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Keenan E, Morris R, Vasiliou VS, Thompson AR. A qualitative feasibility and acceptability study of an acceptance and commitment-based bibliotherapy intervention for people with cancer. J Health Psychol 2024; 29:410-424. [PMID: 38158736 PMCID: PMC11005316 DOI: 10.1177/13591053231216017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Self-directed bibliotherapy interventions can be effective means of psychological support for individuals with cancer, yet mixed findings as to the efficacy of these interventions indicate the need for further research. We investigated the experience of individuals with cancer after using a new self-help book, based on Acceptance and Commitment Therapy (ACT). Ten participants with cancer (nine females and one male, 40-89 years old) were given access to a bibliotherapy self-help ACT-based book and participated in post-intervention semi-structured interviews. Five themes were generated from reflexive thematic analysis: (1) The value of bibliotherapy (2) Timing is important (3) Resonating with cancer experiences (4) Tools of the book (5) ACT in action. The book was found to be acceptable (self-directed, accessible, understandable content, good responsiveness to exercises) and feasible (easy to use, ACT-consistent). Although not explicitly evaluated, participants' reports indicated defusion, present moment awareness, and consideration of values, as the ACT processes that contributed to adjustment, via helping them to regain control over their lives and become more present within the moment. Findings also indicate that the intervention may be best accessed following completion of initial medical treatment.
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Affiliation(s)
- Emma Keenan
- Cardiff and Vale University Health Board and Cardiff University
| | - Reg Morris
- Cardiff and Vale University Health Board and Cardiff University
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Murnaghan S, Scruton S, Urquhart R. Psychosocial interventions that target adult cancer survivors' reintegration into daily life after active cancer treatment: a scoping review. JBI Evid Synth 2024; 22:607-656. [PMID: 38015073 PMCID: PMC10986786 DOI: 10.11124/jbies-23-00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE This review explored psychosocial interventions targeting adult cancer survivors' reintegration following active cancer treatment. This included the types of interventions tested and the tools used to measure reintegration. INTRODUCTION Cancer survivors face lingering health issues following the completion of cancer treatment. Many cancer survivors still experience unmet psychosocial care needs despite receiving follow-up care. Further, many survivorship interventions do not specifically address outcomes important to survivors. A number of primary studies have identified reintegration as an outcome important to cancer survivors. Reintegration is a concept that focuses on returning to normal activities, routines, and social roles after cancer treatment; however, it is emerging and abstract. INCLUSION CRITERIA Studies involving adult cancer survivors (18 years or older at diagnosis) of any cancer type or stage were included in this review. Studies with psychosocial interventions targeted at reintegrating the person into daily life after cancer treatment were included. Interventions addressing clinical depression or anxiety, and interventions treating solely physical needs that were largely medically focused were excluded. METHODS A literature search was conducted in MEDLINE (Ovid), CINAHL (EBSCOhost), and Embase. Gray literature was searched using ProQuest Dissertations and Theses (ProQuest). Reference lists of included studies were searched. Studies were screened at the title/abstract and full-text levels, and 2 independent reviewers extracted data. Manuscripts in languages other than English were excluded due to feasibility (eg, cost, time of translations). Findings were summarized narratively and reported in tabular and diagrammatic format. RESULTS The 3-step search strategy yielded 5617 citations. After duplicates were removed, the remaining 4378 citations were screened at the title and abstract level, then the remaining 306 citations were evaluated at the full-text level by 2 independent reviewers. Forty studies were included that evaluated psychosocial interventions among adult cancer survivors trying to reintegrate after active cancer treatment (qualitative n=23, mixed methods n=8, quantitative n=8, systematic review n=1). Included articles spanned 10 different countries/regions. Over half of all included articles (n=25) focused primarily on breast cancer survivors. Many studies (n=17) were conducted in primary care or community-based settings. The most common types of interventions were peer-support groups (n=14), follow-up education and support (n=14), exercise programs (n=6), and multidisciplinary/multicomponent programs (n=6). While the majority of included studies characterized the outcome qualitatively, 9 quantitative tools were also employed. CONCLUSIONS This review identified 6 types of interventions to reintegrate survivors back into their daily lives following cancer treatment. An important thread across intervention types was a focus on personalization in the form of problem/goal identification. Given the number of qualitative studies, future research could include a qualitative systematic review and meta-aggregation. Quantitative tools may not be as effective for evaluating reintegration. More primary studies, including mixed methods studies, utilizing consistent measurement tools are required. Furthermore, this work provides a basis for future research to continue examining the complexity of implementing such interventions to successfully achieve reintegration. To do so, primary studies evaluating interventions from an implementation science and complex systems perspective would be useful. REVIEW REGISTRATION Open Science Framework https://osf.io/r6bmx.
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Affiliation(s)
- Sarah Murnaghan
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sarah Scruton
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Surgery, Nova Scotia Health, Halifax, NS, Canada
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de Boer AG, Tamminga SJ, Boschman JS, Hoving JL. Non-medical interventions to enhance return to work for people with cancer. Cochrane Database Syst Rev 2024; 3:CD007569. [PMID: 38441440 PMCID: PMC10913845 DOI: 10.1002/14651858.cd007569.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND People with cancer are 1.4 times more likely to be unemployed than people without a cancer diagnosis. Therefore, it is important to investigate whether programmes to enhance the return-to-work (RTW) process for people who have been diagnosed with cancer are effective. This is an update of a Cochrane review first published in 2011 and updated in 2015. OBJECTIVES To evaluate the effectiveness of non-medical interventions aimed at enhancing return to work (RTW) in people with cancer compared to alternative programmes including usual care or no intervention. SEARCH METHODS We searched CENTRAL (the Cochrane Library), MEDLINE, Embase, CINAHL, PsycINFO and three trial registers up to 18 August 2021. We also examined the reference lists of included studies and selected reviews, and contacted authors of relevant studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs on the effectiveness of psycho-educational, vocational, physical or multidisciplinary interventions enhancing RTW in people with cancer. The primary outcome was RTW measured as either RTW rate or sick leave duration measured at 12 months' follow-up. The secondary outcome was quality of life (QoL). DATA COLLECTION AND ANALYSIS Two review authors independently assessed RCTs for inclusion, extracted data and rated certainty of the evidence using GRADE. We pooled study results judged to be clinically homogeneous in different comparisons reporting risk ratios (RRs) with 95% confidence intervals (CIs) for RTW and mean differences (MD) or standardised mean differences (SMD) with 95% CIs for QoL. MAIN RESULTS We included 15 RCTs involving 1477 people with cancer with 19 evaluations because of multiple treatment groups. In this update, we added eight new RCTs and excluded seven RCTs from the previous versions of this review that were aimed at medical interventions. All included RCTs were conducted in high-income countries, and most were aimed at people with breast cancer (nine RCTs) or prostate cancer (two RCTs). Risk of bias We judged nine RCTs at low risk of bias and six at high risk of bias. The most common type of bias was a lack of blinding (9/15 RCTs). Psycho-educational interventions We found four RCTs comparing psycho-educational interventions including patient education and patient counselling versus care as usual. Psycho-educational interventions probably result in little to no difference in RTW compared to care as usual (RR 1.09, 95% CI 0.96 to 1.24; 4 RCTs, 512 participants; moderate-certainty evidence). This means that in the intervention and control groups, approximately 625 per 1000 participants may have returned to work. The psycho-educational interventions may result in little to no difference in QoL compared to care as usual (MD 1.47, 95% CI -2.38 to 5.32; 1 RCT, 124 participants; low-certainty evidence). Vocational interventions We found one RCT comparing vocational intervention versus care as usual. The evidence was very uncertain about the effect of a vocational intervention on RTW compared to care as usual (RR 0.94, 95% CI 0.78 to 1.13; 1 RCT, 34 participants; very low-certainty evidence). The study did not report QoL. Physical interventions Four RCTs compared a physical intervention programme versus care as usual. These physical intervention programmes included walking, yoga or physical exercise. Physical interventions likely increase RTW compared to care as usual (RR 1.23, 95% CI 1.08 to 1.39; 4 RCTs, 434 participants; moderate-certainty evidence). This means that in the intervention group probably 677 to 871 per 1000 participants RTW compared to 627 per 1000 in the control group (thus, 50 to 244 participants more RTW). Physical interventions may result in little to no difference in QoL compared to care as usual (SMD -0.01, 95% CI -0.33 to 0.32; 1 RCT, 173 participants; low-certainty evidence). The SMD translates back to a 1.8-point difference (95% CI -7.54 to 3.97) on the European Organisation for Research and Treatment of Cancer Quality of life Questionnaire Core 30 (EORTC QLQ-C30). Multidisciplinary interventions Six RCTs compared multidisciplinary interventions (vocational counselling, patient education, patient counselling, physical exercises) to care as usual. Multidisciplinary interventions likely increase RTW compared to care as usual (RR 1.23, 95% CI 1.09 to 1.33; 6 RCTs, 497 participants; moderate-certainty evidence). This means that in the intervention group probably 694 to 844 per 1000 participants RTW compared to 625 per 1000 in the control group (thus, 69 to 217 participants more RTW). Multidisciplinary interventions may result in little to no difference in QoL compared to care as usual (SMD 0.07, 95% CI -0.14 to 0.28; 3 RCTs, 378 participants; low-certainty evidence). The SMD translates back to a 1.4-point difference (95% CI -2.58 to 5.36) on the EORTC QLQ-C30. AUTHORS' CONCLUSIONS Physical interventions (four RCTs) and multidisciplinary interventions (six RCTs) likely increase RTW of people with cancer. Psycho-educational interventions (four RCTs) probably result in little to no difference in RTW, while the evidence from vocational interventions (one RCT) is very uncertain. Psycho-educational, physical or multidisciplinary interventions may result in little to no difference in QoL. Future research on enhancing RTW in people with cancer involving multidisciplinary interventions encompassing a physical, psycho-educational and vocational component is needed, and be preferably tailored to the needs of the patient.
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Affiliation(s)
- Angela Gem de Boer
- Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Coronel Institute of Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Sietske J Tamminga
- Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Coronel Institute of Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Julitta S Boschman
- Cochrane Work, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Jan L Hoving
- Cochrane Work, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
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Cheng JT, Ramos Emos M, Leite V, Capozzi L, Woodrow LE, Gutierrez C, Ngo-Huang A, Krause KJ, Parke SC, Langelier DM. Rehabilitation Interventions in Head and Neck Cancer: A Scoping Review. Am J Phys Med Rehabil 2024; 103:S62-S71. [PMID: 38364033 DOI: 10.1097/phm.0000000000002384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
OBJECTIVE The aim of the study is to identify and appraise current evidence for rehabilitation interventions in head and neck cancer. DESIGN A previously published scoping review spanning 1990 through April 2017 was updated through January 11, 2023 and narrowed to include only interventional studies (Arch Phys Med Rehabil. 2019;100(12):2381-2388). Included studies had a majority head and neck cancer population and rehabilitation-specific interventions. Pairs of authors extracted data and evaluated study quality using the PEDro tool. Results were organized by intervention type. RESULTS Of 1338 unique citations, 83 studies with 87 citations met inclusion criteria. The median study sample size was 49 (range = 9-399). The most common interventions focused on swallow (16 studies), jaw (11), or both (6), followed by whole-body exercise (14) and voice (10). Most interventions took place in the outpatient setting (77) and were restorative in intent (65 articles). The overall study quality was fair (median PEDro score 5, range 0-8); none were of excellent quality (PEDro >9). CONCLUSIONS Most head and neck cancer rehabilitation interventions have focused on restorative swallow and jaw exercises and whole-body exercise to address dysphagia, trismus, and deconditioning. More high-quality evidence for head and neck cancer rehabilitation interventions that address a wider range of impairments and activity and social participation limitations during various cancer care phases is urgently needed to reduce head and neck cancer-associated morbidity.
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Affiliation(s)
- Jessica T Cheng
- From the Department of Supportive Care Medicine, City of Hope Orange County Lennar Foundation Cancer Center, California (JTC); Department of Orthopedic Surgery and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, New York (ME); Rehabilitation Department, Instituto do Cancer, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (VL); Faculty of Kinesiology, University of Calgary, Calgary, Canada (LC); Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, Calgary, Canada (LC); Department of Internal Medicine, Section of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, Canada (LEW); Department of Physical Medicine and Rehabilitation, McGovern Medical School at UTHealth Houston, Houston, Texas (CG); Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas (AN-H); Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas (KJK); Department of Physical Medicine and Rehabilitation, Mayo Clinic Arizona, Phoenix, Arizona (SCP); and Department of Medicine, Division of Physical Medicine and Rehabilitation, University Health Network and University of Toronto, Toronto, Canada (DML)
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Thilges S, Mumby P, Sinacore J, Clark J, Czerlanis C. Implementing a cognitive behavioral intervention for patients with head and neck cancer. Support Care Cancer 2023; 31:476. [PMID: 37466682 DOI: 10.1007/s00520-023-07948-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Sequelae of and therapies for head and neck cancers (HNC) are associated with physical and functional impairment as well as increased levels of psychological distress post treatment. Given the impact of HNC and treatment on functioning (i.e., eating and talking), health-related quality of life (HRQOL) is a significant area of survivorship concern within this population. Although prior research indicates that the incidence of anxiety and depression ranges from 15 to 50%, to date, there is a paucity of research on specific psychosocial interventions related to HNC treatment and completed studies have been limited by infrequent use of a randomized design and provision of non-standardized psychosocial interventions. This study aimed to address these gaps and utilize a brief cognitive behavioral intervention (CBI) to improve (1) self-efficacy for coping with cancer, (2) depressive symptoms, (3) other psychological symptoms, and (4) HRQOL among patients with HNC. METHODS In an effort to conduct a randomized clinical trial of those undergoing treatment for HNC, eighty-eight patients were assigned to receive either a standardized CBI or usual psychological care (N = 47 and 41, respectively) with a 1-year follow-up. The means of all variables for both groups, adjusted for baseline, were visually compared at 3, 6, and 12 months post treatment. RESULTS As has been a challenge in other longitudinal HNC studies, a high degree of attrition occurred, with a loss of 35 patients from the CBI group and 29 from the usual care group. Despite the high attrition, analysis of existing data indicated that the effect of CBI was discernable among the patients who completed the course of the study. Of the 38 comparisons, 34 showed that the CBI group had the favorable outcome. Important considerations for implementation of a structured psychotherapy intervention during active cancer treatment with multiple barriers including communication challenges and practical limitations were realized. CONCLUSIONS The impact of HNC treatment can be particularly distressing as it often results in functional impairment and markedly changed activities of daily living among survivors. However, engaging in therapeutic methods to cope and manage distress during treatment can influence QOL and mood into the survivorship phase.
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Affiliation(s)
- Sarah Thilges
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, 60153, USA.
| | - Patricia Mumby
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, 60153, USA
| | - James Sinacore
- Department of Public Health Sciences, Loyola University, 2160 South First Avenue, Maywood, IL, 60153, USA
| | - Joseph Clark
- Department of Hematology and Oncology, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, 60153, USA
| | - Cheryl Czerlanis
- Department of Hematology and Oncology, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, 60153, USA
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Paley CA, Boland JW, Santarelli M, Murtagh FEM, Ziegler L, Chapman EJ. Non-pharmacological interventions to manage psychological distress in patients living with cancer: a systematic review. BMC Palliat Care 2023; 22:88. [PMID: 37407974 DOI: 10.1186/s12904-023-01202-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Psychological distress is common in patients with cancer; interfering with physical and psychological wellbeing, and hindering management of physical symptoms. Our aim was to systematically review published evidence on non-pharmacological interventions for cancer-related psychological distress, at all stages of the disease. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered on PROSPERO (CRD42022311729). Searches were made using eight online databases to identify studies meeting our inclusion criteria. Data were collected on outcome measures, modes of delivery, resources and evidence of efficacy. A meta-analysis was planned if data allowed. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT). RESULTS Fifty-nine studies with 17,628 participants were included. One third of studies included mindfulness, talking or group therapies. Half of all studies reported statistically significant improvements in distress. Statistically significant intervention effects on distress were most prevalent for mindfulness techniques. Four of these mindfulness studies had moderate effect sizes (d = -0.71[95% CI: -1.04, -0.37] p < 0.001) (d = -0.60 [95% CI: -3.44, -0.89] p < 0.001) (d = -0.77 [CI: -0.146, -1.954] p < 0.01) (d = -0.69 [CI: -0.18, -1.19] p = 0.008) and one had a large effect size (d = -1.03 [95% CI: -1.51, -0.54] p < 0.001). Heterogeneity of studies precluded meta-analysis. Study quality was variable and some had a high risk of bias. CONCLUSIONS The majority of studies using a mindfulness intervention in this review are efficacious at alleviating distress. Mindfulness-including brief, self-administered interventions-merits further investigation, using adequately powered, high-quality studies. SYSTEMATIC REVIEW REGISTRATION This systematic review is registered on PROSPERO, number CRD42022311729.
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Affiliation(s)
- Carole A Paley
- University of Leeds, Academic Unit of Palliative Care, Leeds, UK.
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Martina Santarelli
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Lucy Ziegler
- University of Leeds, Academic Unit of Palliative Care, Leeds, UK
| | - Emma J Chapman
- University of Leeds, Academic Unit of Palliative Care, Leeds, UK
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Harnas SJ, Knoop H, Bennebroek Evertsz F, Booij SH, Dekker J, van Laarhoven HWM, van der Lee M, Meijer E, Sharpe L, Sprangers MAG, van Straten A, Zweegman S, Braamse AMJ. Personalized versus standard cognitive behavioral therapy for fear of cancer recurrence, depressive symptoms or cancer-related fatigue in cancer survivors: study protocol of a randomized controlled trial (MATCH-study). Trials 2021; 22:696. [PMID: 34641961 PMCID: PMC8507219 DOI: 10.1186/s13063-021-05657-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/27/2021] [Indexed: 11/12/2022] Open
Abstract
Background Fear of cancer recurrence, depressive symptoms, and cancer-related fatigue are prevalent symptoms among cancer survivors, adversely affecting patients’ quality of life and daily functioning. Effect sizes of interventions targeting these symptoms are mostly small to medium. Personalizing treatment is assumed to improve efficacy. However, thus far the empirical support for this approach is lacking. The aim of this study is to investigate if systematically personalized cognitive behavioral therapy is more efficacious than standard cognitive behavioral therapy in cancer survivors with moderate to severe fear of cancer recurrence, depressive symptoms, and/or cancer-related fatigue. Methods The study is designed as a non-blinded, multicenter randomized controlled trial with two treatment arms (ratio 1:1): (a) systematically personalized cognitive behavioral therapy and (b) standard cognitive behavioral therapy. In the standard treatment arm, patients receive an evidence-based diagnosis-specific treatment protocol for fear of cancer recurrence, depressive symptoms, or cancer-related fatigue. In the second arm, treatment is personalized on four dimensions: (a) the allocation of treatment modules based on ecological momentary assessments, (b) treatment delivery, (c) patients’ needs regarding the symptom for which they want to receive treatment, and (d) treatment duration. In total, 190 cancer survivors who experience one or more of the targeted symptoms and ended their medical treatment with curative intent at least 6 months to a maximum of 5 years ago will be included. Primary outcome is limitations in daily functioning. Secondary outcomes are level of fear of cancer recurrence, depressive symptoms, fatigue severity, quality of life, goal attainment, therapist time, and drop-out rates. Participants are assessed at baseline (T0), and after 6 months (T1) and 12 months (T2). Discussion To our knowledge, this is the first randomized controlled trial comparing the efficacy of personalized cognitive behavioral therapy to standard cognitive behavioral therapy in cancer survivors. The study has several innovative characteristics, among which is the personalization of interventions on several dimensions. If proven effective, the results of this study provide a first step in developing an evidence-based framework for personalizing therapies in a systematic and replicable way. Trial registration The Dutch Trial Register (NTR) NL7481 (NTR7723). Registered on 24 January 2019.
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Affiliation(s)
- Susan J Harnas
- Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Hans Knoop
- Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Floor Bennebroek Evertsz
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sanne H Booij
- Department of Developmental Psychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands.,Center for Integrative Psychiatry, Lentis, Groningen, the Netherlands
| | - Joost Dekker
- Department of Psychiatry, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marije van der Lee
- Research Department, Center for Psycho-Oncology, Helen Dowling Institute, Bilthoven, the Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University Tilburg School of Social and Behavioral Sciences, Tilburg, the Netherlands
| | - Ellen Meijer
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Louise Sharpe
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology & Amsterdam Public Health Research Institute, VU University, Amsterdam, the Netherlands
| | - Sonja Zweegman
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Annemarie M J Braamse
- Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Patterson JM, Lu L, Watson LJ, Harding S, Ness AR, Thomas S, Waylen A, Pring M, Waterboer T, Sharp L. Associations between markers of social functioning and depression and quality of life in survivors of head and neck cancer: Findings from the Head and Neck Cancer 5000 study. Psychooncology 2021; 31:478-485. [PMID: 34591369 DOI: 10.1002/pon.5830] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate associations between markers of social functioning (trouble with social eating and social contact), depression and health-related quality of life (QOL) among head and neck cancer survivors. METHODS This cross-sectional analysis included individuals with oral cavity, oropharynx, larynx, salivary gland and thyroid cancers from Head and Neck 5000 alive at 12 months. Trouble with social eating and social contact were measured using items from EORTC QLQ-H&N35 and QOL using EORTC QLQ-C30; responses were converted into a score of 0-100, with a higher score equalling more trouble or better QOL. A HADS subscale score of ≥8 was considered significant depression. Associations between tertiles of trouble with social eating and social contact and depression and QoL were assessed using multivariable logistic and linear regression (with robust errors), respectively. RESULTS Of 2561 survivors, 23% reported significant depression. The median QOL score was 75.0 (interquartile range 58.3-83.3). For trouble with social eating, after confounder adjustment, those in the intermediate and highest tertiles had higher odds of depression (intermediate: OR = 4.5, 95% CI 3.19-6.45; high: OR = 21.8, 15.17-31.18) and lower QOL (intermediate:β = -8.7, 95% CI -10.35 to -7.14; high: β = -24.8, -26.91 to -22.77). Results were similar for trouble with social contact. CONCLUSION We found strong clinically important associations between markers of social functioning and depression and QOL. More effective interventions addressing social eating and contact are required. These may help survivors regain their independence, reduce levels of isolation and loneliness, and depression, and improve QOL outcomes generally.
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Affiliation(s)
- Joanne M Patterson
- Liverpool Head and Neck Centre, School of Health Science, University of Liverpool, Liverpool, UK
| | - Liya Lu
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | | | - Sam Harding
- Bristol Speech and Language Therapy Research Unit, Southmead Hospital North Bristol NHS Hospital Trust, Bristol, UK
| | - Andy R Ness
- NIHR Bristol Biomedical Research Centre, University of Bristol and Weston NHS Foundation Trust and University of Bristol, UK and Bristol Dental School, University of Bristol, Bristol, UK.,Bristol Dental School, University of Bristol, Bristol, UK
| | - Steve Thomas
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Andrea Waylen
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Miranda Pring
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
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Ichikura K, Nakayama N, Matsuoka S, Ariizumi Y, Sumi T, Sugimoto T, Fukase Y, Murayama N, Tagaya H, Asakage T, Matsushima E. Efficacy of stress management program for depressive patients with advanced head and neck cancer: A single-center pilot study. Int J Clin Health Psychol 2020; 20:213-221. [PMID: 32994794 PMCID: PMC7501452 DOI: 10.1016/j.ijchp.2020.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/05/2020] [Indexed: 12/26/2022] Open
Abstract
Background/Objective Patients with head and neck cancer (HNC) have some problems such as dysfunction of breathing, eating, and/or speaking. The aim of this study was to examine efficacy of the stress management program for HNC patients (SMAP-HNC) compared with usual care (UC). Method We conducted a pilot study of SMAP-HNC for depressive HNC patients between January 2016 and March 2018. The program contains psychoeducation, stress coping training, and operant reinforcement. The outcome measure was the Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Cancer Therapy (FACT), and Brief Coping Inventory (COPE). Results Twenty patients were randomly assigned to SMAP-HNC and UC group. Although a small sample sizes, there was no significant difference of depression score change between SMAP-HNC and UC group (Hedges’d g -0.83; 95% CI -1.80 to 0.13). Conclusions It was the first study to conduct stress management program for HNC patients. Unfortunately, our trial designed as a randomized controlled trial is underpowered to make conclusion as to the efficacy of SMAP-HNC. However, there are some valuable suggestions to modify the stress management program in future.
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Affiliation(s)
- Kanako Ichikura
- Department of Health Sciences, School of Allied Health Sciences, Kitasato University, Japan.,Liaison Psychiatry and Psycho-oncology Unit, Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Nao Nakayama
- Department of Psychosomatic and Palliative Medicine, Medical Hospital, Tokyo Medical and Dental University, Japan
| | - Shiho Matsuoka
- Liaison Psychiatry and Psycho-oncology Unit, Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Yosuke Ariizumi
- Section of Head and Neck Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Takuro Sumi
- Section of Head and Neck Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Taro Sugimoto
- Section of Head and Neck Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan.,Department of Otolaryngology-Head and Neck Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Yuko Fukase
- Department of Health Sciences, School of Allied Health Sciences, Kitasato University, Japan
| | - Norio Murayama
- Department of Health Sciences, School of Allied Health Sciences, Kitasato University, Japan.,Department of Health Science, School of Health and Sports Science, Juntendo University, Japan
| | - Hirokuni Tagaya
- Department of Health Sciences, School of Allied Health Sciences, Kitasato University, Japan
| | - Takahiro Asakage
- Section of Head and Neck Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Eisuke Matsushima
- Liaison Psychiatry and Psycho-oncology Unit, Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
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10
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Patterson JM. Psychological Interventions for the Head and Neck Cancer Population Who Are Experiencing Dysphagia. ACTA ACUST UNITED AC 2019. [DOI: 10.1044/2019_pers-sig13-2019-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Joanne M. Patterson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Speech and Language Therapy, Sunderland Royal Hospital, United Kingdom
- School of Health Sciences, University of Liverpool, United Kingdom
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11
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Malibiran R, Tariman JD, Amer K. Bibliotherapy: Appraisal of Evidence for Patients Diagnosed With Cancer. Clin J Oncol Nurs 2019; 22:377-380. [PMID: 30035795 DOI: 10.1188/18.cjon.377-380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An appraisal of the evidence on the efficacy of bibliotherapy on anxiety, distress, and coping in patients with cancer is lacking in the literature. Bibliotherapy is a self-help intervention using a variety of tools, such as self-help workbooks, pamphlets, novels, and audiobooks, to improve mental health. This review identified nine original research articles that examined bibliotherapy as an intervention to alleviate the psychological issues associated with a cancer diagnosis. Data synthesis from these studies provides preliminary evidence that bibliotherapy is an acceptable and beneficial adjunct therapy for patients with cancer experiencing anxiety, depression, and ineffective coping.
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12
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van Uden-Kraan CF, Jansen F, Lissenberg-Witte BI, Eerenstein SEJ, Leemans CR, Verdonck-de Leeuw IM. Health-related and cancer-related Internet use by patients treated with total laryngectomy. Support Care Cancer 2019; 28:131-140. [PMID: 30993449 PMCID: PMC6892363 DOI: 10.1007/s00520-019-04757-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/18/2019] [Indexed: 01/28/2023]
Abstract
Objectives To investigate among patients treated with a total laryngectomy (TL) (1) Internet-use and Internet use to search for information on health and cancer (content); (2) which patients are most likely to use the Internet in general, for health-related and cancer-related purposes; (3) which other types of eHealth (community, communication, care) are used; and (4) preferences towards future use. Methods Patient members of the Dutch TL patient society were asked to complete a questionnaire on Internet use, health-related and cancer-related Internet use, types of eHealth, preferences towards future use, socio-demographics, clinical factors, and quality of life (QOL). Factors associated with Internet use and health-related and cancer-related Internet use were investigated using stepwise logistic regression analysis. Results In total, 279 TL patients participated, of whom 68% used the Internet. Of these, 63% used the Internet to search for information on health and 49% on cancer. Younger and higher educated TL patients and those with better QOL used the Internet more often. Patients with worse QOL searched more often for health-related information. Younger patients and those with shorter time since TL searched more often for cancer-related information. The current use of eHealth for communication, community, and care purposes among Internet users was limited (range, 2 to 15%). Many were interested in using these types of eHealth in the future (range, 21 to 72%). Conclusion The majority used the Internet, especially to search for information on health and cancer, but only few for communication, community, or care purposes. Many were interested in future use.
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Affiliation(s)
- Cornelia F van Uden-Kraan
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Femke Jansen
- Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Simone E J Eerenstein
- Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - C René Leemans
- Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.
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13
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Richardson AE, Broadbent E, Morton RP. A systematic review of psychological interventions for patients with head and neck cancer. Support Care Cancer 2019; 27:2007-2021. [PMID: 30937599 DOI: 10.1007/s00520-019-04768-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/21/2019] [Indexed: 01/30/2023]
Abstract
AIM The purpose of this systematic review is to identify psychological interventions that have been effective at improving quality of life and reducing psychological distress (depression and anxiety) in patients with head and neck cancer. METHODS All relevant peer-reviewed articles published between March 1980 and March 2017 were identified through an electronic search of five databases: Medline, Embase, PsycINFO, Scopus, and Academic Search Complete. Risk of bias was independently assessed by two reviewers using the Crowe Critical Appraisal Tool (CCAT). Following this, a narrative synthesis of the findings was completed. RESULTS Twenty-one unique intervention studies were identified. Interventions tested included cognitive behavioural therapy (CBT), psychoeducation, meditation/mindfulness, group therapy, and telehealth initiatives. Ten studies utilised a randomised controlled design. Five of these investigated CBT and three examined psychoeducation, with the greatest empirical support found for these intervention types. However, the majority of studies were underpowered to detect significant effects and did not examine whether improvements in quality of life and psychological well-being were sustained over time. CONCLUSIONS Further research is needed to investigate the effects of psychological interventions among patients with head and neck cancer, using randomised controlled designs, adequately powered samples, and long-term follow-up. This would allow evidence-based recommendations to be made regarding the most appropriate interventions to implement in clinical practice. TRIAL REGISTRATION CRD42017069851.
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Affiliation(s)
- Amy E Richardson
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Elizabeth Broadbent
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Randall P Morton
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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14
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Psychosocial Distress and Distress Screening in Multidisciplinary Head and Neck Cancer Treatment. Otolaryngol Clin North Am 2018; 50:807-823. [PMID: 28755706 DOI: 10.1016/j.otc.2017.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Psychosocial distress screening (DS) for cancer and head and neck cancer (HNC) patients is rapidly becoming the standard of care. DS is of particular importance for patients with HNC, given their heightened incidence of distress, depression, anxiety, suicide, quality of life impacts, and negative medical outcomes. In the absence of DS, distress is frequently missed in oncology settings. However, when identified, distress is highly responsive to treatment, with cognitive behavioral and behavioral medicine interventions demonstrating evidence of efficacy. Multidisciplinary HNC teams are uniquely positioned to implement effective DS programs and treatment tailored to HNC patients' psychological and medical vulnerabilities.
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15
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A Self-Regulatory Intervention for Patients with Head and Neck Cancer: Pilot Randomized Trial. Ann Behav Med 2018; 51:629-641. [PMID: 28244003 DOI: 10.1007/s12160-017-9885-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Research is yet to investigate whether psychological interventions delivered early after diagnosis can benefit patients with head and neck cancer (HNC). PURPOSE The aim of this study was to investigate the effectiveness of a brief self-regulatory intervention (targeting illness perceptions and coping) at improving HNC patient health-related quality of life (HRQL). METHODS A pilot randomized controlled trial was conducted, in which 64 patients were assigned to receive three sessions with a health psychologist in addition to standard care or standard care alone. Participants completed questionnaires assessing HRQL, general distress, and illness perceptions at baseline and again 3 and 6 months later. RESULTS Compared to the control group, patients who received the intervention had increased treatment control perceptions at 3 months (p = .01), and increased social quality of life at 6 months (p = .01). The intervention was particularly helpful for patients exhibiting distress at baseline. CONCLUSION A brief psychological intervention following HNC diagnosis can improve patient perceptions of treatment and social quality of life over time. Such interventions could be targeted to patients who are distressed in order to confer the greatest benefit. TRIAL REGISTRATION NUMBER 12614000813684.
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16
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Patterson JM, Fay M, Exley C, McColl E, Breckons M, Deary V. Feasibility and acceptability of combining cognitive behavioural therapy techniques with swallowing therapy in head and neck cancer dysphagia. BMC Cancer 2018. [PMID: 29291726 DOI: 10.1186/s12885‐017‐3892‐2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Head and neck cancer squamous cell carcinoma (HNSSC) patients report substantial rates of clinically significant depression and/or anxiety, with dysphagia being a predictor of distress and poorer quality of life. Evidence-based dysphagia interventions largely focus on the remediation of physical impairment. This feasibility study evaluates an intervention which simultaneously uses a psychological therapy approach combined with swallowing impairment rehabilitation. METHODS This prospective single cohort mixed-methods study, recruited HNSCC patients with dysphagia, from two institutions. The intervention combined Cognitive Behavioural Therapy with swallowing therapy (CB-EST), was individually tailored, for up to 10 sessions and delivered by a speech and language therapist. Primary acceptability and feasibility measures included recruitment and retention rates, data completion, intervention fidelity and the responsiveness of candidate outcome measures. Measures included a swallowing questionnaire (MDADI), EORTC-QLQH&N35, dietary restrictions scale, fatigue and function scales and the Hospital Anxiety and Depression Scale (HADS), administered pre-, post-CB-EST with three month follow-up and analysed using repeated measures ANOVA. Qualitative interviews were conducted to evaluate intervention processes. RESULTS A total of 30/43 (70%) eligible patients agreed to participate and 25 completed the intervention. 84% were male, mean age 59 yrs. Patients were between 1 and 60 months (median 4) post-cancer treatment. All patients had advanced stage disease, treated with surgery and radiotherapy (38%) or primary chemoradiotherapy (62%). Pre to post CB-EST data showed improvements in MDADI scores (p = 0.002), EORTC-QLQH&N35 (p = 0.006), dietary scale (p < 0.0001), fatigue (p = 0.002) but no change in function scales or HADS. Barriers to recruitment were the ability to attend regular appointments and patient suitability or openness to a psychological-based intervention. CONCLUSIONS CB-EST is a complex and novel intervention, addressing the emotional, behavioural and cognitive components of dysphagia alongside physical impairment. Preliminary results are promising. Further research is required to evaluate efficacy and effectiveness.
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Affiliation(s)
- J M Patterson
- Institute of Health and Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK. .,Speech & Language Therapy Department, Sunderland Royal Hospital, Sunderland, UK.
| | | | - C Exley
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - E McColl
- Institute of Health and Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - M Breckons
- Institute of Health and Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - V Deary
- Psychology Department, Northumbria University, Newcastle upon Tyne, UK
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17
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Feasibility and acceptability of combining cognitive behavioural therapy techniques with swallowing therapy in head and neck cancer dysphagia. BMC Cancer 2018; 18:1. [PMID: 29291726 PMCID: PMC5748941 DOI: 10.1186/s12885-017-3892-2] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 12/08/2017] [Indexed: 11/25/2022] Open
Abstract
Background Head and neck cancer squamous cell carcinoma (HNSSC) patients report substantial rates of clinically significant depression and/or anxiety, with dysphagia being a predictor of distress and poorer quality of life. Evidence-based dysphagia interventions largely focus on the remediation of physical impairment. This feasibility study evaluates an intervention which simultaneously uses a psychological therapy approach combined with swallowing impairment rehabilitation. Methods This prospective single cohort mixed-methods study, recruited HNSCC patients with dysphagia, from two institutions. The intervention combined Cognitive Behavioural Therapy with swallowing therapy (CB-EST), was individually tailored, for up to 10 sessions and delivered by a speech and language therapist. Primary acceptability and feasibility measures included recruitment and retention rates, data completion, intervention fidelity and the responsiveness of candidate outcome measures. Measures included a swallowing questionnaire (MDADI), EORTC-QLQH&N35, dietary restrictions scale, fatigue and function scales and the Hospital Anxiety and Depression Scale (HADS), administered pre-, post-CB-EST with three month follow-up and analysed using repeated measures ANOVA. Qualitative interviews were conducted to evaluate intervention processes. Results A total of 30/43 (70%) eligible patients agreed to participate and 25 completed the intervention. 84% were male, mean age 59 yrs. Patients were between 1 and 60 months (median 4) post-cancer treatment. All patients had advanced stage disease, treated with surgery and radiotherapy (38%) or primary chemoradiotherapy (62%). Pre to post CB-EST data showed improvements in MDADI scores (p = 0.002), EORTC-QLQH&N35 (p = 0.006), dietary scale (p < 0.0001), fatigue (p = 0.002) but no change in function scales or HADS. Barriers to recruitment were the ability to attend regular appointments and patient suitability or openness to a psychological-based intervention. Conclusions CB-EST is a complex and novel intervention, addressing the emotional, behavioural and cognitive components of dysphagia alongside physical impairment. Preliminary results are promising. Further research is required to evaluate efficacy and effectiveness.
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18
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Calver L, Tickle A, Moghaddam N, Biswas S. The effect of psychological interventions on quality of life in patients with head and neck cancer: A systematic review and meta-analysis. Eur J Cancer Care (Engl) 2017; 27. [PMID: 29094780 DOI: 10.1111/ecc.12789] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2017] [Indexed: 12/01/2022]
Abstract
This systematic review and meta-analysis aimed to evaluate the effectiveness of psychological interventions in improving quality of life for head and neck cancer patients. Five databases were systematically searched in July 2016. Studies were included if they reported original empirical data from intervention studies utilising psychological approaches (excluding psychoeducational-only interventions) and provided data on quality of life outcomes. Six studies, involving 185 participants, fulfilled eligibility criteria. Study designs included a case study, single-group designs, non-randomised controlled trials and one randomised controlled trial. Meta-analysis of two studies did not provide support for the effectiveness of psychological intervention improving total quality of life scores (or subscales) compared to control groups at end of intervention. Intervention studies evaluating psychological interventions for patients with head and neck cancer have produced insufficient data to support their effectiveness for improving quality of life. This review further highlights the limited evidence base within this area. Existing studies are based on small samples and are inconsistent regarding: intervention type, duration and intensity; follow-up measurement periods; and methodological quality. Further research, addressing these limitations, is required for more definitive conclusions to be drawn about the effectiveness of psychological interventions with this population.
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Affiliation(s)
- L Calver
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - A Tickle
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - N Moghaddam
- Trent DClinPsy Programme, University of Lincoln, Lincoln, UK
| | - S Biswas
- King's Mill Hospital, Nottinghamshire Healthcare NHS Foundation Trust, Sutton-in-Ashfield, UK
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19
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Psychological management for head and neck cancer patients: United Kingdom National Multidisciplinary Guidelines. The Journal of Laryngology & Otology 2017; 130:S45-S48. [PMID: 27841113 PMCID: PMC4873900 DOI: 10.1017/s0022215116000426] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It provides recommendations on the assessment and interventions for the psychological management in this patient group. Recommendations • Audit of information supplied to patients and carers should be conducted on an annual basis to update and review content and media presentation. (G) • Patients and carers should be invited to discuss treatment options and relate possible outcomes to functional retention or loss to provide a patient-centred approach. (G) • Clinical staff should inspect their systems of assessment to make them sensitive enough to identify patients with psychological difficulties. (G) • Flexibility, rather than rigid formulation is required to assess patients frequently, and to allow for change in circumstances to be noted. (G) • Multidisciplinary teams should determine the supportive care services available and commission extra assistance to provide patients and carers with timely information, education or brief supportive advice. (G) • Multidisciplinary teams need to inspect specialist services for mental health interventions at structured and complex levels for the small proportion of patients with more serious, but rarer, psychological difficulties. (G) • Clinical staff at all levels should receive communication skills training to raise and maintain consultation expertise with difficult patient and/or carer interactions. (G).
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20
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Kalavrezos N, Scully C. Mouth cancer for clinicians part 13: life after mouth cancer treatment. ACTA ACUST UNITED AC 2016; 43:672-4, 677-8, 681-2, 684-6. [DOI: 10.12968/denu.2016.43.7.672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nicholas Kalavrezos
- Maxillofacial and Reconstructive Surgeon of The Head, Face and Neck, University College London Hospital and The Harley Street Clinic. Assistant Secretary, European Association of Cranio-Maxillofacial Surgery, UCL, London, UK
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21
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Brebach R, Sharpe L, Costa DSJ, Rhodes P, Butow P. Psychological intervention targeting distress for cancer patients: a meta-analytic study investigating uptake and adherence. Psychooncology 2016; 25:882-90. [PMID: 26893285 DOI: 10.1002/pon.4099] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Although cancer care guidelines recommend screening for distress among cancer patients and offering psychological support when indicated, many patients decline offers of such support. This study aimed to quantify uptake and adherence to psychological support and to identify predictors of each. METHODS Searches were conducted in Embase, Medline, PsychInfo and Scopus to identify studies reporting uptake or adherence rates for individual psychological interventions targeting distress, anxiety or depression for cancer patients or survivors. RESULTS Across the 53 included studies reporting uptake and/or adherence rates for 12 323 cancer patients, the uptake and adherence rates were 60.1% and 90.4%, respectively. Patients screened and identified as distressed were less likely to accept intervention than unselected patients (50.3% compared with 66.3%, Q(1) = 4.66, P = 0.031). Uptake of therapy was higher for interventions delivered by telephone rather than face-to-face (71.2% compared with 53.8%, Q(1) = 4.91, P = 0.027) and when therapy was offered prior to medical treatment compared with later (72.9% compared with 56.8%, Q(1) = 5.60, P = 0.018). Patients were more likely to accept intervention from nurses than other allied health professionals (68.3% compared with 50.5%, Q(1) = 5.76, P = 0.016). CONCLUSIONS Patients appeared more receptive to interventions offered near diagnosis, over the telephone and by nurses. Although this suggests higher acceptability of such interventions, evidence of their greater efficacy is lacking, and this merits further investigation. Research is needed to understand barriers to acceptance of psychological support, particularly because uptake rates were lower for distressed patients. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Rachel Brebach
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel S J Costa
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul Rhodes
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Phyllis Butow
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,PoCoG & CeMPED, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,SoURCe, Institute of Surgery, Sydney, New South Wales, Australia
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22
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de Boer AGEM, Taskila TK, Tamminga SJ, Feuerstein M, Frings‐Dresen MHW, Verbeek JH. Interventions to enhance return-to-work for cancer patients. Cochrane Database Syst Rev 2015; 2015:CD007569. [PMID: 26405010 PMCID: PMC6483290 DOI: 10.1002/14651858.cd007569.pub3] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cancer patients are 1.4 times more likely to be unemployed than healthy people. Therefore it is important to provide cancer patients with programmes to support the return-to-work (RTW) process. This is an update of a Cochrane review first published in 2011. OBJECTIVES To evaluate the effectiveness of interventions aimed at enhancing RTW in cancer patients compared to alternative programmes including usual care or no intervention. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, in the Cochrane Library Issue 3, 2014), MEDLINE (January 1966 to March 2014), EMBASE (January 1947 to March 2014), CINAHL (January 1983 to March, 2014), OSH-ROM and OSH Update (January 1960 to March, 2014), PsycINFO (January 1806 to 25 March 2014), DARE (January 1995 to March, 2014), ClinicalTrials.gov, Trialregister.nl and Controlled-trials.com up to 25 March 2014. We also examined the reference lists of included studies and selected reviews, and contacted authors of relevant studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) of the effectiveness of psycho-educational, vocational, physical, medical or multidisciplinary interventions enhancing RTW in cancer patients. The primary outcome was RTW measured as either RTW rate or sick leave duration measured at 12 months' follow-up. The secondary outcome was quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, assessed the risk of bias and extracted data. We pooled study results we judged to be clinically homogeneous in different comparisons reporting risk ratios (RRs) with 95% confidence intervals (CIs). We assessed the overall quality of the evidence for each comparison using the GRADE approach. MAIN RESULTS Fifteen RCTs including 1835 cancer patients met the inclusion criteria and because of multiple arms studies we included 19 evaluations. We judged six studies to have a high risk of bias and nine to have a low risk of bias. All included studies were conducted in high income countries and most studies were aimed at breast cancer patients (seven trials) or prostate cancer patients (two trials).Two studies involved psycho-educational interventions including patient education and teaching self-care behaviours. Results indicated low quality evidence of similar RTW rates for psycho-educational interventions compared to care as usual (RR 1.09, 95% CI 0.88 to 1.35, n = 260 patients) and low quality evidence that there is no difference in the effect of psycho-educational interventions compared to care as usual on quality of life (standardised mean difference (SMD) 0.05, 95% CI -0.2 to 0.3, n = 260 patients). We did not find any studies on vocational interventions. In one study breast cancer patients were offered a physical training programme. Low quality evidence suggested that physical training was not more effective than care as usual in improving RTW (RR 1.20, 95% CI 0.32 to 4.54, n = 28 patients) or quality of life (SMD -0.37, 95% CI -0.99 to 0.25, n = 41 patients).Seven RCTs assessed the effects of a medical intervention on RTW. In all studies a less radical or functioning conserving medical intervention was compared with a more radical treatment. We found low quality evidence that less radical, functioning conserving approaches had similar RTW rates as more radical treatments (RR 1.04, 95% CI 0.96 to 1.09, n = 1097 patients) and moderate quality evidence of no differences in quality of life outcomes (SMD 0.10, 95% CI -0.04 to 0.23, n = 1028 patients).Five RCTs involved multidisciplinary interventions in which vocational counselling was combined with patient education, patient counselling, and biofeedback-assisted behavioral training or physical exercises. Moderate quality evidence showed that multidisciplinary interventions involving physical, psycho-educational and vocational components led to higher RTW rates than care as usual (RR 1.11, 95% CI 1.03 to 1.16, n = 450 patients). We found no differences in the effect of multidisciplinary interventions compared to care as usual on quality of life outcomes (SMD 0.03, 95% CI -0.20 to 0.25, n = 316 patients). AUTHORS' CONCLUSIONS We found moderate quality evidence that multidisciplinary interventions enhance the RTW of patients with cancer.
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Affiliation(s)
- Angela GEM de Boer
- Academic Medical CentreCoronel Institute of Occupational HealthMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Tyna K Taskila
- The Work FoundationCentre for Workforce Effectiveness21 Palmer StreetLondonUKSW1V 3PF
| | - Sietske J Tamminga
- Academic Medical CentreCoronel Institute of Occupational HealthMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Michael Feuerstein
- Uniformed Services University of the Health SciencesDepartments of Medical and Clinical Psychology and Preventive Medicine and Biometrics4301 Jones Bridge RoadBethesdaUSAMD 20814‐4799
| | - Monique HW Frings‐Dresen
- Academic Medical Center, University of AmsterdamCoronel Institute of Occupational Health and Research Center for Insurance MedicineMeibergdreef 9PO Box 22700AmsterdamNetherlands1100 DE
| | - Jos H Verbeek
- Finnish Institute of Occupational HealthCochrane Work Review GroupPO Box 310KuopioFinland70101
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Norman A, Moss TP. Psychosocial interventions for adults with visible differences: a systematic review. PeerJ 2015; 3:e870. [PMID: 25861556 PMCID: PMC4389275 DOI: 10.7717/peerj.870] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/10/2015] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED Background. Some individuals with visible differences have been found to experience psychosocial adjustment problems that can lead to social anxiety and isolation. Various models of psychosocial intervention have been used to reduce social anxiety and appearance related distress in this population. The objective of this review was to update a previous systematic review assessing the efficacy of psychosocial intervention programs for adults with visible differences. The original review (Bessell & Moss, 2007) identified 12 papers for inclusion. Methods. A search protocol identified studies from 13 electronic journal databases. METHODS Studies were selected in accordance with pre-set inclusion criteria and relevant data were extracted. Results. This update identified an additional four papers that met the inclusion criteria. Two papers provided very limited evidence for the efficacy of a combined cognitive-behavioural and social skills training approach. None of the papers provided sufficient evidence for the optimal duration, intensity or setting of psychosocial interventions for this population. Discussion. The review concluded that a greater number of Randomised Controlled Trials and experimental studies were required to increase the methodological validity of intervention studies.
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Affiliation(s)
- Alyson Norman
- School of Psychology, Plymouth University , Portland Square, Drake Circus, Plymouth , UK
| | - Timothy P Moss
- Centre for Appearance Research, University of the West of England, Frenchay Campus , Bristol , UK
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Moderators of the response to a nurse-led psychosocial intervention to reduce depressive symptoms in head and neck cancer patients. Support Care Cancer 2015; 23:2417-26. [PMID: 25612795 PMCID: PMC4483179 DOI: 10.1007/s00520-015-2603-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 01/05/2015] [Indexed: 11/26/2022]
Abstract
Purpose Little is known about the variables that moderate the response to psychosocial interventions to decrease depressive symptoms in cancer patients. The purpose of this study was to determine whether variables associated with depressive symptoms in cancer patients in general moderate the response to a nurse-led psychosocial intervention in patients with head and neck cancer. Methods This study is a secondary analysis of a randomized controlled trial evaluating the effect of the nurse counseling and after intervention (NUCAI) on depressive symptoms 12 months after cancer treatment in patients with head and neck cancer. Of 205 patients, 103 received the NUCAI and 102 care as usual. Twenty-one variables were selected for analysis and a linear regression analyses including interaction terms was performed for each variable separately. Significant moderators were post hoc probed. Results Four moderators were found: marital status, global quality of life, emotional functioning, and social functioning. Patients who were married/living together or had low scores for global quality of life, and emotional or social functioning at baseline benefited more from the NUCAI than patients who were single or with high scores for global quality of life and emotional or social functioning. Conclusions Marital status, global quality of life, and emotional and social functioning of head and neck cancer patients should be evaluated to determine whether they might benefit from a psychosocial intervention to combat depressive symptoms. Further research is necessary to replicate results and to contribute to the knowledge needed to make screening and personalized patient care possible.
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Moubayed SP, Sampalis JS, Ayad T, Guertin L, Bissada E, Gologan OE, Soulières D, Lambert L, Filion E, Nguyen-Tan PF, Christopoulos A. Predicting depression and quality of life among long-term head and neck cancer survivors. Otolaryngol Head Neck Surg 2014; 152:91-7. [PMID: 25395572 DOI: 10.1177/0194599814557772] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study is to identify clinical factors that are predictive of depression and quality of life (QOL) among long-term survivors of head and neck squamous cell carcinoma and to develop predictive scores using these factors. STUDY DESIGN Cohort study SETTING Tertiary referral center. SUBJECTS AND METHODS A total of 209 posttreatment (median follow-up, 38.7 months) head and neck cancer patients were prospectively evaluated using the Hospital Anxiety Depression Scale (HADS), the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30, and the EORTC Quality of Life Questionnaire Head and Neck 35, and pretreatment patient-related, tumor-related, and treatment-related predictors were identified using chart review. Bivariate (χ(2) and t test) and multivariate (linear regression) analyses were used to construct predictive models. RESULTS Significant pretreatment predictors of depression were identified on multivariate analysis as smoking at diagnosis, >14 alcoholic drinks per week, T3 or T4 status, and >3 medications (P < .001). Two or more of these factors yielded an 82.3% sensitivity in detecting significant depressive symptoms (defined as a HADS cutoff score of 5). Significant predictors of fatigue, global health/QOL, social contact, speech, pain, swallowing, and xerostomia were also identified. CONCLUSION Pretreatment predictors of long-term depression and QOL have been defined using multivariate models, and an easily applicable predictive score of long-term depression is proposed. Potential eventual clinical applications include prophylactic intervention in at-risk patients.
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Affiliation(s)
- Sami P Moubayed
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada Division of Surgical Research, Department of Surgery, McGill University, Montreal, Canada
| | - John S Sampalis
- Division of Surgical Research, Department of Surgery, McGill University, Montreal, Canada
| | - Tareck Ayad
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada
| | - Louis Guertin
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada
| | - Eric Bissada
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada
| | - Olguta E Gologan
- Department of Pathology, Université de Montréal Hospital Center, Montreal, Canada
| | - Denis Soulières
- Medical Oncology Service, Université de Montréal Hospital Center, Montreal, Canada
| | - Louise Lambert
- Department of Radiation Oncology, Université de Montréal Hospital Center, Montreal, Canada
| | - Edith Filion
- Department of Radiation Oncology, Université de Montréal Hospital Center, Montreal, Canada
| | - Phuc Felix Nguyen-Tan
- Department of Radiation Oncology, Université de Montréal Hospital Center, Montreal, Canada
| | - Apostolos Christopoulos
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada
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Capozzi LC, Boldt KR, Lau H, Shirt L, Bultz B, Culos-Reed SN. A clinic-supported group exercise program for head and neck cancer survivors: managing cancer and treatment side effects to improve quality of life. Support Care Cancer 2014; 23:1001-7. [PMID: 25256377 DOI: 10.1007/s00520-014-2436-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 09/08/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of the evaluation of this clinic-supported 12-week progressive strength-training program was to assess the feasibility and impact of an exercise intervention for head and neck cancer (HNC) survivors. METHODS Recruitment and adherence feasibility, as well as health-related fitness measures and patient-reported symptom management were assessed on the 21 HNC survivors in the exercise program. RESULTS Overall, this program was feasible, as indicated by recruitment, adherence, and safety outcomes. Survivors experienced improved acute symptom management over the period of one exercise class for tiredness, depression, anxiety, drowsiness, and overall wellbeing. Over the course of the program, survivors experienced significant improvements in physical functioning outcomes and improved management of tiredness and fatigue. CONCLUSIONS A progressive strength-training program is feasible for HNC survivors on and following treatment and is associated with improved acute and chronic fitness outcomes and symptom management.
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Affiliation(s)
- Lauren C Capozzi
- Faculty of Kinesiology, University of Calgary, KNB 2229 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
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Turner J, Yates P, Kenny L, Gordon LG, Burmeister B, Thomson D, Hughes B, McCarthy AL, Perry C, Chan RJ, Fraser A, Skerman H, Batstone M, Carswell K. The ENHANCES study--Enhancing Head and Neck Cancer patients' Experiences of Survivorship: study protocol for a randomized controlled trial. Trials 2014; 15:191. [PMID: 24885486 PMCID: PMC4053405 DOI: 10.1186/1745-6215-15-191] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/07/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Few cancers pose greater challenges than head and neck (H&N) cancer. Residual effects following treatment include body image changes, pain, fatigue and difficulties with appetite, swallowing and speech. Depression is a common comorbidity. There is limited evidence about ways to assist patients to achieve optimal adjustment after completion of treatment. In this study, we aim to examine the effectiveness and feasibility of a model of survivorship care to improve the quality of life of patients who have completed treatment for H&N cancer. METHODS/DESIGN This is a preliminary study in which 120 patients will be recruited. A prospective randomised controlled trial of the H&N Cancer Survivor Self-management Care Plan (HNCP) involving pre- and post-intervention assessments will be used. Consecutive patients who have completed a defined treatment protocol for H&N cancer will be recruited from two large cancer services and randomly allocated to one of three study arms: (1) usual care, (2) information in the form of a written resource or (3) the HNCP delivered by an oncology nurse who has participated in manual-based training and skill development in patient self-management support. The trained nurses will meet patients in a face-to-face interview lasting up to 60 minutes to develop an individualised HNCP, based on principles of chronic disease self-management. Participants will be assessed at baseline, 3 and 6 months. The primary outcome measure is quality of life. The secondary outcome measures include mood, self-efficacy and health-care utilisation. The feasibility of implementing this intervention in routine clinical care will be assessed through semistructured interviews with participating nurses, managers and administrators. Interviews with patients who received the HNCP will explore their perceptions of the HNCP, including factors that assisted them in achieving behavioural change. DISCUSSION In this study, we aim to improve the quality of life of a patient population with unique needs by means of a tailored self-management care plan developed upon completion of treatment. Delivery of the intervention by trained oncology nurses is likely to be acceptable to patients and, if successful, will be a model of care that can be implemented for diverse patient populations. TRIAL REGISTRATION ACTRN12613000542796 (registered on 15 May 2013).
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Affiliation(s)
- Jane Turner
- School of Medicine, University of Queensland, Herston Rd, Herston, QLD 4029, Australia
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston Rd, Herston, QLD 4029, Australia
| | - Patsy Yates
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Ave, Kelvin Grove, QLD 4059, Australia
| | - Lizbeth Kenny
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston Rd, Herston, QLD 4029, Australia
| | - Louisa G Gordon
- Centre for Applied Health Economics, Griffith Health Institute, Griffith University, University Drive, Meadowbrook, QLD 4131, Australia
| | - Bryan Burmeister
- Cancer Care Services, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD 4101, Australia
| | - Damien Thomson
- Cancer Care Services, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD 4101, Australia
| | - Brett Hughes
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston Rd, Herston, QLD 4029, Australia
| | - Alexandra L McCarthy
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Ave, Kelvin Grove, QLD 4059, Australia
- Cancer Services Southern Clinical Network, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD 4101, Australia
| | - Chris Perry
- Cancer Care Services, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD 4101, Australia
| | - Raymond J Chan
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston Rd, Herston, QLD 4029, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Ave, Kelvin Grove, QLD 4059, Australia
| | - Alana Fraser
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston Rd, Herston, QLD 4029, Australia
| | - Helen Skerman
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Ave, Kelvin Grove, QLD 4059, Australia
| | - Martin Batstone
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston Rd, Herston, QLD 4029, Australia
| | - Kathryn Carswell
- Cancer Care Services, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD 4101, Australia
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van der Meulen IC, May AM, de Leeuw JRJ, Koole R, Oosterom M, Hordijk GJ, Ros WJG. Long-term effect of a nurse-led psychosocial intervention on health-related quality of life in patients with head and neck cancer: a randomised controlled trial. Br J Cancer 2014; 110:593-601. [PMID: 24280999 PMCID: PMC3915114 DOI: 10.1038/bjc.2013.733] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/24/2013] [Accepted: 10/30/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Head and neck cancer (HNC) patients are prone to have a poor health-related quality of life after cancer treatment. This study investigated the effect of the nurse counselling and after intervention (NUCAI) on the health-related quality of life and depressive symptoms of HNC patients between 12 and 24 months after cancer treatment. METHODS Two hundred and five HNC patients were randomly allocated to NUCAI (N=103) or usual care (N=102). The 12-month nurse-led NUCAI is problem-focused and patient-driven and aims to help HNC patients manage with the physical, psychological and social consequences of their disease and its treatment. Health-related quality of life was evaluated with the EORTC QLQ-C30 and QLQ H&N35. Depressive symptoms were evaluated with the CES-D. RESULTS At 12 months the intervention group showed a significant (P<0.05) improvement in emotional and physical functioning, pain, swallowing, social contact, mouth opening and depressive symptoms. At 18 months, global quality of life, role and emotional functioning, pain, swallowing, mouth opening and depressive symptoms were significantly better in the intervention group than in the control group, and at 24 months emotional functioning and fatigue were significantly better in the intervention group. CONCLUSION The NUCAI effectively improved several domains of health-related quality of life and depressive symptoms in HNC patients and would seem a promising intervention for implementation in daily clinical practice.
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Affiliation(s)
- I C van der Meulen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Street 6.131, PO Box: 85500, 3508GA Utrecht, The Netherlands
- Departments of Oral Maxillofacial Surgery and Otorhinolaryngology, University Medical Center Utrecht, G05. 129, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - A M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Street 6.131, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - J R J de Leeuw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Street 6.131, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - R Koole
- Departments of Oral Maxillofacial Surgery and Otorhinolaryngology, University Medical Center Utrecht, G05. 129, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - M Oosterom
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Street 6.131, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - G-J Hordijk
- Departments of Oral Maxillofacial Surgery and Otorhinolaryngology, University Medical Center Utrecht, G05. 129, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - W J G Ros
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Street 6.131, PO Box: 85500, 3508GA Utrecht, The Netherlands
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Head and neck cancer patients want us to support them psychologically in the posttreatment period: Survey results. Palliat Support Care 2013; 12:481-93. [PMID: 24153040 DOI: 10.1017/s1478951513000771] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES No study systematically has investigated the supportive care needs of general head and neck cancer patients using validated measures. These needs include physical and daily living needs, health system and information needs, patient care and support needs, psychological needs, and sexuality needs. Identifying the unmet needs of head and neck cancer patients is a necessary first step to improving the care we provide to patients seen in our head and neck oncology clinics. It is recommended as the first step in intervention development in the Pan-Canadian Clinical Practice Guideline of the Canadian Partnership Against Cancer (see Howell, 2009). This study aimed to identify: (1) met and unmet supportive care needs of head and neck cancer patients, and (2) variability in needs according to demographics, disease variables, level of distress, and quality-of-life domains. METHODS Participants were recruited from the otolaryngology-head and neck surgery clinics of two university teaching hospitals. Self-administered questionnaires included sociodemographic and medical questions, as well as validated measures such as the Supportive Care Needs Survey-Short Form (SCNS-SF34), the Hospital Anxiety and Depression Scale (HADS), and the Functional Assessment of Cancer Therapy-General (FACT-G) and Head and Neck Module (FACT-H&N) (quality of life measures). RESULTS One hundred and twenty-seven patients participated in the survey. 68% of them experienced unmet needs, and 25% revealed a clinically significant distress level on the HADS. The highest unmet needs were psychological (7 of top 10 needs). A multiple linear regression indicated a higher level of overall unmet needs when patients were divorced, had a high level of anxiety (HADS subscale), were in poor physical condition, or had a diminished emotional quality of life (FACT-G subscales). SIGNIFICANCE OF RESULTS The results of this study highlight the overwhelming presence of unmet psychological needs in head and neck cancer patients and underline the importance of implementing interventions to address these areas perceived by patients as important. In line with hospital resource allocation and cost-effectiveness, one may also contemplate screening patients for high levels of anxiety, as well as target patients who are divorced and present low levels of physical well-being, as these patients may have more overall needs to be met.
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Semple C, Parahoo K, Norman A, McCaughan E, Humphris G, Mills M. Psychosocial interventions for patients with head and neck cancer. Cochrane Database Syst Rev 2013:CD009441. [PMID: 23857592 DOI: 10.1002/14651858.cd009441.pub2] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND A diagnosis of head and neck cancer, like many other cancers, can lead to significant psychosocial distress. Patients with head and neck cancer can have very specific needs, due to both the location of their disease and the impact of treatment, which can interfere with basic day-to-day activities such as eating, speaking and breathing. There is a lack of clarity on the effectiveness of the interventions developed to address the psychosocial distress experienced by patients living with head and neck cancer. OBJECTIVES To assess the effectiveness of psychosocial interventions to improve quality of life and psychosocial well-being for patients with head and neck cancer. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 17 December 2012. SELECTION CRITERIA We selected randomised controlled trials and quasi-randomised controlled trials of psychosocial interventions for adults with head and neck cancer. For trials to be included the psychosocial intervention had to involve a supportive relationship between a trained helper and individuals diagnosed with head and neck cancer. Outcomes had to be assessed using a validated quality of life or psychological distress measure, or both. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data and assessed the risk of bias, with mediation from a third author where required. Where possible, we extracted outcome measures for combining in meta-analyses. We compared continuous outcomes using either mean differences (MD) or standardised mean differences (SMD) and 95% confidence intervals (CI), with a random-effects model. We conducted meta-analyses for the primary outcome measure of quality of life and secondary outcome measures of psychological distress, including anxiety and depression. We subjected the remaining outcome measures (self esteem, coping, adjustment to cancer, body image) to a narrative synthesis, due to the limited number of studies evaluating these specific outcomes and the wide divergence of assessment tools used. MAIN RESULTS Seven trials, totaling 542 participants, met the eligibility criteria. Studies varied widely on risk of bias, interventions used and outcome measures reported. From these studies, there was no evidence to suggest that psychosocial intervention promotes global quality of life for patients with head and neck cancer at end of intervention (MD 1.23, 95% CI -5.82 to 8.27) as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). This quality of life tool includes five functional scales, namely cognitive, physical, emotional, social and role. There was no evidence to demonstrate that psychosocial intervention provides an immediate or medium-term improvement on any of these five functional scales. From the data available, there was no significant change in levels of anxiety (SMD -0.09, 95% CI -0.40 to 0.23) or depression following intervention (SMD -0.03, 95% CI -0.24 to 0.19). At present, there is insufficient evidence to refute or support the effectiveness of psychosocial intervention for patients with head and neck cancer. AUTHORS' CONCLUSIONS The evidence for psychosocial intervention is limited by the small number of studies, methodological shortcomings such as lack of power, difficulties with comparability between types of interventions and a wide divergence in outcome measures used. Future research should be targeted at patients who screen positive for distress and use validated outcome measures, such as the EORTC scale, as a measure of quality of life. These studies should implement interventions that are theoretically derived. Other shortcomings should be addressed in future studies, including using power calculations that may encourage multi-centred collaboration to ensure adequate sample sizes are recruited.
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Affiliation(s)
- Cherith Semple
- Cancer Services, South Eastern Health & Social Care Trust, Belfast,
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van der Meulen IC, May AM, Ros WJG, Oosterom M, Hordijk GJ, Koole R, de Leeuw JRJ. One-year effect of a nurse-led psychosocial intervention on depressive symptoms in patients with head and neck cancer: a randomized controlled trial. Oncologist 2013; 18:336-44. [PMID: 23429740 PMCID: PMC3607532 DOI: 10.1634/theoncologist.2012-0299] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 01/03/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Many patients with head and neck cancer (HNC) experience depressive symptoms after treatment. This randomized controlled trial investigated the effects of a psychosocial nurse counseling and after intervention (NUCAI) versus usual care on the depressive and HNC-related physical symptoms of patients with HNC at 1 year after diagnosis. METHODS A total of 205 patients with HNC were randomly assigned to either intervention (n = 103) or usual care (n = 102), with stratification for gender and tumor stage. The NUCAI, which consisted of six bimonthly 45-minute counseling sessions, was a problem-focused intervention aimed at helping patients to manage the physical, psychological, and social consequences of HNC and its treatment. It was nurse-led and offered in combination with regular medical follow-up visits at the University Medical Center Utrecht, the Netherlands. Depressive symptoms at 1 year after diagnosis were the primary outcome. Analyses were performed on an intention-to-treat basis for the total sample and for a predefined subgroup of patients with raised levels of depressive symptoms (Center for Epidemiologic Studies-Depression score ≥ 12; n = 91) at baseline using mixed-effect models. RESULTS One year after HNC treatment, levels of depressive symptoms were significantly lower in the intervention group than in the control group in the total sample and in the subgroup of patients with raised levels of depressive symptoms. CONCLUSION The NUCAI was feasible and effective in reducing depressive symptoms in patients with HNC 1 year after HNC treatment, and especially in patients with raised levels of depressive symptoms. The results of this study need to be confirmed in future studies before the NUCAI can be used in daily clinical practice.
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Affiliation(s)
- Ingeborg C van der Meulen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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Value of the Hospital Anxiety and Depression Scale in the follow up of head and neck cancer patients. The Journal of Laryngology & Otology 2013; 127:285-94. [PMID: 23398854 DOI: 10.1017/s0022215113000078] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Few studies have prospectively investigated psychological morbidity in UK head and neck cancer patients. This study aimed to explore changes in psychological symptoms over time, and associations with patients' tumour and treatment characteristics, including toxicity. METHODS Two hundred and twenty patients were recruited to complete the Hospital Anxiety and Depression Scale and the Late Effects on Normal Tissue (Subjective, Objective, Management and Analytic) ('LENT-SOMA') questionnaires, both pre- and post-treatment. RESULTS Anxiety was highest pre-treatment (38 per cent) and depressive symptoms peaked at the end of treatment (44 per cent). Anxiety significantly decreased and depression significantly increased, comparing pre- versus post-treatment responses (p < 0.001). Hospital Anxiety and Depression Scale scores were significantly correlated with toxicity, age and chemotherapy (p < 0.01 for all). CONCLUSION This is the first study to analyse the relationship between Hospital Anxiety and Depression Scale scores and toxicity scores in head and neck cancer patients. It lends support for the use of the Hospital Anxiety and Depression Scale and the Late Effects on Normal Tissue (Subjective, Objective, Management and Analytic) questionnaire in routine clinical practice; furthermore, continued surveillance is required at multiple measurement points.
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Howren MB, Christensen AJ, Karnell LH, Funk GF. Psychological factors associated with head and neck cancer treatment and survivorship: evidence and opportunities for behavioral medicine. J Consult Clin Psychol 2012; 81:299-317. [PMID: 22963591 DOI: 10.1037/a0029940] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Individuals diagnosed with head and neck cancer (HNC) not only face a potentially life-threatening diagnosis but must endure treatment that often results in significant, highly visible disfigurement and disruptions of essential functioning, such as deficits or complications in eating, swallowing, breathing, and speech. Each year, approximately 650,000 new cases are diagnosed, making HNC the 6th most common type of cancer in the world. Despite this, however, HNC remains understudied in behavioral medicine. In this article, the authors review available evidence regarding several important psychosocial and behavioral factors associated with HNC diagnosis, treatment, and recovery, as well as various psychosocial interventions conducted in this patient population, before concluding with opportunities for behavioral medicine research and practice.
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Affiliation(s)
- M Bryant Howren
- Veterans Affairs Iowa City Healthcare System, Iowa City, Iowa 52242, USA.
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Fear of recurrence significantly influences quality of life in oral cancer patients. Oral Oncol 2012; 48:1276-80. [PMID: 22818822 DOI: 10.1016/j.oraloncology.2012.06.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 06/21/2012] [Accepted: 06/25/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Besides survival time quality of life (QoL) is the most important criterion for measuring the success of the therapy and rehabilitation of patients with carcinoma of the oral cavity. Interestingly, assessments by doctors sometimes differ from those of patients concerning QoL and level of information. Particularly the probability of cancer recurrence is unclear for many patients. MATERIAL AND METHODS Fear of recurrence (FOR) data were gathered from a total collective of 1761 patients from 38 hospitals within the German-language area of Germany, Austria and Switzerland (DÖSAK-REHAB-STUDIE) yielding 1652 patient questionnaires containing 147 items which were evaluated. They refer to periods at least 6 months after therapy. QoL was determined by the patient and ranges from 0% to 100% and FOR was measured using a Likert scale. Statistical analysis was performed using SPSS 19.0. RESULTS FOR affected 80% of the patients to a varying degree and influenced QoL very significantly. Patients with a high level of FOR were also more mentally instable. Their functional impairment in particular contributed to a reduced QoL. They felt less informed by their doctors about their illness and rehabilitation. The medical parameters had a smaller influence on FOR and QoL. CONCLUSION The patients' knowledge of their medical situation must be improved to make patient assessment of QoL more realistic, particularly when patients with good prospects indicate low QoL. The patients' subjective evaluations have to be more strongly integrated into the concept of the multi-disciplinary team in establishing a comprehensive therapy and rehabilitation plan.
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Shuman AG, Fins JJ, Prince ME. Improving end-of-life care for head and neck cancer patients. Expert Rev Anticancer Ther 2012; 12:335-43. [PMID: 22369325 DOI: 10.1586/era.12.6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite improvements in the treatment of head and neck cancer, many patients still succumb to their disease. A litany of medical, psychosocial and ethical challenges arise in managing the end-of-life experiences within this patient population. In this article, we attempt to review existing data about the end-of-life experiences of this cohort, extrapolate relevant data from other cancer patients, and suggest the most promising avenues for additional research and practice improvement for terminal head and neck cancer patients. Clinical decision-making for patients dying of head and neck cancer requires proactive consideration of quality of life, functionality, symptom control and other patient-centered objectives, and frequently benefits from palliative care team involvement. Additional research aimed toward optimizing the end of life experience of head and neck cancer patients and their families is greatly needed.
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Affiliation(s)
- Andrew G Shuman
- Division of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
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Feasibility of EASE: a psychosocial program to improve symptom management in head and neck cancer patients. Support Care Cancer 2012; 21:191-200. [DOI: 10.1007/s00520-012-1510-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 05/21/2012] [Indexed: 11/26/2022]
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Eades M, Murphy J, Carney S, Amdouni S, Lemoignan J, Jelowicki M, Nadler M, Chasen M, Gagnon B. Effect of an interdisciplinary rehabilitation program on quality of life in patients with head and neck cancer: Review of clinical experience. Head Neck 2012; 35:343-9. [DOI: 10.1002/hed.22972] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2011] [Indexed: 11/12/2022] Open
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Haisfield-Wolfe ME, McGuire DB, Soeken K, Geiger-Brown J, De Forge B, Suntharalingam M. Prevalence and correlates of symptoms and uncertainty in illness among head and neck cancer patients receiving definitive radiation with or without chemotherapy. Support Care Cancer 2011; 20:1885-93. [DOI: 10.1007/s00520-011-1291-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 09/26/2011] [Indexed: 11/30/2022]
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Luckett T, Britton B, Clover K, Rankin NM. Evidence for interventions to improve psychological outcomes in people with head and neck cancer: a systematic review of the literature. Support Care Cancer 2011; 19:871-81. [PMID: 21369722 DOI: 10.1007/s00520-011-1119-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 02/13/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE In addition to cancer-related distress, people with head and neck cancer (HNC) endure facial disfigurement and difficulties with eating and communication. High rates of alcohol use and socio-economic disadvantage raise concerns that patients with HNC may be less likely than others to participate in and adhere to psychological interventions. This article aims to inform future practice and research by reviewing the evidence in support of psychological interventions for this patient group. METHODS We searched CENTRAL, Medline, Embase, PsycINFO and CINAHL in December 2009. Relevant studies were rated for internal and external validity against the criteria of the Agency for Healthcare Research and Quality (AHRQ) US Preventive Services Task Force. Wherever possible, outcomes were evaluated using effect sizes to confirm statistically significant results and enable comparison between studies. Meta-analysis was planned according to criteria in the Cochrane Handbook for Systematic Reviews. Levels of evidence for each intervention type were evaluated using AHRQ criteria. RESULTS Nine studies met inclusion criteria. One study was rated 'good' for internal validity and four for external validity. Psycho-education and/or cognitive-behavioural therapy were evaluated by seven studies, and communication skills training and a support group by one study each. Significant heterogeneity precluded meta-analysis. Based on a study-by-study review, there was most support for psycho-education, with three out of five studies finding at least some effect. CONCLUSIONS Research to date suggests it is feasible to recruit people with HNC to psychological interventions and to evaluate their progress through repeated-outcome measures. Evidence for interventions is limited by the small number of studies, methodological problems, and poor comparability. Future interventions should target HNC patients who screen positive for clinical distress and be integrated into standard care.
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Affiliation(s)
- T Luckett
- Psycho-oncology Co-operative Research Group, The University of Sydney, Sydney, NSW, Australia.
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de Boer AG, Taskila T, Tamminga SJ, Frings-Dresen MH, Feuerstein M, Verbeek JH. Interventions to enhance return-to-work for cancer patients. Cochrane Database Syst Rev 2011:CD007569. [PMID: 21328297 DOI: 10.1002/14651858.cd007569.pub2] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cancer survivors are 1.4 times more likely to be unemployed than healthy people. It is therefore important to provide cancer patients with programmes to support the return-to-work process. OBJECTIVES To evaluate the effectiveness of interventions aimed at enhancing return-to-work in cancer patients. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane Library Issue 2, 2010), MEDLINE, EMBASE, CINAHL, OSH-ROM, PsycINFO, DARE, ClinicalTrials.gov, Trialregister.nl and Controlled-trials.com to February 2010, reference lists of included articles and selected reviews, and contacted authors of relevant articles. SELECTION CRITERIA Randomised controlled trials (RCTs) and controlled before-after studies (CBAs) of the effectiveness of psychological, vocational, physical, medical or multidisciplinary interventions enhancing return-to-work in cancer patients. The primary outcome was return-to-work measured as either return-to-work rate or sick leave duration. Secondary outcome was quality of life. DATA COLLECTION AND ANALYSIS Two authors independently selected trials, assessed the risk of bias and extracted data. We pooled studies with sufficient data, judged to be clinically homogeneous in different comparisons. We assessed the overall quality of the evidence for each comparison using the GRADE approach. MAIN RESULTS Fourteen articles reporting 14 RCTs and 4 CBAs were included. These studies involved a total of 1652 participants. Results indicated low quality evidence of similar return-to-work rates for psychological interventions compared to care as usual (odds ratio (OR) = 2.32, 95% confidence interval (CI) 0.94 to 5.71). No vocational interventions were retrieved. Very low evidence suggested that physical training was not more effective than care as usual on improving return-to-work (OR = 1.20, 95% CI 0.32 to 4.54). Eight RCTs on medical interventions showed low quality evidence that functioning conserving approaches had similar return-to-work rates as more radical treatments (OR = 1.53, 95% CI 0.95 to 2.45). Moderate quality evidence showed multidisciplinary interventions involving physical, psychological and vocational components led to higher return-to-work rates than care as usual (OR = 1.87, 95% CI 1.07 to 3.27). No differences in the effect of psychological, physical, medical or multidisciplinary interventions compared to care as usual were found on quality of life outcomes. AUTHORS' CONCLUSIONS Moderate quality evidence showed that employed patients with cancer experience return-to-work benefits from multidisciplinary interventions compared to care as usual. More high quality RCTs aimed at enhancing return-to-work in cancer patients are needed.
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Affiliation(s)
- Angela Gem de Boer
- Coronel Institute of Occupational Health, Academic Medical Centre, Meibergdreef 9, Amsterdam, Netherlands, 1105 AZ
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:134-45. [PMID: 20234215 DOI: 10.1097/moo.0b013e3283383ef9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sherman AC, Simonton S. Advances in Quality of Life Research Among Head and Neck Cancer Patients. Curr Oncol Rep 2010; 12:208-15. [DOI: 10.1007/s11912-010-0092-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Illness cognitions in head and neck squamous cell carcinoma: predicting quality of life outcome. Support Care Cancer 2009; 18:1137-45. [PMID: 19718524 PMCID: PMC2910308 DOI: 10.1007/s00520-009-0728-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 08/13/2009] [Indexed: 12/02/2022]
Abstract
Goals of work This paper presents an observational study of the longitudinal effects of cancer treatment on quality of life (QoL) in patients treated for head and neck squamous cell carcinoma (HNSCC), and evaluated the contribution of patients' baseline illness cognitions to the prediction of QoL 2 years after diagnosis. Patients and methods One hundred seventy-seven patients eligible for primary treatment for HNSCC completed the Illness Perception Questionnaire-Revised at baseline and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire-30 at baseline, at 1-year and 2-year follow-ups. Main results Compared to baseline, patients reported better emotional functioning at both follow-ups (p < 0.001), worse social functioning at 12 months (p < 0.05), and better global health status at 24 months (p < 0.05). Patients' own implicit common sense beliefs about their illness added small but significant amounts of variance to the prediction of QoL after 2 years. Less belief in own behavior causing the illness predicted better functioning and better global health. Strong illness identity beliefs predicted worse functioning and worse global health. Negative perceptions about the duration of the illness (chronic timeline beliefs) and more negative perceived consequences also predicted worse QoL. Conclusions Our results on the negative perceptions about the duration of the illness, perceived consequences, and high symptom awareness predicting worse QoL illustrate the detrimental effects of uncertainty and negative expectations about the future course of the illness. The identification of these cognitive factors provides possible targets for counseling strategies to assist patients in long-term adjustment to HNSCC.
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