Symptoms, psychological distress, and supportive care needs in lung cancer patients

Immunotherapy-associated symptoms, distress, financial toxicity and unmet supportive care needs of patients with cancer

PURPOSE

To examine the unmet care needs (i.e., overall needs and need subdomains [physical and daily living needs, psychological and emotional needs, care and support needs, and health-system and informational needs]) of patients with cancer undergoing immunotherapy alone or in combination with other anticancer therapies, as well as related influencing factors.

METHODS

A cross-sectional design was adopted. Cancer patients who received immunotherapy completed consent and questionnaires. Unmet care needs were evaluated with the Chinese version of the Supportive Care Needs Survey Screening Tool, symptom severity with the Symptom Severity Scale, distress severity with the Distress Thermometer Scale, and financial toxicity using the Financial Toxicity - Functional Assessment of Chronic Illness Therapy Questionnaire.

RESULTS

In total, 105 patients were surveyed. The most frequently reported unmet needs were psychological and emotional needs (56.2%) followed by health-system and informational needs (36.2%). The major factors associated with unmet care needs and their subdomains were years of education, symptoms, distress, and financial toxicity. Years of education predicted overall unmet care needs, psychological and emotional needs, and care and support needs; symptoms predicted overall unmet care needs and all four subdomains; distress predicted psychological and emotional needs and health-system and informational needs; and financial toxicity predicted overall needs and psychological and emotional needs.

CONCLUSIONS

Patients with higher education, severe symptoms, distress, and financial toxicity reported more unmet care needs. The findings of this study could be incorporated into immunotherapy-related clinical practice guidelines and future interventions to improve the quality of cancer care.

Mapping the clinical care pathways for advanced stage non-small cell lung cancer patients in Victoria: A retrospective cohort study of supportive and palliative care

The lung cancer Optimal Care Pathway recommends supportive care and palliative care integration throughout its various steps, with early referral to appropriate services improving the quality of life in advanced stage non-small cell lung cancer patients. Using Victorian Lung Cancer Registry data and linked administrative datasets, this retrospective cohort study mapped clinical care pathways of 525 Stage III-IV non-small cell lung cancer patients in Victoria to 11 recommendations in the Optimal Care Pathway, identifying unwarranted variations in clinical care. Supportive care and palliative care delivery were further examined to understand the involvement and timing of specialist care teams. Our findings showed that palliative care utilization is highest at the time of treatment, despite recommendations that it should be provided early after diagnosis to improve patient outcomes and satisfaction. Early supportive care screening was observed in half the cohort and almost three-quarters of the patients had been presented at a multidisciplinary meeting. Multidisciplinary meeting presentations and supportive care provide an opportunity to improve communication about palliative care needs and integration into routine clinical practice, such as at the time of treatment planning.

The Relationship between Supportive Care Needs and Health-Related Quality of Life in Cancer Patients

The aim of this study was to analyze the relationship between quality of life (QoL) and supportive care needs (SCNs) in cancer patients. It is difficult to relate SCNs to detriments in QoL since SCNs and QoL assessment tools generally comprise different dimensions that cannot be directly related to each other. Therefore, we developed a short questionnaire with eight dimensions for uniformly measuring SCNs, QoL, and the subjective importance of these dimensions. A total of 1108 cancer patients with mixed diagnoses assessed eight dimensions of health-related QoL concerning SCNs, satisfaction, and importance. Among the eight dimensions of QoL, physical functioning received the highest SCN assessments (M = 3.4), while autonomy (M = 20.7) and social relationships (M = 1.88) were the dimensions with the lowest SCN mean scores on the 1-5 scale. For each of the eight dimensions, high levels of SCNs were reported by those patients who had low levels of satisfaction with that dimension (r between -0.32 and -0.66). The subjective importance of the dimensions was not consistently correlated with SCNs (r between -0.19 and 0.20). Females reported higher SCNs than males in six of the eight specific dimensions. Patients with prostate and male genital cancers reported the lowest SCNs. These results suggest gender-specific SCN patterns that warrant further exploration. This study highlights the value of a unified assessment instrument for SCNs and QoL, providing a robust basis for future cancer care strategies.

Unmet Supportive Care Needs after Non-Small Cell Lung Cancer Resection at a Tertiary Hospital in Seoul, South Korea

The aim of this study is to identify the prevalence and predictors of unmet needs of non-small cell lung cancer (NSCLC) patients undergoing surgical resection in Seoul, South Korea. A total of 949 patients who completed survey questionnaires that included the Cancer Survivors' Unmet Needs Korean version (CaSUN-K), fear of cancer recurrence (FCR) inventory-short form, and European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) were recruited from January to October 2020. Multivariable logistic regression was used to determine the potential correlation of significant unmet needs, defined as any moderate or strong need, for each domain of CaSUN-K. Of the 949 participants, the mean age was 63.4 ± 8.8 years old, and 529 (55.7%) were male. Overall, 91.8% of participants reported one or more unmet need. The highest domains of moderate-to-strong unmet needs were existential survivorship (59.1%), comprehensive cancer care (51.2%), and information (49.7%). High FCR and poor emotional function were associated with moderate-to-strong unmet needs across all domains of CaSUN-K. NSCLC survivors with a recent diagnosis had more frequent disease-related unmet needs. Interventions to reduce the unmet needs of NSCLC patients should focus on relieving FCR and improving emotional functioning. Furthermore, emphasis should be placed on decreasing disease-related needs, particularly for early survivors of lung cancer during the re-entry phase.

Supportive care needs and health-related quality of life in cancer patients receiving palliative care

Objective

Cancer patients receiving palliative care experience a variety of impairments in their quality of life (QoL), and have corresponding supportive care needs (SCNs). The aim of this study was to analyze the relationship between SCNs, satisfaction with QoL dimensions, and the perceived importance of these dimensions.

Method

A sample of 152 cancer patients receiving palliative care were included in this cross-sectional study. Eight dimensions of QoL were defined and assessed concerning SCNs, satisfaction, and subjective importance using a new assessment instrument with five-point scales (range 1-5) for each dimension.

Results

Among the eight specific domains examined, the greatest SCNs were observed for absence of pain (M = 3.18; SD = 1.29). The patients were least satisfied with their physical functioning (M = 2.60; SD = 0.84), and the dimension social relationships (M = 4.14; SD = 0.72) received the highest perceived importance ratings. The eight dimensions' SCNs scores were significantly correlated with each other (r between 0.29 and 0.79); the lowest correlations were found for social relationships. The correlations between the satisfaction scores and the SCNs differed from dimension to dimension, with coefficients between -0.32 (absence of pain) and - 0.57 (sleep quality).

Conclusion

The results show that detriments in QoL do not automatically indicate high levels of SCNs in those dimensions. Health care providers should consider both factors, QoL (as measured with QoL questionnaires) and subjectively expressed SCNs, to optimize their patients' care regimens.

Unmet supportive care needs of people with advanced cancer and their caregivers: a systematic scoping review

Examining and addressing unmet care needs is integral to improving the provision and quality of cancer services. This review explored the prevalence of unmet supportive care needs, and factors associated with unmet need, in adults with advanced cancers (solid and hematological malignancies) and their caregivers. Electronic databases (PubMed, CINAHL, EMBASE) were searched, producing 85 papers representing 81 included studies. People with advanced cancer reported the highest unmet needs in financial, health system and information, psychological, and physical and daily living domains, whereas caregivers reported the highest unmet needs in psychological, and patient care and support domains. Distress, depression, and anxiety were associated with higher unmet needs across all unmet need domains for people with advanced cancer and their caregivers. Substantial heterogeneity in study populations and methods was observed. Findings from this review can inform targeted strategies and interventions to address these unmet needs in people with advanced cancer.

Integrating supportive care into the multidisciplinary management of lung cancer: we can't wait any longer

INTRODUCTION

Due to important achievements in terms of diagnostic and therapeutic tools and the complexity of the disease itself, lung cancer management needs a multidisciplinary approach. To date, the classical multidisciplinary team involves different healthcare providers mainly dedicated to lung cancer diagnosis and treatments. Nevertheless, the underlying disease and related treatments significantly impact on patient function and psychological well-being. In this sense, supportive care may offer the best approach to relieve and manage patient symptoms and treatment-related adverse events.

AREAS COVERED

Evidence report that exercise, nutrition, smoking cessation and psychological well-being bring many benefits in patients with lung cancer, from both a physical and socio-psychological points of view, and potentially improving their survival. Nevertheless, supportive care is rarely offered to patients, and even less frequently these needs are discussed within the multidisciplinary meeting.

EXPERT OPINION

Integrating supportive care as part of the standard multidisciplinary approach for lung cancer involves a series of challenges, the first one represented by the daily necessity of specialists, such as kinesiologists, dietitians, psycho-oncologists, able to deliver a personalized approach. In the era of precision medicine this is an essential step forward to guarantee comprehensive and patient-centered care for all patients with lung cancer.

Developing an ACT-based intervention to address lung cancer stigma: Stakeholder recommendations and feasibility testing in two NCI-designated cancer centers

Objective: Few psychosocial interventions have been tailored to meet the unique needs of patients diagnosed with lung cancer. This pilot study developed and tested a six-week intervention for reducing lung cancer stigma.Design and Subjects: Guided by qualitative interviews conducted with 9 lung cancer patients and 5 thoracic oncology care providers, Acceptance and Commitment Therapy was adapted for treatment of lung cancer stigma (ACT-LCS). In a subsequent single arm pilot study, 22 lung cancer patients reporting high levels of stigma completed the intervention.Setting: NCI-designated cancer centers in the Southwestern and Eastern United States.Results: Of 46 eligible patients, 22 provided consent, with 20 completing the intervention (10 in-person, 10 telehealth). Overall stigma decreased across timepoints, largely driven by reductions in internalized stigma. There were also significant reductions in social isolation, sleep disturbance, and fatigue.Conclusions: The ACT-LCS protocol demonstrates preliminary feasibility and acceptability. This intervention may be particularly suited for helping patients navigate feelings associated with internalized stigma.

Unmet supportive care needs associated with quality of life for people with lung cancer: A systematic review of the evidence 2007-2020

INTRODUCTION

The aim of this review was to systematically examine the evidence on the relationship between quality of life (QoL) and unmet supportive care needs in patients with lung cancer.

METHODS

Six databases were searched for studies published since 2007. Studies were included if they measured QoL using a standardised tool and examined its association with unmet supportive care needs in lung cancer patients.

RESULTS

Six studies involving 562 patients were included. Nearly two thirds of the patients had been diagnosed with advanced cancer (Stage III or IV), and the majority had been diagnosed for less than 2 years. There was a negative association between QoL and unmet needs using two different measures (Supportive Care Needs Survey[SCNS] and Cancer Survivors Unmet Needs Survey [CaSUN]). In two studies, the relationship was limited to physical and/or psychological domains.

CONCLUSIONS

Unmet supportive care needs are associated with poorer QoL for people with lung cancer: The findings suggest that unmet physical and psychological needs may have the most impact on QoL and reflect the high symptom burden and psychological distress associated with lung cancer. Further work is needed to examine these relationships to identify the services and interventions that address the range of care needs across the disease trajectory.

Psychological Distress and Its Association with Unmet Needs and Symptom Burden in Outpatient Cancer Patients: A Cross-Sectional Study

OBJECTIVES

To evaluate the relationships of sociodemographic and clinical characteristics, symptom burden, and supportive care needs of patients with a prevalence of psychological distress in outpatients with cancer.

DATA SOURCES

The study was carried out with 298 outpatient cancer patients at an oncology center in Turkey, and a descriptive correlational design was used. The data were collected through Hospital Anxiety-Depression Scale (HADS), Nightingale Symptom Assessment Scale (N-SAS), and Supportive Care Needs Scale Short Form (SCNS-SF34). Descriptive statistics and hierarchical regression analyses were performed.

CONCLUSION

The study determined that the anxiety and depression scores of a significant portion of cancer patients receiving outpatient treatment were clinically significant. It was observed that the physical and psychological symptom burden of the patients and the increase in unmet care needs related to psychological, physical, and activities of daily life contributed to the development of anxiety and depression. Of the sociodemographic and disease-related characteristics of the patients, female sex was found to be an important factor for both anxiety and depression, and advanced age was found to be an important factor for depression. These results indicate that cancer patients receiving outpatient treatment need intensive supportive psychosocial care.

IMPLICATIONS FOR NURSING PRACTICE

It is recommended that patients' psychological distress levels and supportive care needs be included in the care process as a routine component of care, as in symptom assessment, and to develop a more sensitive and supportive care environment in meeting psychosocial care needs and accessing support.

The prevalence of anxiety and depression and its association with coping strategies, supportive care needs, and social support among women with breast cancer

PURPOSE

Diagnosis of breast cancer and its treatment dramatically affects women's psychological health. This study investigated the prevalence of depression and anxiety and their related factor in breast cancer women.

METHODS

We conducted a cross-sectional study with a sample of 120 women with breast cancer in Zahedan, Iran, 2020. Data were collected using instruments included: Hospital Anxiety and Depression Scale (HADS), Supportive Care Needs Survey (SCNS-SF34), Multidimensional Scale of Perceived Social Support (MSPSS), The adjustment to illness measurement inventory for Iranian women with breast cancer (AIMI-IBC). We analyzed the data using the ANOVA, independent sample t-test, Kruskal Wallis, Mann-Whitney U test, Pearson's and Spearman's correlation coefficients.

RESULTS

The prevalence of depression and anxiety in women with breast cancer was 66.6% and 60%, respectively. A significant positive correlation was found between anxiety and depression and unmet psychological needs, care/support needs, and emotional turmoil coping strategy, while reasonable efforts and avoidance coping strategies and adjusting to disease were negatively correlated with anxiety and depression. Also, linear regression results indicated unmet psychological needs, emotional turmoil coping strategy, and a high level of depression predicted a high anxiety level. A lower level of depression was indicated by reasonable efforts strategy and less level of anxiety.

CONCLUSIONS

Women with breast cancer reported a high level of depression and anxiety in Zahedan, and clinicians should pay more attention to these patients' psychological distress. Resolving the unmet need of patients, increasing social support, and using the right coping strategy have an essential role in breast cancer women's psychological distress control.

Can tele-nursing affect the supportive care needs of patients with cancer undergoing chemotherapy? A randomized controlled trial follow-up study

Purpose

In some countries, telephone-based support is one of the key services used for supporting patients with cancer. However, there is a lack of research on the efficacy of this method in Iran. This study aimed to evaluate the effects of tele-nursing on supportive care needs (SCNs) of patients with cancer undergoing chemotherapy.

Methods

This randomized controlled trial was conducted on 60 patients with cancer undergoing chemotherapy who were randomly assigned and allocated to two groups, an intervention group and a control group. Patients’ SCNs were assessed in the baseline, and 1 and 2 months after commencement of the intervention using the SCNs Survey -Short Form 34. The data were analyzed through descriptive statistics, t-test, and repeated measure test, by SPSS version 16.

Results

There were no significant statistical differences in the mean score of dimensions and total SCNs between the two groups in baseline (p˃0.05). However, the results showed that the mean score of dimensions and total SCNs in the intervention group were significantly less than the control group, after the intervention (p˂0.05).

Conclusions

Telephone-based support is an effective method to address and reduce SCNs of patients with cancer undergoing chemotherapy through increasing access to support for this population especially who may be in rural and remote settings. During the COVID_19 pandemic and given the vulnerability of patients with cancer, telephone support can be used to avoid unnecessary visits to hospitals and reduced the risk of transmitting the virus to the patients.

Trial registration number

IRCT20170404033216N1

Improving Social Support to Increase QoL in Lung Cancer Patients

Lung cancer is the most common cause of cancer deaths in the world. According to the World Health Organization, over 2 million new lung cancer cases were reported worldwide in 2018, and there were 1.76 million deaths from the disease. Due to its non-specific symptoms, the disease is usually detected at an advanced stage, which gives few treatment options and a short survival rate after diagnosis. That is why improving QoL in the last months of a patient's life is enormously important. The purpose of this study was to analyse original papers in order to determine whether an increase in social support is important in improving QoL for lung cancer patients. Both the direct influence of social support on QoL and indirect influences such as stigma or depression, etc. were taken into consideration. We conducted a review of 22 papers published in English in the period 2005-2020, which were selected using the following keywords: lung cancer, social support, quality of life. Evidence was found for the connections between the improvement of social support and an increase in the QoL of lung cancer patients. It is crucial, and worth whatever effort is required, to increase social support for lung cancer patients, as it is one of the most important factors in improving QoL. According to the studies, a good QoL and minimalised symptoms of the disease are much more important for lung cancer patients than the length of their life.

Nurse-Delivered Telephone Intervention to Reduce Oral Mucositis and Prevent Dehydration

PROBLEM STATEMENT

This study evaluates the feasibility of a nurse-delivered telephone intervention to reduce oral mucositis severity and prevent dehydration in patients with lung or head and neck cancer undergoing chemotherapy and radiation therapy.

DESIGN

This study used a two-phase, qualitatively driven, mixed-methods descriptive design.

DATA SOURCES

11 participants were recruited from an academic cancer center in southern Florida. Participants received symptom management education followed by twice-weekly tailored nurse coaching telephone calls.

ANALYSIS

Questionnaires measuring symptom severity, health-related quality of life, perceived self-efficacy, and symptom self-management were administered at four data points. Data on unscheduled medical visits were collected. Guided interviews were conducted four weeks post-treatment and analyzed qualitatively using content analysis.

FINDINGS

Participants found the intervention to be acceptable. Oral mucositis symptom severity was minimized, and dehydration was avoided. The intervention enabled symptom self-management and improved perceived self-efficacy.

IMPLICATIONS FOR PRACTICE

Emotional support provided by the nurse was crucial, exemplifying improvement over an automated system.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS AND CONCLUSION

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

Unmet needs from the first diagnosis of cancer until the end of medical treatment: A longitudinal study

OBJECTIVE

This study aimed to examine (1) The courses of Chinese cancer patients' unmet supportive care needs (psychological, physical and daily living, health system and information, patient care and support, and sexual) from the first cancer diagnosis until the end of medical treatment; (2) The predictive role of socio-demographic and medical characteristics (i.e., age, gender, and cancer stage) in the courses of unmet needs; and (3) The associations of courses of unmet needs with courses of depressive and anxiety symptoms.

METHODS

A longitudinal study was performed at Shaanxi Provincial Tumour Hospital in Xi'an, China. A total of 153 heterogeneous cancer patients were assessed after the first diagnosis (T1), at the beginning (T2) and the end (T3) of the receipt of medical treatment. Latent growth curve models were used to examine the research questions.

RESULTS

Psychological needs and health system and information needs showed a decrease over time, whereas physical needs, patient care needs and sexual needs remained stable. Younger and female patients tended to report higher levels of unmet psychological needs at T1 and experienced slower decreases from T1 to T3. Only the courses of unmet psychological needs were associated with the courses of depressive and anxiety symptoms from T1 to T3.

CONCLUSIONS

More attention can be given to young and female cancer patients, as they were more likely to suffer from high unmet psychological needs over the disease trajectory. Future research may focus more on addressing unmet needs reported by Chinese cancer patients.

Supportive care needs and quality of care of patients with lung cancer in Mexico: A cross-sectional study

PURPOSE

To assess the supportive care needs (SC-needs), quality of patient-centered care (PCC), and factors associated with increased SC-needs of patients with lung cancer (LC) in Mexico.

METHODS

We conducted a cross-sectional survey in the main oncology hospital of the Mexican Institute of Social Security in Mexico City. The study included LC ambulatory patients aged ≥18 years with at least one hospitalization before the survey, ≤five years since diagnosis, and without memory loss. Participants answered SC-needs and quality of PCC questionnaires. We performed a multiple negative binomial regression analysis to evaluate the factors associated with an increased number of SC-needs.

RESULTS

One hundred twenty-eight LC patients participated. Most participants had adenocarcinoma (61.7%) and were at an advanced disease stage (92.1%). In the month preceding the survey, 3.9% had undergone surgery and 78.9% had been receiving chemotherapy and/or radiotherapy; 28.9% had symptoms of depression and 21.9% had anxiety. All patients reported one or more SC-needs-predominantly physical, daily living, information, and psychological needs. The significant gaps in PCC-quality were in the domains of care that addressed biopsychosocial needs and information for treatment decision-making. Factors that decreased the probability of SC-needs were respectful and coordinated care, high-school education, and older age. The factors increasing the likelihood of SCneeds were the type of LC (adenocarcinoma, mesenchymal tumors), chemotherapy and/or radiotherapy, and anxiety.

CONCLUSION

PCC improvement initiatives to address SC-needs of LC patients should be prioritized and focus on: (1) information on physical suffering relief and treatment; (2) psychological support; and (3) SC-needs monitoring.

Palliative care needs and utilisation of different specialist services in the last days of life for people with lung cancer

OBJECTIVES

To (a) compare palliative care needs of lung cancer patients on their final admission to community-based and inpatient palliative care services; and (b) explore whether and how these care needs affect their utilisation of different palliative care services in the last days of life.

METHODS

Descriptive study involving 17,816 lung cancer patients who received the last episode of palliative care from specialist services and died between 1 January 2013 and 31 December 2018.

RESULTS

Both groups of patients admitted to community-based and inpatient palliative care services generally experienced relatively low levels of symptom distress, but high levels of functional impairment and dependency. "Unstable" versus "stable" palliative care phase (Odds ratio = 11.66; 95% Confidence Interval: 9.55-14.24), poorer functional outcomes and severe levels of distress from many symptoms predicted greater likelihood of use of inpatient versus community-based palliative care.

CONCLUSIONS

Most inpatient palliative care admissions are not associated with high levels of symptom severity. To extend the period of home care and rate of home death for people with lung cancer, additional investment is required to improve their access to sufficiently skilled palliative care staff, multi-disciplinary teams and 24-hour home support in community settings.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Supportive Care Needs of Patients With Lung Cancer in Mainland China: A Cross-Sectional Study

BACKGROUND

The diagnosis and treatment of lung cancer necessitate a variety of supportive care needs. To our knowledge, no studies have been conducted that target specifically the supportive care needs of patients with lung cancer in Mainland China. Cross-cultural studies indicate that supportive care needs vary by cultural background. Thus, it is necessary to investigate the supportive care needs of patients with lung cancer in the cultural context of China.

PURPOSE

This study aimed to describe the level of supportive care required by patients with lung cancer in China and to examine the relationships between supportive care needs and demographic factors and between supportive care needs and treatment variables.

METHODS

A cross-sectional descriptive study design was adopted. Five hundred fifty-four patients with lung cancer were recruited using a convenience sampling method from inpatient departments in four tertiary teaching hospitals that are affiliated with a medical university in Anhui Province, China. The Nursing Professional Social Support Needs Scale and background information list were used as the data collection instruments. A Wilcoxon rank sum test and a Kruskal-Wallis rank sum test were conducted to examine the differences among the professional supportive care needs of patients of different demographic characteristics and under different treatment conditions.

RESULTS

Participants self-reported the highest scores in the domain of informational needs (M = 3.67, interquartile range = 1.25). The most common supportive care need was "to be cared for by nurses with skilled venipuncture techniques." There were significant differences in needs across different genders, age groups, educational levels, and income levels (p < .05). Patients with metastasis and other illnesses had greater supportive care needs in terms of total and subscale scores in Stages III and IV (p < .05).

CONCLUSIONS

Patients with serious diseases and heavy socioeconomic burdens have greater supportive care needs. Therefore, healthcare providers should improve their awareness and expertise to identify the needs of their patients and to provide supportive care to patients with lung cancer. In addition, patients with high supportive care needs should be identified.

Unmet Supportive Care Needs of Survival Patients with Nasopharyngeal Carcinoma

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

Body changes after cancer: female cancer patients' perceived social support and their perspective on care

PURPOSE

The aim of this study was to investigate among female cancer patients their perceived social support from health care professionals (HCPs), family and friends, and public media, and their perspective on care concerning body changes.

METHODS

A study-specific questionnaire was completed by 235 female cancer patients. Descriptive statistics were used to describe social support and perspective on care. Logistic regression analyses were used to investigate the associations between social support and sociodemographic and clinical factors, psychosocial impact, and importance of appearance.

RESULTS

More than half of the patients received sufficient support from HCPs (54%) and family and friends (55%), and a third from the media (32%). Higher educated patients and those who found appearance not important during illness perceived lower support from HCPs. Patients without a partner, and those with a surgical treatment only, perceived lower support from family and friends. Patients who were older, higher educated, without a partner, and those who found appearance not important during illness perceived lower support from the media. In total, 15-50% of the patients received sufficient care for different domains of body changes. Patients expressed the highest need for psychological support (28%) and nutrition (28%).

CONCLUSIONS

Half of the female cancer patients reported to receive sufficient social support concerning body changes after cancer. Perceived support depended on age, education, relationship status, and treatment modality. The need for more care was moderate.

The Perceived Facilitators and Challenges of Translating a Lung Cancer Palliative Care Intervention Into Community-Based Settings

Despite significant progress in implementing palliative care interventions for patients with cancer, few intervention studies seek health care clinicians' input before implementation of these into the community. The purpose of this study was to explore palliative care and oncology clinicians' perspectives on the perceived facilitators and challenges in meeting the quality-of-life needs of patients with lung cancer and family caregivers in community-based settings. The Reach Effectiveness Adoption Implementation Maintenance model for implementation research was used as a framework. This was a multisite qualitative study using focus group and key informant interviews. Nineteen clinicians addressed useful practices and challenges in the following areas: (a) early palliative care, (b) interdisciplinary care planning, (c) symptom management, (d) addressing psychological and social needs, and (e) providing culturally respectful care, including spiritual care. In preparation for the intervention, specific education needs and organizational challenges were revealed. Challenges included timing and staffing constraints, the need for clinician education on palliative care services to increase organizational buy-in, and education in providing spiritual support for patients and family caregivers. This research allowed investigators to understand perceptions of clinicians as they prepared to integrate palliative care in their settings. Hospice and palliative care nurses can be instrumental in implementing palliative care into community practice.

Gynecological cancer inpatients need more supportive nursing care than outpatients: a comparative study

Background

Gynecological cancer inpatients and outpatients may have distinct supportive nursing care needs. This study aimed to compare the supportive care needs between these two patient cohorts.

Methods

This cross-sectional comparison analytic study aimed to identify the differences between the supportive nursing care needs of the gynecological cancer inpatients and outpatients. Data were collected from 200 participants who were recruited through consecutive sampling method.

Results

The results showed that gynecological cancer inpatients needed more supportive nursing care than the outpatients. The most reported supportive nursing care needs of the inpatients were in the domains of physical (80%) and the psychological (84%). Whilst, the outpatients needed more health information support (78%). There was a significant difference between the supportive nursing care needs of gynecological cancer inpatients and outpatients (p value = 0.001). Supportive nursing care needs of the inpatients were 44 times higher compared to those of the outpatients.

Conclusions

The gynecological cancer inpatients and outpatients need supportive nursing care differently. Therefore, nurses should assess supportive care needs of their patients early during the care in each setting so that the intervention could be tailored to the patient’s individual needs. Our study findings can help nurses navigate the supportive care needs for gynecological cancer patients receiving inpatient and outpatient care.

The prevalence of disability among people with cancer, cardiovascular disease, chronic respiratory disease and/or diabetes: a systematic review

BACKGROUND

Cardiovascular disease (CVD), cancer, diabetes and chronic respiratory disease are noncommunicable diseases (NCDs) that cause extensive social and economic burden worldwide, particularly in low-income and middle-income countries. There is growing recognition of the importance of the disabilities that individuals experience as a consequence of these NCDs.

OBJECTIVES

This systematic review examined the prevalence of disabilities associated with cancer, CVD, chronic respiratory disease and diabetes.

METHODS

A comprehensive literature search was conducted in PubMed, CINAHL, Embase, Web of Science, PsycINFO, CIRRIE, WHO database, LILACS and AIM. Studies were included if their samples were representative of people with at least one of these four conditions and if prevalence estimates of disability were provided. As random sampling was not feasible in the majority of cases, studies were included where they offered evidence that their sample was representative of the general population being investigated.

RESULTS

A total of 105 articles were included in the review. Most studies were conducted in high-income countries. The prevalence of difficulties with activities of daily living (i.e. eating, bathing, dressing) was reported to be 10.4-34.5% amongst cancer survivors, 21.1-64.1% in those with CVD, 7.4-49.8% in those with chronic respiratory disease and 12.2-54.5% for those with diabetes. The prevalence of a range of other physical, cognitive and psychological impairments (systemic or structural) was additionally described for each disease.

CONCLUSION

Substantial proportions of people with cancer, CVD, chronic respiratory disease or diabetes experience some form of disability - although there was great variance in prevalence and definitions. The findings of this review support the evidence base of global impact associated with NCD, indicate frequency measures for specific disabilities and inabilities associated with each NCD and provide direction for future systematic reviews.

WHAT IS KNOWN ABOUT THE TOPIC

WHAT THIS ARTICLE ADDS.

Translation and validation of the Chinese version of the Cancer Stigma Scale

PURPOSE

To test the reliability and validity of the Chinese version of the Cancer Stigma Scale (CASS).

METHODS

After translation, back-translation and cross-cultural adaptation of the CASS into Chinese (C-CASS), a random online survey of the general population in China was conducted. Reliability was analyzed by internal consistency (Cronbach's α) and construct validity was analyzed by confirmatory factor analysis. The C-CASS was evaluated in a sample of 382 non-cancer patients through online format.

RESULTS

The study found that the C-CASS had satisfactory internal reliability (Cronbach's α of the overall scale and six components was 0.88 and 0.70-0.89, respectively). Confirmatory factor analysis confirmed the six-factor structure (χ²/df = 2.2, GFI = 0.91, CFI = 0.94, RMSEA = 0.056, SRMR = 0.065). Younger individuals and those who had less knowledge of cancer showed more negative attitudes towards cancer.

CONCLUSION

The C-CASS had adequate internal consistency, reliability and indices of model fit, allowing its feasible use to assess levels of cancer stigma in Chinese populations.

Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review

BACKGROUND

This systematic review aimed to identify the unmet care needs and their associated variables in patients with advanced cancer and informal caregivers, alongside summarizing the tools used for needs assessment.

METHODS

Ten electronic databases were searched systematically from inception of each database to December 2016 to determine eligible studies. Studies that considered the unmet care needs of either adult patients with advanced cancer or informal caregivers, regardless of the study design, were included. The Mixed Methods Appraisal Tool was utilized for quality appraisal of the included studies. Content analysis was used to identify unmet needs, and descriptive analysis was adopted to synthesize other outcomes.

RESULTS

Fifty studies were included, and their methodological quality was generally robust. The prevalence of unmet needs varied across studies. Twelve unmet need domains were identified in patients with advanced cancer, and seven among informal caregivers. The three most commonly reported domains for patients were psychological, physical, and healthcare service and information. The most prominent unmet items of these domains were emotional support (10.1-84.4%), fatigue (18-76.3%), and "being informed about benefits and side-effects of treatment" (4-66.7%). The most commonly identified  unmet needs for informal caregivers were information needs, including illness and treatment information (26-100%) and care-related information (21-100%). Unmet needs of patients with advanced cancer were associated with their physical symptoms, anxiety, and quality of life. The most commonly used instruments for needs assessment among patients with advanced cancer were the Supportive Care Needs Survey (N = 8) and Problems and Needs in Palliative Care questionnaire (N = 5). The majority of the included studies investigated unmet needs from the perspectives of either patients or caregivers with a cross-sectional study design using single time-point assessments. Moreover, significant heterogeneity, including differences in study contexts, assessment methods, instruments for measurement, need classifications, and reporting methods, were identified across studies.

CONCLUSION

Both advanced cancer patients and informal caregivers reported a wide range of context-bound unmet needs. Examining their unmet needs on the basis of viewing patients and their informal caregivers as a whole unit will be highly optimal. Unmet care needs should be comprehensively evaluated  from the perspectives of all stakeholders and interpreted by using rigorously designed mixed methods research and longitudinal studies within a given context.

Information needs of patients with lung cancer from diagnosis until first treatment follow-up

The aim of this study was to analyze the information needs of lung cancer patients from diagnosis until first treatment follow-up. Sixty-nine participants with lung cancer were recruited from Ditmanson Medical Foundation Chia-Yi Christian Hospital in Midwest Taiwan. The Modified Toronto Informational Needs Questionnaire (TINQ) was used to assess information needs during visits to the outpatient oncology department. Generalized estimating equations were applied to compare changes in information needs over time and to examine correlates of information needs of lung cancer patients. The greatest concern of lung cancer patients was the cancer itself and access to recovery information. The need for information regarding food selection and social welfare resources was also high. However, the means of information needs for each domain significantly decreased over time. Demographic information (age, gender, disease stage, current treatment, education, work status, and having children) was significantly associated with information needs over time. The need for "disease-related information" remained high regardless of disease stage. Oncology nurses can use the results of this study to better address the information needs of patients in an effort to fill knowledge gaps between patients and healthcare providers. Further studies are needed to explore the use of an appropriate instrument, like that used in this study, to identify newly-diagnosed lung cancer patients' difficulties, concerns, and target interventions to improve their quality of life.

Unmet supportive care needs and symptom burden in Taiwanese cancer survivors who have completed primary treatment

PURPOSE

The number of cancer survivors is increasing due to scientific advances. Previous research on unmet care needs of Taiwanese cancer survivors focused on patients with newly or recently diagnosed cancer. Little is known about the needs and symptom experiences of cancer survivors who have completed treatment.

METHODS

This is a cross-sectional survey study. Patients who were over 20 years old; had completed their first-line treatment for their cancer were recruited into the study. The questionnaire included demographic characteristics, a global item of quality of life, the physical effects subscale of the Cancer Survivors' Survey of Needs (CSSN), and Cancer Survivors' Unmet Needs measure (CaSUN).

RESULTS

One hundred and twenty cancer survivors participated in this study. Body changes, loss of strength, weight change, memory and concentration and fatigue were the top five symptom concerns. Nearly half of the Taiwanese survivors reported needs for up-to-date information, understandable information, and an ongoing case manager were not met. On average, survivors reported 7.68 unmet care needs. Male gender, being under 50 years of age, and having a solid tumor were associated with higher levels of unmet needs.

CONCLUSIONS

This study provides preliminary information about the type and levels of physical symptom concerns and supportive care needs in long-term cancer survivors in Taiwan. Specific groups of cancer survivors whose needs were unmet were identified. The current healthcare system is not sufficiently meeting the needs of cancer survivors and more efforts are required to advance survivorship care and research in Taiwan.

Patterns of unmet supportive needs and relationship to quality of life in Chinese cancer patients

OBJECTIVE

This study aimed to (1) identify distinct patterns of unmet needs in Chinese cancer patients; (2) examine whether sociodemographic and medical characteristics distinguished these patterns; and (3) examine whether people with distinct patterns reported differential quality of life (QoL).

METHODS

This cross-sectional study recruited 301 cancer patients from 2 hospitals in China. The 34-item Supportive Care Needs Survey Short-Form was used to measure unmet needs across 5 domains: physical and daily living, psychological, patient care and support, health systems and information, and sexuality. Latent class analysis was performed to identify patterns of unmet needs across these domains.

RESULTS

Four patterns of unmet needs were identified, differing in levels and nature of unmet needs. Participants in class 1 (47%) reported few unmet needs. Patients in class 2 (15%) had moderate levels of unmet needs, displaying similar levels across 5 domains. People in class 3 (25%) and class 4 (13%) reported similarly high levels on "psychological," "health care system and information," "physical and daily living," and "patient care," but differing in "sexuality," with class 3 reporting low levels while class 4 high on "sexuality." None of sociodemographic and medical characteristics distinguished these patterns significantly. Compared to other classes, people in class 1 reported highest levels of QoL.

CONCLUSIONS

This study demonstrates the existence of 4 patterns of unmet supportive needs in Chinese cancer patients. Patients with few unmet needs reported the best QoL.

The effects of supportive care interventions on depressive symptoms among patients with lung cancer: A metaanalysis of randomized controlled studies

Objective:

Our aim was to examine the effect of supportive care interventions on depressive symptoms in patients with lung cancer.

Method:

We searched the databases of the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid EMBASE, PubMed, and the Chinese Electronic Periodical Services (CEPS) from their inception until September of 2015. We included randomized controlled trial studies that compared standard care with supportive care interventions. The standardized mean difference (SMD) (Cohen's d) was calculated to estimate the effect of interventions. Subgroup analysis was conducted to identify possible sources of heterogeneity.

Results:

A total of 1,472 patients with lung cancer were identified. Compared with standard care, the overall effects of all supportive care interventions significantly reduced depressive symptoms (SMD = –0.74, CI95% = –1.07 to –0.41), and the effects could be maintained at weeks 4, 8, and 12 of follow-up. Three types of supportive care interventions were identified: psychotherapy combined with psychoeducation, psychoeducation alone, and an exercise program. Both psychotherapy combined with psychoeducation and exercise significantly improved depressive symptoms, while psychoeducation alone did not yield significant effects. The moderating effects indicated that greater improvements in depressive symptoms were found in lung cancer patients with a severe level of depressive symptoms at baseline.

Significance of results:

Personalized supportive care interventions can be developed based on the main causes of depressive symptoms. Psychotherapy combined with psychoeducation can target the causes of depressive symptoms, including both physical distress and psychological trauma due to lung cancer, while exercise programs can effectively improve depressive symptoms for lung cancer patients with impaired respiratory function.

Short- and long-term use of medication for psychological distress after the diagnosis of cancer

PURPOSE

This study investigated the short- and long-term use of medication for psychological distress after the diagnosis of cancer.

METHODS

Longitudinal data from the Taiwan National Health Insurance database were used to follow 35,137 cancer patients for 2.5 years after being diagnosed in 2006 and 2007.

RESULTS

Among those patients who survived for at least 180 days, 20.9 % had used psychotropic medications; sedatives were the most frequently prescribed (14.3 %), followed by antidepressants (5.5 %), anxiolytics (3.6 %), and antipsychotics (2.7 %). Lung cancer, prostate cancer, and oral cancer showed a significant association with the regular use of medication in the first 180 days. Among patients who survived for at least 2.5 years, 4.8 % still used psychotropic medication on a regular basis. Lung cancer and prostate cancer were associated with such prolonged use.

CONCLUSIONS

This longitudinal study found that the type of cancer was significantly associated with the use of psychotropic drugs after the diagnosis was made. It provided information about the trajectory of that use and found that a small number of patients were still using those medications after 2.5 years.

Factors predicting emotional cue-responding behaviors of nurses in Taiwan: An observational study

OBJECTIVE

Responding to emotional cues is an essential element of therapeutic communication. The purpose of this study is to examine nurses' competence of responding to emotional cues (CRE) and related factors while interacting with standardized patients with cancer.

METHODS

This is an exploratory and predictive correlational study. A convenience sample of registered nurses who have passed the probationary period in southern Taiwan was recruited to participate in 15-minute videotaped interviews with standardized patients. The Medical Interview Aural Rating Scale was used to describe standardized patients' emotional cues and to measure nurses' CRE. The State-Trait Anxiety Inventory was used to evaluate nurses' anxiety level before the conversation. We used descriptive statistics to describe the data and stepwise regression to examine the predictors of nurses' CRE.

RESULTS

A total of 110 nurses participated in the study. Regardless of the emotional cue level, participants predominately responded to cues with inappropriate distancing strategies. Prior formal communication training, practice unit, length of nursing practice, and educational level together explain 36.3% variances of the nurses' CRE.

CONCLUSIONS

This study is the first to explore factors related to Taiwanese nurses' CRE. Compared to nurses in other countries, Taiwanese nurses tended to respond to patients' emotional cues with more inappropriate strategies. We also identified significant predictors of CRE that show the importance of communication training. Future research and education programs are needed to enhance nurses' CRE and to advocate for emotion-focused communication.

Unmet Supportive Care Needs of Iranian Cancer Patients and its Related Factors

Introduction: Investigation of supportive care needs of cancer patients is important to implement any supportive care programs. There is no relevant studies investigated supportive care needs of Iranian cancer patients and factors affecting such needs. So, the aims of present study were to determine the unmet supportive care needs of Iranian cancer patients and its predictive factors.

Methods: In this descriptive- correlational study 274 cancer patients in one referral medical center in North West of Iran participated. For data collection, demographic and cancer related information checklist and Supportive Care Needs Survey (SCNS) was used. Logistic regression was used for data analysis of un-adjusted and adjusted Odds Ratios (ORs) for patients needs and analysis of variables of study based on Backward LR procedure SPSS Ver.13.

Results: More than fifty percent of participants reported unmet needs in 18 items of SCNS. Most frequent unmet needs were related to health system and information domains and most meet needs were related to sexuality and psychological domains. The result of logistic regression identified predictors of each domain of supportive care needs. The variable such as sex, age and living situation were most important predictors of unmet needs.

Conclusion: The results showed that Iranian cancer patients have many supportive care needs in different domains. In general female cancer patients are at risk of more unmet supportive care needs. So, health care professionals should be more sensitive to fulfillment of supportive care needs of female.

Symptom burden in lung cancer: management updates

Lung cancer is recognized to carry a high symptom burden with associated lowered quality of life as compared with other cancers. Research has shown that symptom severity can be a prognostic indicator of poorer clinical outcomes and survival post treatment. The purpose of this paper is to review current literature relative to symptom burden associated with diagnosis, medical and/or surgical intervention, assessment and management updates, and emerging initiatives that promote positive outcomes based on updated evidence. Discussion relative to interdisciplinary coordination of supportive services and palliative care initiation is provided.

Individual difficulties and resources - a qualitative analysis in patients with advanced lung cancer and their relatives

PURPOSE

Lung cancer is a disease with a high percentage of patients diagnosed in an advanced stage. In a situation of palliative treatment, both patients and their relatives experience diverse types of distress and burden. Little research has been done to identify the individual difficulties and resources for patients with advanced lung cancer and their relatives. Especially, standardized questionnaire-based exploration may not assess the specific distressing issues that pertain to each individual on a personal level. The purpose of this qualitative study is to explore and compare individual difficulties and resources for lung cancer patients and their relatives within the palliative care context.

METHODS

Data were collected by qualitative interviews. A total of 18 participants, nine patients diagnosed with advanced lung cancer (International Classification of Diseases, tenth edition, diagnosis C-34, stage IV) starting or receiving palliative treatment and nine relatives, were interviewed. Data were interpreted through qualitative content analysis.

RESULTS

We identified four main categories of difficulties: communication and conflicts, home and everyday life, thinking about cancer, and treatment trajectory. In general, difficulties were related to interpersonal relationships as well as to impact of chemotherapy. Family, professional caregivers, and social life were significant resources and offered support to both patients and relatives.

CONCLUSION

Results suggest that patient and relative education could reduce difficulties in several areas. Patients seem to struggle with the fear of not having any perspective in therapy. Relatives seem to experience helplessness regarding their partner's deterioration and have to handle their own life and the care work simultaneously. The most important resource for both patients and relatives is their family. In addition, professional lung cancer nurses support relatives in an emotional and organizational way. Intense supportive care for relatives should be standardized.

The discordance of information needs between cancer patients and their families in China

OBJECTIVE

We aimed at studying information needs of patients and their families, and their attitude towards the counterparts' information needs. Factors influencing psychological status of patients were investigated.

METHODS

Self-designed questionnaires for information needs and attitude were delivered to participants. Patient Health Questionnaire 9-item and Generalized Anxiety Disorder 7-item scale were used to evaluate psychological status of patients.

RESULTS

183 eligible pairs of patients and families were involved. Except for the patients' expected life span, most patients and families needed information for all other subscales of disease-related information. Most patients wished families know more information; however, caregivers tended to prevent this. The occurrence of patients' psychiatric disorders was related to their needs for expected life span (OR 3.06 95%CI 1.36-6.93), as well as the attitude of caregivers about whether to provide more information about treatment outcomes (OR 0.24 95% CI 0.10-0.63).

CONCLUSIONS

Information discordance between cancer patients and their families tended to happen when it came to patients' prognostic information. The psychological status of cancer patients was found in association with their information needs and families' attitude towards it.

PRACTICE IMPLICATIONS

To guide oncology professionals and cancer patients' families for information provision.

Mindfulness-Based Stress Reduction for lung cancer patients and their partners: Results of a mixed methods pilot study

BACKGROUND

Lung cancer patients and partners show high rates of impaired quality of life and heightened distress levels. Mindfulness-Based Stress Reduction has proven to be effective in reducing psychological distress in cancer patients. However, studies barely included lung cancer patients.

AIM

We examined whether Mindfulness-Based Stress Reduction might be a feasible and effective intervention for patients with lung cancer and partners.

DESIGN

Mindfulness-Based Stress Reduction is a training in which mindfulness practices are combined with psycho-education to help participants cope with distress. In this mixed methods pilot study, questionnaires on psychological distress and quality of life were administered before, directly after and 3 months after the Mindfulness-Based Stress Reduction training, in combination with semi-structured interviews.

SETTING/PARTICIPANTS

Patients with lung cancer and partners were recruited at one tertiary care academic medical centre. A total of 19 lung cancer patients and 16 partners participated in the Mindfulness-Based Stress Reduction training.

RESULTS

Most patients were diagnosed with advanced stage lung cancer. Vast majority completed the training. Those receiving anti-cancer treatment did not miss more sessions than patients who were not currently treated. Patients and partners felt positive about participating in a peer group and with their partner. Among participants no significant changes were found in psychological distress. Caregiver burden in partners decreased significantly after following Mindfulness-Based Stress Reduction. The qualitative analysis showed that the training seemed to instigate a process of change in participants.

CONCLUSION

The Mindfulness-Based Stress Reduction training seemed to be feasible for patients with lung cancer and their partners. A randomized controlled trial is needed to examine the effectiveness of Mindfulness-Based Stress Reduction in reducing psychological distress in lung cancer patients and partners.