'You're putting thoughts into my head': a qualitative study of the readiness of patients with breast, lung or prostate cancer to address emotional needs through the first 18 months after diagnosis

Metacognitions associated with reproductive concerns: A cross-sectional study of young adult female cancer survivors in China

Objective

Cancer and its treatments affect patients’ fertility potential. This study examined the prevalence of reproductive concerns and their relationship with metacognitions among Chinese young adult female cancer survivors (YAFCS).

Methods

A total of 318 YAFCS (aged 18–39) completed an online survey from March to December 2021. Participants reported sociodemographic characteristics, reproductive concerns and metacognitions. Reproductive concerns were measured using the Reproductive Concerns after Cancer scale (RCAC), and metacognitions were measured by the Short Form of Metacognitions Questionnaire (MCQ-30). We used Pearson correlation analysis to examine associations between metacognitions and reproductive concerns across multiple domains and multivariable linear regression to determine the influencing factors of reproductive concerns.

Results

The mean score of reproductive concern among YAFCS was 49.97 ± 12.52. A total of 57.9% of participants reported a high level of concern regarding at least one dimension of reproductive concerns, and they were most concerned about their child’s health and least concerned about partner disclosure of fertility status. We also found a moderate association between RCAC and MCQ-30 scores (r = 0.408, p < 0.001). In multivariate analyses, metacognitions, especially negative metacognitive beliefs had an impact on reproductive concerns among YAFCS (p < 0.001).

Conclusion

Higher reproductive concerns were associated with higher metacognitions among YAFCS, especially with negative metacognitive beliefs. Oncology professionals should pay attention to assessing reproductive concerns in patients who want to have children or who have no children. Moreover, metacognitive beliefs may be an intervention target for alleviating reproductive concerns among YAFCS.

Barriers to seeking psychosocial support among adult patients with hematologic neoplasms: a qualitative study

PURPOSE

This study aims to explore the barriers that adult patients with hematologic neoplasms experience when seeking psychosocial support.

METHODS

A descriptive qualitative approach was used to investigate the experiences of patients with hematologic neoplasms. Face-to-face, semi-structured, in-depth individual interviews were conducted between June and October 2020 with 17 patients diagnosed with hematologic neoplasms. The interviews were audio-recorded and transcribed verbatim. A thematic analysis was performed to identify the essential themes.

RESULTS

Seventeen patients aged 28-67 years completed the interviews. Two themes and six subthemes were identified that describe barriers to seeking psychosocial support. Internal barriers included limited communication, negative emotions, social avoidance, and focusing on treatment rather than psychosocial needs; external barriers included traditional cultural influences and lack of professional support.

CONCLUSIONS

Significant others were the key source for psychosocial support for patients with hematologic neoplasms. Tackling diverse barriers to accessing psychosocial support remains a challenge for these patients. Healthcare providers should continually assess and provide effective support.

Psychological Response to the Diagnosis of Advanced Cancer: A Systematic Review

BACKGROUND

Despite major efforts to address psychological distress and quality of life (QOL) in people with cancer, only none to small intervention effect has been observed. There is reason to question whether psychosocial needs of patients have already been met under the usual oncology care.

PURPOSE

The purpose of this systematic review was to examine changes in depression, anxiety and QOL during the existential plight in advanced cancer.

METHODS

A literature search was performed in the PubMed and APA PsycINFO databases from year 1976 up to May 31, 2021. Longitudinal observational or experimental research targeting depression, anxiety or QOL in advanced cancer (stage III or IV), with baseline time since cancer diagnosis within 100 days, follow-up within 16 weeks post-baseline were eligible. Quality rating was based on the GRADE guidelines.

RESULTS

Overall QOL did not reveal clinically relevant changes for the majority of studies as evaluated by effect size and raw score changes (median effect size 0.01, interquartile range -0.10-0.15). Nonetheless, modest to moderate improvement was found for depression (median effect size 0.28, interquartile range 0.03-0.38) and anxiety (median effect size 0.57, interquartile range 0.32-0.79).

CONCLUSION

Transient distress symptoms and temporarily reduced functioning in the oncology setting may be considered normal, whereas impaired overall QOL needs to be addressed. Developing innovative interventions that enhance QOL for patients newly diagnosed with advanced cancer without interfering with patients' natural adaptation process is imperative.

Waiting Times for Prostate Cancer Diagnosis in a Nigerian Population

Background

Prostate biopsy remains an important surgical procedure in the diagnostic pathway for prostate cancer, but access to prostate biopsy service is poorly studied in the Nigerian population. While there has been a well-documented delay in patient presentation with prostate cancer in Nigeria, little is however known about how long patients wait to have a histological diagnosis of prostate cancer and start treatment after presenting at Nigerian hospitals.

Method

This was a descriptive retrospective study to document the specific duration of the various timelines in getting a diagnosis of prostate cancer at the Lagos State University Teaching Hospital, Ikeja, Nigeria.

Results

There were 270 patients. The mean age was 69.50 ± 8.03 years (range 45-90). The mean PSA at presentation was 563.2 ± 1879.2 ng/ml (range 2.05-15400), and the median PSA was 49.3 ng/ml. The median waiting times were (i) 10 days from referral to presentation; (ii) 30 days from presentation to biopsy; (iii) 24 days from biopsy to review of histology; (iv) 1 day from histology review to discussion/planning of treatment. The median overall waiting time from referral to treatment was 103 days. The mean time from presentation to biopsy was significantly shorter for patients with PSA of ≥50 ng/ml compared to those with PSA < 50 ng/ml. p = 0.048. Overall, the median time from biopsy to histology was significantly shorter for patients whose specimens were processed in private laboratories (17 days) compared to those whose specimens were processed at the teaching hospital laboratory (30 days), p ≤ 0.001.

Conclusion

There is a significant delay within the health care system in getting a prostate cancer diagnosis in the Nigerian population studied. The major points of the identified delay were the waiting time from patient presentation to having a biopsy done and the histology report waiting time.

"We Cannot Have any Negativity": A secondary analysis of expectancies for the experience of emotion among women with gynecologic cancer

This study aimed to elucidate whether gynecologic cancer patients and their support persons have certain expectancies for emotion and whether these expectancies, if they exist, affect cancer-related communication. Semi-structured interviews (N = 34) were conducted separately with 18 patients and one of their support persons (n = 16). Thematic analysis revealed a subset of patients and support persons expected patients to not have any negative emotions, which patients also reported they perceived from support persons, and that these expectancies could affect cancer-related communication. These results have implications and can facilitate appropriate recommendations for how cancer patients and support persons co-manage patients' emotions.

What does an oncology social worker deal with in patient consultations? - An empirical study

The oncology social worker is a core profession in the psychosocial care of cancer patients, and has been scrutinised according to its role, function, and delivery of care, primarily from an Anglo-Saxon perspective. There is, however, a lack of studies outside this context, and empirical studies based on individual data. This study is a contribution by exploring the variability in clinical practice from a Swedish perspective. It is based on documentation from one oncology social worker's (OSW's) patient contacts over the course of one year. The essence of the majority of contacts was counseling and the patients displayed a wide variety of motives for seeing an OSW. The function of the OSW is thus multifaceted, and the findings suggest that the OSW, in addition to guiding patients in social legislation issues, also should be prepared to act as an anchor in an acute crisis, contain despair in different phases of the trajectory, and facilitate the 'carrying on as before' or finding a 'new normal'. The paper discusses the importance of the OSW being acquainted with different counseling/psychotherapy perspectives in the illness context, but primarily the importance of having the ability to establish a 'working alliance' with their patients.

Patients and informal caregivers' experiences of burden of treatment in lung cancer and chronic obstructive pulmonary disease (COPD): a systematic review and synthesis of qualitative research

OBJECTIVE

To identify, characterise and explain common and specific features of the experience of treatment burden in relation to patients living with lung cancer or chronic obstructive pulmonary disease (COPD) and their informal caregivers.

DESIGN

Systematic review and interpretative synthesis of primary qualitative studies. Papers were analysed using constant comparison and directed qualitative content analysis.

DATA SOURCES

CINAHL, EMBASE, MEDLINE, PsychINFO, Scopus and Web of Science searched from January 2006 to December 2015.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Primary qualitative studies in English where participants were patients with lung cancer or COPD and/or their informal caregivers, aged >18 years that contain descriptions of experiences of interacting with health or social care in Europe, North America and Australia.

RESULTS

We identified 127 articles with 1769 patients and 491 informal caregivers. Patients, informal caregivers and healthcare professionals (HCPs) acknowledged lung cancer's existential threat. Managing treatment workload was a priority in this condition, characterised by a short illness trajectory. Treatment workload was generally well supported by an immediacy of access to healthcare systems and a clear treatment pathway. Conversely, patients, informal caregivers and HCPs typically did not recognise or understand COPD. Treatment workload was balanced with the demands of everyday life throughout a characteristically long illness trajectory. Consequently, treatment workload was complicated by difficulties of access to, and navigation of, healthcare systems, and a fragmented treatment pathway. In both conditions, patients' capacity to manage workload was enhanced by the support of family and friends, peers and HCPs and diminished by illness/smoking-related stigma and social isolation.

CONCLUSION

This interpretative synthesis has affirmed significant differences in treatment workload between lung cancer and COPD. It has demonstrated the importance of the capacity patients have to manage their workload in both conditions. This suggests a workload which exceeds capacity may be a primary driver of treatment burden.

PROSPERO REGISTRATION NUMBER

CRD42016048191.

Reflections on a Health Psychology Service for Patients with Uveal Melanoma: The Challenge of Psychological Screening and Intervention When Distress is 'Normal'

We appraise the role of screening for distress as part of health psychology assessment of patients newly diagnosed with cancer. We reviewed records of consecutive patients who accepted a health psychologist’s assessment over 4 years, examining convergence and divergence of the result of screening (whether patients reached threshold as ‘cases’) with the psychologist’s clinical judgment of need for intervention. Of 261 patients, 88 (33.7%) were ‘cases’. Of these, need for psychological intervention was identified in 70 (79.5%). Of the 173 (66.3%) ‘non-cases’, need was identified in 59 (34.1%). Examination of cases where the psychologist’s judgment diverged from screening showed that ‘caseness’ can arise from distress that patients can manage themselves and, conversely, that psychological needs arise in the absence of overt distress. Formal screening may not identify need for psychological intervention. The psychologist’s role is to make expert judgments of patients’ current and future needs. Dialogue with patients should be the vehicle for assessment.

Experiences of adult cancer patients receiving counseling from nurses: a qualitative systematic review

INTRODUCTION

Counseling is a brief psycho-educational intervention that is useful in facilitating personal growth and adaptive resolution of life stresses. With increased recognition on the psycho-emotional needs of patients with cancer, it is prudent to consider the possibility of expanding the role of nurses in the provision of counseling.

OBJECTIVE

This qualitative systematic review aimed to establish the best available evidence on the experiences of adult cancer patients receiving counseling provided by nurses.

INCLUSION CRITERIA

This review included studies on adult cancer patients of at least 18 years of age who were diagnosed with oncological malignancies of any type and staging. The phenomena of interest were the experiences of adult cancer patients who received nurse counseling (patient education, psycho-education and/or supportive counseling) that was conducted face-to-face or via other communication modes. The review included studies done in institutional and community settings. Qualitative data including, but not limited to, designs of phenomenology, grounded theory, ethnography, action research, feminist research and mixed methods research were considered.

SEARCH STRATEGY

A three-step search strategy was utilized to find both published and unpublished studies in the English language. Databases searched included CINAHL, MEDLINE, Embase, JSTOR, PsycINFO, Scopus, ScienceDirect, Wiley Online Library and ProQuest Dissertations and Theses Global. Two reviewers independently appraised the 14 included studies using the Joanna Briggs Institute (JBI) critical appraisal checklist for qualitative research. The studies were of moderate to high quality, mostly, falling short in quality due to lack of statements locating the researchers and their influence on the research. Data were extracted from included papers using the standardized JBI data extraction tool.

DATA SYNTHESIS

Two reviewers independently reviewed and pooled similar findings into categories. All three reviewers then collaborated in finalizing these derived categories to generate a meta-synthesis.

RESULTS

Five synthesized findings were generated during the meta-synthesis: (1) Nurses provide tailored information and teaching to enhance patients' coping; (2) Nurses attend to patients' emotional needs; (3) Nurses assume the role of a significant person in the patients' journey; (4) Patients feel valued as a whole person and the ready availability of nursing interactions; and (5) Nursing role ambiguity and time constraints limit nurse counseling.

CONCLUSION

Overall, cancer patients' experiences with nurse counseling are positive and beneficial to them. Despite some nursing role ambiguity and time constraints impeding nurse counseling, this review has established the diverse instrumental roles nurses have played in enhancing adaptive coping in patients across their illness trajectory. In particular, the nurses' presence and availability, a trusting nurse-patient relationship, use of psychotherapy techniques, a holistic approach, human touch and continuity of care were highlighted as key factors in enhancing healing. The role of the nurse navigator and the use of expressive writing warrant more attention when tending to patients' psycho-emotional distress.

Predictors of emotional distress a year or more after diagnosis of cancer: A systematic review of the literature

Objective

Why some people recover emotionally after diagnosis and treatment of cancer and others do not is poorly understood. To identify factors around the time of diagnosis that predict longer‐term distress is a necessary step in developing interventions to reduce patients' vulnerability. This review identified the demographic, clinical, social, and psychological factors available at or within 3 months of diagnosis that are reliable predictors of emotional distress at least 12 months later.

Methods

A systematic search of literature for prospective studies addressing our research question and predicting a range of distress outcomes was conducted. Thirty‐nine papers (reporting 36 studies) were subjected to narrative synthesis of the evidence.

Results

There was no consistent evidence that demographic, clinical, or social factors reliably predicted longer‐term distress. Of the psychological factors examined, only baseline distress (significant in 26 of 30 relevant papers; 24 of 28 studies) and neuroticism (significant in all 5 papers/studies that examined it) consistently predicted longer‐term distress. The heterogeneity of included studies, particularly in populations studied and methodology, precluded meta‐analytic techniques.

Conclusions

This review supports current clinical guidance advising early assessment of distress as a marker of vulnerability to persistent problems. Additionally, neuroticism is also indicated as a useful marker of vulnerability. However, the review also highlights that more sophisticated research designs, capable of identifying the psychological processes that underlie the association between these marker variables and persistent distress, are needed before more effective early interventions can be developed.

Psychological distress and coping strategies among women with incurable lung cancer: a qualitative study

PURPOSE

Limited research has focused on women with lung cancer (LC) although they are recognized as the most vulnerable to psychological distress. This study explored in-depth the psychological distress experienced by women with incurable LC and analyzed the coping strategies with which they manage that distress.

METHODS

A qualitative methodology with in-depth interviews was employed for 34 women with advanced or recurrent LC. An inductive data-driven thematic analysis was applied to analyze transcripts.

RESULTS

Psychological distress was an iterative process for the women. Four themes were identified: shock regarding the diagnosis, distress regarding cancer treatment and its side effects, the facing of a recurrent or progressive disease, and persistent struggle with the life-limiting disease. Various coping strategies applied by the women to manage psychological distress were grouped into four themes: relying upon social support, focusing on positive thoughts, avoidance-based strategies, and religious faith and acceptance.

CONCLUSIONS

Women with incurable LC experienced substantial iterative psychological distress throughout the illness, regardless of length of illness at time of interview. They applied multiple forms of coping. The findings enrich the limited existing literature on this understudied population and provide direction for the future development of interventions to improve their psychological well-being.

Understanding why cancer patients accept or turn down psycho-oncological support: a prospective observational study including patients' and clinicians' perspectives on communication about distress

BACKGROUND

International standards prioritize introducing routine emotional distress screening in cancer care to accurately identify patients who most need psycho-oncological treatment, and ensure that patients can access appropriate supportive care. However, only a moderate proportion of distressed patients accepts referrals to or uses psycho-oncological support services. Predictors and barriers to psycho-oncological support service utilization are under-studied. We know little about how patients and oncologists perceive the discussions when oncologists assess psychosocial distress with a screening instrument. We aim to 1) assess the barriers and predictors of uptake of in-house psycho-oncological support along the distress screening pathway in cancer patients treated at a University Oncology Outpatient Clinic and, 2) determine how patients and clinicians perceive communication about psychosocial distress after screening with the Distress Thermometer.

METHODS

This is a quantitative prospective observational study with qualitative aspects. We will examine medical and demographic variables, cancer patient self-reports of various psychological measures, and aspects of the patient-clinician communication as variables that potentially predict uptake of psycho-oncological support service. We will also assess the patients' reasons for accepting or refusing psycho-oncological support services. We assess at three points in time, based on paper-and-pencil questionnaires and two patient interviews during the study period. We will monitor outcomes (psycho-oncology service uptake) four months after study entry.

DISCUSSION

The study will improve our understanding of characteristics of patients who accept or refuse psycho-oncological support, and help us understand how patients' and oncologists perceive communication about psychosocial distress, and referral to a psycho-oncologist. We believe this is the first study to focus on factors that affect uptake or rejection of psycho-oncological support services along the screening and referral pathway. The study 1) combines standard assessment with qualitative data collection, 2) embraces patient and oncologist perspectives, and, 3) focuses on patient-clinician communication about psychosocial issues raised by a standard screening instrument. Our results may improve routine practices and eliminate barriers to adequate health care, and make it easier to recognize patients with high distress levels who underuse the service.

Completing a Questionnaire at Home Prior to Needs Assessment in General Practice: A Qualitative Study of Cancer Patients' Experience

BACKGROUND

Systematic assessments of cancer patients' rehabilitation needs are recommended, and questionnaires are considered to be useful tools when making such assessments.

OBJECTIVE

The aim of this study was to explore patients' experience of completing a questionnaire about their problems and distress at home prior to a needs assessment in general practice.

METHODS

Sixteen patients were recruited by their general practitioners (GPs). Semi-structured interviews were conducted in the home of the participants and at the general practice, with one interview taking place over the phone. Data were analyzed using systematic text condensation.

RESULTS

Twelve women and four men aged between 49 and 83 years of age, and diagnosed with various cancers between 1 month and 4 years ago, participated in the study. The results showed how the completion of a questionnaire at home provided patients with an opportunity to reflect on different problems, and the importance of these problems to the patient's everyday life, as well as an opportunity to articulate which problems they wanted to discuss with their GPs.

CONCLUSIONS

The results demonstrate that completing a questionnaire seems to stimulate patients' ability to reflect on their situation, clarify the importance of different problems to their everyday lives, and articulate these considerations to their GPs. Furthermore, we have shown that a questionnaire has the ability to interact with the patient and instigate a process of awareness. It is important to acknowledge this process of interaction between patient and questionnaire as an important part of understanding how and why questionnaires may support the patient when completing a questionnaire prior to a clinical encounter.

Emotions and coping of patients with head and neck cancers after diagnosis: A qualitative content analysis

Background and Rationale:

Patients suffering with head and neck cancers are observed to have a relatively high risk of developing emotional disturbances after diagnosis and treatment. These emotional concerns can be best understood and explored through the method of content analysis or qualitative data. Though a number of qualitative studies have been conducted in the last few years in the field of psychosocial oncology, none have looked at the emotions experienced and the coping by head and neck cancer patients.

Materials and Methods:

Seventy-five new cases of postsurgery patients of head and neck cancers were qualitatively interviewed regarding the emotions experienced and coping strategies after diagnosis.

Results:

Qualitative content analysis of the in-depth interviews brought out that patients experienced varied emotions on realizing that they were suffering from cancer, the cause of which could be mainly attributed to three themes: 1) knowledge of their illness; 2) duration of untreated illness; and 3) object of blame. They coped with their emotions by either: 1) inculcating a positive attitude and faith in the doctor/treatment, 2) ventilating their emotions with family and friends, or 3) indulging in activities to divert attention.

Conclusion:

The results brought out a conceptual framework, which showed that an in-depth understanding of the emotions — Their root cause, coping strategies, and spiritual and cultural orientations of the cancer survivor — Is essential to develop any effective intervention program in India.

Illness representations, coping, and illness outcomes in people with cancer: a systematic review and meta-analysis

OBJECTIVE

Cancer is associated with negative health and emotional outcomes in those affected by it, suggesting the need to better understand the psychosocial determinants of illness outcomes and coping. The common sense model is the leading psychological model of self-regulation in the face of illness and assumes that subjective illness representations explain how people attempt to cope with illness. This systematic review and meta-analysis examines the associations of the common sense model's illness representation dimensions with health and coping outcomes in people with cancer.

METHODS

A systematic literature search located 54 studies fulfilling the inclusion criteria, with 38 providing sufficient data for meta-analysis. A narrative review of the remaining studies was also conducted.

RESULTS

Random-effects models revealed small to moderate effect sizes (Fisher Z) for the relations between illness representations and coping behaviors (in particular between control perceptions, problem-focused coping, and cognitive reappraisal) and moderate to large effect sizes between illness representations and illness outcomes (in particular between identity, consequences, emotional representations, and psychological distress). The narrative review of studies with insufficient data provided similar results.

CONCLUSIONS

The results indicate how illness representations relate to illness outcomes in people with cancer. However, more high-quality studies are needed to examine causal effects of illness representations on coping and outcomes. High heterogeneity indicates potential moderators of the relationships between illness representations and health and coping outcomes, including diagnostic, prognostic, and treatment-related variables. This review can inform the design of interventions to improve coping strategies and mental health outcomes in people with cancer.

Fear of cancer recurrence: a theoretical review and novel cognitive processing formulation

PURPOSE

Fear of cancer recurrence (FCR) is prevalent among survivors. However, a comprehensive and universally accepted theoretical framework of FCR to guide intervention is lacking. This paper reviews theoretical frameworks previously used to explain FCR and describes the formulation of a novel theoretical framework for FCR.

METHODS

A systematic review of the literature was undertaken to identify conceptual frameworks or theories applied to FCR. MEDLINE, PubMED, CINAHL, AMED, PsycINFO and Web of Science were searched. Identified conceptual frameworks were reviewed for strength of evidence supporting their validity.

RESULTS

Of 558 papers initially identified, 16 made reference to six different conceptual frameworks relating to FCR. The most comprehensive and evidence-based theoretical approach is the Common Sense Model (CSM). Other approaches have limited evidence supporting their application to FCR. Two theoretical approaches developed in the context of emotional disorders that appear to be highly relevant to FCR: the Self-Regulatory Executive Function (S-REF) model and Relational Frame Theory were combined with the CSM to produce a novel cognitive processing account of FCR.

CONCLUSIONS

Few conceptual frameworks have been used consistently to guide FCR research, and not all frameworks are empirically well supported, suggesting that further discussion regarding the conceptualisation of FCR is needed. The novel theoretical framework for FCR presented highlights the multidimensional nature of FCR and the importance of cognitive processing and metacognitions in the development and maintenance of FCR.

IMPLICATIONS FOR CANCER SURVIVORS

The novel theoretical formulation of FCR outlined here provides a much-needed comprehensive framework to further investigate and address FCR in cancer survivors.

The association of metacognitive beliefs with emotional distress after diagnosis of cancer

OBJECTIVE

Emotional distress after a diagnosis of cancer is normal and, for most people, will diminish over time. However, a significant minority of patients with cancer experience persistent or recurrent symptoms of emotional distress for which they need help. A model developed in mental health, the self-regulatory executive function model (S-REF), specifies that maladaptive metacognitive beliefs and processes, including persistent worry, are key to understanding why such emotional problems persist. This cross-sectional study explored, for the first, time whether metacognitive beliefs were associated with emotional distress in a cancer population, and whether this relationship was mediated by worry, as predicted by the S-REF model.

METHOD

Two hundred twenty-nine participants within 3 months of diagnosis of, and before treatment for, primary breast or prostate cancer completed self-report questionnaires measuring anxiety, depression, posttraumatic stress disorder (PTSD) symptoms, metacognitive beliefs, worry, and illness perceptions.

RESULTS

Regression analysis showed that metacognitive beliefs were associated with symptoms of anxiety, depression, and PTSD, and explained additional variance in these outcomes after controlling for age, gender, and illness perceptions. Structural equation modeling was consistent with cross-sectional hypotheses derived from the theory that metacognitive beliefs cause and maintain distress both directly and indirectly by driving worry.

CONCLUSIONS

The findings provide promising first evidence that the S-REF model may be usefully applied in cancer. Further study is required to establish the predictive and clinical utility of these findings.

A Prospective Study of the Association of Metacognitive Beliefs and Processes with Persistent Emotional Distress After Diagnosis of Cancer

Two hundred and six patients, diagnosed with primary breast or prostate cancer completed self-report questionnaires on two occasions: before treatment (T1) and 12 months later (T2). The questionnaires included: the Hospital Anxiety and Depression Scale; Impact of Events Scale; the Metacognitions Questionnaire-30 (MCQ-30) and the Illness Perceptions Questionnaire-revised. A series of regression analyses indicated that metacognitive beliefs at T1 predicted between 14 and 19 % of the variance in symptoms of anxiety, depression and trauma at T2 after controlling for age and gender. For all three outcomes, the MCQ-30 subscale 'negative beliefs about worry' made the largest individual contribution with 'cognitive confidence' also contributing in each case. For anxiety, a third metacognitive variable, 'positive beliefs about worry' also predicted variance in T2 symptoms. In addition, hierarchical analyses indicated that metacognitive beliefs explained a small but significant amount of variance in T2 anxiety (2 %) and T2 depression (4 %) over and above that explained by demographic variables, T1 symptoms and T1 illness perceptions. The findings suggest that modifying metacognitive beliefs and processes has the potential to alleviate distress associated with cancer.

Self-management support from the perspective of patients with a chronic condition: a thematic synthesis of qualitative studies

BACKGROUND

Receiving adequate support seems to be crucial to the success of self-management. Although different empirical studies separately examined patients' preferences for self-management support (SMS), an overview is lacking.

OBJECTIVE

The aim of this qualitative review was to identify patients' needs with respect to SMS and to explore by whom this support is preferably provided.

SEARCH STRATEGY

Qualitative studies were identified from Embase, MEDLINE OvidSP, Web of science, PubMed publisher, Cochrane central, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO.

INCLUSION CRITERIA

Articles needed to meet all of the following criteria: (i) focuses on self-management, (ii) concerns adult patients with rheumatic diseases (rheumatoid arthritis and fibromyalgia), a variant of cancer or chronic kidney disease, (iii) explores support needs from the patients' perspective, (iv) uses qualitative methods and (v) published in English.

DATA EXTRACTION AND SYNTHESIS

A thematic synthesis, developed by Thomas and Harden, was conducted of the 37 included studies.

MAIN RESULTS

Chronic patients need instrumental support, psychosocial support and relational support from health-care professionals, family/friends and fellow patients to manage the chronic condition. Relational support is at the centre of the support needs and fuels all other types of support.

DISCUSSION AND CONCLUSIONS

Patients do not self-manage on their own. Patients expect health-care professionals to fulfil a comprehensive role. Support needs can be knitted together only when patients and professionals work together on the basis of collaborative partnership. Dynamics in support needs make it important to regularly assess patient needs.

Screening-detected non-symptomatic breast cancer: a case history

Alice is a 65 year-old woman who was recalled for further investigations following a routine screening mammogram, which showed a 25 mm mass in her left breast. This case history will report on the further investigations and surgery required to manage this infiltrating ductal carcinoma. The histopathology report will be analysed to provide a rationale for future treatment with radiotherapy, and Alice's expected prognosis will be presented using the Nottingham Prognostic Index. Alice's psychological support needs will identified and the appropriate interventions will be discussed with a particular focus on Alice's history of depression. The supportive and educational role of the breast care nurse and the multidisciplinary team will be highlighted throughout the study.

Breast cancer survivors' perspectives on whether clinical staff should ask breast cancer patients about childhood abuse

INTRODUCTION

Recent studies have shown that women who recall childhood abuse are at increased risk of emotional problems following a breast cancer diagnosis. How services should respond is unclear given the risk of compounding the emotional trauma of cancer with questioning about abuse. Our aim was to present the research findings to women with experience of breast cancer so as to obtain their perspective on how this evidence should influence clinical practice.

METHODS

Participants were women who had been treated for breast cancer at one of the study units and women with a history of breast cancer who were members of a local patient support group. Three focus groups were conducted (with six, five and three participants respectively). The interview transcripts were analysed qualitatively.

RESULTS

Participants emphasised the importance of the research findings for cancer care. The consensus was that abuse and its consequences for patients being treated for cancer should not be a 'taboo' area, and that patients should be given the opportunity and choice to disclose abuse as part of a holistic programme of care.

CONCLUSIONS

Services should examine how to include prompts about abuse as part of routine holistic assessment by clinical staff, who will need to be trained in eliciting and managing disclosures of abuse.

Time from diagnosis to surgery and prostate cancer survival: a retrospective cohort study

Background

A diagnosis of prostate cancer leads to emotional distress and anxiety, prompting calls for rapid diagnostic pathways. Nevertheless, it remains unclear what impact time between diagnosis and surgery has upon prostate cancer survival.

Methods

Using national databases for England (cancer registries, Hospital Episode Statistics and Office of National Statistics), we identified 17,043 men with prostate cancer, aged 15 years and older, diagnosed in 1996–2009, and who had surgical resection with curative intent within 6 months of diagnosis. We used relative survival to investigate associations between waiting times and five- and ten-year survival.

Results

Five- and ten-year relative survival estimates for the total study sample were 1.04 (95% CI: 1.04 to 1.05) and 1.08 (95% CI: 1.06-1.09), respectively. There were no notable differences in survival between patients who had surgery at 0–3 and 4–6 months after diagnosis. Relative survival was higher among the elderly (>65) and those with well and moderately differentiated tumours.

Conclusion

The high relative survival in our cohort probably reflects adherence to selection criteria for surgery among men with localised prostate cancer. Among men treated with surgery within 6 months of diagnosis, we found little evidence of an association between time from diagnosis to surgery and survival.