1
|
Raque TL, Bashakevitz K, Wright O, Scout N. Applying the Multicultural Orientation in Cancer Care for Sexual and Gender Minority Cancer Survivors: A Cross-Sectional Correlational Study. LGBT Health 2024; 11:406-413. [PMID: 38215231 DOI: 10.1089/lgbt.2023.0299] [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: 01/14/2024] Open
Abstract
Purpose: Sexual and gender minority (SGM) cancer survivors report unique needs that are not met by some providers. The multicultural orientation (MCO) holds promise for creating a paradigm shift in providing affirmative cancer care, yet has not been tested empirically. This study examines the predictive strength of MCO's tenets of cultural humility and cultural opportunities for SGM cancer patient-provider relationships. Methods: In this cross-sectional study, 108 SGM cancer survivors completed surveys on perceptions of their oncology providers' cultural humility and actualization of cultural opportunities as predictors of survivors' treatment adherence and the patient-provider alliance. Hierarchical regression analyses were conducted. Results: Average participant age was 50 years (standard deviation = 15 years). Over 10 cancer types were represented and 69% of participants were in active treatment, with the remaining 31% receiving follow-up care. Age at diagnosis and not being in active treatment positively correlated with perceptions of providers' cultural humility, patient-provider alliance, and treatment adherence. Regression models explained 38% and 61%, respectively, of the variance in treatment adherence and patient-provider alliance, with cultural humility remaining a significant predictor in both models after accounting for all other variables. Conclusion: Providers' cultural humility and navigation of cultural opportunities in incorporating their patients' salient cultural identities into cancer care are strongly associated with how supported SGM cancer survivors feel by their oncology providers. The MCO is a useful framework for identifying important dimensions in SGM affirmative cancer care.
Collapse
Affiliation(s)
- Trisha L Raque
- Department of Counseling Psychology, University of Denver, Denver, Colorado, USA
| | - Kat Bashakevitz
- Department of Counseling Psychology, University of Denver, Denver, Colorado, USA
| | - Orphea Wright
- Department of Counseling Psychology, University of Denver, Denver, Colorado, USA
| | - Nfn Scout
- National LGBT Cancer Network, Providence, Rhode Island, USA
| |
Collapse
|
2
|
Barry-Hickey D, Aultman C, Danischewsky G, Occhipinti C, Ghisi GLDM. Information needs of women with breast cancer participating in cardiovascular rehabilitation: A mixed-methods study. PATIENT EDUCATION AND COUNSELING 2023; 113:107761. [PMID: 37099840 DOI: 10.1016/j.pec.2023.107761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/26/2023] [Accepted: 04/14/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To determine the information needs of women with a history of breast cancer attending a cardiovascular rehabilitation (CR) program. METHODS A mixed-methods approach was used, including a cross-sectional online survey using an adapted version of the Toronto Information Needs Questionnaire Breast Cancer (TINQ-BC) and 7 virtual focus group sessions (n = 20). RESULTS Overall, 50 responses were received. The TINQ-BC mean was 4.2 ± 0.5/5, with 34/42 items scoring higher than 4 (very important). The highest information needs were related to knowing if cancer is in their bodies or has come back, ways to prevent treatment side effects, and how the illness may affect their future. Participants identified their preferences for education delivery as discussion with peers/healthcare providers and lectures. The focus groups revealed six overarching themes: need for peer support, to make connections, and build relationships; comfort with and utility of technology; desire to learn about specific educational topics; preferences for education sessions; value of education; and value of exercise. CONCLUSIONS These findings provided insight into the information needs of women with a history of breast cancer who participate in CR. PRACTICAL IMPLICATION The care of these patients should be personalized based on these needs to support their adherence to the program.
Collapse
Affiliation(s)
- Danielle Barry-Hickey
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Crystal Aultman
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Gerilyn Danischewsky
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Christine Occhipinti
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| |
Collapse
|
3
|
Sauder CAM, Abidi H, Bold RJ. Shifting paradigms for the treatment of ductal carcinoma in situ: Less is more. Surgery 2023:S0039-6060(23)00119-8. [PMID: 37069008 DOI: 10.1016/j.surg.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/14/2023] [Accepted: 02/23/2023] [Indexed: 04/19/2023]
Abstract
Ductal carcinoma in situ is a diverse disease in which only 50% of lesions progress to invasive carcinoma, but unfortunately, all patients receive similar treatment recommendations independent of the disease variability. De-escalation is the philosophy that treatment for this disease should be differentiated based on the likelihood of future progression and recurrence. Four surgical trials are looking at the possibility of removing surgical intervention, the current mainstay of treatment, from the algorithm. Molecular assays have been developed to help differentiate the risk of an ipsilateral breast tumor recurrence and potentially guide the postsurgical utility of radiation therapy. Primary endocrine therapy is also being explored as an alternative to standard local therapy. Ductal carcinoma in situ therapy is a very complicated algorithm that should be discussed and treated through shared decision-making.
Collapse
Affiliation(s)
- Candice A M Sauder
- Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, CA; University of California Davis Comprehensive Cancer Center, University of California Davis Medical Center, Sacramento CA.
| | - Hira Abidi
- Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, CA; University of California Davis Comprehensive Cancer Center, University of California Davis Medical Center, Sacramento CA
| | - Richard J Bold
- Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, CA; University of California Davis Comprehensive Cancer Center, University of California Davis Medical Center, Sacramento CA
| |
Collapse
|
4
|
Schmidt MK, Kelly JE, Brédart A, Cameron DA, de Boniface J, Easton DF, Offersen BV, Poulakaki F, Rubio IT, Sardanelli F, Schmutzler R, Spanic T, Weigelt B, Rutgers EJT. EBCC-13 manifesto: Balancing pros and cons for contralateral prophylactic mastectomy. Eur J Cancer 2023; 181:79-91. [PMID: 36641897 PMCID: PMC10326619 DOI: 10.1016/j.ejca.2022.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/17/2022] [Accepted: 11/26/2022] [Indexed: 12/15/2022]
Abstract
After a diagnosis of unilateral breast cancer, increasing numbers of patients are requesting contralateral prophylactic mastectomy (CPM), the surgical removal of the healthy breast after diagnosis of unilateral breast cancer. It is important for the community of breast cancer specialists to provide meaningful guidance to women considering CPM. This manifesto discusses the issues and challenges of CPM and provides recommendations to improve oncological, surgical, physical and psychological outcomes for women presenting with unilateral breast cancer: (1) Communicate best available risks in manageable timeframes to prioritise actions; better risk stratification and implementation of risk-assessment tools combining family history, genetic and genomic information, and treatment and prognosis of the first breast cancer are required; (2) Reserve CPM for specific situations; in women not at high risk of contralateral breast cancer (CBC), ipsilateral breast-conserving surgery is the recommended option; (3) Encourage patients at low or intermediate risk of CBC to delay decisions on CPM until treatment for the primary cancer is complete, to focus on treating the existing disease first; (4) Provide patients with personalised information about the risk:benefit balance of CPM in manageable timeframes; (5) Ensure patients have an informed understanding of the competing risks for CBC and that there is a realistic plan for the patient; (6) Ensure patients understand the short- and long-term physical effects of CPM; (7) In patients considering CPM, offer psychological and surgical counselling before surgery; anxiety alone is not an indication for CPM; (8) Eliminate inequality between countries in reimbursement strategies; CPM should be reimbursed if it is considered a reasonable option resulting from multidisciplinary tumour board assessment; (9) Treat breast cancer patients at specialist breast units providing the entire patient-centred pathway.
Collapse
Affiliation(s)
- Marjanka K Schmidt
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Anne Brédart
- Institut Curie, Paris, France; Psychology Institute, Psychopathology and Health Process Laboratory UR4057, Paris City University, Paris, France
| | - David A Cameron
- Edinburgh University Cancer Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Breast Unit, Capio St. Göran's Hospital, Stockholm, Sweden
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital - Aarhus University, Aarhus N, Denmark
| | - Fiorita Poulakaki
- Breast Surgery Department, Athens Medical Center, Athens, Greece; Europa Donna - The European Breast Cancer Coalition, Milan, Italy
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany
| | - Tanja Spanic
- Europa Donna - The European Breast Cancer Coalition, Milan, Italy; Europa Donna Slovenia, Ljubljana, Slovenia
| | - Britta Weigelt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emiel J T Rutgers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
5
|
Ren H, Guo YF, Zhang ZX, Lin BL, Mei YX, Wang WN, Luan WY, Zhang XY, Liang LL, Xue LH. Perception of recurrent risk versus objective measured risk of ischemic stroke in first-ever stroke patients from a rural area in China: A cross-sectional study. PATIENT EDUCATION AND COUNSELING 2023; 107:107586. [PMID: 36495680 DOI: 10.1016/j.pec.2022.107586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Risk perception is critical to the formation of individual health prevention behaviors. A long-term accurate perception of stroke recurrent risks is imperative for stroke secondary prevention. This study aims to explore the level of recurrence risk perceptions and the influential factors of inaccuracy between perceived and objective risk in first-ever ischemic stroke patients from a rural area. METHODS From May to November 2020, 284 first-ever ischemic stroke patients were conveniently recruited in a rural area of Henan Province, China. Perceived risk was measured based on self-reported using a numerical rating scale, whereas the objective risk was measured by the Essen Stroke Risk Score. Patients' perceived risk was compared with their objective risk and categorized as "Accurate," "Underestimated," and "Overestimated." The influencing factors of inaccuracy were further evaluated using multivariate regression analyses. RESULTS 46% of the participants underestimated their stroke risk, while 15.9% overestimated their risks. Patients who were younger (≤65 years), didn't worry about recurrent stroke, and had a low actual recurrent risk were more likely to underestimate their recurrent risk. Patients who were employed, had lower independence, and had greater anxiety were more likely to overestimate their recurrent risk. CONCLUSIONS The majority of participants were unable to accurately perceive their own risk of stroke recurrence. Patients' age, working status, worry about recurrent stroke, actual recurrent risk, level of dependence, and anxiety played a role in perception inaccuracy. PRACTICE IMPLICATIONS The findings could help healthcare providers gain a better understanding of the level and accuracy of recurrence risk perceptions among first-ever stroke patients in the rural area. Future counseling on the perceived risk of stroke recurrence and individual objective risk assessment could be conducted to help patients better understand their risk of recurrence. Individualized risk communication and multidisciplinary teamwork can be developed to improve the accuracy of recurrence risk perceptions and health behaviors.
Collapse
Affiliation(s)
- Hui Ren
- School of Nursing and Health, Zhengzhou University, No. 100 Science Avenue of Zhengzhou City, Henan, PR China.
| | - Yun-Fei Guo
- Henan provincial people's Hospital, Zhengzhou, Henan, PR China.
| | - Zhen-Xiang Zhang
- School of Nursing and Health, Zhengzhou University, No. 100 Science Avenue of Zhengzhou City, Henan, PR China.
| | - Bei-Lei Lin
- School of Nursing and Health, Zhengzhou University, No. 100 Science Avenue of Zhengzhou City, Henan, PR China.
| | - Yong-Xia Mei
- School of Nursing and Health, Zhengzhou University, No. 100 Science Avenue of Zhengzhou City, Henan, PR China.
| | - Wen-Na Wang
- School of Nursing and Health, Zhengzhou University, No. 100 Science Avenue of Zhengzhou City, Henan, PR China.
| | - Wen-Yan Luan
- School of Nursing and Health, Zhengzhou University, No. 100 Science Avenue of Zhengzhou City, Henan, PR China.
| | - Xin-Yue Zhang
- School of Nursing and Health, Zhengzhou University, No. 100 Science Avenue of Zhengzhou City, Henan, PR China.
| | - Li-Li Liang
- Nanyang University of Technology, Nanyang, PR China.
| | - Li-Hong Xue
- Huaxian People's Hospital, Anyang, Henan, PR China.
| |
Collapse
|
6
|
Deuning-Smit E, Kolsteren EEM, Kwakkenbos L, Custers JAE, Hermens RPMG, Prins JB. Barriers and facilitators for implementation of the SWORD evidence-based psychological intervention for fear of cancer recurrence in three different healthcare settings. J Cancer Surviv 2022:10.1007/s11764-022-01285-x. [DOI: 10.1007/s11764-022-01285-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
Abstract
Purpose
Fear of cancer recurrence (FCR) interventions are effective, but few are implemented. This study aimed to identify barriers and facilitators for implementing the evidence-based blended SWORD intervention in routine psycho-oncological care.
Methods
Semi-structured interviews with 19 cancer survivors and 18 professionals from three healthcare settings assessed barriers and facilitators in six domains as described by the determinant frameworks of Grol and Flottorp: (1) innovation, (2) professionals, (3) patients, (4) social context, (5) organization, and (6) economic and political context.
Results
In the innovation domain, there were few barriers. Facilitators included high reliability, accessibility, and relevance of SWORD. In the professional domain, physicians and nurses barriers were lack of self-efficacy, knowledge, and skills to address FCR whereas psychologists had sufficient knowledge and skills, but some were critical towards protocolized treatments, cognitive behavioral therapy, or eHealth. Patient domain barriers included lack of FCR awareness, negative expectations of psychotherapy, and unwillingness/inability to actively engage in treatment. A social context domain barrier was poor communication between different healthcare professionals. Organization domain barriers included inadequate referral structures to psychological services, limited capacity, and complex legal procedures. Economic and political context domain barriers included lack of a national implementation structure for evidence-based psycho-oncological interventions and eHealth platform costs.
Conclusions
Implementation strategies should be targeted at patient, professional, organizational and economic and political domains. Identified barriers and facilitators are relevant to other researchers in psycho-oncology that aim to bridge the research-practice gap.
Implications for cancer survivors
This study contributes to the implementation of evidence-based psychological interventions for cancer survivors, who can benefit from these services.
Collapse
|
7
|
Ankersmid JW, Lansink Rotgerink FK, Strobbe LJA, van Uden-Kraan CF, Siesling S, Drossaert CHC. Relations between recurrence risk perceptions and fear of cancer recurrence in breast cancer survivors. Breast Cancer Res Treat 2022; 195:117-125. [PMID: 35907105 PMCID: PMC9362565 DOI: 10.1007/s10549-022-06684-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/01/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE This study aimed to: (1) determine the accuracy of Dutch breast cancer survivors' estimations of the locoregional recurrence risk (LRR); (2) examine which variables influence (the accuracy of) risk estimations, and risk appraisals; and (3) investigate the influence of the objective LRR risk (estimated using the INFLUENCE-nomogram), risk estimations and risk appraisals on fear of cancer recurrence (FCR). Findings of this study will inform clinicians on risk communication and can improve communication about FCR. METHODS In a cross-sectional survey among 258 breast cancer survivors, women's recurrence risk estimations (in odds) and risk appraisals (in high/low), FCR, demographics and illness perceptions, about one year after surgery were measured and compared to the objective risk for LRRs estimated using the INFLUENCE-nomogram. RESULTS Half of the women (54%) accurately estimated their LRR risk, 34% underestimated and 13% overestimated their risk. Risk estimations and risk appraisals were only moderately positively correlated (r = 0.58). Higher risk appraisals were associated with radiotherapy (r = 0.18) and having weaker cure beliefs (r = - 0.19). Younger age was associated with overestimation of risk (r = - 0.23). Recurrence risk estimations and risk appraisals were associated with more FCR (r = 0.29, r = 0.39). In regression, only risk appraisal contributed significantly to FCR. CONCLUSION Although women were fairly accurate in recurrence risk estimations, it remains difficult to predict over- or underestimation. Recurrence risk estimations and risk appraisal are two different concepts which are both associated with FCR and should therefore be addressed in patient-provider communication.
Collapse
Affiliation(s)
- J W Ankersmid
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
- Santeon, Utrecht, The Netherlands.
| | | | - L J A Strobbe
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - S Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - C H C Drossaert
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| |
Collapse
|
8
|
Optimising patient-initiated follow-up care – A qualitative analysis of women with breast cancer in the UK. Eur J Oncol Nurs 2022; 60:102183. [DOI: 10.1016/j.ejon.2022.102183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 06/01/2022] [Accepted: 07/17/2022] [Indexed: 11/17/2022]
|
9
|
Ankersmid JW, Drossaert CHC, Strobbe LJA, Battjes MS, Uden‐Kraan CF, Siesling S, Riet YEA, Bode‐Meulepas JM, Strobbe LJA, Dassen AE, Olieman AFT, Witjes HHG, Doeksen A, Contant CME. Health care professionals' perspectives on shared decision making supported by personalised‐risk‐for‐recurrences‐calculations regarding surveillance after breast cancer. Eur J Cancer Care (Engl) 2022. [PMCID: PMC9539946 DOI: 10.1111/ecc.13623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objective Breast cancer patients for whom less intensive surveillance is sufficient can be identified based on the risk for locoregional recurrences (LRRs). This study explores health care professionals' (HCPs) perspectives on less intensive surveillance, preferences for shared decision‐making (SDM) about surveillance and perspectives on the use of patients' estimated personal risk for LRRs in decision‐making about surveillance. Methods We conducted semi‐structured interviews with 21 HCPs providing follow‐up care for breast cancer patients in seven Dutch teaching hospitals (Santeon hospitals). Results HCPs were predominantly positive about less intensive surveillance for women with a low risk for recurrences. They mentioned important prerequisites such as clearly defined surveillance schedules based on risk categories, information provision and communication support for patients and HCPs. Most HCPs supported SDM about surveillance and were positive about using patients' estimated personal risk for LRRs. HCPs specified prerequisites such as clear visualisation and explanation of risk information, attention for fear of cancer recurrence (FCR) and defined surveillance schedules for specific risk groups. Conclusion Mentioned prerequisites for less intensive surveillance need to be accounted for. Information needs and existing misconceptions need to be addressed. Outcome information regarding risks for LRRs and FCR can enrich the SDM process about surveillance.
Collapse
Affiliation(s)
- Jet W. Ankersmid
- Department of Health Technology and Services Research, Technical Medical Center University of Twente Enschede
- Santeon Hospital Group Utrecht
| | | | - Luc J. A. Strobbe
- Department of Surgery Canisius Wilhelmina Hospital Nijmegen The Netherlands
| | - Melissa S. Battjes
- Department of Health Technology and Services Research, Technical Medical Center University of Twente Enschede
| | | | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Center University of Twente Enschede
- Department of Research and Development Netherlands Comprehensive Cancer Organisation Utrecht The Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Cescon DW, Kalinsky K, Parsons HA, Smith KL, Spears PA, Thomas A, Zhao F, DeMichele A. Therapeutic Targeting of Minimal Residual Disease to Prevent Late Recurrence in Hormone-Receptor Positive Breast Cancer: Challenges and New Approaches. Front Oncol 2022; 11:667397. [PMID: 35223447 PMCID: PMC8867255 DOI: 10.3389/fonc.2021.667397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 12/29/2021] [Indexed: 12/11/2022] Open
Abstract
While the majority of breast cancers are diagnosed at a curable stage, approximately 20% of women will experience recurrence at a distant site during their lifetime. These metastatic recurrences are incurable with current therapeutic approaches. Over the past decade, the biologic mechanisms underlying these recurrences have been elucidated, establishing the existence of minimal residual disease in the form of circulating micrometastases and dormant disease, primarily in the bone marrow. Numerous technologies are now available to detect minimal residual disease (MRD) after breast cancer treatment, but it is yet unknown how to best target and eradicate these cells, and whether clearance of detectable disease prior to the formation of overt metastases can prevent ultimate progression and death. Clinical trials to test this hypothesis are challenging due to the rare nature of MRD in the blood and bone marrow, resulting in the need to screen a large number of survivors to identify those for study. Use of prognostic molecular tools may be able to direct screening to those patients most likely to harbor MRD, but the relationship between these predictors and MRD detection is as yet undefined. Further challenges include the lack of a definitive assay for MRD with established clinical utility, difficulty in selecting potential interventions due to limitations in understanding the biology of MRD, and the emotional impact of detecting MRD in patients who have completed definitive treatment and have no evidence of overt metastatic disease. This review provides a roadmap for tackling these challenges in the design and implementation of interventional clinical trials aimed at eliminating MRD and ultimately preventing metastatic disease to improve survival from this disease, with a specific focus on late recurrences in ER+ breast cancer.
Collapse
Affiliation(s)
- David W Cescon
- Princess Margaret Cancer Centre, University Health Network, Toronto, CA, Canada
| | - Kevin Kalinsky
- Winship Cancer Institute at Emory University, Atlanta, GA, United States
| | - Heather A Parsons
- Department of Medical Oncology, Division of Breast Oncology, Dana Farber Cancer Institute, Boston, MA, United States
| | - Karen Lisa Smith
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Patricia A Spears
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Alexandra Thomas
- Division of Hematology and Oncology, Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University, Winston-Salem, NC, United States
| | - Fengmin Zhao
- Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center, Boston, MA, United States
| | - Angela DeMichele
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
11
|
Holden CE, Wheelwright S, Harle A, Wagland R. The role of health literacy in cancer care: A mixed studies systematic review. PLoS One 2021; 16:e0259815. [PMID: 34767562 PMCID: PMC8589210 DOI: 10.1371/journal.pone.0259815] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients diagnosed with cancer face many challenges and need a good understanding of their diagnosis and proposed treatments to make informed decisions about their care. Health literacy plays an important role in this and low health literacy has been associated with poorer outcomes. The aims of this review are to identify which outcomes relate to health literacy in patients with cancer, and to combine this through a mixed studies approach with the patient experience as described through qualitative studies. METHODS Four electronic databases were searched in January 2021 to identify records relating to health literacy and patients with cancer. Records were independently screened then assessed for inclusion by two reviewers according to the following criteria: patients aged ≥18 years with cancer, English language publication AND health literacy measured with validated tool and measured outcome associated with health literacy OR qualitative study exploring the role of health literacy as patients make decisions about health. Quality was independently assessed by two reviewers. A narrative synthesis was performed, and findings integrated through concept mapping. This systematic review was registered with PROSPERO, entry CRD42020166454. RESULTS 4441 records were retrieved. Following de-duplication, 2496 titles and abstracts were screened and full texts of 405 papers were reviewed for eligibility. 66 papers relating to 60 studies met the eligibility criteria. Lower health literacy was associated with greater difficulties understanding and processing cancer related information, poorer quality of life and poorer experience of care. Personal and situational influences contributed to how participants processed information and reached decisions about their care. CONCLUSION This review highlights the important role of health literacy for patients with cancer. Outcomes are poorer for those who experience difficulties with health literacy. Further efforts should be made to facilitate understanding, develop health literacy and support patients to become more involved in their care.
Collapse
Affiliation(s)
- Chloe E. Holden
- Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
- Dorset Cancer Centre, University Hospitals Dorset NHS Foundation Trust, Poole, Dorset, United Kingdom
| | - Sally Wheelwright
- Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
| | - Amélie Harle
- Dorset Cancer Centre, University Hospitals Dorset NHS Foundation Trust, Poole, Dorset, United Kingdom
| | - Richard Wagland
- Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
| |
Collapse
|
12
|
Sharifzadeh Y, Slade AN, Weiss E, Sutton AL, Sheppard VB. Attitudes and Perceptions Towards Radiation Therapy in Breast Cancer Patients: The Role of a Multidisciplinary Care Team. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:639-645. [PMID: 31940123 PMCID: PMC7543055 DOI: 10.1007/s13187-019-01677-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Previous studies have shown that breast cancer patients' beliefs regarding radiation therapy (RT) are influenced by a multitude of factors encompassing demographic, socioeconomic, cultural, and healthcare-related domains. The association between consultation with a multidisciplinary care team and breast cancer patients' attitudes towards RT, however, remains understudied. Using survey and medical record data from 185 women with invasive, non-metastatic breast cancer who received breast conserving surgery, we aimed to characterize the relationship between the number and type of oncological specialties consulted and women's belief in RT's ability to decrease the likelihood of breast cancer recurrence. Using multivariable models, we found that compared to women who discussed RT with only one oncologist (medical, radiation, or surgical), women who discussed RT with all three oncologists were more likely to report increased agreement with RT's ability to reduce cancer recurrence. No single specialty of oncology, including radiation oncology, showed increased associations with women's beliefs regarding RT's efficacy. We conclude that women's beliefs in the ability of radiation therapy to reduce breast cancer recurrence are associated with an increased number of oncologic physicians consulted.
Collapse
Affiliation(s)
- Yasamin Sharifzadeh
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Massey Cancer Center, 401 College St, Richmond, VA, 23298, USA
| | - Alexander N Slade
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Massey Cancer Center, 401 College St, Richmond, VA, 23298, USA.
| | - Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Massey Cancer Center, 401 College St, Richmond, VA, 23298, USA
| | - Arnethea L Sutton
- Department of Health Behavior & Policy, Virginia Commonwealth University, 401 College St, Richmond, VA, 23298, USA
| | - Vanessa B Sheppard
- Department of Health Behavior & Policy, Virginia Commonwealth University, 401 College St, Richmond, VA, 23298, USA
| |
Collapse
|
13
|
Lim DW, Metcalfe KA, Narod SA. Bilateral Mastectomy in Women With Unilateral Breast Cancer: A Review. JAMA Surg 2021; 156:569-576. [PMID: 33566074 DOI: 10.1001/jamasurg.2020.6664] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Rates of bilateral mastectomy continue to increase in average-risk women with unilateral in situ and invasive breast cancer. Contralateral prophylactic mastectomy rates increased from 5% to 12% of all operations for breast cancer in the US from 2004 to 2012. Among women having mastectomy, rates of contralateral prophylactic mastectomy have increased from less than 2% in 1998 to 30% in 2012. Observations The increased use of breast magnetic resonance imaging and genetic testing has marginally increased the number of candidates for bilateral mastectomy. Most bilateral mastectomies are performed on women who are at no special risk for contralateral cancer. The true risk of contralateral breast cancer is not associated with the decision for contralateral prophylactic mastectomy; rather, the clinical factors associated with the probability of distant recurrence are associated with bilateral mastectomy. Several changes in society and health care delivery appear to act concurrently and synergistically. First, the anxiety engendered by a fear of cancer recurrence is focused on the contralateral cancer because this is most easily conceptualized and provides a ready target that can be acted upon. Second, the modern woman with breast cancer is supported by the surgeon and the social community of breast cancer survivors. Surgeons want to respect patient autonomy, despite guidelines discouraging bilateral mastectomy, and most women have their expenses covered by a third-party payer. Satisfaction with the results is high, but the association with improved psychosocial well-being remains to be fully understood. Conclusions and Relevance Reducing the use of medically unnecessary contralateral prophylactic mastectomy in women with nonhereditary, unilateral breast cancer requires a social change that addresses patient-, physician-, cultural-, and systems-level enabling factors. Such a transformation begins with educating clinicians and patients. The concerns of women who want preventive contralateral mastectomy must be explored, and women need to be informed of the anticipated benefits (or lack thereof) and risks. Areas requiring further study are considered.
Collapse
Affiliation(s)
- David W Lim
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Kelly A Metcalfe
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
14
|
Szproch AK, Maguire R. A systematic review of the factors associated with regret post-cancer treatment. J Psychosoc Oncol 2020; 40:1-25. [PMID: 33191874 DOI: 10.1080/07347332.2020.1844846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PROBLEM IDENTIFICATION Expanding on previous work in specific cancer populations, this review aimed to explore factors associated with decisional regret following treatment for a range of cancer types. LITERATURE SEARCH A systematic search of four databases identified 1747 studies, using search terms relating to cancer survivors and decisional regret. Following quality appraisal, correlates of regret were abstracted and analyzed using narrative synthesis. DATA EVALUATION/SYNTHESIS Seventy-two studies met the inclusion criteria. Factors associated with treatment regret were categorized as being either modifiable or less modifiable. Regret was associated with various sociodemographic factors, physical health, treatment type, an unsatisfactory decision-making process, poorer mental health and lack of social support. CONCLUSION Results highlight the complex nature of regret and illustrate how this can be experienced following a range of cancer treatments. As regret can be an obstacle to full-recovery from cancer, this review suggests some ways in which the emergence of regret may be mitigated.
Collapse
Affiliation(s)
| | - Rebecca Maguire
- Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland
| |
Collapse
|
15
|
Papaleontiou M, Zebrack B, Reyes-Gastelum D, Rosko AJ, Hawley ST, Hamilton AS, Ward KC, Haymart MR. Physician management of thyroid cancer patients' worry. J Cancer Surviv 2020; 15:418-426. [PMID: 32939685 DOI: 10.1007/s11764-020-00937-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/05/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE The purpose of this study is to understand physician management of thyroid cancer-related worry. METHODS Endocrinologists, general surgeons, and otolaryngologists identified by Surveillance, Epidemiology, and End Results (SEER) patients were surveyed 2018-2019 (response rate 69% (448/654)) and asked to rate in general their patients' worry at diagnosis and actions they take for worried patients. Multivariable-weighted logistic regressions were conducted to determine physician characteristics associated with reporting thyroid cancer as "good cancer" and with encouraging patients to seek help managing worry outside the physician-patient relationship. RESULTS Physicians reported their patients as quite/very worried (65%), somewhat worried (27%), and a little/not worried (8%) at diagnosis. Half of the physicians tell patients their thyroid cancer is a "good cancer." Otolaryngology (odds ratio (OR) 1.87, 95% confidence interval (CI) 1.08-3.21, versus endocrinology), private practice (OR 2.48, 95% CI 1.32-4.68, versus academic setting), and Los Angeles (OR 2.24, 95% CI 1.45-3.46, versus Georgia) were associated with using "good cancer." If patients are worried, 97% of physicians make themselves available for discussion, 44% refer to educational websites, 18% encourage communication with family/friends, 13% refer to support groups, and 7% refer to counselors. Physicians who perceived patients being quite/very worried were less likely to use "good cancer" (OR 0.54, 95% CI 0.35-0.84) and more likely to encourage patients to seek help outside the physician-patient relationship (OR 1.82, 95% CI 1.17-2.82). IMPLICATIONS FOR CANCER SURVIVORS Physicians perceive patient worry as common and address it with various approaches, with some approaches of unclear benefit. Efforts are needed to develop tailored interventions targeting survivors' psychosocial needs.
Collapse
Affiliation(s)
- Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan-North Campus Research Complex, 2800 Plymouth Road, Bldg 16, Rm 453S, Ann Arbor, MI, 48109, USA
| | - Bradley Zebrack
- School of Social Work, University of Michigan, 1080 S. University, Room 2778, Ann Arbor, MI, 48109, USA
| | - David Reyes-Gastelum
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan-North Campus Research Complex, 2800 Plymouth Rd., Bldg. 16, 400S-20, Ann Arbor, MI, 48109, USA
| | - Andrew J Rosko
- Department of Otolaryngology - Head and Neck Surgery, 1904 Taubman Center, 1500 E Medical Center Dr. SPC 5312, Ann Arbor, MI, 48109, USA
| | - Sarah T Hawley
- Division of General Medicine, Department of Internal Medicine, University of Michigan-North Campus Research Complex, 2800 Plymouth Road, Bldg 16, Rm G034, Ann Arbor, MI, 48109, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto St., SSB318E, MC9239, Los Angeles, CA, 90089-9239, USA
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd., NE RM 764, GCR Building Mailstop; 1518-002-7AA, Atlanta, GA, 30322, USA
| | - Megan R Haymart
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan-North Campus Research Complex, 2800 Plymouth Road, Bldg 16, Rm 408E, Ann Arbor, MI, 48109, USA.
| |
Collapse
|
16
|
Babbitt GA, Lynch ML, McCoy M, Fokoue EP, Hudson AO. Function and evolution of B-Raf loop dynamics relevant to cancer recurrence under drug inhibition. J Biomol Struct Dyn 2020; 40:468-483. [DOI: 10.1080/07391102.2020.1815578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Gregory A. Babbitt
- Thomas H. Gosnell School of Life Sciences, Rochester Institute of Technology, Rochester, New York, USA
| | - Miranda L. Lynch
- Hauptmann-Woodward Medical Research Institute, Buffalo, New York, USA
| | - Matthew McCoy
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, DC, USA
| | - Ernest P. Fokoue
- School of Mathematical Sciences, Rochester Institute of Technology, Rochester, New York, USA
| | - André O. Hudson
- Thomas H. Gosnell School of Life Sciences, Rochester Institute of Technology, Rochester, New York, USA
| |
Collapse
|
17
|
Question prompts to empower cancer patients: results of a randomized controlled trial. Support Care Cancer 2019; 28:2571-2579. [DOI: 10.1007/s00520-019-05036-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/08/2019] [Indexed: 12/31/2022]
|
18
|
Killelea BK, Evans SB, Mougalian SS, Gross CP, Fraenkel L, Wang SY. Association between perceived benefits and receipt of radiotherapy among older breast cancer patients. Breast J 2019; 26:231-234. [PMID: 31478585 DOI: 10.1111/tbj.13518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 11/27/2022]
Abstract
While radiotherapy can be safely omitted in many older women with early-stage breast cancer after lumpectomy, approximately two-thirds of eligible women still undergo this treatment. We surveyed 63 older women with stage I (T1N0M0), estrogen-receptor-positive breast cancer who underwent lumpectomy, and were considering/receiving radiotherapy. Participants perceived that radiotherapy would reduce their 10-year risk of local recurrence by an average of 18.7%, which is significantly higher than the 8% risk reduction reported in literature. Multivariate analyses demonstrated that participants who reported a large perceived benefit were significantly more likely to undergo radiotherapy treatment (odds ratio 10.34; 95% confidence interval: 1.66-66.35).
Collapse
Affiliation(s)
- Brigid K Killelea
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Suzanne B Evans
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut.,Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Sarah S Mougalian
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut.,Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Cary P Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut.,Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Liana Fraenkel
- Section of Rheumatology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Shi-Yi Wang
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut
| |
Collapse
|
19
|
van Seijen M, Lips EH, Thompson AM, Nik-Zainal S, Futreal A, Hwang ES, Verschuur E, Lane J, Jonkers J, Rea DW, Wesseling J. Ductal carcinoma in situ: to treat or not to treat, that is the question. Br J Cancer 2019; 121:285-292. [PMID: 31285590 PMCID: PMC6697179 DOI: 10.1038/s41416-019-0478-6] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 03/19/2019] [Accepted: 03/22/2019] [Indexed: 12/27/2022] Open
Abstract
Ductal carcinoma in situ (DCIS) now represents 20-25% of all 'breast cancers' consequent upon detection by population-based breast cancer screening programmes. Currently, all DCIS lesions are treated, and treatment comprises either mastectomy or breast-conserving surgery supplemented with radiotherapy. However, most DCIS lesions remain indolent. Difficulty in discerning harmless lesions from potentially invasive ones can lead to overtreatment of this condition in many patients. To counter overtreatment and to transform clinical practice, a global, comprehensive and multidisciplinary collaboration is required. Here we review the incidence of DCIS, the perception of risk for developing invasive breast cancer, the current treatment options and the known molecular aspects of progression. Further research is needed to gain new insights for improved diagnosis and management of DCIS, and this is integrated in the PRECISION (PREvent ductal Carcinoma In Situ Invasive Overtreatment Now) initiative. This international effort will seek to determine which DCISs require treatment and prevent the consequences of overtreatment on the lives of many women affected by DCIS.
Collapse
Affiliation(s)
- Maartje van Seijen
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Esther H Lips
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alastair M Thompson
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Serena Nik-Zainal
- Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Andrew Futreal
- Department of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Comprehensive Cancer Center, Durham, NC, USA
| | | | - Joanna Lane
- Health Cluster Net, Amsterdam, The Netherlands
| | - Jos Jonkers
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Oncode Institute, Amsterdam, The Netherlands
| | - Daniel W Rea
- Department of Medical Oncology, University of Birmingham, Birmingham, UK
| | - Jelle Wesseling
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
20
|
Systematic review of interventions by non-mental health specialists for managing fear of cancer recurrence in adult cancer survivors. Support Care Cancer 2019; 27:4055-4067. [DOI: 10.1007/s00520-019-04979-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
|
21
|
Li Y, Zhang S, Zhang T, Cao Y, Liu W, Jiang H, Ren D, Ren J, Liu H, Hua Z. Chinese health literacy scale for tuberculosis patients: a study on development and psychometric testing. BMC Infect Dis 2019; 19:545. [PMID: 31221099 PMCID: PMC6587253 DOI: 10.1186/s12879-019-4168-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 06/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The role of health literacy on tuberculosis patients has not been evaluated in China, in part because few special health literacy measurements exist. METHODS A three-step design process was used: (1) Scale construction: Based on the model of revised Bloom's taxonomy, the item-pool was drafted from a literature review, focus group discussion, and in-depth interviews. In addition, a Delphi survey was used in order to select items for inclusion in the scales; (2) Pilot study: Acceptability and clarity were tested with 60 tuberculosis patients; and (3) Psychometric testing: Validity analysis includes content validity, construct validity, and discriminative validity. The Cronbach's alpha coefficient, split-half reliability, and test-retest method were used to assess reliability. Finally, a receiver operating characteristic analysis was conducted to generate a cut-off point. RESULTS The final scale had 29 items with four domains. The item level Content Validity Index ranged from 0.70 to 1.0, and the scale level Content Validity Index was 0.95. The mean score among the lowest 27% group was significantly lower than that those of the highest 27% group (p < 0.01), which supports adequate discriminant validity. Explanatory factor analysis produced a clear four-factor construct, explaining 47.254% of the total variance. Factor 1 and Factor 2 were consistent with read and memorize TB-related words; Factor 3 was associated with understand the meaning of the health education leaflets and examine if TB patients can apply the correct approach to correct context; Factor 4 was related to the ability of TB patient to calculate and identify what unspecified assumptions are included in known conditions. The confirmatory factory analysis results confirmed that a four-factor model was an acceptable fit to the data, with a goodness-of-fit index = 0.930, adjusted goodness of fit index = 0.970, root mean square error of approximation = 0.069, and χ2/df = 2.153. The scale had good internal consistency and test-retest reliability. Additionally, the receiver operating characteristic analysis indicated that the cut-off point for the instrument was set at 45 and 35. CONCLUSIONS The Chinese Health Literacy scale for Tuberculosis has good reliability and validity, and it could be used for measuring the health literacy of Chinese patients with tuberculosis.
Collapse
Affiliation(s)
- Yan Li
- Department of Nursing, Xi'an Jiaotong University, Xian, 710061, China.,School of Nursing, Lanzhou University, Lanzhou, 730000, China
| | - Shaoru Zhang
- Department of Nursing, Xi'an Jiaotong University, Xian, 710061, China.
| | - Tianhua Zhang
- Shaanxi Provincial Institute for TB Control and Prevention, Xian, 710048, China
| | - Yi Cao
- Department of Nursing, Xi'an Jiaotong University, Xian, 710061, China
| | - Weiping Liu
- Shaanxi Provincial Institute for TB Control and Prevention, Xian, 710048, China
| | - Hualin Jiang
- Department of Nursing, Xi'an Jiaotong University, Xian, 710061, China
| | - Dan Ren
- Department of Nursing, Xi'an Jiaotong University, Xian, 710061, China
| | - Jing Ren
- Department of Nursing, Xi'an Jiaotong University, Xian, 710061, China
| | - Haini Liu
- Department of Nursing, Xi'an Jiaotong University, Xian, 710061, China
| | - Zhongqiu Hua
- Department of Nursing, Xi'an Jiaotong University, Xian, 710061, China
| |
Collapse
|
22
|
Shelton RC, Brotzman LE, Crookes DM, Robles P, Neugut AII. Decision-making under clinical uncertainty: An in-depth examination of provider perspectives on adjuvant chemotherapy for stage II colon cancer. PATIENT EDUCATION AND COUNSELING 2019; 102:284-290. [PMID: 30262401 PMCID: PMC6377327 DOI: 10.1016/j.pec.2018.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/22/2018] [Accepted: 09/14/2018] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Decision-making about adjuvant chemotherapy (ACT) for stage II colon cancer is complex, particularly in light of clinical uncertainty regarding treatment benefits. Little is known about provider communication and factors influencing decision-making and recommendations in this setting. METHODS We recruited providers from six US cancer centers and hospitals who care for stage II colon cancer patients. Providers participated in a 30-45 minute interview. Transcripts of interviews were coded for qualitative analysis. RESULTS We interviewed 42 providers (Oncologists: 52%; surgeons: 24%; nurses: 14%). Though most providers were aware of stage II colon cancer treatment guidelines, their use and communication of recommended guidelines was limited. Most reported tailoring delivery and content of their communication, often based on perceived patient education level, but patient involvement in decision-making varied. Findings highlight the complexity of, ACT decision-making, including the central role of providers and family members. CONCLUSIONS Providers are not consistently following recommended guidelines for communicating about ACT among stage II colon cancer patients or eliciting patient preferences for involvement in treatment decisions. PRACTICE IMPLICATIONS Given clinical uncertainty surrounding use of ACT for stage II colon cancer, efforts are needed to enhance guideline implementation, provider education, and communication to facilitate decision-making.
Collapse
Affiliation(s)
- Rachel C Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA.
| | - Laura E Brotzman
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Danielle M Crookes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
| | - Patrick Robles
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - AIfred I Neugut
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
| |
Collapse
|
23
|
Katz SJ, Ward KC, Hamilton AS, Abrahamse P, Hawley ST, Kurian AW. Association of Germline Genetic Test Type and Results With Patient Cancer Worry After Diagnosis of Breast Cancer. JCO Precis Oncol 2018; 2018:PO.18.00225. [PMID: 30656245 PMCID: PMC6333469 DOI: 10.1200/po.18.00225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND There are concerns that multigene panel testing compared with BRCA1/ 2-only testing after diagnosis of breast cancer may lead to unnecessary patient worry about cancer because of more ambiguous results. METHODS Patients with breast cancer diagnosed from 2013 to 2015 and accrued from SEER registries in Georgia and Los Angeles were surveyed (n = 5,080; response rate, 70%), and responses were merged with SEER data and germline genetic testing and results. We examined patient reports of cancer worry by test type and results in 1,063 women who linked to a genetic test and reported undergoing testing. RESULTS More than half of the sample (n = 640; 60.2%) received BRCA1/2-only testing versus 423 patients (39.8%) who had a multigene panel. A minority of tested patients reported substantial cancer worry after treatment: 11.1% (n = 130) reported higher impact of cancer worry, and 15.1% (n = 162) reported a high frequency of cancer worry (worrying often or almost always) in the past month. Impact of cancer worry did not substantively differ by test type, test result outcomes, or clinical or treatment factors. The odds ratio for higher impact of cancer worry was 0.81 (95% CI, 0.51 to 1.28) for multigene versus BRCA1/2-only testing. In a separate model, the odds ratios were 1.21 (95% CI, 0.54 to 2.68) and 0.90 (95% CI, 0.50 to 1.62) for pathogenic variant and variant of uncertain significance, respectively, versus a negative test (the reference group). CONCLUSION Compared with BRCA1/2 testing alone, multigene panel testing was not associated with increased cancer worry after diagnosis of breast cancer.
Collapse
Affiliation(s)
- Steven J. Katz
- Steven J. Katz, Paul Abrahamse, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; and Allison W. Kurian, Stanford University, Stanford, CA
| | - Kevin C. Ward
- Steven J. Katz, Paul Abrahamse, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; and Allison W. Kurian, Stanford University, Stanford, CA
| | - Ann S. Hamilton
- Steven J. Katz, Paul Abrahamse, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; and Allison W. Kurian, Stanford University, Stanford, CA
| | - Paul Abrahamse
- Steven J. Katz, Paul Abrahamse, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; and Allison W. Kurian, Stanford University, Stanford, CA
| | - Sarah T. Hawley
- Steven J. Katz, Paul Abrahamse, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; and Allison W. Kurian, Stanford University, Stanford, CA
| | - Allison W. Kurian
- Steven J. Katz, Paul Abrahamse, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; and Allison W. Kurian, Stanford University, Stanford, CA
| |
Collapse
|
24
|
Greenzang KA, Cronin AM, Kang T, Mack JW. Parent understanding of the risk of future limitations secondary to pediatric cancer treatment. Pediatr Blood Cancer 2018; 65:e27020. [PMID: 29603610 PMCID: PMC5980702 DOI: 10.1002/pbc.27020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/16/2018] [Accepted: 01/19/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Parents and physicians may have different understandings of a child's risk of future limitations due to cancer or cancer treatment. We evaluated alignment between parent- and physician-estimated risk of late effects. METHODS We surveyed 352 parents of children with cancer within 12 weeks of diagnosis, and the children's oncologists, at Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Children's Hospital of Philadelphia. We assessed parent and physician estimations of the child's risk of future limitations in physical abilities, intelligence, or quality of life (QOL) due to cancer treatment. Physician-estimated risk of limitations ≥50% was considered high risk. RESULTS Physicians considered 22% of children at high risk of physical impairments, 9% at high risk for impaired intelligence, and 6% at high risk for impaired QOL. Among high-risk children, 38% of parents recognized this risk in physical abilities, 21% in intelligence, and 5% in QOL. In multivariable analysis, parental understanding of risk, defined as concordant parent and physician estimates, was greater among parents of children at lower risk of future limitations (odds ratio 2.59; 95% confidence interval 1.35-4.96). Regardless of risk, 92% of parents considered it very/extremely important to receive information about potential health implications of cancer treatment. CONCLUSIONS Although most parents want information about life after cancer, most parents of children at high risk of future impairment do not recognize this risk. Strategies to improve communication about late effects throughout pediatric cancer treatment should prioritize meeting information needs and improving parent understanding of the risk of impairment.
Collapse
Affiliation(s)
- Katie A. Greenzang
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
| | - Angel M. Cronin
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | | | - Jennifer W. Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
| |
Collapse
|
25
|
Lee KL, Janz NK, Zikmund-Fisher BJ, Jagsi R, Wallner LP, Kurian AW, Katz SJ, Abrahamse P, Hawley ST. What Factors Influence Women's Perceptions of their Systemic Recurrence Risk after Breast Cancer Treatment? Med Decis Making 2018; 38:95-106. [PMID: 28814131 PMCID: PMC5764769 DOI: 10.1177/0272989x17724441] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Breast cancer patients' misunderstanding of their systemic cancer recurrence risk has consequences on decision-making and quality of life. Little is known about how women derive their risk estimates. METHODS Using Los Angeles and Georgia's SEER registries (2014-2015), a random sample of early-stage breast cancer patients was sent surveys about 2 to 3 months after surgery ( N = 3930; RR, 68%). We conducted an inductive thematic analysis of open-ended responses about why women chose their risk estimates in a uniquely large sub-sample ( N = 1,754). Clinician estimates of systemic recurrence risk were provided for patient sub-groups with DCIS and with low-, intermediate-, and high-risk invasive disease. Women's perceived risk of systemic recurrence (0% to 100%) was categorized as overestimation, reasonably accurate estimation, or underestimation (0% for invasive disease) and was compared across identified factors and by clinical presentation. RESULTS Women identified 9 main factors related to their clinical experience (e.g., diagnosis and testing; treatment) and non-clinical beliefs (e.g., uncertainty; spirituality). Women who mentioned at least one clinical experience factor were significantly less likely to overestimate their risk (12% v. 43%, P < 0.001). Most women who were influenced by "communication with a clinician" had reasonably accurate recurrence estimates (68%). "Uncertainty" and "family and personal history" were associated with overestimation, particularly for women with DCIS (75%; 84%). "Spirituality, religion, and faith" was associated with an underestimation of risk (63% v. 20%, P < 0.001). LIMITATIONS The quantification of our qualitative results is subject to any biases that may have occurred during the coding process despite rigorous methodology. CONCLUSIONS Patient-clinician communication is important for breast cancer patients' understanding of their numeric risk of systemic recurrence. Clinician discussions about recurrence risk should address uncertainty and relevance of family and personal history.
Collapse
Affiliation(s)
- Kamaria L. Lee
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
| | - Nancy K. Janz
- University of Michigan, Department of Health Behavior and Health Education, Ann Arbor, MI
| | - Brian J. Zikmund-Fisher
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
- University of Michigan, Department of Health Behavior and Health Education, Ann Arbor, MI
- University of Michigan, Center for Bioethics and Social Sciences in Medicine, Ann Arbor, MI
| | - Reshma Jagsi
- University of Michigan, Department of Radiation Oncology, Ann Arbor, MI
| | - Lauren P. Wallner
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
- University of Michigan, Department of Epidemiology, Ann Arbor, MI
| | - Allison W. Kurian
- Stanford University, Departments of Medicine and Health Research and Policy, Stanford, CA
| | - Steven J. Katz
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
- University of Michigan, Department of Health Management and Policy, Ann Arbor, MI
| | - Paul Abrahamse
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
| | - Sarah T. Hawley
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
- University of Michigan, Department of Health Management and Policy, Ann Arbor, MI
- Veterans Administration Center for Clinical Management Research, Ann Arbor VA Health Care System, Ann Arbor, MI
| |
Collapse
|
26
|
Berger AM, Buzalko RJ, Kupzyk KA, Gardner BJ, Djalilova DM, Otte JL. Preferences and actual chemotherapy decision-making in the greater plains collaborative breast cancer study . Acta Oncol 2017; 56:1690-1697. [PMID: 28903664 DOI: 10.1080/0284186x.2017.1374555] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION There is renewed interest in identifying breast cancer patients' participation in decision-making about adjuvant chemotherapy. There is a gap in the literature regarding the impact of these decisions on quality of life (QOL) and quality of care (QOC). Our aims were to determine similarities and differences in how patients diagnosed with breast cancer preferred to make decisions with providers about cancer treatment, to examine the patient's recall of her role when the decision was made about chemotherapy and to determine how preferred and actual roles, as well as congruence between them, relate to QOL and perceived QOC. MATERIAL AND METHODS Greater Plains Collaborative clinical data research network of PCORnet conducted the 'Share Thoughts on Breast Cancer' survey among women 12-18 months post-diagnosis at eight sites in seven Midwestern United States. Patients recalled their preferred and actual treatment decision-making roles and three new shared decision-making (SDM) variables were created. Patients completed QOL and QOC measurements. Correlations and t-tests were used. RESULTS Of 1235 returned surveys, 873 (full sample) and 329 (subsample who received chemotherapy) were used. About one-half of women in both the full (50.7%) and subsample (49.8%,) preferred SDM with providers about treatment decisions, but only 41.2% (full) and 42.6% (subsample) reported experiencing SDM. Significant differences were found between preferred versus actual roles in the full (p < .001) and subsample (p < .004). In the full sample, there were no relationships between five decision-making variables with QOL, but there was an association with QOC. The subsample's decision-making variables related to several QOL scales and QOC items, with a more patient-centered decision than originally preferred related to higher physical and social/family well-being, overall QOL and QOC. CONCLUSIONS Patients benefit from providers' efforts to identify patient preferences, encourage an active role in SDM, and tailor decision making to their desired choice.
Collapse
Affiliation(s)
- Ann M. Berger
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Russell J. Buzalko
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kevin A. Kupzyk
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bret J. Gardner
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Julie L. Otte
- School of Nursing, Indiana University, Indianapolis, IN, USA
| |
Collapse
|
27
|
Muriel Fernandez J, Sánchez Ledesma MJ, López Millan M, García Cenador MB. Study of the uses of Information and Communication Technologies by Pain Treatment Unit Physicians. J Med Syst 2017; 41:78. [PMID: 28349348 DOI: 10.1007/s10916-017-0726-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/17/2017] [Indexed: 11/28/2022]
Abstract
Adequate use of Information and Communication Technologies (ICTs) in health has been shown to save the patient and caregiver time, improve access to the health system, improve diagnosis and control of disease or treatment. All this results in cost savings, and more importantly, they help improve the quality of service and the lives of patients. The purpose of this study is to analyse the differences in the uses of this ICTs between those physicians that belong to Pain Treatment Units (PU) and other physicians that work in pain not linked to these PUs. An online survey, generated by Netquest online survey tool, was sent to both groups of professionals and the data collected was statistical analysed through a logistic regression methodology which is the Logit binomial model. Our results show that those physicians that belong to PUs use ICTs more frequently and consider it more relevant to their clinical practice.
Collapse
Affiliation(s)
- Jorge Muriel Fernandez
- Department of Surgery, School of Medicine, University of Salamanca, Avda Alfonso X El Sabio s/n, 37007, Salamanca, Spain.
| | | | - Manuel López Millan
- Anaesthesiology Service, University Hospital Virgen Macarena, Sevilla, Spain
| | - María Begoña García Cenador
- Department of Surgery, School of Medicine, University of Salamanca, Avda Alfonso X El Sabio s/n, 37007, Salamanca, Spain
| |
Collapse
|