Wide-ranging impacts reported by NZ cancer survivors: is supporting cancer survivor resilience a health sector role?

Patients' and carers' priorities for cancer research in Aotearoa/New Zealand

BACKGROUND

Discrepancies have been reported between what is being researched, and what patients/families deem important to be investigated. Our aim was to understand research priorities for those who live with cancer in Aotearoa/New Zealand, with emphasis on Māori.

METHODS

Adult outpatients with cancer and their whānau/family completed a survey (demographics, selecting keywords, free-text comments) at Christchurch hospital. Quantitative and qualitative data were evaluated using standard statistical and thematic analyses, respectively.

RESULTS

We recruited 205 participants, including both tūroro/patients (n = 129) and their whānau/family/carer (n = 76). Partnership with Māori health workers enabled greater recruitment of Māori participants (19%), compared to the proportion of Māori in Canterbury (9%). Cancer research was seen as a priority by 96% of participants. Priorities were similar between Māori and non-Māori participants, with the keywords 'Cancer screening', 'Quality of Life' and 'Development of new drugs' chosen most often. Free-text analysis identified three themes; 'Genetics and Prevention', 'Early Detection and Treatment', and 'Service Delivery', with some differences by ethnicity.

CONCLUSIONS

Cancer research is a high priority for those living with cancer. In addition, participants want researchers to listen to their immediate and practical needs. These findings may inform future cancer research in Aotearoa.

MāORI TERMS AND TRANSLATION

Aotearoa (New Zealand) he aha ō whakaaro (what are your thoughts) hui (gathering) mate pukupuku (cancer) mokopuna (descendent) Ōtautahi (Christchurch) rongoā (traditional healing) tāne (male) te reo (Māori language) Te Whatu Ora (weaving of wellness, Health New Zealand) tikanga (methods, customary practices) tūroro (patients) (alternative terms used: whānau affected by cancer or tangata whaiora (person seeking health)) wahine (female) Waitaha (Canterbury) whakapapa (genealogy) whānau ((extended) family, based on whakapapa, here also carer).

'Survivorship care is one big gap': a qualitative study of post-treatment supportive care in Aotearoa New Zealand

BACKGROUND

This study focuses on the provision of supportive care services and programmes for cancer survivors post-treatment in Aotearoa New Zealand (NZ). It aims to aid our understanding of an often challenging and fragmented phase of cancer survivorship, and lay the groundwork for future research into the development of survivorship care in NZ.

METHODS

This study employed a qualitative design using semi-structured interviews with a range of healthcare providers (n = 47) involved in service provision for cancer survivors post active treatment, including supportive care providers; clinical and allied health providers; primary health providers; and Māori health providers. Data were analysed using thematic analysis.

RESULTS

We found that cancer survivors in NZ face a range of psycho-social and physical issues post-treatment. The provision of supportive care to meet these needs is currently fragmented and inequitable. The key barriers to improved supportive care provision for cancer survivors post-treatment include a lack of capacity and resources within the existing cancer care framework; divergent attitudes to survivorship care within the cancer care workforce; and a lack of clarity around whose responsibility post-treatment survivorship care is.

CONCLUSIONS

Post-treatment cancer survivorship should be established as a distinct phase of cancer care. Measures could include greater leadership in the survivorship space; the implementation of a survivorship model(s) of care; and the use of survivorship care plans; all of which could help improve referral pathways, and clarify clinical responsibility for post-treatment survivorship care.

Colorectal cancer survivorship: A systematic review and thematic synthesis of qualitative research

INTRODUCTION

With rapid changes in treatments for colorectal cancer (CRC), qualitative research into CRC survivorship requires greater synthesis. This paper aims to fill this gap through a systematic review (PROSPERO CRD42019131576) and thematic synthesis of the qualitative literature on survivorship experiences across early-stage and advanced CRC survivors.

METHODS

CINAHL, Embase, MEDLINE, PsycINFO and PubMed were searched for qualitative CRC survivorship papers. Titles, abstracts and full texts were screened. Included articles (n = 81) underwent data extraction, CASP qualitative bias ratings and thematic synthesis.

RESULTS

Bowel dysfunction caused functional limitations and negative quality of life (QoL), while stomas posed threats to body image and confidence. Physical symptoms hindered return to work, increasing financial burdens. Survivors' unmet needs included information regarding symptom expectations and management, and ongoing support throughout recovery. Advanced and early-stage survivors shared similar experiences. Advanced survivors struggled with fear of cancer recurrence/progression and feelings of powerlessness. Functional limitations, financial impacts and sexuality in advanced survivors were underexplored areas.

CONCLUSION

CRC and its treatments impact survivors' QoL in all areas. A coordinated supportive care response is required to address survivors' unmet needs. Future qualitative studies should explore advanced CRC subpopulations, treatment-specific impacts on QoL and long-term (>5 years) impacts on CRC survivors.