Associations between a sense of connection and existential and psychosocial outcomes in gynecologic and breast cancer survivors

Relationship among post-traumatic growth, spiritual well-being, and perceived social support in Chinese women with gynecological cancer

This study aimed to examine the correlation between post-traumatic growth (PTG), spiritual well-being (SWB), perceived social support (PSS), and demographic and clinical factors in Chinese gynecological cancer patients. Through convenience sampling, we conducted a cross-sectional study of 771 adult patients with gynecological cancer. The European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-Spiritual Well-being 32 (EORTC QLQ-SWB32), Post-traumatic Growth Inventory (PTGI), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to measure SWB, PTG, and PSS. A Multiple Linear Regression Model was used to determine the possible factors contributing to PTG. The subscale with the highest centesimal score in the PTGI was the Appreciation of Life Scale, and the lowest was New Possibility. Gynecologic cancer patients with younger ages (B =  - 0.313, P = 0.002), perceived more family support (B = 1.289, P < 0.001), had more existential (B = 0.865, P = 0.010), and had religious belief (B = 5.760, P = 0.034) may have more PTG. Spiritual well-being, perceived social support, younger age, and religious beliefs are associated with post-traumatic growth in gynecological cancer patients. Healthcare staff could provide more professional support to younger patients with religious beliefs. Promoting social support and spiritual well-being could potentially serve as effective interventions for boosting PTG among gynecological cancer.

Effectiveness of telemedicine-based psychosocial intervention for breast cancer patients: a systematic review and meta-analysis

OBJECTIVES

This review aimed to synthesize the available evidence on the effectiveness of telemedicine-based psychosocial interventions among breast cancer (BC) patients regarding quality of life (QOL), depression, anxiety, distress, fatigue, sleep disorders, sexual function, and fear of cancer recurrence (FCR).

METHODS

A search of 10 databases was conducted to identify RCTs of the effects of telemedicine-based psychosocial interventions on outcomes. Selection of studies, quality appraisal, and data extraction were performed by two reviewers independently. GRADE and Cochrane risk of bias assessment tools were used for quality appraisal. Heterogeneity was determined by I2, standardized mean differences (SMD) were used to determine intervention effects, and meta-analyses, subgroup analysis, and sensitivity analysis were performed.

RESULTS

In total, 29 RCTs were included. Telemedicine-based psychosocial interventions improved the primary outcomes of QOL (SMD = 0.32), distress (SMD =  - 0.22), and anxiety (SMD =  - 0.16) in BC patients with moderate effect size. There were some improvements in the secondary outcomes of sleep disorders (SMD =  - 056), sexual function (SMD = 0.19), and FCR (SMD =  - 0.41). After sensitivity analysis, the effect size of fatigue was moderate (SMD =  - 0.24).

CONCLUSION

Telemedicine-based psychosocial interventions are superior to usual care in BC patients with improved QOL, sexual function, and less distress, anxiety, fatigue, sleep disorders, and FCR. Due to the heterogeneity of the results for QOL, anxiety, fatigue, sleep disturbance, and FCR, these results should be interpreted cautiously. In the future, more rigorous RCTs need to be designed to identify better delivery models and intervention times to further test their effectiveness.

Loneliness in Breast Cancer Patients with Early Life Adversity: An Investigation of the Effects of Childhood Trauma and Self-Regulation

Childhood trauma may be prevalent in the general population, and the psychosocial treatment of patients with cancer may require consideration of the effects of such early adversity on the healing and recovery process. In this study, we investigated the long-term effects of childhood trauma in 133 women diagnosed with breast cancer (mean age 51, SD = 9) who had experienced physical, sexual, or emotional abuse or neglect. We examined their experience of loneliness and its associations with the severity of childhood trauma, ambivalence about emotional expression, and changes in self-concept during the cancer experience. In total, 29% reported experiencing physical or sexual abuse, and 86% reported neglect or emotional abuse. In addition, 35% of the sample reported loneliness of moderately high severity. Loneliness was directly influenced by the severity of childhood trauma and was directly and indirectly influenced by discrepancies in self-concept and emotional ambivalence. In conclusion, we found that childhood trauma was common in breast cancer patients, with 42% of female patients reporting childhood trauma, and that these early experiences continued to exert negative effects on social connection during the illness trajectory. Assessment of childhood adversity may be recommended as part of routine oncology care, and trauma-informed treatment approaches may improve the healing process in patients with breast cancer and a history of childhood maltreatment.

The unequal burden of time toxicity

Many cancer treatments impose large time investments on patients. We have termed these time burdens 'time toxicity' and have urged their consideration as adverse events of treatment. Here, we discuss time toxicity measures while considering inequitable access to healthcare, time as a resource, and patterns of time toxicity.

Reflective Journaling as Preparation for Spiritual Care of Patients

Death is a human experience; however, an understanding of dying, grief, and loss continues to elude many cultures, even more elusive is the understanding of complicated grief for families and burnout for providers caring for the dying patient and their families. To prepare students taking care of dying patients and their families, the Catalyzing Relationships at the End of Life program included addressing perceptions of one's own death through journal reflection. The Catalyzing Relationships at the End of Life program utilized journals to ascertain student understanding of issues surrounding family communication at the end of life. Journal reflections were embedded in an online learning management system and utilized structured prompts as the journaling method. These prompts addressed what students desire for their own family relationships during their own death. Results from the qualitative descriptive analysis included 4 themes: meaning, beliefs, connections, and good death. Reflections about their own death were a powerful experience for student participants. Although questions about spirituality were not specifically asked, themes relating to spirituality emerged from the data.

How does patient-centered communication in ovarian cancer care enhance patient well-being? A mixed methods study

OBJECTIVE

Greater perceived patient-centered communication (PCC) is associated with better health-related quality of life (HRQoL) in patients with ovarian cancer. Quantitative measures of PCC and HRQoL do little to explain this association. We interviewed patients with high and low ratings of PCC to understand how it is associated with HRQoL.

METHODS

Explanatory sequential mixed methods study. Participants were English-speaking U.S. adults with ovarian cancer. We assessed PCC with the Patient-Centered Communication - Cancer (PCC-Ca)-36 (possible score range 1-5; higher scores represent greater patient-centeredness), and purposively sampled 14 participants with total scores in the top and bottom quartiles. Participants completed individual, semi-structured interviews about their communication experiences. Guided by the National Cancer Institute Framework for PCC in Cancer Care, we analyzed interview transcripts using directed content analysis. We integrated survey and interview findings in a joint display.

RESULTS

Among 176 survey respondents, PCC-Ca-36 total scores ranged from 1.7 to 5.0. Participants with scores in the top quartile (4.8-5.0) perceived clinicians as proactive and attentive to psychosocial concerns. Those with scores in the bottom quartile (1.7-3.5) described not feeling known as an individual and receiving limited support for self-management.

CONCLUSIONS

The association between PCC and QoL may be partially explained by differences in perceived support for psychosocial concerns and self-management. PCC may facilitate receipt of proactive, personalized care.