Supportive care needs in newly diagnosed oral cavity cancer patients receiving radiation therapy

Consumers' longitudinal health information needs and seeking: a scoping review

Needing and seeking health information often is a longitudinal everyday life information behavior that involves the use of technology. However, no reviews of consumers' longitudinal health information needs (HIN) and health information-seeking (HIS) behavior have been conducted. We performed a scoping review to address this gap. Specifically, we surveyed the characteristics, timeline construction and research findings of studies investigating consumers' longitudinal HIN and HIS. Initial searches were conducted in November 2019 and updated in July 2022. A total of 128 papers were identified, reviewed and analyzed using content and thematic analyses. Results showed that most papers were quantitative, conducted in the USA, related to cancer, conducted during the diagnosis and treatment phases, and followed preset time intervals. Findings concerning the development patterns of consumers' HIN degrees and HIS effort were mixed (i.e. increasing, decreasing or being consistent over time). They seemed to be shaped by factors such as health conditions, data collection methods and the length of data collection. Consumers' use of sources changes depending on health status and source accessibility; their medical terminologies seem to expand over time. HIS has a strong emotional dimension which may lead to adaptive or maladaptive information behaviors (e.g. information avoidance). Overall, the results revealed a lack of understanding of HIN and HIS from a longitudinal perspective, particularly along health condition progression and coping trajectories. There is also a lack of understanding of the role of technologies in the longitudinal HIS process.

Enhancing Self-care Among Oral Cancer Survivors: Protocol for the Empowered Survivor Trial

BACKGROUND

Survivors of oral cavity and oropharyngeal cancer frequently experience difficulties in swallowing; tasting; speaking; chewing; and maintaining comfortable movements of the head, neck, and shoulder. Engagement in regular self-care can reduce further loss of function and mitigate late effects. Despite the substantial self-care requirements, there are no empirically based interventions to enhance the skills and confidence of these survivors in managing their ongoing care.

OBJECTIVE

The aim of this study is to describe the rationale and methodology for a randomized controlled trial evaluating Empowered Survivor (ES) versus Springboard Beyond Cancer, a general web-based program for cancer survivors, on self-efficacy in managing care, preparedness for managing survivorship, and health-related quality of life (QOL).

METHODS

This study will recruit a total of 600 individuals who were diagnosed with oral cavity or oropharyngeal cancer in the past 3 years and are currently cancer free primarily from state cancer registries; these individuals will be randomly assigned to either the ES or Springboard Beyond Cancer condition. The participants complete measures of self-efficacy in managing care, preparedness for survivorship, health-related QOL, and engagement in oral self-examination and head and neck strengthening and flexibility exercises at baseline and 2 and 6 months after baseline. The primary aim of this study is to evaluate the impact of ES versus Springboard Beyond Cancer on self-efficacy, preparedness, and health-related QOL. The secondary aim is to examine the mediators and moderators of ES's impact on self-efficacy in managing care, preparedness, and health-related QOL at 6 months. The exploratory aim is to conduct a process evaluation of ES to identify potential oncology or community settings for future implementation.

RESULTS

Multilevel modeling will be used to examine whether there are significant differences between the ES and Springboard Beyond Cancer interventions over time. Mediational models will evaluate the indirect effects of ES on outcomes. Quantitative analyses will evaluate the predictors of ES use, and qualitative analyses will evaluate the preferred timing and settings for the implementation of ES.

CONCLUSIONS

This randomized controlled trial evaluates a completely web-based intervention, ES, versus a general web-based program for cancer survivors, Springboard Beyond Cancer, on self-efficacy in managing care, preparedness for managing survivorship, and health-related QOL and identifies the putative mediators and moderators of the intervention's effects. If an effect on the primary outcomes is illustrated, the next step could be an implementation trial to evaluate the intervention's uptake in and impact on an oncology care setting or nonprofit organizations.

TRIAL REGISTRATION

ClincalTrials.gov NCT04713449; https://clinicaltrials.gov/ct2/show/NCT04713449.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/39996.

Self-efficacy in managing post-treatment care among oral and oropharyngeal cancer survivors

OBJECTIVE

Physical and psychosocial effects of oral cancer result in long-term self-management needs. Little attention has been paid to survivors' self-efficacy in managing their care. Study goals were to characterise self-care self-efficacy and evaluate socio-demographics, disease, attitudinal factors and psychological correlates of self-efficacy and engagement in head and neck self-exams.

METHODS

Two hundred thirty-two oral cancer survivors completed measures of socio-demographics, self-care self-efficacy, head and neck self-exams and attitudinal and psychological measures. Descriptive statistics characterised self-efficacy. Hierarchical regressions evaluated predictors of self-efficacy.

RESULTS

Survivors felt moderately confident in the ability to manage self-care (M = 4.04, SD = 0.75). Survivors with more comorbidities (β = -0.125), less preparedness (β = 0.241), greater information (β = -0.191), greater support needs (β = -0.224) and higher depression (β = -0.291) reported significantly lower self-efficacy. Head and neck self-exam engagement (44% past month) was relatively low. Higher preparedness (OR = 2.075) and self-exam self-efficacy (OR = 2.606) were associated with more engagement in self-exams.

CONCLUSION

Many survivors report low confidence in their ability to engage in important self-care practices. Addressing unmet information and support needs, reducing depressive symptoms and providing skill training and support may boost confidence in managing self-care and optimise regular self-exams.

The impacts of unmet supportive care needs of cancer survivors in Australia: A qualitative systematic review

INTRODUCTION

Cancer incidence and survivorship are increasing worldwide. With more people living through and beyond cancer, there is a subsequent increase in their supportive care needs. This systematic review of qualitative studies aimed to describe the impacts of unmet supportive care needs on cancer survivors in Australia.

METHODS

Databases MEDLINE, EMBASE and Scopus were searched, and after screening and applying eligibility criteria, 27 qualitative studies were included. Findings were synthesised according to the Supportive Care Framework for Cancer Care, including informational, physical, practical, emotional, psychological, social and spiritual need domains.

RESULTS

The systematic review identified impacts of unmet informational, physical, practical, emotional and psychological needs. Frequently identified impacts of unmet informational needs were feelings of abandonment and isolation, distress, confusion and regret. Common impacts of unmet physical and practical needs were financial burden and return-to-work difficulties. Over half of all unmet supportive care needs caused emotional and psychological impacts.

CONCLUSIONS

Findings identify the detrimental emotional and psychological impacts resulting from a range of unmet supportive care needs. The review highlights the interconnections between supportive care need domains thereby enhancing the understanding of the impacts of unmet SCNs. Findings may inform policy and practice change to improve supportive cancer care.

Trajectories of resilience and related factors in primary caregivers of patients with advanced head and neck cancer: A longitudinal cohort study

PURPOSE

Primary caregivers (PC) of patients with advanced head and neck cancer (HNC) report stress during caregiving time post-treatment. We sought to identify the trajectories of resilience from initial completion of treatment to 1-year post-treatment in PC of patients with advanced HNC and to determine the factors associated with trajectories of resilience.

DESIGN

In this prospective cohort study with convenience sampling, patient-PC dyads were recruited from a medical center in northern Taiwan between August 2015 and July 2020.

METHODS

We recruited 120 patient-PC dyads and followed up at treatment completion and 1, 6, and 12 months post-treatment. Generalized estimating equation analysis was performed to identified factors related to resilience.

FINDINGS

PCs' overall resilience increased from initial completion of treatment to peak at 1-year post-treatment. Patient factors associated with greater overall resilience included older age, higher performance status, and shorter time since cancer diagnosis; PC factors included reporting more social support, better physical health, and better mental health.

CONCLUSIONS

PC mental health was the most important factor in the resilience trajectory of patients with advanced HNC cancer.

CLINICAL RELEVANCE

Quantifying the relevant factors of trajectories of resilience will help to identify vulnerable PCs and guide survivorship care in the early stages of the post-treatment period.

Unmet supportive care needs of patients with rare cancer: A systematic review

OBJECTIVE

Patients with rare cancers may experience different unmet needs than those with common cancer. The objective of this systematic review was to (1) investigate unmet supportive care needs of rare cancer patients throughout the disease trajectory and (2) identify predictive factors for these unmet needs.

METHODS

PubMed, PsycINFO and CINAHL were searched for publications (January 2011 to March 2021) focusing on unmet needs of patients with rare cancer. Two reviewers independently selected studies, extracted data and performed quality assessment. Findings were synthesised.

RESULTS

The search yielded 4,598 articles, of which 59 articles met eligibility criteria and 57 were of medium or high quality. Rare cancer patients most frequently reported unmet needs in the healthcare system and information domain (up to 95%), followed by the psychological domain (up to 93%) and the physical and daily living domain (up to 80%). Unmet needs were mainly reported in the posttreatment phase. The most frequently identified predictors were higher anxiety, younger age and higher neuroticism.

CONCLUSION

Patients with rare cancer have unmet needs throughout their disease trajectory. Supportive care needs of rare cancer patients should be addressed individually, depending on the rare cancer subdomain and phase of disease and from diagnosis onwards.

Supportive Care and Unmet Needs in Upper Gastrointestinal Cancer Patients: Screening and Related Factors

Upper gastrointestinal (UGI) cancer treatment can cause physical and psychological distress and may result in unmet needs. The purposes of this study were to (1) examine the levels of gastrointestinal (GI) symptom distress, social support, and supportive care needs; (2) screen the priorities of unmet supportive care needs; and (3) identify the factors associated with supportive care needs among UGI cancer patients receiving chemotherapy. This cross-sectional study examined UGI cancer patients who received treatment from the outpatient chemotherapy department of a single cancer center in northern Taiwan. Questionnaires were used to collect data regarding GI symptom distress, social support, unmet needs, and supportive care needs. The top three unmet needs were "fears about the cancer spreading", "uncertainty about the future", and "being informed about things you can do to help yourself to get well". Descriptive statistics examined the levels of GI symptom distress, social support, supportive care needs, and priorities of unmet supportive care needs. Stepwise regression was conducted to determine significant factors related to supportive care needs. Greater supportive care needs were found to be associated with higher levels of disease-related worries, increased treatment-related symptoms, and a lower level of physical performance. These factors explained 48.0% of the variance in supportive care needs. Disease-related worries and treatment-related symptoms strongly influence overall supportive care needs and each domain of supportive care needs. Symptom management and psychological support for patients receiving outpatient chemotherapy may help patients meet needs.

Health care needs of elderly patients with lung, liver, or colon cancer in Taiwan

BACKGROUND

Globally, different age groups in the elderly population have experienced major shifts over time. Human life expectancy doubled from the 19th to the twentieth century and has increased to 80 years in the twenty-first century. These conditions imply economic challenges and the increasing prevalence of certain health conditions. Old age is associated with increased care needs in various aspects of daily life. This study assessed the health care needs of elderly patients with lung, liver, and colorectal cancer in Taiwan and analyzed the factors underlying their needs.

METHODS

This cross-sectional descriptive survey assessed 234 elderly patients with diagnosis of lung, liver, and colorectal cancer in Taiwan. We investigated their health care needs and daily living functions by using the Supportive Care Needs Survey and Karnofsky Performance Status, respectively.

RESULTS

Patients required the most assistance in physical functioning and daily living. Patients aged ≥85 years required more care than those aged 65-74 years in terms of information access and sexuality needs. Patients with poor functional status required more care than those capable of undertaking normal activities. Patients diagnosed as having liver cancer required more care than those with lung or colorectal cancer. Patients with advanced cancer required more physical and daily care than those with early-stage cancer.

CONCLUSIONS

Patients' health care needs differed with age, primary cancer site, and functional status. Patients aged ≥85 years and those with poor function, primary liver cancer, and advanced cancer had higher care needs.

Associations of religiosity and spiritual well-being with appearance concerns after head and neck cancer surgery

OBJECTIVE

To investigate whether religiosity and spiritual well-being are associated with appearance concerns among people with visible sequelae due to cancer surgery in the head and neck region.

METHODS

A cross-sectional study was carried in 202 adult patients in a referral hospital for cancer treatment in Midwest Brazil. Data on sociodemographic, psychosocial and clinical aspects and cancer-related behaviours were collected through interviews, clinical examination and medical records. The outcome was the patients' appearance concerns (Derriford Appearance Scale-DAS24). The independent explanatory variables were religiosity (Duke University Religiousness Index-DUREL) and spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-FACIT-Sp12). Data were analysed using Pearson's chi-square and Poisson regression.

RESULTS

Most of the participants were male (76.2%), and mean age was 58.6 years (SD = 11.6). The scores of appearance concerns (DAS24) ranged from 21 to 75 (median = 33.0). In the bivariate analysis, appearance concerns were associated with spiritual well-being (FACIT-Sp12), degree of disfigurement and treatment with radiotherapy/chemotherapy. Religiosity (DUREL) was not associated with the outcome. In the adjusted regression model, a lower prevalence of appearance concerns was found among patients with higher levels of spiritual well-being (PR = 0.86; CI = 0.79-0.94), males (PR = 0.87; CI = 0.79-0.95), those with lower degrees of disfigurement (PR = 0.89; CI = 0.82-0.98) and those who had no treatment with radiotherapy/chemotherapy (PR = 0.83; CI = 0.72-0.94).

CONCLUSION

High spiritual well-being was independently associated with lower levels of appearance concerns in people with visible sequelae due to cancer surgery in the head and neck region. Understanding the role of this psychosocial determinant may help in the coping process.

Unmet supportive care needs of survival patients with breast cancer in different cancer stages and treatment phases

OBJECTIVE

This study aimed to examine the differences between patients with breast cancer (BC) at different cancer stages and treatment phases in terms of unmet supportive care needs as well as to predict the critical factors that influence the unmet needs of such patients.

MATERIALS AND METHODS

A retrospective study was conducted by collecting data from the case consultation and service records of a cancer center in central Taiwan. Information extracted from the case consultation and service records included patients' age, treatment phase, cancer stage, and unmet need domains.

RESULTS AND CONCLUSION

Overall, 1129 BC patients were recruited. In the prediction of critical factors influential to the health information needs of patients with BC, in-treatment patients, and those undergoing a follow-up were found to have significantly lower health information needs than patients newly diagnosed with BC. In-treatment and follow-up patients had significantly lower patient care needs than those newly diagnosed with BC. Stage II, III, and IV BC patients had significantly lower nutritional needs than stage I patients. In-treatment patients and those receiving follow-ups had significantly lower nutritional needs than patients newly diagnosed with BC. Relapse and terminal care patients had significantly higher psychosocial needs than patients newly diagnosed with BC. Thus, unmet needs of patients with cancer differ according to their age, cancer stage, and treatment phase. Appropriate and punctual tailored support provided by medical care personnel to address the unmet needs of patients can reduce the unmet supportive care needs in such patients and improve the quality of medical care services they are provided with. Ultimately, the overall quality of life of patients can be improved.

Association between multidisciplinary team care and the completion of treatment for oral squamous cell carcinoma: A cohort population-based study

OBJECTIVES

This study investigates the relationship between multidisciplinary team care (MDTC) and patient completion of their treatment regimen for oral squamous cell carcinoma (OSCC).

METHODS

We conducted a retrospective cohort study in patients diagnosed with OSCC in Taiwan from 1 January 2016 to 30 June 2018 using a linked cancer registry database.

RESULTS

Of the 969 OSCC MDTC patients in the study cohort, 6.3% reported incomplete treatment, with 1.3% interrupting ongoing treatment and 5.0% terminating definitive treatment. Patients who had advanced-stage disease, experienced primary cancer recurrence or a secondary cancer, or were treated with surgery combined with chemotherapy, radiotherapy or chemoradiotherapy were more likely to terminate treatment before completion. The major reasons for interruption of ongoing treatment included 'patient or their family considered the patient to be in poor physical condition' and 'difficulty enduring physical discomfort caused by treatment'. The major reason for termination of definitive treatment was 'patient or their families or friends experienced negative treatment effects and worried about the side-effects of treatment'.

CONCLUSION

Advanced-stage cancer, recurrence or secondary cancer, and surgery combined with chemotherapy, radiotherapy or chemoradiotherapy negatively affected treatment completion. MDTC allows for shared decision-making to determine the optimal treatment.

Translation and Validation of the Arabic Version of the Cancer Needs Questionnaire-Short Form

Objective:

Care needs among Arabic cancer patients have not been assessed previously due to the lack of translated instrument that can determine the care needs among the cancer patients in Arab countries. The aim of this study was to translate and validate an Arabic version of the Cancer Needs Questionnaire-Short Form (CNQ-SF).

Methods:

A cross-cultural adaptation and psychometric testing was used. Brislin's model of translation was used to translate the CNQ-SF from English to Arabic. A cross-cultural adaptation and psychometric testing was used. A sample of 113 participants with different types of cancer completed the study surveys including the CNQ-SF (Arabic version) and Functional Assessment of Cancer Therapy-General (FACT-G). Descriptive, bivariate statistics and exploratory factor analysis (EFA) were performed.

Results:

Content validity was evaluated by a panel of experts and 20 participants and showed that translated scale was clear, understandable, and logical in order. Reliability analysis of CNQ-SF domains ranged from 0.85 to 0.93 and 0.94 for the total Arabic version of CNQ-SF. Convergent analysis showed a significant relationship between CNQ-SF (Arabic version) and FACT-G. Results of EFA indicated that the CNQ-SF scale has 32-items. It consists of five domains, the results indicated that Kaiser–Meyer–Olkin was 0.851, and Bartlett's Test of Sphericity was significant (significant (P < 0.001).

Conclusions:

The current study indicates that the Arabic version of CNQ-SF is valid, reliable, and applicable. It can be used by researchers, clinical practitioners, and health educators in Arab countries.

Body mass index and self-care behaviors related to oral health-related quality of life in patients with oral squamous cell carcinoma within three months posttreatment

PURPOSE

Oral dysfunction is a common adverse event of treatment and may affect oral health-related quality of life (OHRQoL). This study aimed to identify factors associated with OHRQoL in patients with oral squamous cell carcinoma (OSCC) within the first three months posttreatment.

METHODS

This cross-sectional study examined OSCC patients who received treatment from the outpatient radiation department of a single cancer center in northern Taiwan. Demographic and clinical characteristics were recorded, and patients were assessed using the Self-Care Behaviors Scale (SCB), Oral Health Impact Profile (OHIP), and Karnofsky Performance Status (KPS) questionnaires.

RESULTS

Among 148 OSCC patients, 11.5% reported being underweight and 70.3% reported normal weight. The most common self-care factors associated with adverse effects were decreased appetite and fatigue. Psychological disability, functional limitation, and physical pain were the most negative OHRQoL factors. Poor OHRQoL was associated with more severe adverse effects after self-care behaviors, using feeding tubes during treatment, and having BMI less than 25, which together explained 33.5% of the variance in OHRQoL.

CONCLUSIONS

The severity of adverse effects after self-care behaviors and using feeding tubes during treatment strongly influenced overall OHRQoL and seven specific dimensions of OHRQoL.

Impact of illness perception, mental adjustment, and sociodemographic characteristics on return to work in patients with head and neck cancer

PURPOSE

To examine the effects of emotional distress, illness perception, and mental adjustment on return to work (RTW) among patients with head and neck cancer (HNC) and identify factors associated with RTW.

METHODS

A cross-sectional study with convenience sampling was conducted in Taiwan. Structured questionnaires were used to collect data on RTW status and to explore possible factors related to RTW. RTW status was assessed by a single question. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, illness perception was assessed by the Brief Illness Perception Questionnaire, and mental adjustment was assessed using the Mini-mental Adjustment to Cancer Scale. Sociodemographic and disease background data were also collected and analyzed. Factors related to RTW were identified by multivariate logistic regression.

RESULTS

A total of 150 patients with HNC were recruited into the study. Of them, 58 (38.7%) returned to work after treatment. Compared to those who did not RTW, patients who did RTW had lower levels of emotional distress (anxiety and depression), better illness perception (cognitive illness representations and illness comprehensibility), and better mental adjustment (hopelessness and helplessness, anxious preoccupation, avoidance, and fatalism). Multivariable analysis indicated that anxiety (OR = 0.863, p < 0.05), avoidance (OR = 1.280, p < 0.001), cognitive illness representations (OR = 0.891, p < 0.01), illness comprehensibility (OR = 1.271, p < 0.05), higher education level (OR = 3.048-3.609, p < 0.05), married status (OR = 5.220, p < 0.05), tumor site in oral cavity (OR = 5.057, p < 0.05), and no reconstruction (OR = 3.415, p < 0.05) were significantly associated with RTW.

CONCLUSION

The issue of RTW among patients with HNC is related to multidimensional factors, including sociodemographic, psychological, and disease-related situations. We suggest that programs for emotional rehabilitation and occupational counseling need to be developed to assist patients with HNC to RTW at an early stage.

Unmet supportive care needs and its relation to quality of life among adult acute leukaemia patients in China: a cross-sectional study

Background

Patients with acute leukaemia (AL) usually require prolonged periods of hospitalisation. The treatment and clinical symptoms may lead to patients’ supportive care needs (SCNs) not being met and impairs their quality of life (QoL). Studies on QoL and SCNs among AL patients are limited. This study aimed to identify the unmet SCNs and its relation to QoL of adult AL patients in China.

Methods

This multicentre cross-sectional study recruited 346 participants to complete a self-developed questionnaire, detailing demographic information and disease-related variables. A 34-item Supportive Care Needs Survey (SCNS-SF34) was used to identify unmet SCNs, and the Functional Assessment of Cancer Therapy-Leukaemia (FACT-Leu) questionnaire measured patients’ QoL.

Results

Unmet SCN rates for the 34 items ranged from17.6 to 81.7%. Patients’ needs were high for health systems and information, but low in the sexual domain. The results reveal nine factors associated with the unmet SCNs of adult AL patients, including marital status, original residence, age, education, occupation, other diseases, chemotherapy course, disease course, and treatment stage (p < 0.05). The total score of the FACT-Leu negatively correlated with the SCNS-SF34 in the physical/daily living (r = − 0.527, p < 0.01), psychological (r = − 0.688, p < 0.01), sexual (r = − 0.170, p < 0.01), patient care and support (r = − 0.352, p < 0.01), and health systems and information (r = − 0.220, p < 0.01) domains.

Conclusions

Adult AL patients exhibit a high demand for unmet SCNs, especially in the domain of health systems and information. There was a significant association between patients’ unmet SCNs and QoL. Future research should develop tailored interventions to address the unmet SCNs of adult AL patients, to further improve their QoL.

The unmet supportive care needs of Chinese patients and caregivers affected by cancer: A systematic review

INTRODUCTION

Cancer patients and caregivers have myriad unmet needs which can have detrimental consequences on their psychosocial wellbeing. This systematic review aims to identify the unmet supportive care needs of immigrant and native Chinese cancer patients and caregivers.

METHODS

We systematically searched various electronic databases (e.g. Scopus, CINAHL, PsycInfo, etc.) from the earliest date available until January 2018. Additional studies were identified through reference lists and citation tracking. Eligibility criteria included: (a) qualitative, quantitative and/or mixed methods studies published in English; (b) immigrant and native Chinese cancer patients and/or caregivers (age ≥18 years); (c) unmet needs and/or their correlates. Studies were assessed for their risk of bias, and a narrative synthesis of findings was performed.

RESULTS

Forty-seven papers from 45 studies met eligibility criteria. The most prevalent area of unmet needs was health system and information. Patients most commonly desired one member of the hospital to talk to about all aspects of their care. Caregivers preferred information about the patient's prognosis and likely outcome. Anxiety was most commonly associated with higher levels of health system and information needs.

CONCLUSION

Chinese patients and caregivers experience a range of unmet health system and information needs, which differ depending on their stage along the cancer trajectory.

Validation of the Supportive Care Needs Survey Screening Tool Chinese Version for Patients With Head and Neck Cancer in Taiwan

BACKGROUND

The increasing number of cancer survivors and the trend of shifting cancer treatments into outpatient clinics have increased rapidly the supportive care needs of patients with cancer. However, no brief assessment tool is available to screen for these needs.

PURPOSE

In this study, we aimed to (a) translate and develop a nine-item Chinese version of the Supportive Care Needs Survey Screening Tool (SCNS-ST9-C) and (b) examine the psychometric properties of this tool in a sample of patients with head and neck cancer (HNC) in Taiwan.

METHODS

In this two-phase instrument validation study, the SCNS-ST9-C was translated and evaluated for content, face validity, and feasibility in Phase I and was examined for internal consistency reliability and construct validity (including factor structure and theoretically supported correlations) on a sample of patients with HNC in Phase II.

RESULTS

In Phase I, the SCNS-ST9-C was translated and developed by three bilingual doctoral-prepared nurse researchers (Chinese and English). A standardized score system ranging from 0 to 100 was built, with higher scores indicating higher unmet supportive care needs. Good content and face validity were confirmed by five cancer care experts and 20 patients with HNC, respectively. In Phase II, 116 subjects were recruited. A clear four-factor structure, which incorporated one of the original five dimensions (sexuality care needs, with one item) into the dimension of psychological and emotional care needs, was identified using exploratory factor analysis. Good internal consistency reliability for the overall SCNS-ST9-C was supported by a Cronbach's α of .75 and its four subscales (domains). Good construct validity was also confirmed by the theoretically supported correlations. Better performance status and longer time since treatment completion correlated negatively with the SCNS-ST9-C (i.e., lower unmet care needs), whereas higher distress (anxiety, depression, and symptoms) correlated positively with the SCNS-ST9-C (i.e., greater unmet care needs). Female patients reported higher overall unmet care needs and psychological and emotional care needs and higher scores on the care and support needs subscale than male patients.

CONCLUSIONS

The SCNS-ST9-C is a brief, low-burden, and psychometrically valid instrument that may be applied in ethnically Chinese settings. This tool takes 1-2 minutes to complete. Further testing of the psychometrics of this instrument in different cancer populations is recommended.

Unmet Supportive Care Needs of Survival Patients with Nasopharyngeal Carcinoma

This study examined unmet supportive care needs for nasopharyngeal carcinoma (NPC) patients by cancer stage and treatment phase, as well as the factors associated with these unmet needs. At a cancer center in central Taiwan, information on consultations and services patients received at the resource center was described in the service chart. We extracted data available for NPC patients to evaluate their unmet supportive care needs (health information, patient care, treatment, nutritional, psychosocial, and economic) and their association with sex, age, cancer stage, and treatment phase. The 145 NPC patients were 68.3% male, 60.0% less than 50 years old, and 83.5% diagnosed at stages III and IV. The most prevalent unmet need was nutritional (40.7%), followed by psychosocial and patient care, with economic unmet needs the least (4.8%). Women were more likely than men to have patient care unmet needs (32.6% vs. 15.2%). Nutritional unmet need was higher in older patients than in younger ones (83.3% vs. 35.6%), with an adjusted odds ratio (aOR) of 9.39 (95% confidence interval (CI) = 2.17–40.70). Psychosocial unmet needs were higher in younger patients than old patients (34.5% vs. 0%) and in patients interviewed during follow-up period than those at newly diagnosed (55.2% vs. 23.1%). In conclusion, the most commonly reported concern was nutritional unmet needs for NPC patients. Their unmet needs may vary by demographic and disease factors, including patient sex and age, cancer stage, and treatment phase.

The impact of an educational video about radiotherapy and its toxicities in head and neck cancer patients. Evaluation of patients' understanding, anxiety, depression, and quality of life

OBJECTIVES

Head and neck radiotherapy can cause several toxicities, and its management has important treatment implications. Proper information about treatment is crucial to assist patients by preparing them and enhancing their ability to manage their illness. Thus, this study aimed to verify the impact of an educational video on the improvement of the patient's understanding, satisfaction, quality of life, and influence on their emotional state in different moments of treatment.

METHODS

A 10 min video about head and neck radiotherapy and its toxicities was produced. A prospective randomized clinical trial was performed in two groups: a control group (n = 65), which received standard verbal and written information, and an experimental group (n = 65), which received standard information and the video. Appropriated questionnaires (HADS, UW-QOLv4, IRTU, and Post-RTU) were applied in four different moments in order to evaluate patients' understanding, anxiety, depression, and quality of life.

RESULTS

The video improved the understanding of treatment and its side effects. Also, the video group reported better awareness about oral health care during the treatment. Osteoradionecrosis and radiation-related caries were the most unknown side effects. On the other hand, the educational video did not modify the patients' anxiety, depression, and quality of life. All patients reported high satisfaction with the video.

CONCLUSIONS

Audiovisual tools may improve patients' understanding of radiotherapy and were shown to be a useful tool when used in association with verbal and written information in cancer centers. In addition, information about osteoradionecrosis and radiation-related caries must be reinforced to patients.

Content comparison of unmet needs self-report measures used in patients with head and neck cancer: A systematic review

OBJECTIVE

Morbidity from head and neck cancers (HNCs) and their treatment are significant, given their proximity to anatomical sites impacting facial appearance and function. Assessing the needs of HNC patients throughout their cancer journey is critical to informing quality care and improving quality of life. We aimed to identify available unmet needs measures in the HNC setting and appraise their content and psychometric properties.

METHODS

We conducted a systematic search of five electronic databases (July 2007-July 2019) to identify studies of unmet needs in patients with HNC. In addition, three web-based patient-reported outcome measures (PROMs) databases were searched for unmet needs measures. Citations were screened for eligibility and identified measures reviewed for content coverage and psychometric properties. From identified measures and literature, a conceptual framework with 12 clinically relevant aspects of unmet needs was developed and used to assess the conceptual coverage of available unmet needs measures.

RESULTS

Literature search identified 273 records of which 28 studies assessing unmet needs in HNC cancer met eligibility criteria. Seven unmet needs measures were identified from retrieved studies and seven additional measures from PROM databases. Thus, 14 measures in total were reviewed. Content mapping revealed that three measures demonstrated excellent content validity (greater than 80% conceptual coverage): Patient Concerns Inventory (PCI), Needs Assessment for Advanced Cancer Patients (NA-ACP), and James Supportive Care Screening (JSCS).

CONCLUSION

We recommend PCI be used to measure unmet needs in the HNC setting considering the importance of content validity over quantitative psychometric properties.

Using the patients concerns inventory for distress screening in post-treatment head and neck cancer survivors

PURPOSE

Cancer patients can experience significant distress during their cancer trajectory, which impacts upon clinical outcomes and quality of life. Screening for distress using holistic assessments can help identify and address unmet concerns/needs. The purpose of this study was to evaluate the relationship between concerns and distress, and the impact of distress on clinic outcomes in post-treatment head and neck cancer patients.

METHODS

170 patients attending routine follow-up clinics were prospectively recruited. All patients completed the Patient Concerns Inventory (PCI) and the Distress thermometer (DT) at preconsultation.

RESULTS

The rate of significant distress (i.e. DT cut-off score ≥4) was 36% (62/170). Significantly distressed patients selected more items overall than patients without distress (mean, median (QR) of 5.40, 5 (2-8) vs 2.61, 2 (0-4), p < 0.001). Significant distress was most strongly associated with Physical and Functional well-being (p < 0.001) and Psychological and Emotional well-being domains (p = 0.001). On balance, very little difference was noted between cut-off points of either ≥4 or ≥5 PCI items of concern selected. Both cut-off points demonstrated an acceptable level of sensitivity, specificity and predictive values for significant distress. Consultations were longer with increasing numbers of concerns.

CONCLUSIONS

Just over one-third of patients are significantly distressed. They were more likely to express a higher number of concerns. A cutoff score ≥4 or ≥5 PCI items selected can identify those at risk of significant distress. Concerns causing significant distress were related to emotional/psychological issues and physical function.

Unmet information needs and limited health literacy in newly diagnosed breast cancer patients over the course of cancer treatment

OBJECTIVE

To investigate unmet information needs in newly diagnosed breast cancer patients over the course of cancer treatment and its association with health literacy.

METHODS

We present results from a prospective, multicenter cohort study (PIAT). Newly diagnosed breast cancer patients (N=1060) were surveyed directly after breast cancer surgery, 10 and 40 weeks later. Pooled linear regression modeling was employed analyzing changes in unmet information needs over time and its association with health literacy.

RESULTS

Unmet information needs on side effects and medication and medical examination results and treatment options were high and increased during the first 10 weeks after breast cancer surgery. Considering health promotion and social issues, unmet information needs started high and decreased during post-treatment. Patients with limited health literacy had higher unmet information needs.

CONCLUSION

Our results indicate a mismatch in information provision and breast cancer patients' information needs. Patients with limited health literacy may be at a distinct disadvantage in having their information needs met over the course of breast cancer treatment.

PRACTICE IMPLICATIONS

Strategies are needed to reduce unmet information needs in breast cancer patients considering treatment-phase and health literacy and thereby enable them to better cope with their diseases.

Elevated Matrix Metalloproteinase-9 Expression Correlates With Advanced Stages of Oral Cancer and Is Linked to Poor Clinical Outcomes

PURPOSE

Using a meta-analytic approach, the relation between increased matrix metalloproteinase-9 (MMP-9) expression, tumor stage, and clinical outcomes in oral cancers was investigated.

MATERIALS AND METHODS

Multiple English- and Chinese-language electronic databases were searched to identify high-quality case-and-control studies relevant to this meta-analysis. Methodologic quality of the included trials was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology statement to ensure consistency in reviewing and reporting the results. Statistical analyses were carried out with STATA 12.0 statistical software.

RESULTS

Nine case-and-control studies containing a combined total of 419 patients with oral cancer were included in the present meta-analysis. Results showed that patients who were positive for MMP-9 expression had a significantly poorer overall survival compared with those negative for MMP-9 (effect size = 2.10; 95% confidence interval, 0.98 to 3.22; P < .001). MMP-9 expression also positively correlated with lymph node metastasis and advanced T-stage groups (P < .05 for all comparisons). Further, high MMP-9 expression level correlated with increased oral cancer risk in Asians (P < .05 for all comparisons) as shown by method-stratified subgroup analysis.

CONCLUSION

The present results strongly suggest that MMP-9 expression level influences tumor invasion and metastasis in oral cancers. Based on these results, MMP-9 can be an excellent therapeutic target in patients with oral cancer.

Communication dysfunction, body image, and symptom severity in postoperative head and neck cancer patients: factors associated with the amount of speaking after treatment

PURPOSE

The purpose of this study was to determine the relationships of communication dysfunction, body image, and amount of speaking in patients who were treated for head and neck cancers (HNCs).

METHODS

This was a cross-sectional study of postoperative HNC patients at the otolaryngology outpatient departments of two leading medical centers in northern Taiwan. Data were collected using questionnaires to assess perceived communication dysfunction, body image, symptom severity, and amount of speaking after treatment.

RESULTS

A total of 130 HNC patients were included in the analysis, and 70.8 % of patients reported speaking less after surgery as compared to the period before having HNC surgery. Overall, patients perceived a moderate level of communication dysfunction. Those with higher distress over their body image, higher symptom severity, and with hypopharyngeal and laryngeal cancer reported speaking less. Patients with advanced stage cancer and a tumor in a facial area and those that received reconstructive surgery were more likely to have a negative body image.

CONCLUSIONS

Dissatisfaction with body image, greater symptom severity, and hypopharyngeal and laryngeal cancer are predictive of the amount HNC patients speak, as compared with the amount they spoke before having HNC. Clinicians should be aware of and systematically assess communication problems of HNC patients to promote their social function. Further research on interventions that facilitate the development of a positive body image and communication is strongly suggested.

Changes and predictors of radiation-induced oral mucositis in patients with oral cavity cancer during active treatment

PURPOSE

Radiation-induced oral mucositis (OM) is the most debilitating side effect of radiation treatment in oral cavity cancer. The purpose of the study was to investigate change of prevalence of severe OM, OM-related symptoms, and predictors in oral cavity cancer patients during active treatment.

METHODS AND SAMPLE

Longitudinal study design with repeated measures was used. Patients with oral cavity cancer were recruited from a head and neck outpatient radiation department at a major medical center in Taiwan. Patients' OM-related symptoms were measured at three time points. Patients' oral mucosa was assessed at nine time points. Generalized estimating equations (GEE) were used to analyze the predictive factors of prevalence of severe OM and OM-related symptoms.

RESULTS

Patients reported highest prevalence of severe OM at T5 (5 weeks after beginning RT) and T6 (6 weeks after beginning radiation therapy, RT), with the combined chemotherapy and RT (CCRT) patients reporting a higher prevalence than those receiving RT alone. The peak of OM-related symptoms was at T8 (8 week after beginning RT), with primary symptoms of mouth pain, mouth dryness, eating difficulties, swallowing difficulties, and taste change. Patients with CCRT, a higher cumulative radiation dose, smoking, and lower body mass index (BMI) were at high risk to develop severe OM. OM-related symptoms were predicted by type of treatment, cumulative radiation dose, and smoking.

CONCLUSIONS

Patients with oral cavity cancer suffer from OM and OM-related symptoms during aggressive RT or CCRT. Patient-specific oral care and emotional support are needed to relieve distressful OM-related symptoms during active treatment.

Supportive care needs of Iranian cancer patients

Background:

A supportive needs assessment is an essential component of any care program. There is no research evidence regarding the supportive care needs of cancer patients in Iran or other Middle Eastern countries.

Aims:

The aim of this study was to determine the supportive care needs of Iranian cancer patients.

Materials and Methods:

This descriptive study was conducted in a referral medical center in the northwest of Iran. A total of 274 cancer patients completed the Supportive Care Needs Survey (SCNS-59). Descriptive statistics were used for data analysis.

Results:

In 18 items of the SCNS, more than 50% of the participants reported that their needs were unmet. Most frequently, unmet needs were related to the health system, information, physical, and daily living domains, and most met needs were related to sexuality, patient care, and support domains.

Conclusions:

Iranian cancer patients experience many unmet needs and there is an urgent need for establishing additional supportive care services in Iran.