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Saiganesh H, Duffy C, Chrysanthopoulou SA, Dizon DS. Predictors and impact of survivorship care plans and survivorship care visits. J Cancer Surviv 2024; 18:836-843. [PMID: 36692704 PMCID: PMC9871419 DOI: 10.1007/s11764-023-01334-z] [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] [Received: 08/25/2022] [Accepted: 01/08/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE We performed this study to characterize the population at the Lifespan Cancer Institute (LCI) who received a survivorship care plan (SCP) with or without a survivorship care visit (SCV) to determine both the impact on specialty referrals and the demographic and clinical predictors of SCPs and SCVs. METHODS We retrospectively reviewed EMR records on 1960 patients at LCI between 2014 and 2017 for SCPs and SCVs and extracted demographics, distress thermometer (DT) scores collected at the time of initial presentation, and subsequent referrals. We evaluated the bivariate associations of SCP and SCV with continuous and categorical factors and assessed the adjusted effect of these factors on receipt of SCP and SCV independently. All analyses were performed in R v4.0.2. RESULTS SCPs were completed in 740 (37.8%) patients, and of those, 65.9% had a SCV. The mean age was 63.9, 67% were female, and 51.2% were married or partnered. Patients treated for breast, lung, and prostate cancers most received an SCP. Compared to SCP alone, the SCV was associated with more specialty referrals. Those who were younger and had breast cancer were more likely to receive a SCP, and those who were younger and female and had breast cancer were more likely to receive a SCV. CONCLUSIONS Gender, age, and type of cancer are significant predictors of receipt of SCP and SCV. Patients who received either SCP, SCV, or both were more likely to receive specialty referrals than those who received neither. IMPLICATIONS FOR CANCER SURVIVORS Identifying predictive factors of SCP and SCV can help facilitate earlier receipt of specialty services and specialty referrals as needed.
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Affiliation(s)
- Harish Saiganesh
- Brown University, 593 Eddy Street, George 302, Providence, RI, 02903, USA.
| | - Christine Duffy
- Lifespan Cancer Institute, 593 Eddy Street, George 302, Providence, RI, 02903, USA
| | | | - Don S Dizon
- Lifespan Cancer Institute, 593 Eddy Street, George 302, Providence, RI, 02903, USA
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Nic Giolla Chomhaill C, Ward J, Dowling M. Fear of recurrence in women with ovarian cancer: A qualitative evidence synthesis. Eur J Oncol Nurs 2024; 68:102487. [PMID: 38113769 DOI: 10.1016/j.ejon.2023.102487] [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] [Received: 09/08/2023] [Revised: 11/16/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Approximately 80% of ovarian cancers recur after first-line treatments. Women with ovarian cancer (OC) are therefore particularly vulnerable to experiencing fear of cancer recurrence (FCR). This study aimed to synthesise experiences of fear of cancer recurrence among women living with ovarian cancer. METHOD A qualitative evidence synthesis (QES) was conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. A systematic search of seven databases was undertaken to identify all available qualitative research exploring fear of cancer recurrence in women with OC. Thematic synthesis of extracted data from included studies was undertaken and managed in NVivo. RESULTS Twenty-two papers reporting on eighteen studies were included in the synthesis. Three main themes were developed (triggers, responses, and coping) and included ten subthemes. FCR was triggered by factors relating to awareness of prognosis, treatment, and negative communication. Women responded to FCR by performing body checking and protecting their families. FCR led to adverse effects on women's wellbeing as it exacerbated uncertainty about their future. Women attempted to cope with FCR through seeking support, regaining control, and redirecting negative thoughts and actions. CONCLUSIONS Women use a variety of approaches to manage their fear of recurrence. Further research on the most appropriate interventions for FCR tailored specifically to the needs of women with OC is needed.
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Affiliation(s)
| | - Jana Ward
- Occupational Therapy Department, Galway University Hospital, Ireland.
| | - Maura Dowling
- School of Nursing and Midwifery, University of Galway, Ireland.
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Woopen H, Keller M, Zocholl D, Mittelstadt S, Barretina-Ginesta MP, Heinzelmann-Schwarz V, Lafleur J, Kocián R, Baum J, Krabisch P, Achimas-Cadariu P, Vardar MA, Vergote I, Nasser S, Link T, Gil-Martin M, Zwimpfer TA, Leitner K, Jedryka M, Boxler T, Braicu EI, Sehouli J. Side Effects from Cancer Therapies and Perspective of 1044 Long-Term Ovarian Cancer Survivors-Results of Expression VI-Carolin Meets HANNA-Holistic Analysis of Long-Term Survival with Ovarian Cancer: The International NOGGO, ENGOT, and GCIG Survey. Cancers (Basel) 2023; 15:5428. [PMID: 38001688 PMCID: PMC10670049 DOI: 10.3390/cancers15225428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
The aim of this survey was to increase the knowledge on the characteristics and health concerns of long-term survivors (LTS; survival > 5 years) after ovarian cancer in order to tailor follow-up care. This international survey was initiated by the NOGGO and was made available to members of ENGOT and GCIG. The survey is anonymous and consists of 68 questions regarding sociodemographic, medical (cancer) history, health concerns including distress, long-term side effects, and lifestyle. For this analysis, 1044 LTS from 14 countries were recruited. In total, 58% were diagnosed with FIGO stage III/IV ovarian cancer and 43.4% developed recurrent disease, while 26.0% were receiving cancer treatment at the time of filling in the survey. LTS who survived 5-10 years self-estimated their health status as being significantly worse than LTS who survived more than 10 years (p = 0.034), whereas distress also remained high 10 years after cancer diagnosis. Almost half of the cohort (46.1%) reported still having symptoms, which were mainly lymphedema (37.7%), fatigue (23.9%), pain (21.6%), polyneuropathy (16.9%), gastrointestinal problems (16.6%), and memory problems (15.5%). Almost all patients (94.2%) regularly received follow-up care. Specialized survivorship care with a focus on long-term side effects, lifestyle, and prevention should be offered beyond the typical five years of follow-up care.
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Affiliation(s)
- Hannah Woopen
- Department of Gynecology with Center for Oncological Surgery, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
- North-Eastern German Society for Gynecological Oncology (NOGGO), 13359 Berlin, Germany
| | - Maren Keller
- North-Eastern German Society for Gynecological Oncology (NOGGO), 13359 Berlin, Germany
| | - Dario Zocholl
- North-Eastern German Society for Gynecological Oncology (NOGGO), 13359 Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Suzana Mittelstadt
- North-Eastern German Society for Gynecological Oncology (NOGGO), 13359 Berlin, Germany
- Department of Women’s Health, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Maria-Pilar Barretina-Ginesta
- Institut Català d’Oncologia, Medical Oncology Department, 17007 Girona, Spain
- Precision Oncology Group, Institut d’Investigació Biomèdica de Girona, 17007 Girona, Spain
- Medical Sciences Department, Universitat de Girona, 17003 Girona, Spain
- Grupo Español de Investigación en Cáncer de Ovario (GEICO), 28003 Madrid, Spain
| | - Viola Heinzelmann-Schwarz
- Department of Gynecology and Gynecologic Oncology, University Hospital of Basel, 4056 Basel, Switzerland
- Swiss GO Trial Group (Swiss-GO), 4031 Basel, Switzerland
| | - Judith Lafleur
- Department of Gynecology and Obstetrics, Ordensklinikum Barmherzige Schwestern Linz, 4020 Linz, Austria
- Arbeitsgemeinschaft Gynaekologische Onkologie Austria (AGO Austria), 6020 Innsbruck, Austria
| | - Roman Kocián
- Department of Gynaecology, Obstetrics and Neonatology First Faculty of Medicine, Charles University and General University Hospital in Prague, 12 108 Prague, Czech Republic
- General University Hospital in Prague, 12 808 Prague, Czech Republic
- Central and Eastern European Gynecologic Oncology Group (CEEGOG), 128 51 Prague, Czech Republic
| | - Joanna Baum
- Department of Gynecology with Center for Oncological Surgery, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
- North-Eastern German Society for Gynecological Oncology (NOGGO), 13359 Berlin, Germany
| | - Petra Krabisch
- North-Eastern German Society for Gynecological Oncology (NOGGO), 13359 Berlin, Germany
- Department of Gynaecology and Obstetrics, Klinikum Chemnitz, 09116 Chemnitz, Germany
| | - Patriciu Achimas-Cadariu
- Institute of Oncology Prof. Dr. I. Chiricuta Cluj-Napoca, University of Medicine and Pharmacy Iuliu Hatieganu, 400015 Cluj-Napoca, Romania
| | - Mehmet Ali Vardar
- Department of Gynecologic Oncology, Cukurova University, 01250 Adana, Turkey
- Turkish Society of Gynecologic Oncology (TRSGO), Ovecler, 06450 Ankara, Turkey
| | - Ignace Vergote
- Division of Gynaecological Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG), 3000 Leuven, Belgium
| | - Sara Nasser
- Department of Gynecology with Center for Oncological Surgery, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
- Pan-Arabian Research Society of Gynecological Oncology (PARSGO), 13353 Berlin, Germany
| | - Theresa Link
- North-Eastern German Society for Gynecological Oncology (NOGGO), 13359 Berlin, Germany
- Department of Gynecology and Obstetrics, Technische Universität Dresden, 01307 Dresden, Germany
| | - Marta Gil-Martin
- Grupo Español de Investigación en Cáncer de Ovario (GEICO), 28003 Madrid, Spain
- Catalan Institute of Oncology—IDIBELL, L’Hospitalet-Barcelona, 08908 Barcelona, Spain
| | - Tibor A. Zwimpfer
- Department of Gynecology and Gynecologic Oncology, University Hospital of Basel, 4056 Basel, Switzerland
- Swiss GO Trial Group (Swiss-GO), 4031 Basel, Switzerland
| | - Katharina Leitner
- Arbeitsgemeinschaft Gynaekologische Onkologie Austria (AGO Austria), 6020 Innsbruck, Austria
- Department of Obstetrics and Gynecology, Innsbruck Medical University, 6020 Innsbruck, Austria
| | - Marcin Jedryka
- Central and Eastern European Gynecologic Oncology Group (CEEGOG), 128 51 Prague, Czech Republic
- Gynecological Oncology Department, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Oncological Gynecology Department, Lower Silesian Oncology, Pulmonology and Hematology Center, 53-413 Wroclaw, Poland
| | | | - Elena Ioana Braicu
- Department of Gynecology with Center for Oncological Surgery, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
- North-Eastern German Society for Gynecological Oncology (NOGGO), 13359 Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
- North-Eastern German Society for Gynecological Oncology (NOGGO), 13359 Berlin, Germany
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Marcu I, Melnyk M, Nekkanti S, Nagel C. Pelvic floor dysfunction survivorship needs and referrals in the gynecologic oncology population: a narrative review. Int J Gynecol Cancer 2023:ijgc-2023-004810. [PMID: 37935522 DOI: 10.1136/ijgc-2023-004810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
The population of survivors of gynecologic malignancies continues to grow. The population of gynecologic oncology survivors has a high prevalence of pelvic floor disorders. Gynecologic oncology patients identify several survivorship needs, including a need for more focused pelvic floor disorder sequelae care. The increasing focus on patient needs following cancer treatment has led to the development of survivorship care plans and other strategies for addressing post-treatment transitions and sequelae. Common themes in patient survivorship care are patient needs for flexible and integrated care, and it is unclear if survivorship care plans in their current state improve patient outcomes. Patient referrals, specifically to urogynecologists, may help address the gaps in survivorship care of pelvic floor dysfunction.The objective of this review is to discuss the burden of pelvic floor disorders in the gynecologic population and to contextualize these needs within broader survivorship needs. The review will then discuss current strategies of survivorship care, including a discussion of whether these methods meet survivorship pelvic floor disorder needs. This review addresses several gaps in the literature by contextualizing pelvic floor disorder needs within other survivorship needs and providing a critical discussion of current survivorship care strategies with a focus on pelvic floor disorders.
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Affiliation(s)
- Ioana Marcu
- Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Megan Melnyk
- School of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Silpa Nekkanti
- Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christa Nagel
- Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Rose GL, Stewart EM, Clifford BK, Bailey TG, Rush AJ, Abbott CR, Hayes SC, Obermair A, McCarthy AL. Efficacy of exercise interventions for women during and after gynaecological cancer treatment - a systematic scoping review. Support Care Cancer 2023; 31:342. [PMID: 37195433 DOI: 10.1007/s00520-023-07790-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE To systematically synthesise evidence of exercise intervention efficacy for physical/psychosocial outcomes that matter to women during/following treatment for gynaecological cancer. METHODS Five databases were searched (PubMed, EMBASE, CINAHL, PsychInfo, Scopus). Exercise-only intervention studies that included women during/ following treatment for any gynaecological cancer, with/ without control comparison, on any physical or psychosocial outcome(s), were included and qualitatively appraised using the Revised Cochrane Risk of Bias tool and a modified Newcastle-Ottawa Scale. RESULTS Seven randomised controlled trials (RCTs), three single-arm pre-post studies, and one prospective cohort study satisfied were included (11 studies). Most studies were completed following treatment (91%), included combined (aerobic and resistance; 36%) and aerobic (36%) training, were fully/mostly (63%) unsupervised, and had a moderate-to-high risk of bias. Overall, 33 outcomes (64% objectively-measured) were assessed. Improvements were observed in aerobic capacity (V̇O2 Peak +1.6 mL/kg/min, 6-minute walk distance +20-27 m), lower- (30-second sit-to-stand +2-4 repetitions) and upper-limb strength (30-second arm curl +5 repetitions; 1RM grip strength/chest press +2.4-3.1 kg), and agility (timed up-and-go -0.6 seconds). However, changes in quality of life, anthropometry/body composition, balance and flexibility were inconsistent. There was no evidence to support worsening of outcomes. CONCLUSION Preliminary research into the role of exercise post-gynaecological cancer suggests an improvement in exercise capacity, muscular strength, and agility which, in the absence of exercise, typically decline following gynaecological cancer. Future exercise trials involving larger and more diverse gynaecological cancer samples will improve understanding of the potential and magnitude of effect of guideline-recommended exercise on outcomes that matter to patients.
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Affiliation(s)
- Grace Laura Rose
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
- School of Health, University of the Sunshine Coast, Sippy Downs, Australia.
| | - Elizabeth Mary Stewart
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Briana Kristine Clifford
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Tom George Bailey
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Alexandra Jane Rush
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Claudia Rose Abbott
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Sandra Christine Hayes
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Andreas Obermair
- School of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Alexandra Leigh McCarthy
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Mater Research Institute, Brisbane, Australia
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Tevaarwerk AJ, Zhang X, Haine J, Norslien K, Henningfield MF, Stietz C, Hahn D, Sesto ME. Re-engineering Survivorship Care Plans to Support Primary Care Needs and Workflow: Results From an Engineering, Primary Care and Oncology Collaborative for Survivorship Health (EPOCH). JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1654-1661. [PMID: 33904117 PMCID: PMC8546004 DOI: 10.1007/s13187-021-02008-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 06/11/2023]
Abstract
Maintaining the health of survivors requires communication, collaboration and care coordination between oncology and primary care. Primary care clinicians have been acknowledged as important recipients of survivorship care plans (SCPs); however, current SCP templates have not been evaluated for usefulness in the primary care context. We surveyed and interviewed primary care clinicians from a rural research network regarding SCP content, format and layout (phase 1), and potential use and clinical workflows around SCPs (phase 2). Based on these data, an existing SCP template was iteratively redesigned to better support survivorship care in the primary care setting. A total of 13 clinicians (9 MDs, 4 APPs) participated. Interviewees advocated for maintaining a single SCP document shared by survivors and clinicians. Changes to the SCP template included prioritizing follow-up over summary of treatment and removing or down-playing screening recommendations not impacted by cancer or cancer treatment. The re-engineered SCP was regarded as highly relevant for survivors, but clinicians noted the significant effort to "disassemble" SCPs in order to enter the information into on the receiving health record. Primary care clinicians value the information in SCPs but had important recommendations regarding content, layout, and format. Additionally, a significant effort appears to be required by recipients in order to extract SCP information for future use.
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Affiliation(s)
- Amye J Tevaarwerk
- Division of Hematology/Oncology, University of Wisconsin, Madison, 6037 Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA.
- Carbone Cancer Center, Madison, WI, USA.
| | | | - James Haine
- Division of Hematology/Oncology, University of Wisconsin, Madison, 6037 Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA
| | | | - Mary F Henningfield
- Division of Hematology/Oncology, University of Wisconsin, Madison, 6037 Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA
| | | | - David Hahn
- Division of Hematology/Oncology, University of Wisconsin, Madison, 6037 Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Mary E Sesto
- Division of Hematology/Oncology, University of Wisconsin, Madison, 6037 Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA
- Carbone Cancer Center, Madison, WI, USA
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Adams EJ, Tallman D, Haynam ML, Nekhlyudov L, Lustberg MB. Psychosocial Needs of Gynecological Cancer Survivors: Mixed Methods Study. J Med Internet Res 2022; 24:e37757. [PMID: 36125848 PMCID: PMC9533206 DOI: 10.2196/37757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/17/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Internet and social media platforms offer insights into the lived experiences of survivors of cancer and their caregivers; however, the volume of narrative data available is often cumbersome for thorough analysis. Survivors of gynecological cancer have unique needs, such as those related to a genetic predisposition to future cancers, impact of cancer on sexual health, the advanced stage at which many are diagnosed, and the influx of new therapeutic approaches. OBJECTIVE This study aimed to present a unique methodology to leverage large amounts of data from internet-based platforms for mixed methods analysis. We analyzed discussion board posts made by survivors of gynecological cancer on the American Cancer Society website with a particular interest in evaluating the psychosocial aspects of survivorship. METHODS All posts from the ovarian, uterine, and gynecological cancers (other than ovarian and uterine) discussion boards on the American Cancer Society Cancer Survivors Network were included. Posts were web scraped using Python and organized by psychosocial themes described in the Quality of Cancer Survivorship Care Framework. Keywords related to each theme were generated and verified. Keywords identified posts related to the predetermined psychosocial themes. Quantitative analysis was completed using Python and R Foundation for Statistical Computing packages. Qualitative analysis was completed on a subset of posts as a proof of concept. Themes discovered through latent Dirichlet allocation (LDA), an unsupervised topic modeling technique, were assessed and compared with the predetermined themes of interest. RESULTS A total of 125,498 posts made by 6436 survivors of gynecological cancer and caregivers between July 2000 and February 2020 were evaluated. Of the 125,489 posts, 23,458 (18.69%) were related to the psychosocial experience of cancer and were included in the mixed methods psychosocial analysis. Quantitative analysis (23,458 posts) revealed that survivors across all gynecological cancer discussion boards most frequently discussed the role of friends and family in care, as well as fatigue, the effect of cancer on interpersonal relationships, and health insurance status. Words related to psychosocial aspects of survivorship most often used in posts included "family," "hope," and "help." Qualitative analysis (20 of the 23,458 posts) similarly demonstrated that survivors frequently discussed coping strategies, distress and worry, the role of family and caregivers in their cancer care, and the toll of managing financial and insurance concerns. Using LDA, we discovered 8 themes, none of which were directly related to psychosocial aspects of survivorship. Of the 56 keywords identified by LDA, 2 (4%), "sleep" and "work," were included in the keyword list that we independently devised. CONCLUSIONS Web-based discussion platforms offer a great opportunity to learn about patient experiences of survivorship. Our novel methodology expedites the quantitative and qualitative analyses of such robust data, which may be used for additional patient populations.
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Affiliation(s)
- Elizabeth J Adams
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - David Tallman
- Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Marcy L Haynam
- Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Larissa Nekhlyudov
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Maryam B Lustberg
- Yale Cancer Center, School of Medicine, Yale University, New Haven, CT, United States
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Seib C, Anderson D, McGuire A, Porter-Steele J, McDonald N, Balaam S, Sapkota D, McCarthy AL. Improving health-related quality of life in women with breast, blood, and gynaecological Cancer with an eHealth-enabled 12-week lifestyle intervention: the women's wellness after Cancer program randomised controlled trial. BMC Cancer 2022; 22:747. [PMID: 35804322 PMCID: PMC9264489 DOI: 10.1186/s12885-022-09797-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/16/2022] [Indexed: 01/04/2023] Open
Abstract
Background The residual effects of cancer and its treatment can profoundly affect women’s quality of life. This paper presents results from a multisite randomized controlled trial that evaluated the clinical benefits of an e-health enabled health promotion intervention (the Women’s Wellness after Cancer Program or WWACP) on the health-related quality of life of women recovering from cancer treatment. Methods Overall, 351 women previously treated for breast, blood or gynaecological cancers were randomly allocated to the intervention (WWACP) or usual care arms. The WWACP comprised a structured 12-week program that included online coaching and an interactive iBook that targeted physical activity, healthy diet, stress and menopause management, sexual wellbeing, smoking cessation, alcohol intake and sleep hygiene. Data were collected via a self-completed electronic survey at baseline (t0), 12 weeks (post-intervention, t1) and 24 weeks (to assess sustained behaviour change, t2). The primary outcome, health-related quality of life (HRQoL), was measured using the Short Form Health Survey (SF-36). Results Following the 12-week lifestyle program, intervention group participants reported statistically significant improvements in general health, bodily pain, vitality, and global physical and mental health scores. Improvements were also noted in the control group across several HRQoL domains, though the magnitude of change was less. Conclusions The WWACP was associated with improved HRQoL in women previously treated for blood, breast, and gynaecological cancers. Given how the synergy of different lifestyle factors influence health behaviour, interventions accounting for the reciprocity of multiple health behaviours like the WWACP, have real potential for immediate and sustainable change. Trial registration The protocol for this randomised controlled trial was submitted to the Australian and New Zealand Clinical Trials Registry on 15/07/2014 and approved on 28/07/2014 (ACTRN12614000800628). Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09797-6.
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Affiliation(s)
- Charrlotte Seib
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Queensland, Australia.
| | - Debra Anderson
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
| | - Amanda McGuire
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Janine Porter-Steele
- The Wesley Hospital Choices Cancer Support Program, Wesley Hospital, Brisbane, Queensland, Australia
| | - Nicole McDonald
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Sarah Balaam
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
| | - Diksha Sapkota
- Griffith Criminology Institute, Griffith University, Queensland, Australia
| | - Alexandra L McCarthy
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Queensland, Australia
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9
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Galica J, Saunders S, Romkey-Sinasac C, Silva A, Ethier JL, Giroux J, Jull J, Maheu C, Ross-White A, Stark D, Robb K. The needs of gynecological cancer survivors at the end of primary treatment: A scoping review and proposed model to guide clinical discussions. PATIENT EDUCATION AND COUNSELING 2022; 105:1761-1782. [PMID: 34865888 DOI: 10.1016/j.pec.2021.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Gynecological cancer (GC) survivors have unmet needs when they complete primary cancer treatment. Despite this, no known research has summarized these needs and survivors' suggestions to address them. We conducted a scoping review to fill these gaps and develop a model useful to guide clinical discussions and/or interventions. METHODS English, full length, and accessible primary studies describing the needs of GC survivors were included. No restrictions on date nor country of publication were applied. Two reviewers screened and extracted data, which was verified by a third reviewer. RESULTS Seventy-one studies met the inclusion criteria for data extraction. Results were thematically grouped into seven dimensions: physical needs, sexuality-related concerns, altered self-image, psychological wellbeing, social support needs, supporting the return to work, and healthcare challenges and preferences. After consulting with a stakeholder group (a GC survivor, clinicians, and researchers), the dimensions were summarized into a proposed model to guide clinical assessments and/or interventions. CONCLUSION Results illuminate the diverse needs of GC survivors as they complete primary cancer treatment and their recommendations for care to meet these needs. PRACTICE IMPLICATIONS The resulting model can be used to guide assessments, discussions and/or interventions to optimally prepare GC survivors for transition out of primary cancer treatment.
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Affiliation(s)
- Jacqueline Galica
- Queen's University School of Nursing, Kingston, Ontario, Canada; Queen's Cancer Research Institute, Division of Cancer Care and Epidemiology, Kingston, Ontario, Canada.
| | | | | | - Amina Silva
- Queen's University School of Nursing, Kingston, Ontario, Canada
| | - Josée-Lyne Ethier
- Queen's Cancer Research Institute, Division of Cancer Care and Epidemiology, Kingston, Ontario, Canada; Queen's University Department of Oncology; Kingston, Ontario, Canada
| | - Janet Giroux
- Queen's University School of Nursing, Kingston, Ontario, Canada; Kingston Health Sciences Centre, Kingston General Hospital Site and the Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada; Queen's University, Department of Obstetrics and Gynecology, Kingston, Ontario, Canada
| | - Janet Jull
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Christine Maheu
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
| | | | - Debora Stark
- Kingston Health Sciences Centre, Kingston General Hospital Site and the Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada
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GCIG-Consensus guideline for Long-term survivorship in gynecologic Cancer: A position paper from the gynecologic cancer Intergroup (GCIG) symptom benefit committee. Cancer Treat Rev 2022; 107:102396. [PMID: 35525106 DOI: 10.1016/j.ctrv.2022.102396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Long-term survivors of gynecological cancers may be cured but still have ongoing health concerns and long-term side effects following cancer treatment. The aim of this brainstorming meeting was to develop recommendations for long-term follow-up for survivors from gynecologic cancer. METHODS International experts, representing each member group within the Gynecologic Cancer InterGroup (GCIG), met to define long-term survival, propose guidelines for long term follow-up and propose ways to implement long term survivorship follow-up in clinical trials involving gynecological cancers. RESULTS Long-term survival with/from gynecological cancers was defined as survival of at least five years from diagnosis, irrespective of disease recurrences. Review of the literature showed that more than 50% of cancer survivors with gynecological cancer still experienced health concerns/long-term side effects. Main side effects included neurologic symptoms, sleep disturbance, fatigue, sexual dysfunction, bowel and urinary problems and lymphedema. In this article, long-term side effects are discussed in detail and treatment options are proposed. Screening for second primary cancers and lifestyle counselling (nutrition, physical activity, mental health) may improve quality of life and overall health status, as well as prevent cardiovascular events. Clinical trials should address cancer survivorship and report patient reported outcome measures (PROMs) for cancer survivors. CONCLUSION Long-term survivors after gynecological cancer have unique longer term challenges that need to be addressed systematically by care givers. Follow-up after completing treatment for primary gynecological cancer should be offered lifelong. Survivorship care plans may help to summarize cancer history, long-term side effects and to give information on health promotion and prevention.
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Peerenboom R, Ackroyd SA, Chang C, Diaz Moore E, Jenkins Vogel T, Lippitt MH, Rodriguez G, Kirschner Concept development CV. Surviving and thriving: what do survivors of gynecologic cancer want? Gynecol Oncol Rep 2022; 41:101011. [PMID: 35663850 PMCID: PMC9160655 DOI: 10.1016/j.gore.2022.101011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/16/2022] [Accepted: 05/21/2022] [Indexed: 11/26/2022] Open
Abstract
Gynecologic cancer survivors’ top concern was fear of cancer recurrence. Nutrition and weight loss were the most desired survivorship program components. Survivorship concerns/preferences varied by clinical and demographic factors.
The purpose of this study was to characterize survivorship concerns and survivorship program preferences among gynecologic cancer survivors. Women treated for gynecologic malignancy at our cancer center were surveyed from 1/2019 to 10/2020 on concerns and preferences using a 5-point Likert scale. Descriptive analysis and multivariable logistic regression were performed to describe survivors’ concerns/preferences. The most frequent survivorship concerns were fear of cancer recurrence (49.6%), desire to lose weight (40.0%), and long-term side effects (30.7%). The highest ranked survivorship program components included assistance with nutrition (36.5%), weight loss (30.4%), and stress reduction (29.0%). Older patients (≥64 y) were less likely to report concern with losing weight (OR 0.26, p < 0.05), sex life (OR 0.18, p < 0.01), and strain in family relationships (OR 0.27, p < 0.05) compared with younger patients. Compared with ovarian/fallopian tube/primary peritoneal cancer survivors, endometrial cancer survivors were less likely to desire nutritional education (OR 0.06, p < 0.01). Participants with advanced cancer were less likely to desire assistance with weight loss than those with early stage cancer (OR 0.23, p < 0.05). A significant portion of gynecologic cancer survivors reported a fear of cancer recurrence. Assistance with nutrition and weight loss were the most desired survivorship program components. Variation in patient preferences and differences among clinical subgroups highlight the need for tailored survivorship care.
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Tsai LY, Tsay SL, Hsu CY, Tsai MC, Liu CM, Tsai JM. Together through the valley of death: Lived experience of case managers to meet the informational needs of gynecologic cancer survivors. Taiwan J Obstet Gynecol 2022; 61:339-344. [PMID: 35361398 DOI: 10.1016/j.tjog.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Case managers are crucial providers of health education and consultation for patients with gynecologic cancer to satisfy their informational needs. The purpose of this study is to understand the experience of case managers working to meet the needs of these patients in order to further improve their overall quality of care. MATERIALS AND METHODS A qualitative study employed. Twenty case managers recruited from Taiwanese healthcare institutes using purposive sampling. Participants were interviewed in semi-structure fashion. All interviews were verbatim transcribed. The steps of Giorgi's phenomenological method were used to analyze the transcripts. RESULTS Three major themes and twelve subthemes emerged. Major themes were associated with cancer development: (1) during diagnosis, build a communication bridge and provide appropriate treatment early on, become consultants; (2) during treatment, provide comprehensive medical care for cancer, become the patient's manager; (3) during follow-ups, assist patients to comprehend and adapt to living with cancer, return to society and the original pace of life. CONCLUSION Case managers accompany patients with gynecologic cancer and address their problems to other medical professional. The informational needs of patients with gynecologic cancer differ along the course of the disease. It is important for cancer care manager to deliver the information of individualized health care in timely manner to ensure the overall quality of care for patients with gynecologic cancer.
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Affiliation(s)
- Li-Yun Tsai
- College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan
| | - Shiow-Luan Tsay
- College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan
| | - Chen-Yuan Hsu
- Department of Nursing, Dayeh University, Changhua, Taiwan
| | - Meng-Chuan Tsai
- Department of Sport and Health Management, Dayeh University, Changhua, Taiwan
| | - Chien-Miao Liu
- Department of Optometry, Dayeh University, Changhua, Taiwan
| | - Jung-Mei Tsai
- College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan; Mackay Memorial Hospital, Taipei City, Taiwan; Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan; Department of Nursing, Mackay Medical College, New Taipei City, Taiwan.
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Survivors' preferences for the organization and delivery of supportive care after treatment: An integrative review. Eur J Oncol Nurs 2021; 54:102040. [PMID: 34571444 DOI: 10.1016/j.ejon.2021.102040] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE Quality supportive care during cancer survivorship contributes to positive physical and psychosocial health. However, the potential positive impacts are influenced by survivors' perceptions of and ability to access the supportive care services that they deem important to their well-being. The purpose of this integrative review was to examine cancer survivors' preferences for the organization and delivery of supportive care services in the post-treatment period. METHODS We conducted a systematic search for relevant quantitative, qualitative and mixed methods studies. Included studies were analyzed using directed content analysis, focused on models of care and type of provider, site of care, specialized services, structural supports through transitions, and sources of information. RESULTS Sixty-nine studies were included. Overall, survivors' preferences are not static and fluctuate over time based on their perceived health needs, concerns and points of transition in care. While specialist supportive care led by consultant oncologists is often identified as the preferred model of care, survivors' also express preferences for integrated and shared models of care, involving oncology nurses, primary care and multidisciplinary professionals to optimise coordination and impact of supportive care. Flexibility in care delivery, leveraging technology and expertise, was preferred to ensure convenient and timely access to supportive care. CONCLUSIONS Cancer survivors express preferences for the organization and delivery of supportive care in the post-treatment phase that fluctuate based on their perceived health needs. The development of novel survivorship health services must consider survivors' preferences and allow flexibility in care delivery to facilitate engagement, uptake, and effectiveness.
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Examination of a distress screening intervention for rural cancer survivors reveals low uptake of psychosocial referrals. J Cancer Surviv 2021; 16:582-589. [PMID: 33983534 PMCID: PMC8116196 DOI: 10.1007/s11764-021-01052-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 04/26/2021] [Indexed: 12/14/2022]
Abstract
Purpose To determine the impact of a telemedicine-delivered intervention aimed at identifying unmet needs and cancer-related distress (CRD) following the end of active treatment on supportive care referral patterns. Methods We used a quasi-experimental design to compare supportive care referral patterns between a group of rural cancer survivors receiving the intervention and a control group (N = 60). We evaluated the impact of the intervention on the number and type of referrals offered and whether or not the participant accepted the referral. CRD was measured using a modified version of the National Comprehensive Cancer Network Distress Thermometer and Problem List. Results Overall, 30% of participants received a referral for further post-treatment supportive care. Supporting the benefits of the intervention, the odds of being offered a referral were 13 times higher for those who received the intervention than those in the control group. However, even among the intervention group, only 28.6% of participants who were offered a referral for further psychosocial care accepted. Conclusions A nursing telemedicine visit was successful in identifying areas of high distress and increasing referrals. However, referral uptake was low, particularly for psychosocial support. Distance to care and stigma associated with seeking psychosocial care may be factors. Further study to improve referral uptake is warranted. Implications for Cancer Survivors Screening for CRD may be inadequate for cancer survivors unless patients can be successfully referred to further supportive care. Strategies to improve uptake of psychosocial referrals is of high importance for rural survivors, who are at higher risk of CRD. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01052-4.
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Alvarez KCP, Sales CA. Existential phenomenological view of health care experiences from the perspective of cancer survivors. Rev Bras Enferm 2020; 73:e20190811. [PMID: 33338150 DOI: 10.1590/0034-7167-2019-0811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/01/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to understand the experience of post-discharge health care of primary cancer treatment from the perspective of survivors. METHODS a descriptive study with a qualitative approach, using Martin Heidegger's Existential Phenomenology framework. Analysis of semi-structured interviews of 11 cancer survivors, after primary treatment, was carried out through vague and median and hermeneutic understanding. RESULTS three units of meaning emerged in the search for the unveiling of the phenomenon: Respecting physical limitations after cancer; Transcending themselves after illness; and Overcoming the ghost of fear. FINAL CONSIDERATIONS cancer survivors experience care in intentional choices favorable to health, when they overcome their own limitations, fear of relapse or new cancer. The need to improve continuous professional monitoring in order to answer questions reinforce favorable attitudes and enhance the chances of better quality of life for cancer survivors.
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The Symptom Experience and Self-management Strategies of Women Undergoing Cervical Cancer Treatment: A Qualitative Study. Cancer Nurs 2020; 45:12-20. [PMID: 32675630 DOI: 10.1097/ncc.0000000000000843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cervical cancer treatment modalities, such as surgery, chemotherapy, radiation, and brachytherapy, often result in short- and long-term adverse effects such as nausea, fatigue, and sexual dysfunction. Chemotherapy and radiation are typically provided on an outpatient basis, requiring women to be more active in self-managing their symptoms at home. OBJECTIVE The aim of this study was to explore how women with cervical cancer experience symptoms and manage daily life during treatment. METHODS Individual interviews with 10 women diagnosed with cervical cancer and undergoing curative concurrent chemotherapy and radiation were carried out. Data analysis was conducted using a phenomenological-hermeneutic perspective, inspired by Ricoeur. RESULTS Three themes were identified based on the interviews: (1) new life perspectives, (2) suffering in silence, and (3) enhanced symptom self-management strategies. CONCLUSION Diagnosis and treatment create an opportunity for the women to critically reflect on their lives and to develop new life perspectives. During treatment, a mental transformation involving the use of various individual social, mental, and physical coping strategies allowed the women to manage their daily lives. This enabled self-management strategies, resulting in maintaining a sense of normalcy, trying to defy the adverse effects, and prioritizing themselves, their families, and the treatment. IMPLICATIONS FOR PRACTICE Women with cervical cancer undergoing oncological treatment need more specific and detailed information about the course of treatment, symptom management, adverse effects, and psychological reactions to better manage their daily lives. Healthcare professionals play a crucial role in supporting and guiding the women and in ensuring optimal symptom management.
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McDonough AL, Rabin J, Horick N, Lei Y, Chinn G, Campbell EG, Park ER, Peppercorn J. Practice, Preferences, and Practical Tips From Primary Care Physicians to Improve the Care of Cancer Survivors. J Oncol Pract 2019; 15:e600-e606. [PMID: 31150311 DOI: 10.1200/jop.18.00740] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There is a need to improve the coordination of care and communication between primary care physicians (PCPs) and oncology after completion of initial cancer treatment. We sought to evaluate PCP experiences and perspectives in cancer survivorship and to identify practical opportunities to improve care within an integrated health care system with a shared electronic health record (EHR). METHODS We conducted a self-administered, anonymous, electronic survey of PCPs in practices affiliated with an academic medical center to evaluate practices, the sense of preparedness, and preferences in the delivery of survivorship care and communication with oncology. RESULTS One hundred seventeen of 225 PCPs responded (response rate, 52%). A majority were engaged in survivorship care, with 94% reporting managing psychological sequelae of cancer, 84% managing chronic physical complications, 71% screening for cancer recurrence, and 60% screening for late complications. However, few PCPs felt prepared to manage these issues: 65% felt unprepared to screen for late complications, and 36% felt unprepared to screen for recurrence. Common barriers to survivorship care were uncertainty about delegation of responsibility (73%) and a lack of training (72%). PCPs expressed strong interest in survivorship care plans, preferring active tracking of ongoing care needs and delegation of care responsibility in the EHR active problem list over traditional summary documents. CONCLUSION Most PCPs are engaged in cancer survivorship care but report barriers to optimal care delivery. Opportunities to improve care could include targeted education to increase preparedness to deliver survivorship care, and optimization of communication among providers, including active survivorship care plans in the EHR.
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Affiliation(s)
| | | | - Nora Horick
- 1 Massachusetts General Hospital, Boston, MA
| | - Yvonne Lei
- 1 Massachusetts General Hospital, Boston, MA
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Reb AM, Cope DG. Quality of Life and Supportive Care Needs of Gynecologic Cancer Survivors. West J Nurs Res 2019; 41:1385-1406. [DOI: 10.1177/0193945919846901] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gynecologic cancer survivors experience significant distress that can impact quality of life (QOL). Optimal survivorship care requires an understanding of the survivor’s QOL and supportive care needs. The purpose of this study was to describe the QOL and needs of gynecologic cancer survivors. Women with an initial diagnosis of gynecologic cancer within 7 months of completing primary treatment ( N = 34) completed the QOL-Cancer Survivor tool and the Cancer Survivors’ Unmet Needs Survey. Fear of cancer recurrence was a repetitive theme for both tools. The lowest ranking QOL items were distress from diagnosis and treatment, family distress, and uncertainty about the future. Commonly reported needs included help to reduce stress, manage side effects, cope with fears of cancer recurrence, and gain reassurance that providers were communicating, and providing the very best medical care. Appreciating QOL and needs can facilitate the development of support services specifically tailored to gynecologic survivors.
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Affiliation(s)
| | - Diane G. Cope
- Florida Cancer Specialists & Research Institute, Fort Myers, USA
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