Symptom burden in cancer survivorship

Physical function in older adults with and without a cancer history: Findings from the National Health and Aging Trends Study

BACKGROUND

Previous studies identified physical function limitations in older cancer survivors, but few have included objective measures and most focused on breast and prostate cancer survivors. The current study compared patient-reported and objective physical function measures between older adults with and without a cancer history.

METHODS

Our cross-sectional study used a nationally representative sample of community-dwelling, Medicare beneficiaries from the 2015 National Health and Aging Trends Study (n = 7495). Data collected included patient-reported physical function, including a composite physical capacity score and limitations in strength, mobility, and balance, and objectively measured physical performance metrics, including gait speed, five time sit-to-stand, tandem stand, and grip strength. All analyses were weighted to account for the complex sampling design.

RESULTS

Thirteen percent of participants (n = 829) reported a history of cancer, of which more than half (51%) reported a diagnosis other than breast or prostate cancer. In models adjusted for demographics and health history, older cancer survivors had lower Short Physical Performance Battery scores (unstandardized beta [B] = -0.36; 95% CI: -0.64, -0.08), slower gait speed (B = -0.03; 95% CI: -0.05, -0.01), reduced grip strength (B = -0.86; 95% CI: -1.44, -0.27), worse patient-reported composite physical capacity (B = -0.43; 95% CI: -0.67, -0.18) and patient-reported upper extremity strength (B = 1.27; 95% CI: 1.07, 1.50) compared to older adults without cancer. Additionally, the burden of physical function limitations was greater in women than in men, which may be explained by cancer type.

CONCLUSIONS

Our results extend studies in breast and prostate cancer to show worse objective and patient-reported physical function outcomes in older adults with a range of cancer types compared to those without a cancer history. Moreover, these burdens seem to disproportionately affect older adult women, underscoring the need for interventions to address functional limitations and prevent further health consequences of cancer and its treatment.

The long-term burden of a symptom cluster and association with longitudinal physical and emotional functioning in breast cancer survivors

BACKGROUND

Fatigue, insomnia and pain are some of the most common and distressing symptoms experienced during breast cancer (BC) treatment and survivorship. The symptoms have been found to impact one another and to form a symptom cluster, and greater severity of the symptoms may be negatively associated with physical and emotional functioning in survivorship. In exploratory analyses from a randomized controlled trial examining the effect of progressive resistance training on the development of lymphedema after BC, we aimed to examine the burden of the symptom cluster fatigue-pain-insomnia, and its prognostic value for long-term symptom severity as well as emotional and physical functioning.

MATERIAL AND METHODS

Latent profile analysis was used to identify groups with similar severity of pain, fatigue and insomnia among 158 patients with BC two weeks after surgery. Mixed effects Tobit regression models were used to estimate fatigue, pain, insomnia, and physical and emotional functioning 20 weeks, 1 year and 3.5 years after surgery.

RESULTS

Two symptom burden groups were identified: 80% of women had a low severity while 20% of women had a high severity of the three symptoms after BC surgery. 3.5 years later, the women with high symptom burden post-surgery still had higher pain, insomnia and fatigue scores than women with low symptom burden. High symptom burden post-surgery was associated with worse physical functioning 3.5 years later, while emotional functioning was only negatively impacted during the first year.

DISCUSSION

These findings warrant larger studies investigating if symptom burden early in BC trajectory can be used for risk stratification for persistent symptoms and diminished physical functioning with the purpose of developing and implementing targeted interventions.

Symptoms and Needs Monitoring in Diverse Ambulatory Oncology Patients: Usage Characteristics and Impact on Emergency Room Visits and Hospitalization

PURPOSE

Symptoms and needs monitoring using patient-reported outcomes (PRO) is associated with improved clinical outcomes in cancer care. However, these improvements have been observed predominantly in non-Hispanic White patients using English assessments with high completion rates. The documented impact of such monitoring on system-level outcomes including emergency room (ER) visits and hospitalizations remains limited. We explored factors affecting the completion of PRO measures and evaluated clinical outcomes in an ambulatory oncology setting with a diverse racial, ethnic, and linguistic population.

METHODS

A retrospective analysis (October 2019-February 2022) was performed for patients with cancer assigned to My Wellness Check (MWC), a patient-portal-administered and electronic health record-based PRO assessment that generates automated alerts to oncology providers. Patient demographics, clinical characteristics, and clinical outcomes were collected. Logistic regression models examined factors affecting the completion of MWC questionnaires. Cumulative incidence of ER visits and hospitalization were assessed by Cox proportional hazards regression models adjusting for demographics.

RESULTS

We identified 9,553 patients; 43.1% (n = 4,117) answered one or more questions. Patients age 65 years or older (adjusted odds ratio [aOR], 0.77; P < .0001), male (aOR, 0.81; P < .0001), Hispanic/Latino ethnicity (aOR, 0.70; P < .0001), living without partners (aOR, 0.75; P < .0001), or receiving no treatment (aOR, 0.76; P < .0001) were less likely to answer MWC questionnaires. Patients who completed the entire MWC questionnaires had a reduced risk of an ER visit (adjusted hazard ratio, 0.78; P < .0001) and hospitalization (adjusted hazard ratio, 0.80; P = .0007) relative to patients who did not.

CONCLUSION

Completing electronic health record-based PRO assessments was associated with significantly better clinical outcomes in a diverse cancer population. Specific patient groups were less likely to participate. Further research is needed to identify barriers to completing PRO measures and the long-term benefits of such programs.

Safety of acupuncture in oncology: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Acupuncture is frequently used to treat the side effects of cancer treatment, but the safety of this intervention remains uncertain. The current meta-analysis was conducted to assess the safety of acupuncture in oncological patients.

METHODS

The PubMed, Cochrane Central Register of Controlled Trials, and Scopus databases were searched from their inception to August 7, 2020. Randomized controlled trials in oncological patients comparing invasive acupuncture with sham acupuncture, treatment as usual (TAU), or any other active control were eligible. Two reviewers independently extracted data on study characteristics and adverse events (AEs). Risk of bias was assessed using the Cochrane Risk of Bias Tool.

RESULTS

Of 4590 screened articles, 65 were included in the analyses. The authors observed that acupuncture was not associated an with increased risk of intervention-related AEs, nonserious AEs, serious AEs, or dropout because of AEs compared with sham acupuncture and an active control. Compared with TAU, acupuncture was not associated with an increased risk of intervention-related AEs, serious AEs, or drop out because of AEs but was associated with an increased risk for nonserious AEs (odds ratio, 3.94; 95% confidence interval, 1.16-13.35; P = .03). However, the increased risk of nonserious AEs compared with TAU was not robust against selection bias. The meta-analyses may have been biased because of the insufficient reporting of AEs in the original randomized controlled trials.

CONCLUSIONS

The current review indicates that acupuncture is as safe as sham acupuncture and active controls in oncological patients. The authors recommend researchers heed the CONSORT (Consolidated Standards of Reporting Trials) safety and harm extension for reporting to capture the side effects and better investigate the risk profile of acupuncture in oncology.

LAY SUMMARY

According to this analysis, acupuncture is a safe therapy for the treatment of patients with cancer. Acupuncture seems to be safe compared with sham acupuncture and active controls.

Documenting patients’ and providers’ preferences when proposing a randomized controlled trial: a qualitative exploration

Background

With advances in cancer diagnosis and treatment, women with early-stage breast cancer (ESBC) are living longer, increasing the number of patients receiving post-treatment follow-up care. Best-practice survivorship models recommend transitioning ESBC patients from oncology-provider (OP) care to community-based care. While developing materials for a future randomized controlled trial (RCT) to test the feasibility of a nurse-led Telephone Survivorship Clinic (TSC) for a smooth transition of ESBC survivors to follow-up care, we explored patients’ and OPs’ reactions to several of our proposed methods.

Methods

We used a qualitative study design with thematic analysis and a two-pronged approach. We interviewed OPs, seeking feedback on ways to recruit their ESBC patients for the trial, and ESBC patients, seeking input on a questionnaire package assessing outcomes and processes in the trial.

Results

OPs identified facilitators and barriers and offered suggestions for study design and recruitment process improvement. Facilitators included the novelty and utility of the study and simplicity of methods; barriers included lack of coordination between treating and discharging clinicians, time constraints, language barriers, motivation, and using a paper-based referral letter. OPs suggested using a combination of electronic and paper referral letters and supporting clinicians to help with recruitment. Patient advisors reported satisfaction with the content and length of the assessment package. However, they questioned the relevance of some questions (childhood trauma) while adding questions about trust in physicians and proximity to primary-care providers.

Conclusions

OPs and patient advisors rated our methods for the proposed trial highly for their simplicity and relevance then suggested changes. These findings document processes that could be effective for cancer-patient recruitment in survivorship clinical trials.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-022-01549-1.

Cancer Survivorship Care in Colombia: Review and Implications for Health Policy

INTRODUCTION

The number of cancer survivors is increasing in Colombia, and health policy changes are necessary to meet their unmet needs and improve their health outcomes. Similar trends have been identified in developed countries, and positive changes have been made.

METHODS

We conducted a narrative review to provide an overview of Colombia's social structure, health care system, and health care delivery in relation to cancer, with recommendations for improving cancer survivorship in Colombia based on the model of survivorship care in the United States.

RESULTS

We proposed general recommendations for improving cancer survivors' care including (1) recognizing cancer survivorship as a distinct phase of cancer, (2) strengthening methods and metrics for tracking cancer survivorship, (3) assessing and monitoring cancer symptoms and quality of life of cancer survivors, (4) publishing evidence-based guidelines considering the social, economic, and cultural characteristics of Colombian population and cancer survivors' specific needs.

CONCLUSION

These recommendations could be used to inform and prioritize health policy development in Colombia related to cancer survivorship outcomes.

Development of a Framework and the Content for a Psychoeducational Internet-Delivered Intervention for Women after Treatment for Gynecological Cancer

The number of women treated for gynecological cancer is increasing. At the same time, the duration of in-patient hospitalization has decreased, and follow-up with its primary focus on early recognition of recurrence does not meet all patients' needs. One method of follow-up may be digital intervention. This study describes the development of a psychoeducational Internet-delivered intervention targeting women's psychosocial needs during the follow-up period after treatment for gynecological cancer. The project consisted of three phases following the UK Medical Research Council Framework guidelines for the development of complex interventions. Phase one identified the evidence in the field, phase two identified the relevant theoretical framework, and phase three included a two-year work process including focus group interviews and think aloud interviews with users. Through the steps of literature review, theoretical framework, and an iterative development process with users and other stakeholders, a six-week program was developed. The program included psychoeducational information, multimedia, exercises, and weekly telephone follow-up with a dedicated nurse. This Internet-delivered intervention can be a novel method for addressing the gap in the provision of follow-up for women after treatment for gynecological cancer.

Transitions in coping profiles after breast cancer diagnosis: implications for depressive and physical symptoms

The objective of this study was to determine whether: (a) cancer-related coping profiles change across time; (b) coping profile transition types predict changes in depressive and physical symptoms. Latent transition analysis was conducted with repeated measures of seven cancer-related coping processes from 460 women recently diagnosed with breast cancer. In multilevel models, coping profile transition groups were entered as predictors of symptoms across 12 months. Three coping profiles emerged at study entry, with two profiles at later assessments. Forty-eight percent of women maintained high-moderate approach-oriented coping over time. Specific factors (e.g., age, acceptance of emotions) differentiated the transition groups. Women who increased and then maintained high-moderate approach-oriented coping had relatively high initial depressive symptoms that declined steeply. When cancer-related acceptance predominated, women experienced increasing physical symptoms. Distinct cancer-related coping patterns are related to the level of and change in depressive and physical symptoms longitudinally. Early intervention to increase approach-oriented coping strategies could yield favorable outcomes.

Symptom Clusters in Postchemotherapy Neutropenic Fever in Hematological Malignancy: Associations Among Sickness Behavior Symptom Cluster, Inflammatory Biomarkers of Procalcitonin and C-Reactive Protein, and Febrile Measures

CONTEXT

Little research has been conducted to investigate symptom clusters in postchemotherapy neutropenic fever (NF), their relationships with inflammatory biomarkers, and febrile outcome measures in patients with hematological malignancy, a population with high febrile rates incurring considerable costs to the health care system.

OBJECTIVES

The aim of the present study was to investigate these.

METHODS

One hundred four NF episodes were observed in patients with hematological malignancy who were enrolled in the study. Patient-reported symptoms were recorded using the M.D. Anderson Symptom Inventory. Inflammatory biomarkers of procalcitonin (PCT) and C-reactive protein (CRP), vital signs, blood specimens for cultures, blood cell counts, and biochemistry were also collected. Serious complications from NF were reviewed from medical records if documented. Exploratory factor analysis and Spearman's rank correlation were used in the data analysis.

RESULTS

Three symptom clusters-sickness behavior, chemotherapy neurotoxicity, and emesis-were identified by exploratory factor analysis. The factor score of the sickness behavior cluster was significantly correlated with CRP (P < 0.05), PCT (P < 0.01), and the highest (P < 0.05) and maximum increased in (P < 001) temperatures at the onset (first day) of neutropenic fever.

CONCLUSION

This study identified symptom clusters of sickness behavior, chemotherapy neurotoxicity, and emesis and highlighted significant associations between sickness behavior cluster, PCT, CRP, and febrile temperatures at the onset of postchemotherapy NF. These areas have lacked exploration in previous research. Monitoring and analyzing patient-reported sickness behavior symptoms, PCT, CRP, and temperature data would provide significant complementary data for the management and surveillance of postchemotherapy NF in hematological malignancy.

The Influence of Comorbidity on Health-Related Quality of Life After Esophageal Cancer Surgery

BACKGROUND

Esophageal cancer surgery reduces patients' health-related quality of life (HRQoL). This study examined whether comorbidities influence HRQoL in these patients.

METHODS

This prospective cohort study included esophageal cancer patients having undergone curatively intended esophagectomy at St Thomas' Hospital London in 2011-2015. Clinical data were collected from patient reports and medical records. Well-validated cancer-specific and esophageal cancer-specific questionnaires (EORTC QLQ-C30 and QLQ-OG25) were used to assess HRQoL before and 6 months after esophagectomy. Number of comorbidities, American Society of Anesthesiologists physical status classification (ASA), and specific comorbidities were analyzed in relation to HRQoL aspects using multivariable linear regression models. Mean score differences with 95% confidence intervals were adjusted for potential confounders.

RESULTS

Among 136 patients, those with three or more comorbidities at the time of surgery had poorer global quality of life and physical function and more fatigue compared with those with no comorbidity. Patients with ASA III-IV reported more problems with the above HRQoL aspects and worse social function and pain compared with those with ASA I-II. Cardiac comorbidity was associated with worse global quality of life and dyspnea, while pulmonary comorbidities were related to coughing. Patients assessed both before and 6 months after surgery (n = 80) deteriorated in most HRQoL aspects regardless of comorbidity status, but patients with several comorbidities had worse physical function and fatigue and more trouble with coughing compared with those with fewer comorbidities.

CONCLUSION

Comorbidity appears to negatively influence HRQoL before esophagectomy, but appears not to severely impact 6-month recovery of HRQoL.

The linguistic validation process of the Vanderbilt Head and Neck Symptom Survey - Italian Version (VHNSS-IT)

PURPOSE

To linguistically validate the Italian translation of the Vanderbilt Head and Neck Symptom Survey (VHNSS), there is a patient-reported outcome measure to screen for symptoms in the head and neck cancer (HNC) patients population. The goal was to ensure conceptually equivalence with the original version and maintain clarity, ease of use and understanding.

METHODS

We conducted a multi-step linguistic process (forward translation, backward translation and patient testing) to generate and validate an Italian translation of the VHNSS.

RESULTS

Two intermediate Italian versions were created: The first Italian version was derived from a reconciliation of the three forward translations, and the second Italian version was derived from changes in the first version after the backward translation step. All investigators involved actively discussed possible solutions to produce a translated instrument that maintained a reading and comprehension level accessible by most respondents, without altering the meaning and content of the original source. During the patient testing step, only two patients reported problems with items comprehension and the rate of comprehension problems per single item was lower than expected. This phase allowed patients to give suggestion in order to make items clearer and easier to understand: 43% of patients proposed a revision of the survey during the face-to-face interview, and most of these suggestions were retained.

CONCLUSIONS

A valid multi-step process leads to the creation of the final version of the VHNSS-IT, a suitable instrument to screen for symptoms in the Italian HNC patients population and an official measurement tool that can be used in cooperative research group.

Psychological issues in cancer survivorship

Thankfully, many more women are now surviving cancer due to advances in awareness, surveillance, and treatment. In fact, many oncology clinicians now consider cancer a chronic illness. This has meant that a growing number are living with the physical and psychological consequences of the disease. The psychological impact and emotions experienced by survivors are varied. Some reactions are more common than others, including the onset of depression, anxiety, and sexual dysfunction and feelings of abandonment, isolation, grief, and fear of recurrence. Body image and sexuality are also commonly impacted by cancer, particularly by women who experience treatment-induced menopause. Existential and spiritual concerns can also cause psychological consequences. In time, however, many women adjust to life as a cancer patient and find new meaning and purpose in their lives. The aim of this article is to highlight the key psychological issues faced by women who are in the chronic or survivorship phase of their cancer experience. The article also aims to emphasize the need for ongoing evaluation of the psychological status of these women during regular follow-up appointments. This will ensure that patient-centered supportive care is optimized.

Lived experiences and quality of life after gynaecological cancer-An integrative review

Aim and objectives

To review the literature on Nordic women's lived experiences and quality of life (QoL) after gynaecological cancer treatment.

Background

While incidence and survival are increasing in all groups of gynaecological cancers in the Nordic countries, inpatient hospitalisation has become shorter in relation to treatment. This has increased the need for follow‐up and rehabilitation.

Design

Integrative literature review using the Equator PRISMA guidelines.

Methods

The review was selected, allowing inclusion of both experimental and nonexperimental research. The search included peer‐reviewed articles published 1995–2017. To frame the search strategy, we applied the concept of rehabilitation, which holds a holistic perspective on health.

Results

Fifty‐five articles were included and were contextualised within three themes. Physicalwell-being in a changed body encompasses bodily changes comprising menopausal symptoms, a changed sexual life, complications in bowels, urinary tract, lymphoedema and pain, bodily‐based preparedness and fear of recurrence. Mental well-being as a woman deals with questioned womanliness, the experience of revitalised values in life, and challenges of how to come to terms with oneself after cancer treatment. Psychosocial well-being and interaction deals with the importance of having a partner or close person in the process of coming to terms with oneself after cancer. Furthermore, the women needed conversations with health professionals around the process of coping with changes and late effects, including intimate and sensitive issues.

Conclusion

Years after gynaecological cancer, women have to deal with fundamental changes and challenges concerning their physical, mental and psychosocial well‐being. Future research should focus on how follow‐up programmes can be organised to target the multidimensional aspects of women's QoL. Research collaboration across Nordic countries on rehabilitation needs and intervention is timely and welcomed.

Relevance to clinical practice

To ensure that all aspects of cancer rehabilitation are being addressed, we suggest that the individual woman is offered an active role in her follow‐up.

What is Symptom Burden: A Qualitative exploration of Patient Definitions

Current definitions of “symptom burden” are largely derived from clinicians, and there are many variations in the way the term is used, defined, and operationalized. The aim of this study was to explore patient perceptions of symptom burden in the context of advanced and incurable disease. A group of 58 cancer patients followed by a palliative care team answered a single open-ended question: “Please define ‘symptom burden.”’ Three authors independently coded and analyzed patient responses using a grounded theory approach. They identified six themes, the most frequently coded of which were: “can't do usual activities,” “psychological suffering,” and “specific severe symptoms.” Our findings indicate that the concept of symptom burden is complex and extends beyond numerical symptom-scoring systems. In addition to inquiring about specific symptoms, it may be important to directly ask patients about their overall burden or experience of symptoms.

Intervention Protocol for Investigating Yoga Implemented During Chemotherapy

OBJECTIVE

Fatigue and other treatment-related symptoms are critical therapeutic targets for improving quality of life in patients with colorectal cancer during chemotherapy. Yoga is a promising intervention for improving these therapeutic targets and has been primarily investigated in the group-class format, which is less feasible for cancer patients with high symptom burden to attend. Thus, we developed a protocol for implementing yoga individually in the clinic among patients receiving chemotherapy.

METHODS

We followed recommended domains for developing a yoga protocol to be used in an efficacy trial. These recommendations include consideration to the style, delivery, components of the intervention, dose, specific class sequences, facilitation of home practice, measurement of intervention fidelity, selection of instructors, and dealing with modifications. The intervention protocol was developed by an interdisciplinary team.

PROTOCOL

Yoga Skills Training (YST) consists of four 30-minute in-person sessions and was implemented while in the chair during chemotherapy infusions for colorectal cancer with recommended daily home practice for eight weeks. Therapeutic goals of the YST are to reduce fatigue, circadian disruption, and psychological distress. Elements of the YST are awareness meditation, gentle seated movement, breathing practice, and relaxation meditation. Attention, comfort, and ease are also highlighted.

CONCLUSION

This description of a protocol for integrating yoga with conventional cancer treatment will inform future study designs and clinical practice. The design of the YST is novel because it implements yoga-most commonly studied when taught to groups outside of the clinical setting- individually during clinical care.

Education level and health-related quality of life after oesophageal cancer surgery: a nationwide cohort study

OBJECTIVE

The purpose of the study was to investigate whether low education level was associated with patients' health-related quality of life (HRQOL) after oesophageal cancer resection.

SETTING

A nationwide cohort study in Sweden.

PARTICIPANTS

In total, 378 patients who underwent oesophageal cancer surgery in 2001-2005 were followed up 6 months and 3 years after surgery.

OUTCOME MEASURES

HRQOL was assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30) and the oesophageal cancer-specific module. The association between level of education and HRQOL was calculated with linear regression models, providing mean score differences (MD) and 95% CIs. Data were analysed separately for women and men.

RESULTS

Education level was not associated with HRQOL recovery after oesophageal cancer surgery. However, when data were stratified by sex, lower education was associated with worse emotional function (MD -13; 95% CI -22 to -3), more symptoms of insomnia (MD 20; 95% CI 8 to 32) and reflux (MD: 15; 95% CI 3 to 26) for women, but not for men. Among women, low education was in general associated with worse functioning and more symptoms.

CONCLUSIONS

Low education was not associated with worse HRQOL after oesophageal cancer surgery. However, when data were stratified for sex, low education level was associated with worse functioning and more symptoms in certain HRQOL domains for women, particularly in a short-term perspective. For men, no such association was found.

Symptom experience and symptom burden of patients following first-ever stroke within 1 year: a cross-sectional study

Symptoms that are multidimensional and concurrent should be assessed from different dimensions and managed together. Few studies have evaluated concurrent and multidimensional symptoms in patients with stroke. Most studies of stroke focused on dysfunctions and complications. We hypothesize that patients with stroke have a heavy symptom burden within 1 year. This study aimed to describe multidimensional and concurrent symptoms within 1 year after stroke. This study recruited 230 patients with stroke from the Rehabilitation Department of Xuhui District Center Hospital of Shanghai and the Shanghai Sunshine Rehabilitation Center in China from March to September 2017. The patients’ multidimensional symptom experience and symptom burden were analyzed using a self-made structured questionnaire and the influential factors for symptom burden were identified. The mean number of symptoms in patients with stroke was 11.7 ± 3.5. More than two thirds of the participants suffered from at least 10 co-occurring symptoms. Unilateral limb weakness had the highest prevalence and frequency. Participation restriction had the highest symptom dimensions of severity and distress. Lack of self-care ability (severity), memory deterioration (frequency), imbalance of body (distress), moodiness (distress), being unable to move limbs at will (distress), shoulder pain (distress), and slower response (frequency) were independent factors of the total symptom burden score. These findings can provide essential information for efficient symptom management of patients with stroke. This trial was registered with the ISRCTN registry (registration number: ISRCTN18421629).

An evaluation of the effectiveness of 'Time to Adjust' a group-based cognitive-behavioural-therapy (CBT) programme for patients recovering from cancer

OBJECTIVES

'Time to Adjust' (TTA) is a 6-week group-based cognitive-behavioural-therapy programme for patients recovering from cancer. The TTA intervention is designed to facilitate patient's adjustment to life after cancer by enhancing existing coping skills, developing new coping skills and drawing on peer support within the context of group delivery of the programme. The study aims to explore patient psychological adjustment and to identify features of the intervention that patients find most beneficial.

METHODS

This retrospective repeated measures design study represents a clinical evaluation of a group-based intervention routinely delivered by the Cancer Psychology Service at University Hospital Limerick. TTA was open to patients with a cancer diagnosis who had completed their surgery, radiotherapy and chemotherapy treatment by the programme start date. Patients self-referred and suitability for the programme was assessed by pre-programme clinical interview. Pre- and post-intervention data from 59 participants was collected using self-report measures of stress and coping. A brief end-of-programme questionnaire provided descriptive feedback on patients' experience of the programme.

RESULTS

Findings revealed favourable trends in the psychological adjustment of patients. Self-reported depression, anxiety and negative adjustment was lower post-TTA.

CONCLUSIONS

This study indicates that TTA supports patients' psychological recovery from cancer with multiple components of the programme facilitating psychological adjustment. Findings support the delivery of group-based therapeutic interventions for this patient group. Future research could use in-depth post-intervention interviews for a richer understanding of the programme benefits. Longer-term follow-up in could examine the degree to which benefits are maintained over time.

Co-morbidity after oesophageal cancer surgery and recovery of health-related quality of life

BACKGROUND

Although health-related quality of life (HRQoL) recovers after surgery for oesophageal cancer in most long-term survivors, one in seven patients experiences a deterioration in HRQoL for reasons yet unknown. The aim of this study was to assess whether co-morbidities diagnosed after surgery influence recovery of HRQoL.

METHODS

Patients who underwent surgery for cancer of the oesophagus or gastro-oesophageal junction in Sweden between 2001 and 2005 were included. HRQoL was assessed by means of the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-OES18 questionnaires. Repeated-measures ANOVA was used to assess mean differences in HRQoL scores between three co-morbidity status groups (healthy, stable and increased) over time. Probabilities of deterioration in HRQoL were calculated based on marginal probabilities from logistic regression models.

RESULTS

At 5 years' follow-up, 153 (24·8 per cent) of 616 patients were alive and 137 responded to at least two of three questionnaires. The healthy and increased co-morbidity groups showed deterioration in almost all aspects of HRQoL at 6 months after surgery compared with baseline. The increased co-morbidity group also deteriorated in several aspects from 3 to 5 years after surgery. Patients with an increase in co-morbidity did not have a significantly increased probability of deterioration in HRQoL over time compared with healthy or stable patients, except with respect to cognitive function, loss of appetite, choking and coughing.

CONCLUSION

Patients with an increase in co-morbidities after oesophagectomy experience long-term deterioration in HRQoL.

"The Monkey on Your Shoulder": A Qualitative Study of Lymphoedema Patients' Attitudes to and Experiences of Acupuncture and Moxibustion

Background. Lymphoedema, a distressing consequence of cancer treatment, has significant negative impact on health-related quality of life. Multidisciplinary approaches are needed to improve physical and psychosocial wellbeing. Acupuncture and moxibustion (acu/moxa), two modalities of traditional East Asian medicine, may contribute to improved outcomes for cancer survivors with lymphoedema. Aim. To explore how patients with lymphoedema secondary to cancer treatment perceive and experience acu/moxa treatment. Design and Setting. A qualitative focus group study, nested in a 3-step mixed methods observational study, was carried out in a cancer drop-in and information centre in north-west London. Methods. Six focus groups and one telephone interview were conducted with 23 survivors of breast or head and neck cancer, who had completed up to 13 acu/moxa treatments. Scripts were transcribed, coded, and analysed to identify salient and overarching themes. Results. Participants described feeling disempowered by cancer treatment and subsequent diagnosis of lymphoedema. Acu/moxa was valued for its whole-person approach and for time spent with a practitioner who cared, listened, and responded. Participants reported changes in physical and psychosocial health, including increased energy levels and reduced pain and discomfort, and feelings of empowerment, personal control, and acceptance. Many were motivated to improve self-care. Conclusion. Many participants who received acu/moxa treatment reported improved wellbeing and a more proactive attitude towards self-care.

Great expectations: racial differences in outcome expectations for a weight lifting intervention among black and white breast cancer survivors with or without lymphedema

BACKGROUND

Black breast cancer survivors are less likely to engage in physical activity than are White survivors. This is unfortunate because physical activity may be especially beneficial given Black breast cancer survivors' higher rates of obesity and adverse treatment effects related to obesity, such as breast cancer-related lymphedema (BCRL). The analysis explored outcome expectations for a weight lifting intervention by sedentary Black or White female breast cancer survivors and assessed the role of BCRL on outcome expectations for exercise.

METHODS

Chi-squared tests compared mean outcome expectation values for Black and White breast cancer survivors who completed baseline surveys for the Physical Activity and Lymphedema trial (n = 281). With race as the independent variable, multivariable analysis compared results for women without BCRL with those with BCRL, separately.

RESULTS

Across the entire sample, Black survivors (n = 90) had significantly higher (p < 0.05) outcome expectations than White survivors (n = 191) for improvements in sleep, appearance, mental health, affect, energy, and eating habits, with small to moderate effect sizes. When stratified by BCRL status, differences by race were robust only among those with BCRL.

CONCLUSIONS

Black cancer survivors had greater expectations than White cancer survivors for how a weight lifting intervention would improve their physical and mental states; these differences were most apparent among women with BCRL. Improving outcomes in Black breast cancer survivors rests on the development of interventions that are appropriately tailored to address the expectations of this population and account for differences in persistent adverse effects of cancer such as BCRL. Copyright © 2016 John Wiley & Sons, Ltd.

Psychosocial issues in post-treatment cancer survivors: Desire for support and challenges in identifying individuals in need

PURPOSE

The ongoing and late effects of cancer treatment can interfere with quality of life and adoption of healthy behaviors, thus potentially impairing recovery and survival. Developing effective methods to identify individuals in need of support is crucial in providing comprehensive, ongoing care and ensuring optimal use of limited resources. The current study provides an examination of long-term survivors' reports of psychosocial issues, their desire for follow-up, and the role of widely used distress-screening measures for identifying survivors who desire help.

METHOD

317 cancer survivors (M age = 62.98 years, female = 70%, Md years since treatment = 7.5 years, mixed diagnoses) completed measures of psychosocial adjustment and quality of life as well as a checklist of psychosocial issues on which they indicated whether they would like to speak with a health professional regarding each issue.

RESULTS

Participants reported an average of 1.7 psychosocial issues. Only a minority desired to speak to a health professional; however, those desiring follow-up reported significant impairments in adjustment and quality of life. Though far from adequate as a stand-alone measure, area under the curve and regression analysis suggested a combination of the distress thermometer and number of psychosocial issues may be the best assessment of those desiring follow-up assistance.

CONCLUSION

These results indicate that there is a need for a more sophisticated system of assisting survivors that takes into account issues, symptoms, and motivation for help. The present study is important in guiding the development of effective survivorship care and contributing to the growing literature describing the adjustment and care needs of survivors.

Identification and prioritization of candidate genes for symptom variability in breast cancer survivors based on disease characteristics at the cellular level

Research is beginning to suggest that the presence and/or severity of symptoms reported by breast cancer survivors may be associated with disease-related factors of cancer. In this article, we present a novel approach to the identification and prioritization of biologically plausible candidate genes to investigate relationships between genomic variation and symptom variability in breast cancer survivors. Cognitive dysfunction is utilized as a representative breast cancer survivor symptom to elucidate the conceptualization of and justification for our cellular, disease-based approach to address symptom variability in cancer survivors. Initial candidate gene identification was based on genes evaluated as part of multigene expression profiles for breast cancer, which are commonly used in the clinical setting to characterize the biology of cancer cells for the purpose of describing overall tumor aggressiveness, prognostication, and individualization of therapy. A list of genes evaluated within five multigene expression profiles for breast cancer was compiled. In order to prioritize candidate genes for investigation, genes used in each profile were compared for duplication. Twenty-one genes (BAG1, BCL2, BIRC5, CCNB1, CENPA, CMC2, DIAPH3, ERBB2, ESR1, GRB7, MELK, MKI67, MMP11, MYBL2, NDC80, ORC6, PGR, RACGAP1, RFC4, RRM2, and SCUBE2) are utilized in two or more profiles, including five genes (CCNB1, CENPA, MELK, MYBL2, and ORC6) used in three profiles. To ensure that the parsimonious 21 gene set is representative of the more global biological hallmarks of cancer, an Ingenuity Pathway Analysis was conducted. Evaluation of genes known to impact pathways involved with cancer development and progression provide a means to evaluate the overlap between the biological underpinnings of cancer and symptom development within the context of cancer.

Health Services Utilization and Payments in Patients With Cancer Pain: A Comparison of Intrathecal Drug Delivery vs. Conventional Medical Management

Introduction

To compare health services utilization and payments for cancer patients who received an implantable intrathecal drug delivery (IDD) system, consisting of a pump and catheter, vs. conventional medical management (CMM) for the treatment of cancer‐related pain.

Methods

This retrospective claims‐data analysis compared health services utilization and payments in a population of patients receiving either IDD or CMM for treatment of cancer pain. Patients were propensity score‐matched 1:1 based on characteristics including, but not limited to, age, gender, cancer type, comorbid conditions, and health care utilization and payments.

Results

From a sample of 142 IDD patients and 3188 CMM patients who met all inclusion/exclusion criteria, 73 matched pairs were obtained. In the year following implant, IDD patients had a consistent trend of lower medical utilization, and total payments that were $3195 lower compared to CMM.

Conclusions

Despite the high initial cost of IDD, this analysis suggests that patients with IDD incur lower medical utilization and payments over the first year post‐implant. Further analysis comprised of a larger, longitudinal sample would contribute to health economics and outcomes research, and assist with future practice guideline development.

Long-term anorectal, urinary and sexual dysfunction causing distress after radiotherapy for anal cancer: a Danish multicentre cross-sectional questionnaire study

AIM

The objective of primary radiotherapy for anal cancer is to remove cancer while maintaining anorectal function. However, little is known about anorectal function among long-term survivors without colostomy. Using a cross-sectional questionnaire study, we examined symptoms and distress related to the dysfunction of pelvic organs after radiotherapy for anal cancer.

METHOD

A questionnaire regarding anorectal, urinary and sexual symptoms was sent to anal cancer patients without recurrence or colostomy, diagnosed during 1996-2003, and treated with curative intent (chemo)radiotherapy at three Danish centres. For each symptom we assessed frequency and severity and the level of symptom-induced distress (no, little, moderate or great distress).

RESULTS

Of 94 eligible patients, 84 (89%) returned the completed questionnaire at a median of 33 months after radiotherapy. Incontinence for solid stools, liquid stools and gas occurred at least monthly in 31%, 54% and 79% of patients, respectively. Overall 40% of patients reported great distress from incontinence for solid or liquid stools at least monthly. Faecal urgency occurring at least monthly was experienced by 87% of patients and caused great distress in 43%. Stress, urge or another type of urinary incontinence occurred at least monthly in 45% and caused great distress in 21%. Urinary urgency occurred at least monthly in 48% but only caused great distress in 14%. Sexual desire was severely decreased in 58% and only 24% were satisfied with their sexual function.

CONCLUSION

Distressing long-term anorectal and sexual dysfunction was common after radiotherapy for anal cancer, and morbidity due to urinary dysfunction was moderate.

Symptom burden clusters: a challenge for targeted symptom management. A longitudinal study examining symptom burden clusters in breast cancer

CONTEXT

Although there has been a growing interest in cancer symptom clusters, less is known about symptom burden clusters.

OBJECTIVES

To explore clusters of burdensome symptoms over time, the impact on health status and quality of life, and coping capacity in patients with breast cancer.

METHODS

In this longitudinal study, a sample of 206 patients completed the Memorial Symptom Assessment Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and the Sense of Coherence scale, at diagnosis of primary or recurrent breast cancer, and at one-, three-, and six-month follow-ups.

RESULTS

Three clusters of burdensome symptoms were identified: emotional symptom burden, gastrointestinal symptom burden, and unwellness symptom burden. Most burdensome were emotional symptoms, with worrying, feeling sad, and feeling nervous as the core or defining symptoms. Over time, additional symptoms escalated the emotional symptom burden. The gastrointestinal symptom burden, with "change in the way food tastes" as a core symptom, was more often associated with chemotherapy. Less stable over time, the unwellness symptom burden could be interpreted as short- and long-term side effects of hormonal therapy. Of these clusters, only the emotional symptom burden cluster significantly diminished health status and quality of life. Patients reporting lower coping capacity experienced higher levels of symptom burden.

CONCLUSION

This study provides insights into symptom burden clusters over time. A challenging approach toward symptom management in clinical oncology is to target the burden of a symptom cluster and to recognize the need for individually designed interventions to ameliorate symptom burden in cancer patients.

Breast cancer in African Americans: from patient to survivor

PURPOSE

The purpose of this synthesis is to explore the experience of the transition from cancer patient to survivor in African Americans with breast cancer, addressing the risk/ protective factors that have an influence on successful transition using the social ecological model.

METHODS

The investigator searched CINAHL, PubMed, and PsycInfo databases. Articles were assessed for content addressing risk and protective factors of transition in African American breast cancer survivorship. Eleven research articles were obtained and synthesized.

RESULTS

Risk and protective factors exist at all levels of the social ecological model. Emotional issues are prevalent after the cessation of cancer treatment, enhanced by the lack of social support in this population. Spirituality was shown to be present in many levels as a protective factor during this period.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The entrance to survivorship represents a time of increased stressors and subsequent coping. Through careful identification of influencing factors, health care providers can develop strategies to attenuate the emotional distress and negative complications of the transition specific to this vulnerable population. Illuminating the experiences of African American women during this transition period provides insight into the interventional needs during and after the cessation of breast cancer treatment.

Influence of co-morbidity on long-term quality of life after oesophagectomy for cancer

BACKGROUND

The extent to which co-morbidities affect recovery of health-related quality of life (HRQoL) in long-term survivors of oesophageal cancer surgery is poorly understood.

METHODS

This was a prospective, population-based, nationwide Swedish cohort study of patients who underwent surgery for oesophageal cancer between 2001 and 2005, and were alive 5 years after operation. The European Organization for Research and Treatment of Cancer QLQ-C30 and the QLQ-OES18 questionnaires were used to assess HRQoL up to 5 years after surgery. Eight aspects from the questionnaires were selected. Matched reference values from the Swedish general population were used as a proxy for HRQoL before presentation of the cancer. Adjusted multivariable linear mixed-effect models were used to assess mean score differences (MDs) of each HRQoL aspect in patients with or without co-morbidities.

RESULTS

Of 616 patients who underwent surgery, 153 (24·8 per cent) survived 5 years, of whom 141 (92·2 per cent) completed the questionnaires at 5 years. Among these, 79 (56·0 per cent) had co-morbidities. Patients with co-morbidity had clinically relevant (MD at least 10) and statistically significantly poorer global quality of life (MD -10, 95 per cent confidence interval -12 to -7), and more problems with dyspnoea (MD 10, 6 to 13) throughout the whole follow-up period than those without co-morbidity. Patients with co-morbidity had a clinically relevant worse level of fatigue at 6 months (MD 10, 1 to 19) and 5 years (14, 4 to 24). With regard to specific co-morbidities, only patients with diabetes reported more clinically relevant, but not statistically significant, problems with fatigue at 6 months (MD 16, 2 to 31) and 5 years (MD 13, -5 to 31) compared with patients without co-morbidity.

CONCLUSION

Among survivors of oesophageal cancer surgery, the presence of co-morbidity was associated with poor HRQoL over time and increasing symptoms of fatigue.

Metrics to evaluate treatment summaries and survivorship care plans: a scorecard

PURPOSE

The Institute of Medicine (IOM) and Commission on Cancer have called for provision of treatment summaries (TSs) and survivorship care plans (SCPs) at the end of primary cancer therapy and endorsed guidelines for content. Institutions are providing TS/SCPs but with little guidance concerning concordance with IOM recommended content. This manuscript presents a recently developed tool to allow rating of breast cancer-specific TS/SCPs as a model for assessing concordance with IOM recommendations and facilitating research and clinical fidelity.

METHOD

An interdisciplinary team developed items mapped to the IOM recommendations for TS/SCP content as well as scoring rules. Dual raters used this tool to independently assess 65 completed TS/SCPs from 13 different cancer treatment facilities affiliated with the LIVESTRONG Survivorship Centers of Excellence to assess reliability.

RESULTS

The final set of measures contained 92 items covering TSs and SCPs. The TS scale consisted of 13 informational domains across 60 items, while the SCP scale had 10 domains across 32 items. Inter-rater reliability within TSs indicated substantial agreement (M kappa = 0.76, CI = 0.73-0.79), and interclass correlation (ICC) was high (ICC = 0.85, CI = 0.76-0.91). For the SCP scale, inter-rater reliability was also substantial (M kappa = 0.66, CI = 0.62-0.70), as was interclass correlation (ICC = 0.75, CI = 0.62-0.84).

CONCLUSION

Concordance with IOM recommendations for TS/SCP information can be reliably assessed using this instrument, which should facilitate implementation efforts, allow comparison of different TS/SCPs, and facilitate research into the utility of TS/SCPs including which elements are essential.

The persistence of symptom burden: symptom experience and quality of life of cancer patients across one year

PURPOSE

The purpose of this longitudinal study was to track the symptom experience in a sample of cancer patients, determine the persistence of cancer symptoms and symptom burden, and examine the relationship between symptoms and QOL over time.

METHODS

Five hundred forty-two patients provided longitudinal data, completing surveys over a 12-month period. Patients had breast, colorectal, gynecologic, lung, or prostate cancer with stage 1, 2, or 3 disease. Surveys included the Memorial Symptom Assessment Scale and the Functional Assessment of Cancer Therapy-General Scale and were administered every 3 months. Demographic and clinical information and comorbidities were collected from the tumor registry.

RESULTS

The number and type of symptoms experienced by patients varied by cancer type, but about 90% of patients reported one or more symptoms--with prostate cancer patients reporting fewer symptoms and colorectal patients, more symptoms. Prostate patients also had the lowest symptom burden at every time point. Overall, symptom burden decreased over time, as did the Physical subscale for the MSAS. Quality of life was stable over time, except for physical well-being, which improved. Quality of life was negatively correlated with symptom burden at every time point.

CONCLUSIONS

The differences in symptom experience by cancer type suggest that assessment and management of symptoms must be individually tailored or at least adjusted by cancer type. While symptom burden decreased over time, residual symptom burden was still noteworthy. As quality of life was persistently negatively correlated with symptom burden, the results suggest the need for comprehensive symptom assessment and management.

Impact of symptom burden in post-surgical non-small cell lung cancer survivors

PURPOSE

Pain, fatigue, dyspnea, and distress are commonly reported cancer-related symptoms, but few studies have examined the effects of multiple concurrent symptoms in longer-term cancer survivors. We examined the impact of varying degrees of symptom burden on health-related quality of life (HRQOL) and performance status in surgically treated non-small cell lung cancer (NSCLC) survivors.

METHODS

A sample of 183 NSCLC survivors 1-6 years post-surgical treatment completed questionnaires assessing five specific symptoms (pain, fatigue, dyspnea, depression, and anxiety), HRQOL, and performance status. The number of concurrent clinically significant symptoms was calculated as an indicator of symptom burden.

RESULTS

Most survivors (79.8 %) had some degree of symptom burden, with 30.6 % reporting one clinically significant symptom, 27.9 % reporting two symptoms, and 21.3 % reporting three or more symptoms. Physical HRQOL significantly decreased as the degree of symptom burden increased, but mental HRQOL was only significantly decreased in those with three or more symptoms. Receiver-operating characteristic (ROC) curves showed that having multiple concurrent symptoms (two or more) was most likely associated with limitations in functioning (area under a ROC curve = 0.75, sensitivity = 0.81, specificity = 0.54).

CONCLUSIONS

Two or more clinically significant symptoms are identified as the "tipping point" for showing adverse effects on HRQOL and functioning. This highlights the need for incorporating multiple-symptom assessment into routine clinical practice. Comprehensive symptom management remains an important target of intervention for improved post-treatment HRQOL and functioning among lung cancer survivors.

The importance of symptom surveillance during follow-up care of leukemia, bladder, and colorectal cancer survivors

PURPOSE

We examined cancer survivors' experience of bothersome symptoms, association of symptom bother with health-related quality of life (HRQOL), survivors' perception of symptom care, and their symptom-related information needs.

METHODS

Using self-report survey measures, survivors of leukemia, bladder, or colorectal cancer who were 2-5 years post-diagnosis and received follow-up care in the past year (N = 623) provided information about the presence of bothersome symptoms, symptom-related information needs, adequacy of symptom-related care, and their physical and mental HRQOL. Multivariable statistical analyses were conducted to identify correlates of symptom bother, inadequate care, and symptom information needs and to examine the association between symptom bother and HRQOL.

RESULTS

Twenty-eight percent of the 606 respondents experienced symptom bother in the past year (46 % of leukemia, 24 % of bladder, and 26 % of colorectal cancer survivors). Younger survivors, those of Hispanic ethnicity, with low income, those with recurrent cancer, and chemotherapy recipients were more likely to report symptom bother (all p < 0.05). Symptom bother was associated with lower physical and mental HRQOL (p < 0.001). While 92 % of survivors with symptoms discussed them with their follow-up care physician, 52 % of these reported receiving inadequate symptom care. Survivors reporting inadequate symptom care were 2.5 times as likely to identify symptom information needs compared to those who received adequate care (p < 0.05).

CONCLUSIONS

One in four cancer survivors report symptoms 2-5 years post-diagnosis, and only half of these survivors receive adequate care to address those symptoms. Research that refines and tests symptom care interventions for this population is warranted.

Impaired health-related quality of life after chemoradiotherapy for anal cancer: late effects in a national cohort of 128 survivors

BACKGROUND

Chemoradiotherapy is an effective treatment for anal cancer, yet from follow-up many survivors seem to suffer from late effects. Data of long-term health-related quality of life (HRQOL) in anal cancer survivors are limited, and there is a growing interest in cancer survivorship.

MATERIAL AND METHODS

A national cohort of all anal cancer survivors treated with curative chemoradiotherapy in 2000-2007 was invited to a cross-sectional study. Of 199 eligible survivors, 128 (64%) returned the questionnaires, the median time since diagnosis was 66 months. The median age was 61 years and 79% were women. HRQOL was evaluated with EORTC questionnaires QLQ-C30 and QLQ-CR29, and neurotoxicity with the Scale of Chemotherapy-Induced Neurotoxicity. An age- and sex-matched reference group of volunteers (n = 269) not treated for pelvic cancer answered the same questionnaires. Results from QLQ-C30 of the reference group were compared to Norwegian and Dutch normative data.

RESULTS

The mean scores of anal cancer survivors were poorer compared to volunteers and normative data. Anal cancer survivors reported significant impairment of function, especially social and role function, compared to the volunteers (difference ≥ 20 points, p < 0.001). Survivors had markedly increased scores for fatigue, dyspnoea, insomnia and diarrhoea (difference ≥ 15 points, p < 0.001). The global quality of life was significantly reduced (difference 15 points, p < 0.001). Anal cancer survivors had increased stool frequency, more buttock pain, flatulence, faecal incontinence, impotence (males), dyspareunia and reduced sexual interest (females) (difference ≥ 15 points, p < 0.001). There was increased frequency of tinnitus in survivors treated with cisplatin-based chemotherapy (p = 0.004).

CONCLUSIONS

Survivors after chemoradiotherapy for anal cancer have significant long-term impairment of HRQOL. Reduced social, role and sexual function, and increased diarrhoea, incontinence for gas and stools, and buttock pain were commonly reported. Increased awareness of this may lead to better management of late effects and better care for cancer survivors.

Education and counselling group intervention for women treated for gynaecological cancer: does it help?

BACKGROUND

Women who have been through gynaecological cancer, experience challenges on many levels after diagnosis and treatment. Studies show that, in order to help women in their rehabilitation process, there is a need for holistic care and follow-up.

AIM

The aim of this qualitative study is to provide insight into women's own lived experiences of participating in an education and counselling group intervention after curative treatment for gynaecological cancer.

METHOD

A qualitative study based on data from three focus groups with 17 women who had participated in a nurse-led education and counselling group intervention after treatment for gynaecological cancer.

RESULTS

The main findings show that participation in the rehabilitation group was described as a special community of mutual understanding and belonging. Education and the sharing of knowledge provided a clearer vocabulary for, and understanding of, the women's own lived experiences. The presence of dedicated and professional care workers was reported to be essential for the outcome of the group intervention.

CONCLUSION

Attending a nurse-led education and counselling group intervention had a positive impact on various aspects of the women's lived experiences. The programme also provided professionals with important insights into the patients' views and feelings regarding cancer treatment, trajectories and rehabilitation. This knowledge has already proven itself useful in clinical practice for improving staff communication skills and psycho-social support related to gynaecological cancer care.

Trajectories of quality of life among Chinese patients diagnosed with nasopharynegeal cancer

OBJECTIVE

This secondary longitudinal analysis describes distinct quality of life trajectories during eight months of radiation therapy (RT) among patients with nasopharyngeal cancer (NPC) and examines factors differentiating these trajectories.

METHODS

253 Chinese patients with NPC scheduled for RT were assessed at pre-treatment, and 4 months and 8 months later on QoL (Chinese version of the FACT-G), optimism, pain, eating function, and patient satisfaction. Latent growth mixture modelling identified different trajectories within each of four QoL domains: Physical, Emotional, Social/family, and Functional well-being. Multinomial logistic regression compared optimism, pain, eating function, and patient satisfaction by trajectories adjusted for demographic and medical characteristics.

RESULTS

We identified three distinct trajectories for physical and emotional QoL domains, four trajectories for social/family, and two trajectories for functional domains. Within each domain most patients (physical (77%), emotional (85%), social/family (55%) and functional (63%)) experienced relatively stable high levels of well-being over the 8-month period. Different Physical trajectory patterns were predicted by pain and optimism, whereas for Emotion-domain trajectories pain, optimism, eating enjoyment, patient satisfaction with information, and gender were predictive. Age, appetite, optimism, martial status, and household income predicted Social/family trajectories; household income, eating enjoyment, optimism, and patient satisfaction with information predicted Functional trajectories.

CONCLUSION

Most patients with NPC showed high stable QoL during radiotherapy. Optimism predicted good QoL. Symptom impacts varied by QoL domain. Information satisfaction was protective in emotional and functional well-being, reflecting the importance in helping patients to establish a realistic expectation of treatment impacts.

SNPs in PTGS2 and LTA predict pain and quality of life in long term lung cancer survivors

PURPOSE

Lung cancer survivors report the lowest quality of life relative to other cancer survivors. Pain is one of the most devastating, persistent, and incapacitating symptoms for lung cancer survivors. Prevalence rates vary with 80-100% of survivors experiencing cancer pain and healthcare costs are five times higher in cancer survivors with uncontrolled pain. Cancer pain often has a considerable impact on quality of life among cancer patients and cancer survivors. Therefore, early identification, and treatment is important. Although recent studies have suggested a relationship between single nucleotide polymorphisms (SNPs) in several cytokine and inflammation genes with cancer prognosis, associations with cancer pain are not clear. Therefore, the primary aim of this study was to identify SNPs related to pain in lung cancer survivors.

PATIENTS AND METHODS

Participants were enrolled in the Mayo Clinic Lung Cancer Cohort upon diagnosis of their lung cancer. 1149 Caucasian lung cancer survivors (440 surviving <3 years; 354 surviving 3-5 years; and 355 surviving >5 years) completed study questionnaires and had blood DNA samples available. Ten SNPS from PTGS2 and LTA genes were selected based on the serum-based studies in the literature. Outcomes included pain, and quality of life as measured by the SF-8.

RESULTS

Of the 10 SNPs evaluated in LTA and PTGS2 genes, 3 were associated with pain severity (rs5277; rs1799964), social function (rs5277) and mental health (rs5275). These results suggested both specificity and consistency of these inflammatory gene SNPs in predicting pain severity in lung cancer survivors.

CONCLUSION

These results provide support for genetic predisposition to pain severity and may aid in identification of lung cancer survivors at high risk for morbidity and poor QOL.

Educating health care professionals to provide institutional changes in cancer survivorship care

The Institute of Medicine (IOM) 2006 report, From Cancer Patient to Cancer Survivor: Lost in Transition (In M. Hewitt, S. Greenfield and E. Stovall (Eds.), (pp. 9-186). Washington DC: The National Academies Press, 2006) identifies the key components of care that contribute to quality of life for the cancer survivor. As cancer survivorship care becomes an important part of quality cancer care oncology professionals need education to prepare themselves to provide this care. Survivorship care requires a varied approach depending on the survivor population, treatment regimens and care settings. The goal of this program was to encourage institutional changes that would integrate survivorship care into participating centers. An NCI-funded educational program: Survivorship Education for Quality Cancer Care provided multidiscipline two-person teams an opportunity to gain this important knowledge using a goal-directed, team approach. Educational programs were funded for yearly courses from 2006 to 2009. Survivorship care curriculum was developed using the Quality of Life Model as the core around the IOM recommendations. Baseline data was collected for all participants. Teams were followed-up at 6, 12 and 18 months postcourse for goal achievement and institutional evaluations. Comparison data from baseline to 18 months provided information on the 204 multidiscipline teams that participated over 4 years. Teams attended including administrators, social workers, nurse practitioners, registered nurses, physicians and others. Participating centers included primarily community cancer centers and academic centers followed by pediatric centers, ambulatory/physician offices and free standing cancer centers. Statistically significant changes at p = <0.05 levels were seen by 12 months postcourse related to the effectiveness, receptiveness and comfort of survivorship care in participant settings. Institutional assessments found improvement in seven domains of care that related to institutional change. This course provided education to participants that led to significant changes in survivorship care in their settings.

What happens now? Psychosocial care for cancer survivors after medical treatment completion

The growing population of adults living with a history of cancer in the United States mandates attention to quality of life and health in this group, as well as to the implementation of evidence-based interventions to address psychosocial and physical concerns at completion of medical treatments and beyond. The goals of this article are to document the need for attention to psychosocial domains during the re-entry and later phases of the cancer survivor trajectory, offer an overview of current evidence on efficacy of psychosocial interventions during those phases, and offer suggestions for application and research regarding post-treatment psychosocial care.

Documenting the symptom experience of cancer patients

BACKGROUND

Cancer patients experience symptoms associated with their disease, treatment, and comorbidities. Symptom experience is complicated, reflecting symptom prevalence, frequency, and severity. Symptom burden is associated with treatment tolerance as well as patients' quality of life (QOL).

OBJECTIVES

The purpose of this study was to document the symptom experience and QOL of patients with commonly diagnosed cancers. The relationship between symptoms and QOL was also explored.

METHODS

A convenience sample of patients with the five most common cancers at a comprehensive cancer center completed surveys assessing symptom experience (Memorial Symptom Assessment Survey) and QOL (Functional Assessment of Cancer Therapy). Patients completed surveys at baseline and at 3, 6, 9, and 12 months thereafter. This article describes the study's baseline findings.

RESULTS

Surveys were completed by 558 cancer patients with breast, colorectal, gynecologic, lung, or prostate cancer. Patients reported an average of 9.1 symptoms, with symptom experience varying by cancer type. The mean overall QOL for the total sample was 85.1, with results differing by cancer type. Prostate cancer patients reported the lowest symptom burden and the highest QOL.

LIMITATIONS

The sample was limited in terms of racial diversity. Because of the method of recruitment, baseline data were collected 6-8 months after diagnosis, meaning that participants were at various stages of treatment.

CONCLUSIONS

The symptom experience of cancer patients varies widely depending on cancer type. Nevertheless, most patients report symptoms, regardless of whether or not they are currently receiving treatment. Patients' QOL is inversely related to their symptom burden.

Service user involvement in cancer care: the impact on service users

BACKGROUND

Service user involvement is embedded in the United Kingdom's National Health Service, but knowledge about the impact of involvement on service users, such as the benefits and challenges of involvement, is scant. Our research addresses this gap.

OBJECTIVE

To explore the personal impact of involvement on the lives of service users affected by cancer.

DESIGN

We conducted eight focus groups with user groups supplemented by nine face-to-face interviews with involved individuals active at a local, regional and national level. Thematic analysis was conducted both independently and collectively.

SETTING AND PARTICIPANTS

Sixty-four participants, engaged in involvement activities in cancer services, palliative care and research, were recruited across Great Britain.

RESULTS

We identified three main themes: (i) 'Expectations and motivations for involvement'- the desire to improve services and the need for user groups to have a clear purpose, (ii) 'Positive aspects of involvement'- support provided by user groups and assistance to live well with cancer and (iii) 'Challenging aspects of involvement'- insensitivities and undervaluing of involvement by staff.

CONCLUSIONS

This study identified that involvement has the capacity to produce varied and significant personal impacts for involved people. Involvement can be planned and implemented in ways that increase these impacts and that mediates challenges for those involved. Key aspects to increase positive impact for service users include the value service providers attach to involvement activities, the centrality with which involvement is embedded in providers' activities, and the capacity of involvement to influence policy, planning, service delivery, research and/or practice.

Elderly cancer survivorship: an integrative review and conceptual framework

The intersection of ageing and cancer in the phase of post-treatment survivorship represents a large and growing population with unique needs.

PURPOSE

The goal of this work is to review and integrate the current gerontology and oncology literature relevant to elderly cancer survivorship, to identify knowledge gaps and research opportunities and to propose a conceptual model to guide future research. The long-term, global goal is the prevention of morbidity and mortality in elderly cancer survivors by identification of vulnerable elders, maintenance of independence, tailoring of treatment, establishing intervention guidelines and planning for necessary resources within the entire trajectory of cancer survival for older survivors.

METHODS

Targeted and integrative review of selected literature from multiple disciplines. Search engines included PubMed, article reference lists and internet searches for epidemiological data (US Census, World Health Organization, American Cancer Society, Canadian Cancer Cancer Society, etc).

RESULTS

A conceptual model that incorporates the gerontologic, oncologic and personal characteristics of older cancer survivors is proposed that may provide a comprehensive approach by which to frame elderly survivorship research.

CONCLUSION

Cancer survivorship among the elderly is quantitatively and qualitatively different from cancer survivorship among other age groups. The current large numbers and predicted increase in elderly cancer survivors in the near future mandate attention to this population. Future research must consider the complexity of intersecting needs in the gero-oncology population.