1
|
Baum J, Lax H, Lehmann N, Merkel-Jens A, Beelen DW, Jöckel KH, Dührsen U. Impairment of vocational activities and financial problems are frequent among German blood cancer survivors. Sci Rep 2023; 13:22856. [PMID: 38129654 PMCID: PMC10739705 DOI: 10.1038/s41598-023-50289-9] [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: 08/28/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
Little is known about changes in the personal living conditions of long-term blood cancer survivors in Germany. To gather information about social relationships, work life, overall well-being, and religion, we performed a questionnaire-based retrospective study on 1551 survivors who had been on follow-up for ≥ 3 years (median, 9 years). Most survivors reported that marital status and relationships with relatives and friends remained constant before and after blood cancer. Vocational activities were temporarily impaired for 47.5%, with a median time of 11 months to return to work. More than a third of the patients (35.6%) discontinued work permanently, with disability and retirement pension rates of 7.9% and 38.1%, respectively, at the time of the survey. Financial problems due to reduced income were reported by 26.2%, in particular after relapse or allogeneic transplantation. Patient reports addressing their quality of life showed large variations. It was best in acute leukemia survivors without a history of allogeneic transplantation and worst in patients with myeloproliferative disorders. Religion tended to become more important after blood cancer. In conclusion, vocational impairment and financial problems are frequent among German blood cancer survivors. Efforts should be made at an early stage to reestablish the patients' ability to work.
Collapse
Affiliation(s)
- Julia Baum
- Klinik für Hämatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Hildegard Lax
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universität Duisburg-Essen, Essen, Germany
| | - Nils Lehmann
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universität Duisburg-Essen, Essen, Germany
| | - Anja Merkel-Jens
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universität Duisburg-Essen, Essen, Germany
| | - Dietrich W Beelen
- Klinik für Knochenmarktransplantation, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universität Duisburg-Essen, Essen, Germany
| | - Ulrich Dührsen
- Klinik für Hämatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
| |
Collapse
|
2
|
Roseleur J, Edney LC, Jung J, Karnon J. Prevalence of unmet supportive care needs reported by individuals ever diagnosed with cancer in Australia: a systematic review to support service prioritisation. Support Care Cancer 2023; 31:676. [PMID: 37934313 PMCID: PMC10630245 DOI: 10.1007/s00520-023-08146-y] [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: 07/08/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Improved health outcomes for individuals ever diagnosed with cancer require comprehensive, coordinated care that addresses their supportive care needs. Implementing interventions to address these is confounded by a lack of evidence on population needs and a large pool of potential interventions. This systematic review estimates the point prevalence of different supportive care needs stratified by the tool used to measure needs and cancer type in Australia. METHODS We searched MEDLINE, Embase, and Scopus from 2010 to April 2023 to identify relevant studies published on the prevalence of supportive care needs in Australia. RESULTS We identified 35 studies that met the inclusion criteria. The highest prevalent unmet need across all cancers was 'fear of cancer spreading' (20.7%) from the Supportive Care Needs Survey Short-Form 34 (SCNS-SF34), ranging from 9.4% for individuals ever diagnosed with haematological cancer to 36.3% for individuals ever diagnosed with gynaecological cancer, and 'concerns about cancer coming back' (17.9%) from the Cancer Survivors' Unmet Needs (CaSUN), ranging from 9.7% for individuals ever diagnosed with prostate cancer to 37.8% for individuals ever diagnosed with breast cancer. Two studies assessed needs in Aboriginal and Torres Strait Islander populations, reporting the highest needs for financial worries (21.1%). CONCLUSIONS Point prevalence estimates presented here, combined with estimates of the costs and effects of potential interventions, can be used within economic evaluations to inform evidence-based local service provision to address the supportive care needs of individuals ever diagnosed with cancer. IMPLICATIONS FOR CANCER SURVIVORS Local health services can use local evidence to prioritise the implementation of interventions targeted at unmet needs.
Collapse
Affiliation(s)
- Jackie Roseleur
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
| | - Laura Catherine Edney
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jayda Jung
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| |
Collapse
|
3
|
Chen M, Li R, Chen Y, Ding G, Song J, Hu X, Jin C. Unmet supportive care needs and associated factors: Evidence from 4195 cancer survivors in Shanghai, China. Front Oncol 2022; 12:1054885. [PMID: 36530993 PMCID: PMC9748420 DOI: 10.3389/fonc.2022.1054885] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/10/2022] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Cancer survivors at different stages of life often have different needs that make it challenging for services to provide satisfactory care. Few studies have considered whether services are truly meeting the needs of cancer patients by exploring and identifying their perspectives on unmet needs. OBJECTIVE The aim of this study was to identify the unmet needs of cancer survivors and to further determine the potential impact of socio-demographic factors. METHODS A cross-sectional study that included 4195 cancer patients was conducted in Shanghai, China. Using Maslow's hierarchy of needs theory as a conceptual framework, the questionnaire included five dimensions: information, life and finances, continuing care, emotions, and self-actualization. Correlation analysis and ordered logistic regression analysis was used to explore the relationship between demographic sociological factors and unmet needs for supportive care. RESULTS The most common unmet supportive care needs include information needs (2.91 ± 1.32), self-actualization needs (2.69 ± 1.32) and continuing care needs (2.59 ± 1.30). Unmet needs for life and finances were more pronounced among cancer participants in the 45-69 age group. After adjusting for confounders, we found that each 6-month increase in the time since diagnosis was associated with a 0.8% (OR: 0.992, 95% CI: 0.985-0.998) reduction in high need for continuing care and a 0.9% (OR:0.991, 95% CI: 0.983-0.999) reduction in high need for self-actualization, respectively. CONCLUSIONS Information needs are the most important concern among the diverse unmet needs of cancer survivors. Time since diagnosis is associated with unmet supportive care needs of cancer survivors. The findings highlight the large gap between actual health services and patients' unmet need for supportive care, which will provide the basis for a patient-centered supportive care system for cancer survivors.
Collapse
Affiliation(s)
- Minxing Chen
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Ruijia Li
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Yujie Chen
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Gang Ding
- Oncology Department, Shanghai International Medical Center, Shanghai, China
| | - Jie Song
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Xiaojing Hu
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Chunlin Jin
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| |
Collapse
|
4
|
Anxiety and Depression in Patients with Prostate Cancer, at Cancer Diagnosis and after a One-Year Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159122. [PMID: 35897487 PMCID: PMC9368515 DOI: 10.3390/ijerph19159122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023]
Abstract
Prostate cancer (PCa) is the most prevalent among men, and psychological symptoms may affect many patients. This study aims to describe the prevalence of probable anxiety and depression before PCa treatments and after one year and to identify sociodemographic and clinical factors associated with these outcomes. Between February 2018 and March 2020, 292 patients recently diagnosed with PCa were recruited at the Instituto Português de Oncologia—Porto. The Hospital Anxiety and Depression Scale (HADS) was used to define probable anxiety and depression (cutoff = 11). The prevalence of probable anxiety remained stable from baseline to one year (7.8% vs. 8.5%, p = 0.866) while there was an increase in probable depression (3.1% vs. 6.8%, p = 0.012). After one year, probable depression persisted in 55.6% of patients with probable depression at baseline and 47.8% of those with probable anxiety at the first assessment had normal anxiety scores. At baseline, anxiety was more frequent among dwellers in rural areas (adjusted odds ratio—aOR, 95%CI: 2.80, 0.91–8.58) and less frequent in patients with body mass index 25–29.9 kg/m2 (aOR, 95%CI: 0.33, 0.12–0.91) compared to 18.5–24.9 Kg/m2, while those living alone had higher odds of depression (aOR, 95%CI: 6.35, 1.43–28.30). The frequency of anxiety and depression fluctuated during the course of treatment. Monitoring these symptoms would identify the most affected patients, contributing for a better use of mental health services.
Collapse
|
5
|
Kappel C, Rushton-Marovac M, Leong D, Dent S. Pursuing Connectivity in Cardio-Oncology Care-The Future of Telemedicine and Artificial Intelligence in Providing Equity and Access to Rural Communities. Front Cardiovasc Med 2022; 9:927769. [PMID: 35770225 PMCID: PMC9234696 DOI: 10.3389/fcvm.2022.927769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/24/2022] [Indexed: 01/22/2023] Open
Abstract
The aim of this review is to discuss the current health disparities in rural communities and to explore the potential role of telehealth and artificial intelligence in providing cardio-oncology care to underserviced communities. With advancements in early detection and cancer treatment, survivorship has increased. The interplay between cancer and cardiovascular disease, which are the leading causes of morbidity and mortality in this population, has been increasingly recognized. Worldwide, cardio-oncology clinics (COCs) have emerged to deliver a multidisciplinary approach to the care of patients with cancer to mitigate cardiovascular risks while minimizing interruptions in cancer treatment. Despite the value of COCs, the accessibility gap between urban and rural communities in both oncology and cardio-oncology contributes to health care disparities and may be an underrecognized determinant of health globally. Telehealth and artificial intelligence offer opportunities to provide timely care irrespective of rurality. We therefore explore current developments within this sphere and propose a novel model of care to address the disparity in urban vs. rural cardio-oncology using the experience in Canada, a geographically large country with many rural communities.
Collapse
Affiliation(s)
- Coralea Kappel
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Moira Rushton-Marovac
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Darryl Leong
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Susan Dent
- Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, NC, United States
| |
Collapse
|
6
|
Li YS, Wang R, Deng YQ, Jia XR, Li SP, Zhao LP, Sun XY, Qi F, Wu YB. Influence factors analysis of COVID-19 Prevention behavior of chinese Citizens: a path analysis based on the hypothetical model. BMC Public Health 2022; 22:1098. [PMID: 35650608 PMCID: PMC9159041 DOI: 10.1186/s12889-022-13514-0] [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: 09/22/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Under the outbreak of Coronavirus disease 2019 (COVID-19), a structural equation model was established to determine the causality of important factors that affect Chinese citizens' COVID-19 prevention behavior. METHODS The survey in Qingdao covered several communities in 10 districts and used the method of cluster random sampling. The research instrument used in this study is a self-compiled Chinese version of the questionnaire. Of the 1215 questionnaires, 1188 were included in our analysis. We use the rank sum test, which is a non-parametric test, to test the influence of citizens'basic sociodemographic variables on prevention behavior, and the rank correlation test to analyze the influencing factors of prevention behavior. IBM AMOS 24.0 was used for path analysis, including estimating regression coefficients and evaluating the statistical fits of the structural model, to further explore the causal relationships between variables. RESULTS The result showed that the score in the prevention behavior of all citizens is a median of 5 and a quartile spacing of 0.31. The final structural equation model showed that the external support for fighting the epidemic, the demand level of health information, the cognition of (COVID-19) and the negative emotions after the outbreak had direct effects on the COVID-19 prevention behavior, and that negative emotions and information needs served as mediating variables. CONCLUSIONS The study provided a basis for relevant departments to further adopt epidemic prevention and control strategies.
Collapse
Affiliation(s)
- Yun-Shan Li
- School Of Public Health, Shandong University, 250012, Shandong, China
| | - Rui Wang
- Center for Disease Control and Prevention of Qingdao, 175 Shandong Road, 266033, Shandong, China
| | - Yu-Qian Deng
- Xiangya School of Nursing, Central South University, 410000, Changsha, China
| | - Xiao-Rong Jia
- Center for Disease Control and Prevention of Qingdao, 175 Shandong Road, 266033, Shandong, China
| | - Shan-Peng Li
- Center for Disease Control and Prevention of Qingdao, 175 Shandong Road, 266033, Shandong, China
| | - Li-Ping Zhao
- The Second Xiangya Hospital, Central South University, 410000, Changsha, China
| | - Xin-Ying Sun
- School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, 100191, Beijing, China
| | - Fei Qi
- Center for Disease Control and Prevention of Qingdao, 175 Shandong Road, 266033, Shandong, China.
| | - Yi-Bo Wu
- School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, 100191, Beijing, China. .,Key Research Base of Philosophy and Social Sciences in Shaanxi Province, Health Culture Research Center of Shaanxi, 712046, Xi'an, China.
| |
Collapse
|
7
|
Hart NH, Crawford-Williams F, Crichton M, Yee J, Smith TJ, Koczwara B, Fitch MI, Crawford GB, Mukhopadhyay S, Mahony J, Cheah C, Townsend J, Cook O, Agar MR, Chan RJ. Unmet supportive care needs of people with advanced cancer and their caregivers: a systematic scoping review. Crit Rev Oncol Hematol 2022; 176:103728. [PMID: 35662585 DOI: 10.1016/j.critrevonc.2022.103728] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 01/11/2023] Open
Abstract
Examining and addressing unmet care needs is integral to improving the provision and quality of cancer services. This review explored the prevalence of unmet supportive care needs, and factors associated with unmet need, in adults with advanced cancers (solid and hematological malignancies) and their caregivers. Electronic databases (PubMed, CINAHL, EMBASE) were searched, producing 85 papers representing 81 included studies. People with advanced cancer reported the highest unmet needs in financial, health system and information, psychological, and physical and daily living domains, whereas caregivers reported the highest unmet needs in psychological, and patient care and support domains. Distress, depression, and anxiety were associated with higher unmet needs across all unmet need domains for people with advanced cancer and their caregivers. Substantial heterogeneity in study populations and methods was observed. Findings from this review can inform targeted strategies and interventions to address these unmet needs in people with advanced cancer.
Collapse
Affiliation(s)
- Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, SA, Australia; Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, WA, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia; Institute for Health Research, University of Notre Dame Australia, WA, Australia.
| | - Fiona Crawford-Williams
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, SA, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia
| | - Megan Crichton
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia; Nutrition and Dietetics Research Group, Bond University, QLD, Australia
| | - Jasmine Yee
- Centre for Medical Psychology and Evidence-Based Decision-Making, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Thomas J Smith
- Division of General Internal Medicine, John Hopkins Medical Institutions, Baltimore, MD, USA
| | - Bogda Koczwara
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, SA, Australia; Flinders Cancer and Innovation Centre, Flinders Medical Centre, SA, Australia
| | - Margaret I Fitch
- School of Graduate Studies, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Gregory B Crawford
- Discipline of Medicine, University of Adelaide, SA, Australia; Northern Adelaide Local Health Network, SA, Australia
| | - Sandip Mukhopadhyay
- Burdwan Medical College, West Bengal, Kolkata, India; Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Chan Cheah
- Internal Medicine, UWA Medical School, University of Western Australia, WA, Australia; Department of Haematology, Sir Charles Gairdner Hospital, WA, Australia; Department of Haematology, Hollywood Private Hospital, WA, Australia
| | | | - Olivia Cook
- McGrath Foundation, NSW, Australia; School of Nursing and Midwifery, Monash University, VIC, Australia
| | - Meera R Agar
- IMPACCT Centre, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, SA, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia
| |
Collapse
|
8
|
DeGuzman PB, Vogel DL, Bernacchi V, Scudder MA, Jameson MJ. Self-reliance, Social Norms, and Self-stigma as Barriers to Psychosocial Help-Seeking Among Rural Cancer Survivors With Cancer-Related Distress: Qualitative Interview Study. JMIR Form Res 2022; 6:e33262. [PMID: 35588367 PMCID: PMC9164097 DOI: 10.2196/33262] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/04/2022] [Accepted: 03/28/2022] [Indexed: 01/19/2023] Open
Abstract
Background Even when technology allows rural cancer survivors to connect with supportive care providers from a distance, uptake of psychosocial referrals is low. Fewer than one-third of participants in a telemedicine intervention for identifying rural survivors with high distress and connecting them with care accepted psychosocial referral. Objective The purpose of this research was to examine the reasons for which rural cancer survivors did not accept a psychosocial referral. Methods We utilized a qualitative design to address the research purpose. We interviewed participants who had been offered psychosocial referral. Semistructured interviews were conducted 6 weeks later (n=14), and structured interviews were conducted 9 months later (n=6). Data were analyzed descriptively using an inductive approach. Results Ultimately, none of the rural cancer survivors (0/14, 0%) engaged with a psychosocial care provider, including those who had originally accepted referrals (0/4, 0%) for further psychosocial care. When explaining their decisions, survivors minimized their distress, emphasizing their self-reliance and the need to handle distress on their own. They expressed a preference for dealing with distress via informal support networks, which was often limited to close family members. No survivors endorsed public stigma as a barrier to accepting psychosocial help, but several suggested that self-stigma associated with not being able to handle their own distress was a reason for not seeking care. Conclusions Rural cancer survivors’ willingness to accept a psychosocial referral may be mediated by the rural cultural norm of self-reliance and by self-stigma. Interventions to address referral uptake may benefit from further illumination of these relationships as well as a strength-based approach that emphasizes positive aspects of the rural community and individual self-affirmation.
Collapse
Affiliation(s)
| | - David L Vogel
- Department of Pyschology, Iowa State University, Ames, IA, United States
| | - Veronica Bernacchi
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Margaret A Scudder
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Mark J Jameson
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Virginia, Charlottesville, VA, United States
| |
Collapse
|
9
|
Consequences of Structural Urbanism: Urban-Rural Differences in Cancer Patients' Use and Perceived Importance of Supportive Care Services from a 2017-2018 Midwestern Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063405. [PMID: 35329094 DOI: 10.3390/ijerph19063405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Structural inequities, in part, undergird urban-rural differences in cancer care. The current study aims to understand the potential consequences of structural inequities on rural and urban cancer patients' access to and perceived importance of supportive cancer care resources. METHODS We used data collected from November 2017 to May 2018 from a larger cross-sectional needs assessment about patients' support needs, use of services, and perceptions at a Midwestern United States cancer center. Oncology patients received a study packet during their outpatient clinic visit, and interested patients consented and completed the questionnaires. RESULTS Among the sample of 326 patients, 27% of the sample was rural. In adjusted logistic regression models, rural patients were less likely to report using any secondary support services (15% vs. 27%; OR = 0.43, 95%CI [0.22, 0.85], p = 0.02) and less likely than urban counterparts to perceive secondary support services as very important (51% vs. 64%; OR = 0.57, 95%CI [0.33, 0.94], p = 0.03). CONCLUSION Structural inequities likely have implications on the reduced access to and importance of supportive care services observed for rural cancer patients. To eliminate persistent urban-rural disparities in cancer care, rural residents must have programs and policies that address cancer care and structural inequities.
Collapse
|
10
|
Zomerdijk N, I Jongenelis M, Turner J, Huntley K, Smith A, Short CE. Telehealth access among hematology patients during the COVID-19 pandemic in Australia: a cross-sectional survey. Leuk Lymphoma 2022; 63:1488-1491. [PMID: 34989290 DOI: 10.1080/10428194.2021.2023743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hematology patients are more vulnerable to the effects of COVID-19 than patients with other cancers. We surveyed hematology patients to better understand their experiences of cancer care during the pandemic. A large reduction was observed in the number of healthcare services accessed by respondents. Telehealth assisted with access but requires improvement.
Collapse
Affiliation(s)
- Nienke Zomerdijk
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
| | - Michelle I Jongenelis
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Melbourne Centre for Behaviour Change, University of Melbourne, Melbourne, Australia
| | - Jane Turner
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | | | - Camille E Short
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Melbourne Centre for Behaviour Change, University of Melbourne, Melbourne, Australia.,School of Health Sciences, University of Melbourne, Melbourne, Australia
| |
Collapse
|
11
|
Uwayezu MG, Nikuze B, Maree JE, Buswell L, Fitch MI. Competencies for Nurses Regarding Psychosocial Care of Patients With Cancer in Africa: An Imperative for Action. JCO Glob Oncol 2022; 8:e2100240. [PMID: 35044834 PMCID: PMC8789211 DOI: 10.1200/go.21.00240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/19/2021] [Accepted: 12/17/2021] [Indexed: 12/28/2022] Open
Abstract
Psychosocial care is considered an important component of quality cancer care. Individuals treated for cancer can experience biologic or physical, emotional, spiritual, and practical consequences (eg, financial), which have an impact on their quality of living. With the establishment of cancer centers in Africa, there is growing advocacy regarding the need for psychosocial care, given the level of unmet supportive care needs and high emotional distress reported for patients. Nurses are in an ideal position to provide psychosocial care to patients with cancer and their families but must possess relevant knowledge and skills to do so. Across Africa, nurses are challenged in gaining the necessary education for psychosocial cancer care as programs vary in the amount of psychosocial content offered. This perspective article presents competencies regarding psychosocial care for nurses caring for patients with cancer in Africa. The competencies were adapted by expert consensus from existing evidenced-based competencies for oncology nurses. They are offered as a potential basis for educational program planning and curriculum development for cancer nursing in Africa. Recommendations are offered regarding use of these competencies by nursing and cancer program leaders to enhance the quality of care for African patients with cancer and their family members. The strategies emphasize building capacity of nurses to engage in effective delivery of psychosocial care for individuals with cancer and their family members.
Collapse
Affiliation(s)
- Marie Goretti Uwayezu
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Bellancille Nikuze
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Johanna E. Maree
- Department of Nursing Education, University of the Witwatersrand, Johannesburg & Netcare Education, Johannesburg, South Africa
| | - Lori Buswell
- Dana-Farber Cancer Institute, Boston, MA
- Partners in Health, Boston, MA
| | - Margaret I. Fitch
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Rory Meyer's College of Nursing, New York University, New York, NY
| |
Collapse
|
12
|
van der Kruk SR, Butow P, Mesters I, Boyle T, Olver I, White K, Sabesan S, Zielinski R, Chan BA, Spronk K, Grimison P, Underhill C, Kirsten L, Gunn KM. Psychosocial well-being and supportive care needs of cancer patients and survivors living in rural or regional areas: a systematic review from 2010 to 2021. Support Care Cancer 2021; 30:1021-1064. [PMID: 34392413 PMCID: PMC8364415 DOI: 10.1007/s00520-021-06440-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/13/2021] [Indexed: 01/16/2023]
Abstract
Purpose To summarise what is currently known about the psychosocial morbidity, experiences, and needs of people with cancer and their informal caregivers, who live in rural or regional areas of developed countries. Methods Eligible studies dating from August 2010 until May 2021 were identified through several online databases, including MEDLINE, EMBASE, PsychINFO, and RURAL (Rural and Remote Health Database). Results were reported according to the PRISMA guidelines and the protocol was registered on PROSPERO (CRD42020171764). Results Sixty-five studies were included in this review, including 20 qualitative studies, 41 quantitative studies, and 4 mixed methods studies. Qualitative research demonstrated that many unique psychosocial needs of rural people remain unmet, particularly relating to finances, travel, and accessing care. However, most (9/19) quantitative studies that compared rural and urban groups reported no significant differences in psychosocial needs, morbidity, or quality of life (QOL). Five quantitative studies reported poorer psychosocial outcomes (social and emotional functioning) in urban cancer survivors, while three highlighted poorer outcomes (physical functioning, role functioning, and self-reported mental health outcomes) in the rural group. Conclusion Recent research shows that rural people affected by cancer have unique unmet psychosocial needs relating to rurality. However, there was little evidence that rural cancer survivors report greater unmet needs than their urban counterparts. This contrasts to the findings from a 2011 systematic review that found rural survivors consistently reported worse psychosocial outcomes. More population-based research is needed to establish whether uniquely rural unmet needs are due to general or cancer-specific factors.
Collapse
Affiliation(s)
- Shannen R. van der Kruk
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
- Cancer Research Institute, University of South Australia, Adelaide, SA Australia
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, NSW Australia
| | - Ilse Mesters
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Terry Boyle
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA Australia
| | - Ian Olver
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA Australia
| | - Kate White
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Sabe Sabesan
- College of Medicine and Dentistry (CMD), James Cook University, QLD, Townsville, Australia
| | - Rob Zielinski
- Central West Cancer Care Centre, Orange Base Hospital, Orange, NSW Australia
- Western Sydney University, Sydney, NSW Australia
| | - Bryan A. Chan
- School of Medicine, Griffith University, Brisbane, QLD Australia
| | - Kristiaan Spronk
- Cancer Research Institute, University of South Australia, Adelaide, SA Australia
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA Australia
| | - Peter Grimison
- Department of Medical Oncology, Chris O’Brien Lifehouse, Sydney, NSW Australia
| | | | | | - Kate M. Gunn
- Cancer Research Institute, University of South Australia, Adelaide, SA Australia
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA Australia
| | | |
Collapse
|
13
|
Prevalence and correlates of psychological distress, unmet supportive care needs, and fear of cancer recurrence among haematological cancer patients during the COVID-19 pandemic. Support Care Cancer 2021; 29:7755-7764. [PMID: 34164740 PMCID: PMC8221273 DOI: 10.1007/s00520-021-06369-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Abstract
Background The COVID-19 pandemic has had a disruptive effect on people with haematological cancers, who represent a high-risk population due to the nature of their disease and immunosuppressive treatments. We aimed to identify the psychological impacts of the COVID-19 pandemic on haematology patients and identify correlated factors to inform the development of appropriate supportive interventions. Methods Three hundred and ninety-four respondents volunteered their participation in response to a study advertisement distributed online through established haematology groups. Participants completed a self-report online survey exploring wellbeing, psychological distress, unmet supportive care needs, and fear of cancer recurrence. Results At least 1 in 3 respondents (35%) reported clinical levels of distress and nearly 1 in 3 (32%) identified at least one unmet need. Among respondents in remission (n = 134), clinical fear of cancer recurrence was reported by nearly all (95%). Unmet needs, pre-existing health conditions, younger age, financial concerns, and perceived risk of contracting COVID-19 were the dominant factors contributing to psychological distress during the pandemic. Psychological distress, lost income, perceived inadequate support from care team, perceived risk of contracting COVID-19, and being a woman were significantly associated with unmet needs. Psychological distress and concern about the impact of COVID-19 on cancer management were significantly associated with fear of cancer recurrence among respondents in remission. Conclusion Results highlight the high psychological burden and unmet needs experienced by people with haematological cancers during the COVID-19 pandemic and indicate a need for innovative solutions to rapidly identify distress and unmet needs during, and beyond, pandemic times. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06369-5.
Collapse
|
14
|
Fitch MI, Lockwood G, Nicoll I. Physical, emotional, and practical concerns, help-seeking and unmet needs of rural and urban dwelling adult cancer survivors. Eur J Oncol Nurs 2021; 53:101976. [PMID: 34111722 DOI: 10.1016/j.ejon.2021.101976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This study explores the influence of residency location on the experiences of cancer survivors. The influence of where individuals live during cancer screening, diagnosis, and treatment has been described in various countries. However, understanding the context of residency on experiences during survivorship has received less attention. METHODS A survey was designed to assess experiences of cancer survivors transitioning to follow-up care. Descriptive statistics were used to contrast physical, emotional, and practical concerns, help-seeking, and unmet needs of rural and urban dwelling respondents. Difference in proportions of greater than 5% were considered clinically meaningful. RESULTS In total, 13,319 respondents completed the survey of which 4646 met the criteria for rural dwelling (e.g., living in villages or towns with 10,000 or less residents or on an acreage, ranch, or farm). Proportions of respondents in rural and urban groups were similar in terms of level of concerns. Differences were observed for help seeking regarding return to work and for difficulty in obtaining help regarding taking care of children and other family members, changes in relationships with family, friends and co-workers, and getting to and from appointments. Unmet needs existed across all domains and were similar in both groups. A larger proportion of rural dwelling respondents experienced unmet needs regarding return to work. CONCLUSIONS [implications]: High proportions of cancer survivors experienced concerns following cancer treatment. However, rural dwelling survivors were more challenged in obtaining help for selected concerns. Implications exist for development of community-based support services in rural settings.
Collapse
Affiliation(s)
- Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, 207 Chisholm Ave., Toronto, Ontario, M4C 4V9, Canada.
| | - Gina Lockwood
- Biostatistician Consultant (Independent), Toronto, Canada.
| | - Irene Nicoll
- Health Care Consultant (Independent), Toronto, Canada.
| |
Collapse
|
15
|
Yeung CW, Gilbertson-White S, Wickersham KE. "Live your life cuz everybody's terminal": Describing emotions and coping behaviors of rural advanced cancer patients. J Rural Health 2021; 38:63-69. [PMID: 33856695 DOI: 10.1111/jrh.12576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Culturally competent health care has led to increasing interest in how patients' identities influence the management of their health. The ways rural patients with advanced cancer process emotions and cope with their disease may be influenced by their rural context. The aims for this study were to (1) describe the emotions rural cancer patients experience, (2) describe how rural cancer patients manage their emotions within their rural context, and (3) interlace the themes related to coping with emotions. METHODS This paper is a subanalysis of a larger project focused on symptom management among rural patients living with advanced cancer. Using a qualitative descriptive design, authors read and coded patient interview transcripts to extract key perspectives related to managing emotions within a rural context. FINDINGS Sixteen participants, 10 men and 6 women, with a mean age of 68.75 years completed this study. Participants described a spectrum of emotional experiences. Some participants reported no distress, and some described high levels of distress. While previous writers described low levels of religious coping among rural patients, participants in this study often named their faith/spirituality as a major source of emotional coping. Participants also galvanized their social support network, particularly those in their religious community. Finally, participants in this study reported the use of medication as a last resort. CONCLUSION Results from this study might be influenced from cultural variables found in the rural community; specifically, religiosity and close social networks. Future interventions need to be tailored to the unique responses of rural patients.
Collapse
Affiliation(s)
- Chi W Yeung
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Karen E Wickersham
- University of South Carolina College of Nursing, Columbia, South Carolina, USA
| |
Collapse
|
16
|
Tsatsou I, Konstantinidis T, Kalemikerakis I, Adamakidou T, Vlachou E, Govina O. Unmet Supportive Care Needs of Patients with Hematological Malignancies: A Systematic Review. Asia Pac J Oncol Nurs 2021; 8:5-17. [PMID: 33426184 PMCID: PMC7785074 DOI: 10.4103/apjon.apjon_41_20] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/27/2020] [Indexed: 12/12/2022] Open
Abstract
Hematological malignancies require intensive and long-term treatment, which brings a significant burden on patients, leading to unmet supportive care needs. The purpose of this review was to investigate the unmet supportive care needs of patients with hematological malignancies during and after active treatment as well as the factors that affect them. A systematic bibliographic search was carried out in the PubMed database for English articles published between 2009 and 2020 according to the Preferred Reporting Items for Systematic Reviews guidelines and under the terms: "unmet needs", "supportive care", "hematological malignancy" and "hematological cancer." Twenty studies were evaluated and reviewed. Hierarchical frequently reported unmet supportive care needs were informational, emotional, physical, daily living/practical (accessibility, transportation, and financial problems), and family life/relational needs. In particular, patients with multiple myeloma most frequently reported unmet needs at the informational, physical, emotional, and daily living/practical domain. Patients with myelodysplastic syndromes reported physical, emotional, practical, and relational needs. Patients with leukemia and lymphoma rated their needs as informational, physical, psychological, daily living, and sexual. Sexual and spiritual unmet needs were reported at a low level. Predictive indicators for increased unmet supportive care needs were the type of the hematological malignancy, younger age, marital status, female gender, monthly income, coexistence of anxiety and depression, and altered quality of life. To conclude with, the literature reports a significant number of unmet supportive care needs in patients with hematological malignancies, whose frequency and intensity were influenced by a variety of factors. However, the large heterogeneity of studies (design, sample, and needs assessment tools) makes the generalization of the results difficult.
Collapse
Affiliation(s)
- Ioanna Tsatsou
- Oncology-Hematology Department, Hellenic Airforce General Hospital, Heraklion, Greece
| | | | | | | | - Eugenia Vlachou
- Department of Nursing, University of West Attica, Athens, Greece
| | - Ourania Govina
- Department of Nursing, University of West Attica, Athens, Greece
| |
Collapse
|
17
|
Herrmann A, Mansfield E, Tzelepis F, Lynagh M, Hall A. Use of the supportive care framework to explore haematological cancer survivors' unmet needs: a qualitative study. BMC Health Serv Res 2020; 20:1062. [PMID: 33228652 PMCID: PMC7686725 DOI: 10.1186/s12913-020-05927-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/15/2020] [Indexed: 12/30/2022] Open
Abstract
Background Some sub-types of haematological cancers are acute and require intensive treatment soon after diagnosis. Other sub-types are chronic, relapse over many years and require life-long cycles of monitoring interspersed with bouts of treatment. This often results in significant uncertainty about the future, high levels of depression and anxiety, and reduced quality of life. Little is known about how to improve care for haematological cancer survivors. This study explored qualitatively, in a sample of haematological cancer survivors, (i) their unmet needs experienced as a result of their disease and treatment; and (ii) strategies that may help address these needs. Methods Semi-structured interviews were conducted with 17 adult haematological cancer survivors. Data was analysed using qualitative content analysis. The Supportive Care Framework guided data collection and analysis. Results Participants had a mean age of 57 years (SD 13). Most were male (n = 10, 59%). Five themes emerged from the data: (i) changes in unmet needs across the care trajectory (with greatest unmet needs experienced soon after diagnosis, at discharge from hospital and with cancer recurrence); (ii) informational unmet needs requiring improved patient-centred communication; (iii) uncertainty about treatment and the future; (iv) coordinated, tailored and documented post-treatment care planning as a strategy for optimal care delivery; and (v) ongoing support services to meet psychosocial and practical unmet needs by involving peer support, less bureaucratic transport services and flexible work arrangements. Conclusions To our knowledge, this is the first qualitative investigation using the Supportive Care Framework to explore unmet needs of haematological cancer survivors. Our findings offer fresh insights into this important area of study. Written, take-home care plans which provide simple but tailored guidance on where to seek additional support may help decrease uncertainty and feelings of vulnerability post-treatment for adult haematological cancer survivors. Future research should further develop and test strategies aimed at addressing unmet needs of haematological cancer survivors identified in this study. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05927-7.
Collapse
Affiliation(s)
- Anne Herrmann
- Department for Epidemiology and Preventive Medicine, Professorship for Medical Sociology, University of Regensburg, Regensburg, Germany. .,Department of Haematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany. .,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia. .,Hunter Medical Research Institute, Newcastle, Australia.
| | - Elise Mansfield
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Marita Lynagh
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Alix Hall
- Hunter Medical Research Institute, Newcastle, Australia.,Clinical Research, Design and Statistics, Hunter Medical Research Institute, Newcastle, Australia
| |
Collapse
|
18
|
Palmer NR, Avis NE, Fino NF, Tooze JA, Weaver KE. Rural cancer survivors' health information needs post-treatment. PATIENT EDUCATION AND COUNSELING 2020; 103:1606-1614. [PMID: 32147307 PMCID: PMC7311274 DOI: 10.1016/j.pec.2020.02.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/03/2020] [Accepted: 02/26/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study describes the most common cancer-related health information needs among rural cancer survivors and characteristics associated with reporting more information needs. METHODS Rural breast, prostate, and colorectal cancer survivors, two to five years post-diagnosis, identified from an institutional cancer registry, completed a mailed/telephone-administered survey. Respondents were asked about 23 health information needs in eight domains (tests and treatment, side effects and symptoms, health promotion, fertility, interpersonal, occupational, emotional, and insurance). Poisson regression models were used to assess relationships between number of health information needs and demographic and cancer characteristics. RESULTS Participants (n = 170) reported an average of four health information needs, with the most common domains being: side effects and symptoms (58 %), health promotion (54 %), and tests and treatment (41 %). Participants who were younger (compared to 5-year increase, rate ratio [RR] = 1.11, 95 % CI = 1.02-1.21), ethnic minority (RR = 1.89, 95 % CI = 1.17-3.06), less educated (RR = 1.49, 95 % CI = 1.00-2.23), and financially stressed (RR = 1.87, 95 % CI = 1.25-2.81) had a greater number of information needs. CONCLUSIONS Younger, ethnic minority, less educated, and financially strained rural survivors have the greatest need for informational support. PRACTICE IMPLICATIONS The provision of health information for rural cancer survivors should consider type of cancer, treatments received, and sociocultural differences to tailor information provided.
Collapse
Affiliation(s)
- Nynikka R Palmer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nora F Fino
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Janet A Tooze
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
19
|
Febbraro M, Conlon M, Caswell J, Laferriere N. Access to cancer care in northwestern Ontario-a population-based study using administrative data. ACTA ACUST UNITED AC 2020; 27:e271-e275. [PMID: 32669933 DOI: 10.3747/co.27.5717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Despite universal access to health care in Canada, there are disparities relating to social determinants of health that contribute to discrepancies between rural and urban areas in cancer incidence and outcomes. Given that Canada has one of the highest-quality national population-based cancer registry systems in the world and that little information is available about cancer statistics specific to northwestern Ontario, the purpose of the present study was to estimate the percentage of cancer patients without documentation of a specialist consultation (medical or radiation oncology consultation) and to determine factors that affect access to specialist consultation in northwestern Ontario. Methods This population-based retrospective study used administrative data obtained through the Ontario Cancer Data Linkage Project. For each index case, a timeline was constructed of all Ontario Health Insurance Plan billing codes and associated service dates, starting with the primary cancer diagnosis and ending with death. Specific factors affecting access to specialist consultation were assessed. Results Within the 6-year study period (2010-2016), 2583 index cases were identified. Most (n = 2007, 78%) received a specialist consultation. Factors associated with not receiving a specialist consultation included older age [p < 0.0001; odds ratio (or): 0.29; 95% confidence interval (ci): 0.19 to 0.44] and rural residence (p < 0.0001; or: 0.48; 95% ci: 0.48 to 0.72). Factors associated with receiving a specialist consultation included a longer timeline (p < 0.0001; or: 1.32; 95% ci: 1.19 to 1.46), a diagnosis of breast cancer (p < 0.0001; or: 2.51; 95% ci: 1.43 to 4.42), and a diagnosis of lung cancer (p < 0.0001; or: 1.77; 95% ci: 1.38 to 2.26). Conclusions This study is the first to look at care access in northwestern Ontario. The complexity and multidisciplinary nature of cancer care makes the provision of appropriate care a challenge; a one-size-fits-all disease prevention and treatment strategy might not be appropriate.
Collapse
Affiliation(s)
- M Febbraro
- Northern Ontario School of Medicine, McMaster University, Thunder Bay, ON
| | - M Conlon
- Institute for Clinical Evaluative Sciences North, and Epidemiology, Outcomes and Evaluation Research, Health Sciences North Research Institute, Northeast Cancer Centre, Sudbury, ON
| | - J Caswell
- Institute for Clinical Evaluative Sciences North, and Epidemiology, Outcomes and Evaluation Research, Health Sciences North Research Institute, Northeast Cancer Centre, Sudbury, ON
| | - N Laferriere
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON
| |
Collapse
|
20
|
DeGuzman PB, Bernacchi V, Cupp CA, Dunn B, Ghamandi BJF, Hinton ID, Jameson MJ, Lewandowski DL, Sheffield C. Beyond broadband: digital inclusion as a driver of inequities in access to rural cancer care. J Cancer Surviv 2020; 14:643-652. [DOI: 10.1007/s11764-020-00874-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/04/2020] [Indexed: 12/24/2022]
|
21
|
El-Jawahri A, Nelson AM, Gray TF, Lee SJ, LeBlanc TW. Palliative and End-of-Life Care for Patients With Hematologic Malignancies. J Clin Oncol 2020; 38:944-953. [PMID: 32023164 PMCID: PMC8462532 DOI: 10.1200/jco.18.02386] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2019] [Indexed: 12/18/2022] Open
Abstract
Hematologic malignancies are a heterogeneous group of diseases with unique illness trajectories, treatment paradigms, and potential for curability, which affect patients' palliative and end-of-life care needs. Patients with hematologic malignancies endure immense physical and psychological symptoms because of both their illness and often intensive treatments that result in significant toxicities and adverse effects. Compared with patients with solid tumors, those with hematologic malignancies also experience high rates of hospitalizations, intensive care unit admissions, and in-hospital deaths and low rates of referral to hospice as well as shorter hospice length of stay. In addition, patients with hematologic malignancies harbor substantial misperceptions about treatment risks and benefits and frequently overestimate their prognosis. Even survivors of hematologic malignancies struggle with late effects, post-treatment complications, and post-traumatic stress symptoms that can significantly diminish their quality of life. Despite these substantial unmet needs, specialty palliative care services are infrequently consulted for the care of patients with hematologic malignancies. Several illness-specific, cultural, and system-based barriers to palliative care integration and optimal end-of-life care exist in this population. However, recent evidence has demonstrated the feasibility, acceptability, and efficacy of integrating palliative care to improve the quality of life and care of patients with hematologic malignancies and their caregivers. More research is needed to develop and test population-specific palliative and supportive care interventions to ensure generalizability and to define a sustainable clinical delivery model. Future work also should focus on identifying moderators and mediators of the effect of integrated palliative care models on patient-reported outcomes and on developing less resource-intensive integrated care models to address the diverse needs of this population.
Collapse
Affiliation(s)
- Areej El-Jawahri
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ashley M. Nelson
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Tamryn F. Gray
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | | | | |
Collapse
|
22
|
Mooi NM, Ncama BP. Perceived needs of patients and family caregivers regarding home-based enteral nutritional therapy in South Africa: A qualitative study. PLoS One 2020; 15:e0228924. [PMID: 32049983 PMCID: PMC7015406 DOI: 10.1371/journal.pone.0228924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 01/26/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The need for specialized care, particularly enteral nutritional therapy in community settings is now increasing with implications for both patients and primary care providers. More research is needed to identify the needs of patients and primary caregivers. The study aimed to explore the perceived support needs regarding the provision of home-based enteral nutritional therapy among critically ill adult patients and family caregivers in the KwaZulu-Natal Province of South Africa. METHODS A qualitative study of purposely selected adult patients on homebased enteral nutritional therapy and family caregivers was conducted in a district hospital, a community health centre, two primary health care clinics and selected households in the KwaZulu-Natal Province, South Africa. Semi-structured individual interviews were conducted between June and September 2018 and the content analysis approach was used to analyse data. RESULTS Two major themes and five subthemes emerged from the results of the interviews. The major themes concerned socioeconomic and psychosocial support needs related to the provision of home-based enteral nutritional therapy. Subthemes included the need for financial assistance, need for enteral nutrition products and supplementary supplies, need for infrastructure for continuity of care, and psychological support needs. CONCLUSION Results of this study confirm the need for developing strategies adapted to a South African context and yonder to meet patients' and family caregivers' needs with regard to nutritional services. More research on the identification of needs through monitoring and evaluation of the implementation of nutritional guidelines is needed, particularly in the district hospital and primary health care (PHC) setting.
Collapse
Affiliation(s)
- Nomaxabiso Mildred Mooi
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Busisiwe Purity Ncama
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
23
|
Valizadeh L, Zamanzadeh V, Ghahremanian A, Musavi S, Akbarbegloo M, Chou FY. Experience of Adolescent Survivors of Childhood Cancer about Self-Care Needs: A Content Analysis. Asia Pac J Oncol Nurs 2019; 7:72-80. [PMID: 31879687 PMCID: PMC6927151 DOI: 10.4103/apjon.apjon_47_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 08/26/2019] [Indexed: 11/23/2022] Open
Abstract
Objective: In cancer care management, patients or their family are usually responsible for continuing health care. Achieving this goal requires identification of their self-care needs. The purpose of this study is to explore the perception of self-care needs of adolescent cancer survivors. Methods: This study was conducted by the qualitative content analysis method. Participants were 19 adolescent childhood cancer survivors and six parents, nurses, physicians, and charity institution staff from children teaching hospitals in Iran. Participants were selected through purposeful sampling, and individual semistructured interviews were used for data collection. Graneheim and Lundman stages of content analysis were employed for data analysis. Data were managed with the MAXQDA10 software. Results: Content analysis revealed nine subcategories as follows: (1) nutritional protection, (2) prevention from infection, (3) prevention from physical damage, (4) control over cancer recurrence, (5) informational needs, (6) pain management, (7) releasing positive thoughts, (8) continuing routine life, and (9) family protection. The first six subthemes were related to protection against physical distress, and the final three ones were related to protection against psychological distress. These two categories form one theme: “protective self-care need” as an essential self-care need in adolescent cancer survivors. Conclusions: Pediatric and school health nurses can prepare strategies to meet these needs by providing effective informational and psychosocial supports, and healthcare providers are able to check periodically the status of survivors care to provide second or third level of care to prevent escalation and incidence of the adverse outcomes of the disease.
Collapse
Affiliation(s)
- Leila Valizadeh
- Department of Pediatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Department of Pediatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akram Ghahremanian
- Department of Pediatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Musavi
- Department of Pediatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masumeh Akbarbegloo
- Department of Nursing, Tabriz University of Medical Sciences, Educational, Research, Student and Cultural Deputy of Khoy University of Medical Sciences, Tabriz, Iran
| | - Fang-Yu Chou
- Department of Nursing, San Francisco State University, San Francisco, California, USA
| |
Collapse
|
24
|
Chen L, Payne JB, Dance KV, Imbody CB, Ho CD, Ayers AA, Flowers CR. Priorities for Rural Lymphoma Survivors: A Qualitative Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:47-52.e3. [PMID: 31708453 DOI: 10.1016/j.clml.2019.09.599] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/23/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND We gathered rural patient perspectives on lymphoma care and unmet needs throughout the treatment course to better understand their attitudes toward treatment and their barriers to participating in clinical research studies. PATIENTS AND METHODS We conducted 12 individual semi-structured telephone interviews in the spring of 2018 with lymphoma survivors from rural counties in Georgia. Patients were identified by a residential address in counties classified as rural according to the Rural-Urban Commuting Areas codes. Participants were recruited from regional patient education conferences and from current research participants at a university research hospital in Georgia. The interviews were recorded and transcribed verbatim. Thematic analysis and MAXQDA, version 18.0.8, were used to facilitate a constant comparative coding process during theme development. RESULTS The greatest barrier to care was the travel distance. The participants described difficulty navigating between local clinics and larger cancer centers. The lack of communication between the local and specialized clinics complicated the process, and participants had difficulty contacting or seeking advice from the team at the larger cancer centers. Seeking treatment from specialized clinics farther away introduced additional barriers. Most participants agreed that the use of technology was important for improved communication. Participants described lymphoma etiology, subtype-specific studies, alternative therapies, and quality of life as key research priorities. CONCLUSION These findings suggest that targeted research and interventions are necessary to address the specific needs of rural patients with and survivors of lymphoma. To address the disparity in health outcomes within rural populations, healthcare professionals and investigators can use these data to engage rural patients in treatment decision-making and research planning.
Collapse
Affiliation(s)
- Lillian Chen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Jackelyn B Payne
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA; Department of Psychology, Stony Brook University, Stony Brook, NY
| | - Kaylin V Dance
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Conner B Imbody
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA
| | - Cathy D Ho
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Amy A Ayers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Christopher R Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
| |
Collapse
|
25
|
Valizadeh L, Zamanzadeh V, Ghahramanian A, Musavi S, Akbarbegloo M, Chou FY. Adolescent cancer survivors' experiences of supportive care needs: A qualitative content analysis. Nurs Health Sci 2019; 22:212-219. [PMID: 31411805 DOI: 10.1111/nhs.12640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/22/2019] [Accepted: 07/16/2019] [Indexed: 12/01/2022]
Abstract
Supportive care is an important strategy that can help cancer survivors manage changes and problems during their follow-up care. Identifying patients' care needs is one of the primary steps of the nursing process to plan effective nursing interventions. The aim of this study was to explore adolescent cancer survivors' supportive care needs. Purposeful sampling was adopted to select 49 participants from hospitals to participate in face-to-face, semistructured interviews. The qualitative content analysis method was conducted for data analysis. Ten subcategories and four main categories - empathetic care, information about survival period, instrumental support, and cooperation in care - were extracted from the data. These four categories formed a major theme, "supportive care", as the primary healthcare need. This study highlights that supportive care should be developed collaboratively by family and healthcare providers to meet the needs of adolescent cancer survivors. Survivors' strengths and limitations should be identified, and then supportive care can be provided, such as giving appropriate information, enabling survivors to access supportive networks, and improving survivors' confidence and autonomy with their self-management.
Collapse
Affiliation(s)
- Leila Valizadeh
- Department of Nursing, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Department of Nursing, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akram Ghahramanian
- Department of Nursing, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Musavi
- Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoomeh Akbarbegloo
- Department of Nursing, Tabriz University of Medical Sciences, Educational, Research, Student and Cultural Deputy of Khoy University of Medical Sciences, Tabriz, Iran
| | - Fang-Yu Chou
- Department of Adult MedSurg, San Francisco State University, San Francisco, California, USA
| |
Collapse
|
26
|
Understanding survivors' needs and outcomes: the role of routinely collected data. Curr Opin Support Palliat Care 2019; 12:254-260. [PMID: 29916842 DOI: 10.1097/spc.0000000000000352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW The number of cancer survivors is growing due to population ageing, earlier detection and more effective therapies. Routinely collected data (RCD), generally cancer registry data, has been used to investigate survivors' needs and outcomes. We reviewed uses of RCD since 2017, identifying novel findings and research directions. RECENT FINDINGS Survival is improving internationally but continues to vary between subgroups. Longitudinal survivor surveys suggest malignancy-specific temporal patterns in unmet needs and health-related quality-of-life (HRQoL). Unmet needs are a risk factor for future depression and depression predicts poorer HRQoL in all domains. Emerging evidence suggests links between posttraumatic stress and poor HRQoL and posttraumatic growth and improved HRQoL. Evidence for a link between cancer-related financial hardship and poor HRQoL is accumulating. Surveys and linkage studies continue to show poorer work outcomes in survivors. Among survivors of childhood and young adult cancers, large linkage studies demonstrate significant risk of late effects, including hospitalization, pregnancy and labour complications, and cardiac death. SUMMARY RCD plays a significant role in understanding survivors' needs and outcomes. New approaches which overlay different types of data - including detailed clinical and treatment data, biomarker data and nonhealth administrative data - have the potential to generate considerable new knowledge.
Collapse
|
27
|
Konstantinidis TI, Spinthouri M, Ramoutsaki A, Marnelou A, Kritsotakis G, Govina O. Assessment of Unmet Supportive Care Needs in Haematological Cancer Survivors. Asian Pac J Cancer Prev 2019; 20:1487-1495. [PMID: 31127913 PMCID: PMC6857858 DOI: 10.31557/apjcp.2019.20.5.1487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Health needs assessment is crucial for the provision of individualized nursing care. However, many patients report a significant number of unmet needs. The aim of the present study was the assessment of self-reported unmet supportive care needs among haematological cancer survivors in Greece. Methods: 102 patients (mean age 66.2 years old) diagnosed with haematological cancer were included in a cross-sectional study, conducted in two major Greek public hospitals, between October and December 2016. Patients’ needs were assessed using the ‘Needs Evaluation Questionnaire’ (NEQ). Data analysis was conducted using the Statistical Package for Social Sciences software for Windows. Alfa-level (p-value) selected was 5%, bootstrap techniques were used for 95% CI estimation, χ2 was used for differentiation control and Kuder-Richardson coefficient for reliability score assessment (ρ = 0.922). Results: Patients reported higher needs levels “to receive less commiseration from other people” (48%), “more information about my future condition” (44.1%) and “to feel more useful within my family” (42.2%). In contrast, patients reported lower levels to the needs “to speak with a spiritual advisor” (11.8%), “to have more help with eating, dressing and going to the bathroom” (13.7%) and “better attention from nurses” (18.6%). The mean score of satisfied patients (≥8/10) was 8.9 (SD 1.7). Associations between socio-demographic, hospitalization data and unmet needs groups were identified. The less satisfied patients (<8/10) reported more informational needs about their diagnosis and their future condition (p-value=0.002), about their exams and treatments (p-value=0.001), communicative (p-value <0.001), assistance and treatment (p-value<0.001) and hospital infrastructure (p-value <0.001). Conclusion: Various factors seem to be associated to the prevalent unmet care needs among haematological cancer patients. Establishing NEQ as a routine needs assessment tool could aid health professionals to early identify patients’ needs in a busy clinical setting and implement more individualized and patient-centered quality care.
Collapse
Affiliation(s)
| | | | | | | | - George Kritsotakis
- Department of Nursing, Technological Educational Institute of Crete, Heraklion, Greece.
| | - Ourania Govina
- Faculty of Nursing, University of West Attica, Athens, Greece
| |
Collapse
|
28
|
Patterns of primary health care service use of Indigenous Australians diagnosed with cancer. Support Care Cancer 2019; 28:317-327. [DOI: 10.1007/s00520-019-04821-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/16/2019] [Indexed: 12/19/2022]
|