related outcomes. Specifically, appropriate habitual physical activity, adequate sleep, and a regular wholesome diet are of paramount importance for the wellness and supportive care of survivors of cancer. Mobile health (mHealth) apps have the potential to support novel tailored lifestyle interventions. OBJECTIVE This observational pilot study aims to assess the feasibility of mHealth multidimensional longitudinal monitoring in survivors of cancer. The primary objective is to test the compliance (user engagement) with the monitoring solution. Secondary objectives include recording clinically relevant subjective and objective measures collected through the digital solution. METHODS This is a monocentric pilot study taking place in Bangor, Wales, United Kingdom. We plan to enroll up to 100 adult survivors of cancer not receiving toxic anticancer treatment, who will provide self-reported behavioral data recorded via a dedicated app and validated questionnaires and objective data automatically collected by a paired smartwatch over 16 weeks. The participants will continue with their normal routine surveillance care for their cancer. The primary end point is feasibility (eg, mHealth monitoring acceptability). Composite secondary end points include clinically relevant patient-reported outcome measures (eg, the Edmonton Symptom Assessment System score) and objective physiological measures (eg, step counts). This trial received a favorable ethical review in May 2023 (Integrated Research Application System 301068). RESULTS This study is part of an array of pilots within a European Union funded project, entitled "GATEKEEPER," conducted at different sites across Europe and covering various chronic diseases. Study accrual is anticipated to commence in January 2024 and continue until June 2024. It is hypothesized that mHealth monitoring will be feasible in survivors of cancer; specifically, at least 50% (50/100) of the participants will engage with the app at least once a week in 8 of the 16 study weeks. CONCLUSIONS In a population with potentially complex clinical needs, this pilot study will test the feasibility of multidimensional remote monitoring of patient-reported outcomes and physiological parameters. Satisfactory compliance with the use of the app and smartwatch, whether confirmed or infirmed through this study, will be propaedeutic to the development of innovative mHealth interventions in survivors of cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52957.
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Affiliation(s)
- Pasquale F Innominato
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- Warwick Medical School & Cancer Research Centre, University of Warwick, Coventry, United Kingdom
- Chronotherapy, Cancers and Transplantation Research Unit, Faculty of Medicine, Université Paris-Saclay, Villejuif, France
| | - Jamie H Macdonald
- Institute for Applied Human Physiology, School of Psychology and Sports Science, Bangor University, Bangor, United Kingdom
| | - Wendy Saxton
- Research and Development Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Laura Longshaw
- Research and Development Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Rachel Granger
- Institute for Applied Human Physiology, School of Psychology and Sports Science, Bangor University, Bangor, United Kingdom
| | - Iman Naja
- Knowledge Media Institute, The Open University, Milton Keynes, United Kingdom
| | | | - Ruth Edwards
- Dietetics Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Solah Rasheed
- Dietetics Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Frans Folkvord
- PredictBy, Barcelona, Spain
- Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | | | - Rohit Ail
- Health Innovation, Samsung, Staines, United Kingdom
| | - Enrico Motta
- Knowledge Media Institute, The Open University, Milton Keynes, United Kingdom
| | - Catherine Bale
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Claire Fuller
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Anna P Mullard
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Christian P Subbe
- Acute and Critical Care Medicine, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- School of Medical Sciences, Bangor University, Bangor, United Kingdom
| | - Dawn Griffiths
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Nicholas I Wreglesworth
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- School of Medical Sciences, Bangor University, Bangor, United Kingdom
| | - Leandro Pecchia
- School of Engineering, University of Warwick, Coventry, United Kingdom
- Facoltà Dipartimentale di Ingegneria, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giuseppe Fico
- Life Supporting Technologies, Escuela Técnica Superior de Ingenieros de Telecomunicaciones, Universidad Politécnica de Madrid, Madrid, Spain
| | - Alessio Antonini
- Knowledge Media Institute, The Open University, Milton Keynes, United Kingdom
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12
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Onyedibe MCC, Blickle P, Schmidt ME, Steindorf K. Posttraumatic growth and health-related quality of life in cancer survivors: Does fatigue moderate the link? Stress Health 2024; 40:e3299. [PMID: 37547957 DOI: 10.1002/smi.3299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/26/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
Interest in post-traumatic growth (PTG) as a predictor of health-related quality of life (HRQoL) is currently gaining attention. However, current evidence is still inconclusive on the nature of this relationship. The first objective of this study was to investigate the relationship between PTG and global HRQoL among cancer survivors. We further investigated the moderating role of fatigue in the association between PTG and global HRQoL. In the FiX study (Fatigue in Germany - Examination of prevalence, severity, and state of screening and treatment) cancer-related fatigue (EORTC QLQ-FA12), PTG inventory and global HRQoL (EORTC QLQ-C30) were assessed four years after cancer diagnosis in 1316 cancer-free survivors (mean age = 67.28, SD = 11.05, 51.4% female). Multiple linear regression analysis and moderation analysis were performed. The results showed that PTG had a convex quadratic relationship with global HRQoL (p < 0.001). Contrary to our hypothesis, fatigue did not moderate the relationship between PTG (linear and quadratic terms) and global HRQoL, neither when considering the overall PTG score nor for any PTG subdimension. In conclusion, PTG has a convex quadratic relationship with long-term global HRQoL that was not modified by persisting fatigue. Future statistical models investigating PTG and global HRQoL should take this non-linear relationship into account. Aiming to increase PTG might contribute to, but is likely not sufficient for high levels of global HRQoL in cancer survivors in the long run.
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Affiliation(s)
- Maria-Chidi C Onyedibe
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
| | - Patricia Blickle
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
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13
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Been-Dahmen JMJ, van der Stege H, Oldenmenger WH, Braat C, van der Lans MCM, Scheper M, van Staa A, Ista E. What factors contribute to cancer survivors' self-management skills? A cross-sectional observational study. Eur J Oncol Nurs 2024; 69:102539. [PMID: 38460391 DOI: 10.1016/j.ejon.2024.102539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE Many cancer survivors, facing the consequences of their disease and its treatment, have medical and supportive aftercare needs. However, limited knowledge exists regarding the relationship between support needs and survivors' self-management skills. The study aim is to explore factors contributing to cancer survivors' self-management skills. METHODS A cross-sectional study was conducted among cancer survivors (n = 277) of two outpatient oncology clinics at a university hospital in the Netherlands. Patients with head and neck cancer (n = 55) who had received radiotherapy and cisplatin or cetuximab were included, as well as patients who had undergone hematopoietic stem cell transplantation (n = 222). The primary outcome was self-management skills, assessed using the Partners in Health Scale (PIH), which comprises two subscales: knowledge and coping (PIH-KC), and recognition and management of symptoms, and adherence to treatment (PIH-MSA). Secondary outcomes were quality of life (EORTC QLQ-C30), self-efficacy (SECD6), patient-centered care (CAPHS), and social support (HEIQ). Machine learning-based Random Forest models were employed to construct associative models. Feature Importance (FI) was used to express the contribution to the model. RESULTS High emotional quality of life (FI = 33.1%), increased self-efficacy (FI = 22.2%), and greater social support (FI = 18.2%) were identified as key factors contributing to cancer survivors' self-management knowledge (PIH-KC). Furthermore, greater support from professionals (FI = 36.1%) and higher self-efficacy (FI = 18.2%) were found to benefit participants' recognition and management, and therapy adherence (PIH-MSA). CONCLUSIONS A patient-centered relationship between nurses and cancer survivors is essential for therapy adherence and the management of aftercare needs. Training to provide this holistic self-management support is required.
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Affiliation(s)
- Janet M J Been-Dahmen
- Rotterdam University of Applied Sciences, Research Center Innovations in Care, Rotterdam, P.O. Box 25035, 3001 HA, Rotterdam, the Netherlands.
| | - Heleen van der Stege
- Rotterdam University of Applied Sciences, Research Center Innovations in Care, Rotterdam, P.O. Box 25035, 3001 HA, Rotterdam, the Netherlands.
| | - Wendy H Oldenmenger
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Medical Oncology, Rotterdam, the Netherlands.
| | - Cora Braat
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands.
| | - Mariska C M van der Lans
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Hematology, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Mark Scheper
- Rotterdam University of Applied Sciences, Research Center Innovations in Care, Rotterdam, P.O. Box 25035, 3001 HA, Rotterdam, the Netherlands; Macquarie University, Faculty of Medicine and Science, Allied Health Professions, Sydney, Australia.
| | - AnneLoes van Staa
- Rotterdam University of Applied Sciences, Research Center Innovations in Care, Rotterdam, P.O. Box 25035, 3001 HA, Rotterdam, the Netherlands.
| | - Erwin Ista
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine - Section Nursing Science, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands; Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
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14
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Stout NL, Boatman D, Rice M, Branham E, Miller M, Salyer R. Unmet Needs and Care Delivery Gaps Among Rural Cancer Survivors. J Patient Exp 2024; 11:23743735241239865. [PMID: 38505492 PMCID: PMC10949551 DOI: 10.1177/23743735241239865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Community-based healthcare delivery systems frequently lack cancer-specific survivorship support services. This leads to a burden of unmet needs that is magnified in rural areas. Using sequential mixed methods we assessed unmet needs among rural cancer survivors diagnosed between 2015 and 2021. The Supportive Care Needs Survey (SCNS) assessed 5 domains; Physical and Daily Living, Psychological, Support and Supportive Services, Sexual, and Health Information. Needs were analyzed across domains by cancer type. Survey respondents were recruited for qualitative interviews to identify care gaps. Three hundred and sixty two surveys were analyzed. Participants were 85% White (n = 349) 65% (n = 234) female and averaged 2.03 years beyond cancer diagnosis. Nearly half (49.5%) of respondents reported unmet needs, predominantly in physical, psychological, and health information domains. Needs differed by stage of disease. Eleven interviews identified care gap themes regarding; Finding Support and Supportive Services and Health Information regarding Care Delivery and Continuity of Care. Patients experience persistent unmet needs after a cancer diagnosis across multiple functional domains. Access to community-based support services and health information is lacking. Community based resources are needed to improve access to care for long-term cancer survivors.
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Affiliation(s)
- Nicole L Stout
- Department of Cancer Prevention and Control, School of Medicine, West Virginia University, Morgantown, WV, USA
- Department of Health Policy, Management, and Leadership, School of Public, West Virginia University, Morgantown, WV, USA
| | - Dannell Boatman
- Department of Cancer Prevention and Control, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Madeline Rice
- Division of Physical Therapy, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Emelia Branham
- Division of Physical Therapy, School of Medicine, West Virginia University, Morgantown, WV, USA
| | | | - Rachel Salyer
- Department of Internal Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
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15
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Faithfull S, Greenfield D. Cancer survivor late-effects, chronic health problems after cancer treatment: what's the evidence from population and registry data and where are the gaps? Curr Opin Support Palliat Care 2024; 18:55-64. [PMID: 38170192 DOI: 10.1097/spc.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Improvements in cancer treatment have led to more people living with and beyond a cancer diagnosis but survivors may have increased health problems as they age. The purpose of this review is to critically evaluate population data exploring incidence of late effects for cancer survivors. RECENT FINDINGS 18 studies were identified between 2013 and 2023 that explored the impact on survivors' physical and emotional health. Patients who had been treated at least 2 years previously for cancer had significant cardiovascular risk factors compared with age-matched controls. Women with breast cancer were more likely to have cardiovascular disease, including hypertension, arrythmias and congestive heart failure. This was associated with anthracyclines and/or trastuzumab as part of systemic anti-cancer therapy. Survivors of colorectal cancer were three times more likely to have acute kidney injury than age-matched controls. Stress and mood disorders were higher in survivors of testicular cancer and prostate cancer. SUMMARY Population studies are important to identify the 'real world' consequences of cancer and its treatment beyond clinical trials. Knowledge is critical for managing an ageing cancer population. Data to personalise cancer survivorship care, not only helps determine potential health risks, but can improve secondary prevention, emotional health, recovery, and long-term outcomes.
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Affiliation(s)
- Sara Faithfull
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, the University of Dublin, Trinity Centre for Health Sciences St. James's Hospital Campus Dublin 8, Ireland
| | - Diana Greenfield
- Specialised Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust
- Medicine and Population Health, University of Sheffield, Sheffield, UK
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16
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Ali N, Nelson D, McInnerney D, Quaife SL, Laparidou D, Selby P, Kane R, Civello S, Skinner D, Pogson Z, Peake MD, Harding-Bell A, Cooke S. A systematic review on the qualitative experiences of people living with lung cancer in rural areas. Support Care Cancer 2024; 32:144. [PMID: 38316704 PMCID: PMC10844412 DOI: 10.1007/s00520-024-08342-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To synthesize the qualitative literature exploring the experiences of people living with lung cancer in rural areas. METHODS Searches were performed in MEDLINE, CINAHL, and PsycINFO. Articles were screened independently by two reviewers against pre-determined eligibility criteria. Data were synthesized using Thomas and Harden's framework for the thematic synthesis of qualitative research. The CASP qualitative checklist was used for quality assessment and the review was reported in accordance with the ENTREQ and PRISMA checklists. RESULTS Nine articles were included, from which five themes were identified: (1) diagnosis and treatment pathways, (2) travel and financial burden, (3) communication and information, (4) experiences of interacting with healthcare professionals, (5) symptoms and health-seeking behaviors. Lung cancer diagnosis was unexpected for some with several reporting treatment delays and long wait times regarding diagnosis and treatment. Accessing treatment was perceived as challenging and time-consuming due to distance and financial stress. Inadequate communication of information from healthcare professionals was a common concern expressed by rural people living with lung cancer who also conveyed dissatisfaction with their healthcare professionals. Some were reluctant to seek help due to geographical distance and sociocultural factors whilst others found it challenging to identify symptoms due to comorbidities. CONCLUSIONS This review provides a deeper understanding of the challenges faced by people with lung cancer in rural settings, through which future researchers can begin to develop tailored support to address the existing disparities that affect this population.
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Affiliation(s)
- Nabilah Ali
- Lincoln Medical School, College of Health and Science, Universities of Nottingham and Lincoln, Lincoln, LN6 7TS, UK
| | - David Nelson
- College of Health and Science, Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, LN6 7TS, UK
- Macmillan Cancer Support, London, SE1 7UQ, UK
| | - Daisy McInnerney
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Samantha L Quaife
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Despina Laparidou
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, LN6 7TS, UK
| | - Peter Selby
- Lincoln Medical School, College of Health and Science, Universities of Nottingham and Lincoln, Lincoln, LN6 7TS, UK
- School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Ros Kane
- School of Health and Social Care, University of Lincoln, Lincoln, LN6 7TS, UK
| | - Sarah Civello
- Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, Lincoln, LN2 5QY, UK
| | - Dawn Skinner
- Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston, PE21 9QS, UK
| | - Zara Pogson
- Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, Lincoln, LN2 5QY, UK
| | - Michael D Peake
- Cancer Research UK, London, E20 1JQ, UK
- Glenfield Hospital, University of Leicester, Leicester, LE1 7RH, UK
| | - Ava Harding-Bell
- Swineshead Patient Participation Group, Swineshead Medical Group, Boston, PE20 3JE, UK
| | - Samuel Cooke
- College of Health and Science, Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, LN6 7TS, UK.
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17
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Levinsen AKG, Dalton SO, Thygesen LC, Jakobsen E, Gögenur I, Borre M, Zachariae R, Christiansen P, Laurberg S, Christensen P, Hölmich LR, Brown PDN, Johansen C, Kjær SK, van de Poll-Franse L, Kjaer TK. Cohort Profile: The Danish SEQUEL cohort. Int J Epidemiol 2024; 53:dyad189. [PMID: 38205845 DOI: 10.1093/ije/dyad189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Indexed: 01/12/2024] Open
Affiliation(s)
| | - Susanne Oksbjerg Dalton
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Erik Jakobsen
- Department of Thoracic surgery, Odense University Hospital, Odense, Denmark
| | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Køge, Denmark
- Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Robert Zachariae
- Danish Breast Cancer Group Center, Clinic for Late Effects, Aarhus, Denmark
| | - Peer Christiansen
- Danish Breast Cancer Group Center, Clinic for Late Effects, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Laurberg
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Christensen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Peter de Nully Brown
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Christoffer Johansen
- Cancer Late Effects, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lonneke van de Poll-Franse
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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Feng Y, Su M, Liu Y, Peng J, Sun X. Health-related quality of life among cancer survivors: pre-existing chronic conditions are to be given priority. Support Care Cancer 2024; 32:124. [PMID: 38252273 DOI: 10.1007/s00520-024-08315-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE This study aimed to describe the health-related quality of life (HRQoL) of cancer survivors in China by the five-level EuroQol-5-dimension (EQ-5D-5L) questionnaire and to explore the impact of the comorbidity of pre-existing chronic conditions on HRQoL in cancer survivors. METHODS Data on cancer survivors were obtained from two cross-sectional surveys conducted in Shandong Province, China. The data of the Chinese general population, the Chinese diabetes population, the Chinese hypertension population, and the Chinese urban population from the published studies were used as the controls. The χ2 test was conducted to compare the incidence of five-dimensional problems between the study and control populations. The non-parametric Mann-Whitney U test and Kruskal-Wallis test were performed to examine the differences in EQ-5D-5L utility scores. Besides, the Tobit regression model was used to examine the variables influencing the EQ-5D-5L utility score. RESULTS One thousand fifty-one adult cancer survivors were included. Cancer survivors had significantly lower EQ-5D-5L utility scores (Z = - 15.939, P < 0.001) and EQ-VAS scores (Z = - 11.156, P < 0.001) than the general adult population. The average EQ-5D-5L utility score of hypertensive cancer survivors was lower than that of the hypertensive population (Z = - 1.610, P = 0.107), but the difference was not statistically significant. CONCLUSION Compared to the general population, the HRQoL of cancer survivors was extremely poor in all dimensions of the EQ-5D-5L. Pre-existing chronic conditions had significant antecedent effects on the HRQoL of cancer survivors. Therefore, more attention should be paid to chronic diseases, and effective interventions should be adopted based on this.
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Affiliation(s)
- Yujia Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhuaxi Road 44#, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Mingzhu Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhuaxi Road 44#, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Yanxiu Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhuaxi Road 44#, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Jiaqi Peng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhuaxi Road 44#, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhuaxi Road 44#, Jinan, China.
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China.
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Nolazco JI, Rosner BA, Roebuck EH, Bergerot CD, Rammant E, Iyer GS, Tang Y, Al-Faouri R, Filipas DK, Leapman MS, Mossanen M, Chang SL. Impact of smoking status on health-related quality of life (HRQoL) in cancer survivors. Front Oncol 2024; 13:1261041. [PMID: 38239633 PMCID: PMC10795065 DOI: 10.3389/fonc.2023.1261041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/23/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction The Health-Related Quality of Life (HRQoL) often declines among cancer survivors due to many factors. Some cancer patients who smoke before the cancer diagnosis continue this harmful habit, potentially contributing to a more significant decline in their HRQoL. Therefore, this study investigates the association between smoking status and HRQoL in cancer survivors. Methods We conducted a cross-sectional study utilizing self-reported cancer history from 39,578 participants of the Behavioral Risk Factor Surveillance System (BRFSS) database, leveraging 2016 and 2020 year questionaries. A multidimensional composite outcome was created to assess HRQoL, integrating four distinct dimensions - general health, mental health, physical health, and activity limitations. After accounting for the complex survey design, logistic regression models were used to analyze the association between smoking status and poor HRQoL, adjusting for demographic, socioeconomic, and health-related confounders. Results Our study found that, after adjusting for potential confounders, current smokers exhibited a significantly poorer HRQoL than never smokers (OR 1.65, 95%CI 1.40-1.93). Furthermore, former smokers showed a poorer HRQoL than never smokers; however, this association was not as strong as current smokers (OR 1.22, 95%CI 1.09-1.38). Conclusion Our findings highlight the adverse association of smoking with poor HRQoL in cancer survivors, underscoring the importance of healthcare professionals prioritizing smoking cessation and providing tailored interventions to support this goal.
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Affiliation(s)
- José Ignacio Nolazco
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Servicio de Urología, Hospital Universitario Austral, Universidad Austral, Pilar, Argentina
| | - Bernard A. Rosner
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Emily H. Roebuck
- Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC, United States
| | - Cristiane Decat Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Grupo Oncoclinicas, Brasília, DF, Brazil
| | - Elke Rammant
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Geetha S. Iyer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Yuzhe Tang
- Urology Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ra’ad Al-Faouri
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Dejan K. Filipas
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael S. Leapman
- Yale School of Medicine, Department of Urology, New Haven, CT, United States
| | - Matthew Mossanen
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Steven Lee Chang
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
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Blickle P, Schmidt ME, Steindorf K. Post-traumatic growth in cancer survivors: What is its extent and what are important determinants? Int J Clin Health Psychol 2024; 24:100418. [PMID: 37867603 PMCID: PMC10585376 DOI: 10.1016/j.ijchp.2023.100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/08/2023] [Indexed: 10/24/2023] Open
Abstract
Background/Objective The aim was to investigate the extent and longitudinal determinants of post-traumatic growth (PTG) in cancer survivors. Methods A sample of 1316 cancer survivors with various cancer types was examined using the EORTC QLQ-FA12 to assess fatigue, the EORTC QLQ-C30 pain items to assess pain and the Patient Health Questionnaire (PHQ-4) to assess emotional distress two years after diagnosis (t0). Additionally, patients rated how well they felt informed about fatigue at t0. PTG was assessed with the 21-item PTG-Inventory four years after diagnosis (t1) comprising the five subdimensions appreciation of life, relation to others, personal strengths, new possibilities and spiritual change. Results Regarding the extent of PTG, most positive developments were experienced in the PTG subdimension appreciation of life whereas the subdimension spiritual change was the least pronounced domain. Fatigue, pain and emotional distress were longitudinal but non-linear predictors of long-term PTG. Additionally, poor informedness about fatigue was associated with less PTG. Conclusions PTG can be perceived even years after a traumatic cancer event and is longitudinally associated with common cancer side effects like fatigue, emotional distress and pain. Further research into the role of individuals' informedness contributing to PTG is needed.
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Affiliation(s)
- Patricia Blickle
- German Cancer Research Center (DKFZ) Heidelberg, Division Physical Activity, Prevention and Cancer, Germany
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Martina E. Schmidt
- German Cancer Research Center (DKFZ) Heidelberg, Division Physical Activity, Prevention and Cancer, Germany
| | - Karen Steindorf
- German Cancer Research Center (DKFZ) Heidelberg, Division Physical Activity, Prevention and Cancer, Germany
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Rimmer B, Brown MC, Sotire T, Beyer F, Bolnykh I, Balla M, Richmond C, Dutton L, Williams S, Araújo-Soares V, Finch T, Gallagher P, Lewis J, Burns R, Sharp L. Characteristics and Components of Self-Management Interventions for Improving Quality of Life in Cancer Survivors: A Systematic Review. Cancers (Basel) 2023; 16:14. [PMID: 38201442 PMCID: PMC10777971 DOI: 10.3390/cancers16010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024] Open
Abstract
Self-management can improve clinical and psychosocial outcomes in cancer survivors. Which intervention characteristics and components are beneficial is unclear, hindering implementation into practice. We systematically searched six databases from inception to 17 November 2021 for studies evaluating self-management interventions for adult cancer survivors post-treatment. Independent reviewers screened for eligibility. Data extraction included population and study characteristics, intervention characteristics (TIDieR) and components (PRISMS), (associations with) quality of life (QoL), self-efficacy, and economic outcomes. Study quality was appraised, and narrative synthesis was conducted. We identified 53 papers reporting 32 interventions. Studies had varying quality. They were most often randomised controlled trials (n = 20), targeted at survivors of breast (n = 10), prostate (n = 7), or mixed cancers (n = 11). Intervention characteristics (e.g., provider, location) varied considerably. On average, five (range 1-10) self-management components were delivered, mostly "Information about condition and its management" (n = 26). Twenty-two studies reported significant QoL improvements (6 also reported significant self-efficacy improvements); these were associated most consistently with combined individual and group delivery. Economic evaluations were limited and inconclusive. Self-management interventions showed promise for improving QoL, but study quality was variable, with substantial heterogeneity in intervention characteristics and components. By identifying what to adapt from existing interventions, these findings can inform development and implementation of self-management interventions in cancer.
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Affiliation(s)
- Ben Rimmer
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Morven C. Brown
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Tumi Sotire
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Fiona Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Iakov Bolnykh
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Michelle Balla
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Catherine Richmond
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Lizzie Dutton
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Sophie Williams
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | - Vera Araújo-Soares
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
- Centre for Preventive Medicine and Digital Health, Department for Prevention, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Pamela Gallagher
- School of Psychology, Dublin City University, D09 N920 Dublin, Ireland
| | - Joanne Lewis
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | - Richéal Burns
- Faculty of Science, Atlantic Technological University, F91 YW50 Sligo, Ireland
- Health and Biomedical Strategic Research Centre, Atlantic Technological University, F91 YW50 Sligo, Ireland
| | - Linda Sharp
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
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22
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Hill RE, Mercieca‐Bebber R, Fardell JE, Wakefield CE, Signorelli C, Webber K, Cohn RJ. Relationship between survivorship care plans and unmet information needs, quality of life, satisfaction with care, and propensity to engage with, and attend, follow-up care. Cancer 2023; 129:3820-3832. [PMID: 37566341 PMCID: PMC10952368 DOI: 10.1002/cncr.34984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 06/29/2023] [Accepted: 07/15/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The impact of survivorship care plans (SCPs) on the proximal and distal outcomes of adult and childhood cancer survivors, and parent proxies, is unclear. This study aimed to determine the relationship between SCP receipt and these outcomes. METHODS A cross-sectional survey of adult and childhood cancer survivors (and parent proxies for survivors aged younger than 16 years) across Australia and New Zealand was conducted. Multivariate regression models were fitted to measure the impact of SCP receipt on proximal (unmet information needs and propensity to engage with, and attend, cancer-related follow-up care) and distal outcomes (quality of life and satisfaction with cancer-related follow-up care) with control for cancer history and sociodemographic factors. RESULTS Of 1123 respondents, 499 were adult cancer survivors and 624 were childhood cancer survivors (including 222 parent proxies). We found that SCP receipt was predictive of greater attendance at, and awareness of, cancer-related follow-up care (adult: odds ratio [OR], 2.46; 95% CI, 1.18-5.12; OR, 2.38; 95% CI, 1.07-5.29; child/parent: OR, 2.61; 95% CI, 1.63-4.17; OR, 1.63; 95% CI, 1.06-2.50; respectively). SCP receipt also predicted fewer unmet information needs related to "follow-up care required" and "possible late effects" (adult: OR, 0.44; 95% CI, 0.20-0.96; OR, 0.29; 95% CI, 0.13-0.64; child/parent: OR, 0.46; 95% CI, 0.30-0.72; OR, 0.57; 95% CI, 0.38-0.85; respectively). In terms of distal outcomes, SCP receipt predicted a better global quality of life for adult cancer survivors (β, 0.08; 95% CI, -0.01-7.93), proxy-reported health-related quality of life (β, 0.15; 95% CI, 0.44-7.12), and satisfaction with follow-up care for childhood cancer survivors (OR, 2.93; 95% CI, 1.64-5.23). CONCLUSIONS Previous studies have shown little impact of SCPs on distal end points. Results suggest that SCPs may be beneficial to cancer survivors' proximal and distal outcomes.
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Affiliation(s)
- Rebecca E. Hill
- Discipline of Paediatrics & Child HealthSchool of Clinical MedicineUniversity of New South Wales (UNSW) Medicine and HealthUNSW SydneyRandwickNew South WalesAustralia
- Behavioural Sciences UnitKids Cancer CentreSydney Children’s HospitalSydneyNew South WalesAustralia
| | - Rebecca Mercieca‐Bebber
- National Health and Medical Research Council Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | - Joanna E. Fardell
- Discipline of Paediatrics & Child HealthSchool of Clinical MedicineUniversity of New South Wales (UNSW) Medicine and HealthUNSW SydneyRandwickNew South WalesAustralia
- Behavioural Sciences UnitKids Cancer CentreSydney Children’s HospitalSydneyNew South WalesAustralia
| | - Claire E. Wakefield
- Discipline of Paediatrics & Child HealthSchool of Clinical MedicineUniversity of New South Wales (UNSW) Medicine and HealthUNSW SydneyRandwickNew South WalesAustralia
- Behavioural Sciences UnitKids Cancer CentreSydney Children’s HospitalSydneyNew South WalesAustralia
| | - Christina Signorelli
- Discipline of Paediatrics & Child HealthSchool of Clinical MedicineUniversity of New South Wales (UNSW) Medicine and HealthUNSW SydneyRandwickNew South WalesAustralia
- Behavioural Sciences UnitKids Cancer CentreSydney Children’s HospitalSydneyNew South WalesAustralia
| | - Kate Webber
- School of Clinical Sciences at Monash HealthFaculty of MedicineMonash UniversityClaytonVictoriaAustralia
| | - Richard J. Cohn
- Discipline of Paediatrics & Child HealthSchool of Clinical MedicineUniversity of New South Wales (UNSW) Medicine and HealthUNSW SydneyRandwickNew South WalesAustralia
- Behavioural Sciences UnitKids Cancer CentreSydney Children’s HospitalSydneyNew South WalesAustralia
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23
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Li R, Liu M, Song J, Xu Y, He A, Hu X, Yang S, Ding G, Chen M, Jin C. Association between residential greenspace and mental health among cancer survivors in Shanghai, China. ENVIRONMENTAL RESEARCH 2023; 238:117155. [PMID: 37775008 DOI: 10.1016/j.envres.2023.117155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/27/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Living near and enjoying visually green landscapes is associated with better mental health, but evidence focusing on vulnerable populations (such as cancer survivors) is sparse. The purpose of this study was to explore the association between residential greenspace and anxiety and depressive symptoms among cancer survivors in Shanghai, China. METHODS In total, 4195 cancer survivors participated in this study from the 2022 Shanghai Cancer Patient Needs Survey. The estimation of residential greenspaces was based on Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI). The presence and severity of depressive and anxiety symptoms were assessed by using the Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2). The relation between mental health and green space was assessed using the Generalized Additive Model (GAM) after controlling for relevant individual covariates and contextual characteristics. RESULTS The prevalence of anxiety and depression in cancer survivors was 36.2% and 28.3% respectively. After multivariate adjustment, each increase in inter-quartile range (IQR) for NDVI in the 250 m buffer (NDVI-250m) was associated with a decrease in PHQ-2 score (△score (95%CI): 0.018 (-0.034, -0.002)) and GAD-2 score (△score (95%CI): 0.018 (-0.034, -0.002)), respectively. We observed that an increase in IQR for NDVI-250m was associated with a 3.3% (Odds ratio (OR) (95%CI):0.967 (0.943, 0.991)) reduction in anxiety symptoms. More pronounced greenspace-mental health effects were found among young adults (18-65 years) and participants living in suburban areas, compared to young people over 65 and those living in urban areas (P-interaction < 0.05). CONCLUSIONS Higher levels of residential green space are associated with lower risk of depression and anxiety disorders. Our findings will fill the gap in the relationship between green space and mental health among cancer survivors in urban China, and provide new evidence for garden afforestation, community planning and policy-making. To better understand this association, more longitudinal studies are necessary to investigate the mechanisms involved.
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Affiliation(s)
- Ruijia Li
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, 200031, China
| | - Mengying Liu
- School of Pharmacy, Anhui Xinhua University, Hefei, 230088, China
| | - Jie Song
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, 200031, China
| | - Yuan Xu
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, 200031, China
| | - Amei He
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, 200031, China
| | - Xiaojing Hu
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, 200031, China
| | - Shanshi Yang
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, 200031, China
| | - Gang Ding
- Oncology Department, Shanghai International Medical Center, 200120, Shanghai, China
| | - Minxing Chen
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, 200031, China.
| | - Chunlin Jin
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, 200031, China.
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Fernandes DCR, Nelson D, Siriwardena AN, Law G, Andreyev HJN. Understanding colorectal cancer patient follow-up: a qualitative interview study. Support Care Cancer 2023; 31:634. [PMID: 37843671 DOI: 10.1007/s00520-023-08108-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE There are increasing numbers of patients who have been treated for colorectal cancer (CRC) who struggle with ongoing physical and psychological symptoms. 'Cancer survivor' is often used to describe these patients but this terminology remains controversial. This study sought to understand the follow-up experience of CRC patients in the UK and identify the terminology they prefer following diagnosis and treatment. METHODS Purposeful sampling of patients from specialist CRC follow-up clinics was performed until data saturation was achieved. Two 1:1 semi-structured qualitative interviews were performed for each participant. Data were analysed thematically. RESULTS Seventeen participants, median age = 62, 53% male were interviewed. Several themes were identified. Of note, fear of cancer recurrence dominates patients' agendas at follow-up appointments. There are also clinical and administrative barriers to discussing symptoms including being embarrassed, feeling that their symptoms were not relevant or not having enough time to discuss issues. However, there are several methods which may improve this, such as through the use of video consultations and questionnaires. In addition, patients identified inadequate holistic support despite significant psychological and social distress. Our data suggest that labelling a diverse group of patients as 'cancer survivors' can be problematic. CONCLUSION It is important that clinicians systematically screen patients for symptoms that are known to occur following treatment. Clinicians and patients should have routine access to pathways and programmes that can support patients in navigating their life after cancer therapy.
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Affiliation(s)
- Darren C R Fernandes
- The Department of Gastroenterology, United Lincolnshire NHS Trust, Lincoln County Hospital, Lincoln, UK.
- Community and Health Research Unit, University of Lincoln, Lincoln, UK.
| | - David Nelson
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
- Macmillan Cancer Support, London, UK
| | | | - Graham Law
- Lincoln Clinical Trials Unit, University of Lincoln, Lincoln, UK
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - H Jervoise N Andreyev
- The Department of Gastroenterology, United Lincolnshire NHS Trust, Lincoln County Hospital, Lincoln, UK
- The Biomedical Research Centre, Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
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Blickle P, Haussmann A, Holzner B, Berger AK, Steindorf K, Schmidt ME. Providing the basis for a patient-centred and effective screening for cancer-related fatigue (MERLIN study): design of a longitudinal observational study. BMJ Open 2023; 13:e073802. [PMID: 37770278 PMCID: PMC10546148 DOI: 10.1136/bmjopen-2023-073802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/06/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Cancer-related fatigue (CRF) is a frequent and burdensome sequela of cancer and cancer therapies. It can persist from months to years and has a substantial impact on patients' quality of life and functioning. CRF is often still not adequately diagnosed and insufficiently treated. According to guideline recommendations, patients should be routinely screened for CRF from cancer diagnosis onwards. We will investigate how an effective screening should be designed regarding timing, frequency, screening type and cut-off points. METHODS AND ANALYSIS MERLIN is a longitudinal observational study that will include 300 patients with cancer at the beginning of cancer therapy. The main study centre is the National Center for Tumour Diseases Heidelberg, Germany. Patients answer five items to shortly screen for CRF at high frequency during their therapy and at lower frequency during the post-treatment phase for 18 months. Further, CRF is assessed at wider intervals based on the Cella criteria, the Brief Fatigue Inventory impact scale, the quality of life fatigue questionnaire (QLQ-FA12) and the fatigue and cognitive items of the quality of life core questionnaire (QLQ-C30), both of the European Organisation for Research and Treatment of Cancer. Important psychological, socio-demographical or medical factors, which may exacerbate CRF are assessed. All assessments are performed online. Receiver operating curves, areas under the curve, sensitivity, specificity, positive and negative predictive values and likelihood ratios will be calculated to determine optimal short screening modalities. ETHICS AND DISSEMINATION The study was approved by the ethics committee of the Medical Faculty of the Heidelberg University, Germany (approval number: S-336/2022). Written informed consent is obtained from all participants. The study is conducted in full conformance with the principles of the Declaration of Helsinki. Results will be published in peer-reviewed scientific journals, presented at conferences and communicated to clinical stakeholders to foster the implementation of an effective CRF management. TRIAL REGISTRATION NUMBER ClinicalTrials.gov; registration number: NCT05448573.
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Affiliation(s)
- Patricia Blickle
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and University Medical Center Heidelberg, Heidelberg, Germany
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Alexander Haussmann
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and University Medical Center Heidelberg, Heidelberg, Germany
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anne Katrin Berger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and University Medical Center Heidelberg, Heidelberg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and University Medical Center Heidelberg, Heidelberg, Germany
| | - Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and University Medical Center Heidelberg, Heidelberg, Germany
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Zhang J, Chan DNS, Liu X, Cai Y, Chen J, Xie M. Effects of self-management interventions for cancer patients with pain: A systematic review of randomised controlled trials. J Clin Nurs 2023; 32:5652-5667. [PMID: 36929168 DOI: 10.1111/jocn.16669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/09/2023] [Accepted: 02/08/2023] [Indexed: 03/18/2023]
Abstract
AIMS To evaluate the effects of self-management interventions targeting individuals with cancer-related pain on pain intensity, self-efficacy, quality of life (QoL), pain medication adherence, and pain-related knowledge and provide recommendations for the content and format of self-management interventions based on the existing evidence. DESIGN A systematic review of randomised controlled trials (RCTs) and narrative synthesis. DATA SOURCES A search of six electronic databases, including Medline, PsycINFO, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus. REVIEW METHODS This systematic review followed the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published from January 2011 to March 2022 in English were retrieved. The Cochrane Risk of Bias Tool was used to assess quality. Data were summarised using narrative synthesis. RESULTS This systematic review included six RCTs involving 748 patients with cancer-related pain. The results support the effectiveness of the intervention on QoL and pain-related knowledge. Mixed results were observed in the effectiveness on pain intensity, self-efficacy and medication adherence. Overall, the quality of the evidence was low. The content of self-management interventions varied across studies but with similar formats (face-to-face coaching and telephone follow-up). CONCLUSION The existing evidence supports the effectiveness of self-management interventions on pain-related knowledge and QoL. Further high-quality RCTs are needed to determine the most effective interventions. RELEVANCE TO CLINICAL PRACTICE Self-management is recommended to improve cancer patients' pain awareness, self-management behaviour and adaptability. Components for self-management of cancer pain, including patient attitude and knowledge assessment, nurse coaching and counselling, reinforcement during follow-up period, and provision of supplementary materials on pain management and medication adherence, could be covered in the intervention. In the future, it is worthwhile exploring an effective intervention using Internet-based information technology, for example WeChat, to aid the delivery of self-management intervention. NO PATIENT OR PUBLIC CONTRIBUTION This systematic review does not necessarily involve patients or public members in this work.
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Affiliation(s)
- Junfeng Zhang
- Department of Nursing, SSL Central Hospital of Dongguan City, Dongguan, People's Republic of China
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Dorothy N S Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Xingling Liu
- Department of Nursing, SSL Central Hospital of Dongguan City, Dongguan, People's Republic of China
| | - Yingying Cai
- Department of Nursing, Jieyang People's Hospital, Jieyang, People's Republic of China
| | - Jiawen Chen
- Department of Nursing, SSL Central Hospital of Dongguan City, Dongguan, People's Republic of China
| | - Minjuan Xie
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, People's Republic of China
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Vlaski T, Slavic M, Caspari R, Fischer H, Brenner H, Schöttker B. Development Trajectories of Fatigue, Quality of Life, and the Ability to Work among Colorectal Cancer Patients in the First Year after Rehabilitation-First Results of the MIRANDA Study. Cancers (Basel) 2023; 15:3168. [PMID: 37370777 DOI: 10.3390/cancers15123168] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Cancer-related fatigue, low quality of life (QoL), and low ability to work are highly prevalent among colorectal cancer (CRC) patients after tumor surgery. We aimed to analyze their intercorrelations and trajectories in the first year after in-patient rehabilitation in the German multicenter MIRANDA cohort study. Recruitment is ongoing, and we included the first 147 CRC patients in this analysis. Participants filled out questionnaires at the beginning of in-patient rehabilitation (baseline) and at 3, 6, 9, and 12 months after the baseline. The EORTC-QLQ-C30-General-Health-Status (GHS)/QoL, the FACIT-F-Fatigue Scale, and the FACIT-F-FWB-ability-to-work items were used to evaluate QoL, fatigue, and ability to work, respectively. The fatigue and QoL scales were highly correlated (r = 0.606). A moderate correlation was observed between the fatigue and ability to work scales (r = 0.487) and between the QoL and ability to work scales (r = 0.455). Compared to the baseline, a statistically significant improvement in the QoL, ability to work, and fatigue scales were observed at the 3-month follow-up (Wilcoxson signed rank test, all p < 0.0001). The three scales plateaued afterward until the 12-month follow-up. In conclusion, fatigue, QoL, and ability to work were highly interrelated, improved quickly during/after in-patient rehabilitation, and did not change much afterward in German CRC patients.
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Affiliation(s)
- Tomislav Vlaski
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, 69120 Heidelberg, Germany
| | - Marija Slavic
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Reiner Caspari
- Clinic Niederrhein, 53474 Bad Neuenahr-Ahrweiler, Germany
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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28
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Yang Z, Leng K, Shi G. Causes of death among patients with hepatocellular carcinoma in United States from 2000 to 2018. Cancer Med 2023. [PMID: 37083308 DOI: 10.1002/cam4.5986] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/21/2023] [Accepted: 04/09/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The gains in survival outcomes of US patients with hepatocellular carcinoma (HCC) have come at the expense of developing non-cancer-related morbidities, such as cardiovascular diseases (CVDs) and infections. However, population-based data on causes of death (CODs) in patients with HCC are scarce. METHODS A cancer registry database in the United States was used to analyze the CODs among patients with HCC. Death cause distribution and standardized mortality ratios were calculated to quantify the disease-specific death burden. RESULTS A total of 40,094 patients with a histological diagnosis of HCC were identified from the SEER-18 database between 2000 and 2018, of which 30,796 (76.8%) died during the follow-up period. The majority of these deaths (25,153, 81.7%) occurred within 2 years after diagnosis, 13.2% (4075) occurred within 2-5 years, and 5.1% (1568) occurred after 5 years. All age groups had a lower burden of female deaths than of male deaths during the study period. With respect to CODs, 23,824 (77.4%), 2289 (7.4%), and 4683 (15.2%) were due to HCC, other cancers, and non-cancer causes, respectively. Non-cancer-related deaths were more common among older patients and those with longer latency periods since diagnosis. The major causes of non-cancer-related deaths are other infectious and parasitic diseases, including HIV and CVDs. CONCLUSIONS CODs during HCC survivorship varied, and a growing number of survivors tended to die from causes other than HCC, with an increasing latency period since diagnosis. Comprehensive analyses of mortality patterns and temporal trends could underpin strategies to reduce these risks.
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Affiliation(s)
- Zhen Yang
- Department of Hepatopancreatobiliary Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, People's Republic of China
- Department of Hepatopancreatobiliary Surgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, People's Republic of China
| | - Kaiming Leng
- Department of Hepatopancreatobiliary Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, People's Republic of China
- Department of Hepatopancreatobiliary Surgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, People's Republic of China
| | - Guangjun Shi
- Department of Hepatopancreatobiliary Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, People's Republic of China
- Department of Hepatopancreatobiliary Surgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, People's Republic of China
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29
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Perspectives on Emotional Care: A Qualitative Study with Cancer Patients, Carers, and Health Professionals. Healthcare (Basel) 2023; 11:healthcare11040452. [PMID: 36832985 PMCID: PMC9956222 DOI: 10.3390/healthcare11040452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
The emotional consequences of a cancer diagnosis are well documented and range from emotional distress, defined as suffering associated with feelings such as shock, fear, and uncertainty, through to psychological distress that may manifest as depression, anxiety, feelings of hopelessness, or heightened risk of suicide. This study set out to explore the assumption that the provision of emotional care should be the platform upon which all other aspects of cancer care are delivered and, that without attention to emotional care, no other aspects of cancer care can be fully realized. Utilizing qualitative focus groups and in-depth interviews with 47 patients, carers, and health professionals, emotional care was shown to be (1) fundamental to the provision of comprehensive cancer care, (2) essential to easing the burden of a cancer diagnosis and demands of treatment, (3) everyone's business, and (4) a component of cancer care at any time and every time. Future studies are needed to test interventions to enhance provision of intentional, purposeful, and individualized emotional care to help patents achieve the best health outcomes possible.
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Gu J, Hu M, Chen Y, Yu J, Ji Y, Wei G, Huo J. Bibliometric analysis of global research on physical activity and sedentary behavior in the context of cancer. Front Oncol 2023; 13:1095852. [PMID: 36776335 PMCID: PMC9909561 DOI: 10.3389/fonc.2023.1095852] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/13/2023] [Indexed: 01/27/2023] Open
Abstract
Objective Numerous studies focusing on sedentary behavior (SB) and physical activity (PA) in the context of cancer have been reported in recent years. We analyzed and visualized studies on SB and PA in patients with cancer over the last 20 years using scientometric methods, to provide insights on gaps and deficiencies in the literature, and to inform future research guidelines. Methods All relevant studies in the field from 2001 to October 2022 were reviewed using bibliometric tools, including VOSviewer, Bibliometric online analysis platform, and biblioshiny, to determine the most influential countries, institutions, journals, and authors. We explored current research hotpots and potential research trends, based on keyword clustering and dynamic changes. Our research focuses on PA, SB, and cancer across the entire cancer continuum, from primary prevention to treatment to cancer survivorship. Results Scientometric analysis identified 4,382 relevant manuscripts on SB and PA in the context of cancer, with a 10-fold increase in articles over the past 20 years. The United States, Canada, and Australia were the most influential countries. The journal, Supportive Care in Cancer, had the highest number of publications, while Clinical Oncology had the highest H-index. K.S. Courneya was the most influential author in this field, with the highest number of publications, total citations, and H-index. Keyword analysis revealed that current research is focused on PA and SB in patients with breast cancer, quality of life, and aerobic exercise. Future frontiers include cancer prehabilitation programs and cardiorespiratory fitness, and remote intervention and social support. Conclusion By using bibliometrics, we conducted a comprehensive review of SB and PA in cancer-related studies. The current research focused on exercise and sedentariness in breast cancer patients and the role of PA in improving quality of life in survivorship. Emerging research foci were generally around cancer prehabilitation programs and remote intervention issues for PA. In addition, some publication deficits are noted: studies of PA and SB in less common cancers; the recommended doses and intensities of exercise for cancer; the timing of interventions for prehabilitation and the establishment of individualized exercise protocols. These deficiencies align with the needs for future research topics.
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Affiliation(s)
- Jialin Gu
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,The Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Miao Hu
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,The Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yonglin Chen
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jialin Yu
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,Department of Oncology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Yi Ji
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,Department of Oncology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Guoli Wei
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,Department of Oncology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China,*Correspondence: Guoli Wei, ; Jiege Huo,
| | - Jiege Huo
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,Department of Oncology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China,*Correspondence: Guoli Wei, ; Jiege Huo,
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Wang Z, Wu Z, Xiang Q, Yang J, Xia Z, Hao A, Song E, Mei S. Effects of botanical drugs in the treatment of cancer-related fatigue in patients with gastric cancer: A meta-analysis and prediction of potential pharmacological mechanisms. Front Pharmacol 2022; 13:979504. [PMID: 36160404 PMCID: PMC9490126 DOI: 10.3389/fphar.2022.979504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/15/2022] [Indexed: 11/14/2022] Open
Abstract
Objective: To systematically review the efficacy and safety of botanical drugs in the treatment of cancer-related fatigue (CRF) caused by gastric cancer (GC) and to determine the underlying pharmacological mechanisms using a network analysis. Methods: Databases such as China National Knowledge Infrastructure (CNKI), SinoMed, Wanfang, Pubmed, Embase, Cochrane Library, and Web of Science were searched for randomized controlled trials (RCTs) from inception to 18 April 2022. Methodological quality assessment was performed using the collaborative tool Cochrane, and data analysis were carried out using RevMan 5.4 and STATA 16 software. The botanical drugs with the highest frequency of use in the included studies was selected. The chemical composition, targets of action, disease targets, and shared targets of these botanical drugs were screened based on network analysis to explore the potential mechanisms of treating CRF in patients with gastric cancer (GC). Results: A total of 13 studies that included 986 patients with gastric CRF met the inclusion criteria. The results showed that botanical drugs could improve the CRF scores of gastric CRF, including the total scores of CRF dichotomous data [Odds Ratio (OR) = 4.22; 95% confidence interval (CI) 1.67-10.68; p = 0.002], the total scores of CRF continuous data [Standardized Mean Difference (SMD) = -0.98; 95% CI -1.36 to -0.60; p < 0.00001], the affective subscales of Piper Fatigue Scale (PFS) scores [Weighted Mean Difference (MD) = -0.79; 95%CI -0.92 to -0.65; p < 0.00001], the sensory subscales of PFS scores (MD = -0.57; 95%CI -0.77 to -0.37; p < 0.00001), the behavioral subscales of PFS scores (MD = -1.05; 95% CI -1.29 to -0.82; p < 0.00001), Quality of Life Questionnaire Core 30 (QLQ-C30) (MD = 10.53, 95% CI 8.26 to12.80; p < 0.00001), and the Karnofsky Performance Status scale (KPS) (MD = 5.18, 95% CI 2.60 to 7.76; p < 0.0001). The botanical drugs group had milder adverse effects than the control group. A total of 44 chemical components and 241 potential targets were obtained from the online database and 121 drug targets overlapped with the disease targets of CRF in patients with GC. Moreover, five key active ingredients, namely quercetin, Stigmasterol, luteolin, kaempferol, and isorhamnetin, as well as five key targets including AKT1, TP53, TNF, VEGFA, and CASP3, were screened. In addition, five key signaling pathways, including cancer, Hepatitis B, Prostate cancer, Hepatitis C, and Pancreatic cancer pathways, were obtained through enrichment analysis. Conclusion: The results of the study showed that botanical drugs have positive effects on CRF in patients with GC. However, more well-designed, multicenter, and large sample-sized Randomized Controlled Trials are required to evaluate the effectiveness of botanical drugs on CRF in patients with GC.
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Affiliation(s)
- Ziming Wang
- Department of Traditional Chinese Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zihong Wu
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qiong Xiang
- Department of Traditional Chinese Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingyi Yang
- Department of Traditional Chinese Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhenzhong Xia
- Department of Traditional Chinese Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Aohan Hao
- Department of Traditional Chinese Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Enfeng Song
- Department of Traditional Chinese Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shasha Mei
- Department of Traditional Chinese Medicine, Renmin Hospital of Wuhan University, Wuhan, China
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