Measuring symptom prevalence, severity and distress of cancer survivors

Mental and physical health correlates of the psychological impact of the first wave of COVID-19 among general population of Pakistan

The primary aim was to assess the role of mental and physical health of COVID-19 and its psychological impact in the general population of Pakistan during the first wave of COVID-19. It was hypothesized that there would be a significant predictive association among socio-demographic variables, psychological impact and mental health status resulting from COVID-19, and poor self-reported physical health would be significantly associated with adverse psychological impact and poor mental health status because of COVID-19. A cross-sectional survey research design was used in which 1,361 respondents were sampled online during lockdown imposed in the country. The Impact of Events Scale-Revised (IES-R) was used to assess the psychological impact of COVID-19, and the Depression Anxiety Stress Scales (DASS-21) was used to assess participants’ mental health status. 18% of the respondents reported moderate to severe event-specific distress, 22.6% reported moderate to severely extreme depression, 29% reported moderate to extreme anxiety, and 12.1% reported moderate to extreme stress. Female gender, having graduate-level education, currently studying, and self-reported physical symptoms (persistent fever, chills, headache, cough, breathing difficulty, dizziness, and sore throat) were significantly associated with higher levels of psychological impact exhibited through higher scores on the IES-R and poorer mental health status exhibited through higher scores on the DASS-21 (Depression, Anxiety, and Stress Subscales).

Symptoms and their implications on quality of life and psychological distress in sarcoma patients

The aim of this study was to investigate symptoms, their variation over time and their relationship with quality of life (QoL)/psychological distress in sarcoma patients, as few data regarding QoL and psychological distress in this set of patients are currently available. A total of 188 sarcoma patients from an Italian referral center were involved. Symptoms and financial difficulties were evaluated with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire from the first treatment and over the follow-up period, up to 6 years. The authors found that patients with sarcoma experience several symptoms, especially fatigue and pain, which may dramatically worsen QoL and psychological distress. In conclusion, patients with sarcoma often experience fatigue, pain and financial difficulties, which negatively impacts QoL and psychological distress. To ameliorate overall QoL, proper control of symptoms is necessary.

Characteristics and Symptom Burden of Patients Accessing Acupuncture Services at a Cancer Hospital

BACKGROUND

Patients with cancer are often impacted by a significant symptom burden. Cancer hospitals increasingly recognize the value of complementary and integrative therapies to support the management of cancer related symptoms. The aim of this study is to provide a better understanding of the demographic characteristics and symptoms experienced by cancer patients who access acupuncture services in a tertiary hospital in Australia.

METHODS

A retrospective audit was conducted of patients that presented to the acupuncture service at Chris O'Brien Lifehouse between July 2017 and December 2018. Edmonton Symptom Assessment Scale (ESAS) and Measure Yourself Concerns and Wellbeing (MYCaW) outcome measures were used. The quantitative data was analyzed using descriptive statistics and Principal Component Analysis.

RESULTS

A total of 127 inpatients and outpatients (mean age 55, range 19-85) were included with 441 individual surveys completed (264 ESAS, 177 MYCaW). Patients were predominantly female (76.8%) and breast cancer was the most prevalent primary diagnosis (48%). The most prevalent symptoms in the ESAS were sleep problems (88.6%), fatigue (88.3%), lack of wellbeing (88.1%), and memory difficulty (82.6%). Similarly, symptoms with the highest mean scores were numbness, fatigue, sleep problems and hot flushes, whilst neuropathy, and hot flashes were scored as the most severe (score ≥7) by patients. Cluster analysis yielded 3 symptom clusters, 2 included "physical symptoms" (pain, sleep problems, fatigue and numbness/neuropathy), and (nausea, appetite, general well-being), whilst the third included "psychological" symptoms (anxiety, depression, spiritual pain, financial distress). The most frequent concerns expressed by patients (MyCaW) seeking acupuncture were side effects of chemotherapy (24.6%) and pain (20.8%).

CONCLUSION

This audit highlights the most prevalent symptoms, the symptoms with the greatest burden and the types of patients that receive acupuncture services at an Australian tertiary hospital setting. The findings of this audit provide direction for future acupuncture practices and research in hospital settings.

The Effects of Pharmacological and Non-Pharmacological Interventions on Symptom Management and Quality of Life among Breast Cancer Survivors Undergoing Adjuvant Endocrine Therapy: A Systematic Review

Breast cancer survivors need to undergo adjuvant endocrine therapy after completion of curative treatments to prevent disease recurrence. These individuals often experience symptoms which are detrimental to their quality of life (QOL). Implementation of interventions for effective symptom management among these survivors is warranted. This review provides an overview of studies on the effectiveness of the previously developed interventions for breast cancer survivors undergoing adjuvant endocrine therapy on symptom alleviation and enhancement of QOL or health-related QOL (HRQOL). Five electronic databases were employed in the literature search. Study selection, data extraction and critical appraisal of the included studies were conducted by three authors independently. Twenty-four studies were included. Both pharmacological and non-pharmacological interventions are effective in addressing the symptoms associated with adjuvant endocrine therapy among the breast cancer survivors, and in improving their QOL, although discrepancies were noted between the studies in terms of the significance of these effects. Pharmacological and non-pharmacological interventions can be effective for symptom management among breast cancer survivors. Their implementation is recommended for effective survivorship care for these individuals. Further research on intervention development for breast cancer survivors is recommended to provide further evidence for the utility of the explored interventions in survivorship care for these patients.

Effects of dignity therapy on dignity, psychological well-being, and quality of life among palliative care cancer patients: A systematic review and meta-analysis

OBJECTIVES

The review aims to identify available evidence related to the effects of dignity therapy on dignity, psychological well-being, and quality of life (QoL) among patients with cancer under palliative care.

METHODS

Thirteen electronic databases were searched for published articles in English or Chinese from inception to May 2018. Methodological rigour was assessed through the Joanna Briggs Institute (JBI) checklist for randomised controlled trials and quasi-experimental studies. Sufficient data from four trials were statistically pooled with Review Manager; otherwise, a narrative summary was used.

RESULTS

Ten articles describing eight studies met the selection criteria and were included in the review. None of the studies met all JBI checklist criteria. Meta-analysis results revealed that dignity therapy significantly improved dignity-related distress in existential distress domain (mean differences [MD]: -0.26, 95% CI, -0.50 to -0.02, .03) and social support domain (MD: -0.23, 95% CI, -0.39 to -0.07, .004), but nonsignificant improved depression and anxiety. Narrative summaries indicated that dignity therapy exerted positive effects on patients' dignity, psychological well-being, and QoL.

CONCLUSIONS

Dignity therapy is a promising approach to improve psychological well-being among patients with cancer under palliative care. However, the effects of dignity therapy on dignity and QoL are inconsistent. Further extensive studies should measure the impact of dignity therapy through qualitative and quantitative approaches to establish outcomes in psychological well-being. Studies with sensitivity to the cultural context within which dignity therapy applied should be conducted to explore its effects on patients with cancer at the early stages of illness trajectory.

Colorectal cancer survivors: an investigation of symptom burden and influencing factors

Background

Colorectal cancer is a significant issue internationally, with over 1.3 million people diagnosed annually. Survival rates are increasing as treatments improve, although physical symptoms can persist despite eradication of the tumour. In order to optimize survivorship care, further research is warranted in relation to symptom burden. Therefore, the objectives of this study are to (i) investigate frequency of physical symptoms in colorectal cancer survivors (ii) identify which symptoms occur together (iii) examine the associations between demographic and clinical variables, and symptoms.

Methods

Participants nine months to three years post diagnosis were identified from the population-based National Cancer Registry Ireland. Respondents completed the EORTC QLQ-C30 and EORTC QLQ-CR29. Reported physical symptom frequencies were transformed into continuous scale variables, which were then analysed using one way analysis of variance, general linear modelling and Spearman rank correlations.

Results

There were 496 participants. Fatigue, insomnia and flatulence were the most frequent symptoms, with ≥20% of respondents reporting these to be often present in the previous week. Eight other symptoms were experienced often by 10–20% of respondents. At least one of these eleven most common symptoms was experienced frequently by almost every respondent (99%). 66% of respondents experienced at least two of these symptoms together, and 16% experienced five or more together. Current stoma was the single most common variable associated with increased symptom scores, although statistically significant relationships (p ≤ 0.05) between symptom frequency scores and clinical/demographic variables were generally weak (R-sq value ≤0.08).

Conclusion

Findings may inform targeted interventions during the nine month to three year post diagnosis timeframe, which would enable supported self-management of symptoms.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-4923-3) contains supplementary material, which is available to authorized users.

A dyadic approach to understanding the impact of breast cancer on relationships between partners during early survivorship

BACKGROUND

The shared impact of breast cancer for women and their male partners is emerging as an important consideration during the experience of a breast cancer diagnosis, particularly during survivorship. This study aimed to explore the experiences of women and their partners during early survivorship and contributes a range of insights into the lives of those intimately affected by breast cancer.

METHODS

In-depth interviews were completed with Australian women survivors of breast cancer (n = 8) and their partners (n = 8), between six months and five years following cessation of treatment. Questions included a focus on the women and their partners' daily experiences during early survivorship, including the management of ongoing symptoms, engagement in leisure and social interests, returning to work, communicating with each other, maintenance of the current relationship and other important roles and responsibilities. Thematic analysis was employed to determine key themes arising from the dyadic accounts of women and their partners' experiences during early breast cancer survivorship.

RESULTS

Women and their partners experienced many changes to their previous roles, responsibilities and relationships during early breast cancer survivorship. Couples also reported a range of communication, intimacy and sexuality concerns which greatly impacted their interactions with each other, adding further demands on the relationship. Three significant themes were determined: (1) a disconnection within the relationship - this was expressed as the woman survivor of breast cancer needing to prioritise her own needs, sometimes at the expense of her partner and the relationship; (2) reformulating the relationship - this reflects the strategies used by couples to negotiate changes within the relationship; and (3) support is needed to negotiate the future of the relationship - couples emphasised the need for additional support and resources to assist them in maintaining their relationship during early survivorship.

CONCLUSION

It can be concluded that the early survivorship period represents a crucial time for both women and their partners and there are currently limited options available to meet their shared needs and preferences for support. Findings indicate that a suitable model of care underpinned by a biopsychosocial framework, access to comprehensive assessment, timely support and the provision of targeted resources are urgently needed to assist women and their partners during this critical time.

Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis

CONTEXT

Cancer pain has a severe impact on quality of life and is associated with numerous psychosocial responses. Recent studies suggest that treatment of cancer pain has improved during the last decade.

OBJECTIVES

The aim of this review was to examine the present status of pain prevalence and pain severity in patients with cancer.

METHODS

A systematic search of the literature published between September 2005 and January 2014 was performed using the databases PubMed, Medline, Embase, CINAHL, and Cochrane. Articles in English or Dutch that reported on the prevalence of cancer pain in an adult population were included. Titles and abstracts were screened by two authors independently, after which full texts were evaluated and assessed on methodological quality. Study details and pain characteristics were extracted from the articles with adequate study quality. Prevalence rates were pooled with meta-analysis; meta-regression was performed to explore determinants of pain prevalence.

RESULTS

Of 4117 titles, 122 studies were selected for the meta-analyses on pain (117 studies, n = 63,533) and pain severity (52 studies, n = 32,261). Pain prevalence rates were 39.3% after curative treatment; 55.0% during anticancer treatment; and 66.4% in advanced, metastatic, or terminal disease. Moderate to severe pain (numerical rating scale score ≥5) was reported by 38.0% of all patients.

CONCLUSION

Despite increased attention on assessment and management, pain continues to be a prevalent symptom in patients with cancer. In the upcoming decade, we need to overcome barriers toward effective pain treatment and develop and implement interventions to optimally manage pain in patients with cancer.

Assessing the response to opioids in cancer patients: a methodological proposal and the results

PURPOSE

The efficacy of treatment with opioids in cancer pain is variable. To evaluate this variability, we (1) applied two parameters, changes in pain intensity (PI) and opioid daily doses (DDs), to distinguish different responses to opioids. The need to switch to another opioid was recorded. We then (2) evaluated the distribution of the responses depending on these parameters, alone and taken together, in cancer patients with pain.

METHODS

The cutoffs between positive and negative responses related to PI and DD were defined on the basis of the literature. For PI, responders were patients who obtained simultaneously a decrease of 30% or more and a final score ≤4 points (numerical rating scale 0 to 10). For DD changes, we applied the opioid escalation index percentage, a positive response corresponding to a dose increase ≤5%. These criteria were applied to 201 cancer patients treated with WHO step III "strong" opioids for 21 days. The results were mainly analyzed case by case.

RESULTS

Of the patients, 63.7% obtained a positive analgesic response and 80.1% a dose-related positive response. Combining the parameters, the response was double positive in 55.2% of cases, double negative in 11.4%, a good analgesic response with a large dose escalation in 8.5%, and no pain relief with a stable dose in 24.9%. Switches were made 21 times, 15 because of the lack of analgesia.

CONCLUSIONS

Different degrees of response to opioids were observed, PI and DD changes both contributing. Only over half the patients had a full positive response.

Symptom burden and medication use in adult sarcoma patients

PURPOSE

Limited data are available on how symptom burden affects health-related quality of life (HRQoL) in patients with sarcoma. This study aims to describe the symptom burden, HRQoL, and medication use in adult sarcoma patients.

METHODS

A single-center, cross-sectional study was conducted, and 79 patients were evaluated using three tools: the Rotterdam Symptom Checklist (RSCL), the Beck Anxiety Inventory (BAI), and the Functional Assessment of Cancer Therapy scale-General (FACT-G). Patients' demographic and clinical information, medication history, and use of concomitant medications were recorded. The proportion of patients with clinically significant RSCL score for a particular symptom was compared with the percentage of patients receiving medication for that symptom.

RESULTS

The mean age was 57.3 ± 15.2 years, with majority of the patients diagnosed with stromal tumor (46.8 %), leiomyosarcoma (15.2 %), and liposarcoma (10.1 %). The most prevalent physical symptoms experienced were tiredness (2.38 ± 1.00), lack of energy (2.04 ± 1.02), and difficulty sleeping (2.00 ± 1.15). The most common psychological symptoms experienced were irritability (1.92 ± 1.01), worrying (1.86 ± 0.90), and anxiety (1.68 ± 0.74). Few (6.3 %) patients received hypnotics while 33.0 % of patients reported difficulty sleeping. A proportion of patients (27.9 %) reported experiencing lack of appetite with only 1.3 % received appetite stimulants.

CONCLUSION

Adult sarcoma patients experience significant physiological and psychological symptom burden, which has a strong negative impact on HRQoL, with a number of physiological symptoms undertreated with pharmacotherapy.

Characteristics of elderly cancer patients' concerns and their quality of life in Japan: a Web-based survey

OBJECTIVE

Cancer incidence and the number of cancer patients are increasing in today's aging society. The purpose of this study was to investigate the characteristics of elderly cancer patients' concerns and examine the association between their concerns and quality of life.

METHODS

This was a cross-sectional web-based survey completed by ambulatory cancer patients aged 20 years or older. The questionnaire on cancer patients' concerns, comprehensive concerns assessment tool and the European Organization for Research and Treatment of Cancer QLQ-C30 were distributed to the subjects. Multiple regression analysis was conducted to determine which patients' concerns significantly contributed to their quality of life.

RESULTS

The final study population consisted of 807 cancer patients, among whom 243 (30%) were elderly (65 years or older). Elderly cancer patients had particular difficulty with self-management, psychological symptoms and medical information, and the prevalence of their concerns was generally lower than that of younger patients, with the exception of physical symptoms. Multiple types of elderly patients' concerns were independently associated with quality of life.

CONCLUSIONS

We found that elderly cancer patients suffered from various concerns, thus multidisciplinary intervention is important for providing them with optimal care. The results of this study suggest that elderly cancer patients' quality of life will improve if their concerns are properly handled.

Perceived symptoms and the supportive care needs of breast cancer survivors six months to five years post-treatment period

PURPOSE

This study characterized the range and levels of perceived symptoms and unmet needs reported by breast cancer survivors in the half-year to five year post-treatment period, and determined whether the symptoms can be a predictor of unmet needs.

METHODS

In a cross-sectional study, 150 breast cancer survivors (mean age: 55.1 ± 8 years) at the half-year to five year post-treatment period were enrolled for analysis. The measuring scales used included the Memorial Symptom Assessment Scale (MSAS), and the Supportive Care Needs Survey Short Form (SCNS-SF34).

RESULTS

88% of the survivors reported having at least one symptom, while 51% reported at least one unmet need. Lack of energy was the most prevalent symptom (47%), followed by numbness/tingling in hands/feet (41%). Most of the survivors had unmet needs in the Health care system/Information domain (37% reported at least one unmet need for help), followed by Psychological needs (29%). The mean scores for the SCNS-SF34 domains, except for sexuality, were significantly higher in the high-symptom group (mean 17.6-32.2) compared with the low-symptom group (mean 3.5-22.3) (p < 0.01). Regression of the SCNS-SF34 domain scores against the MSAS scores revealed an increase in the explained variance of from 14% to 54%.

CONCLUSION

Our results suggest that breast cancer survivors continue to experience a multitude of symptoms, and the burden of symptoms may be associated with unmet needs across a range of domains.

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.

Adaptation of the illness trajectory framework to describe the work of transitional cancer survivorship

PURPOSE/OBJECTIVES

To examine and refine the Illness Trajectory Framework, and to address transitional cancer survivorship.

DATA SOURCES

CINAHL®, PubMed, and relevant Institute of Medicine reports were searched for survivors' experiences during the year following treatment.

DATA SYNTHESIS

Using an abstraction tool, 68 articles were selected from the initial search (N > 700). Abstracted data were placed into a priori categories refined according to recommended procedures for theory derivation, followed by expert review.

CONCLUSIONS

Derivation resulted in a framework describing the work of transitional cancer survivorship, defined as survivor tasks, performed alone or with others, to carry out a plan of action for managing one or more aspects of life following primary cancer treatment. Theoretically, survivors engage in three reciprocally interactive lines of work: (a) illness-related, (b) biographical, and (c) everyday life work. Adaptation resulted in refinement of these domains and the addition of survivorship care planning under "illness-related work."

IMPLICATIONS FOR NURSING

Understanding this process of work may allow survivors and those who support them to better prepare for the post-treatment period. This adaptation provides a framework for future testing and development. Validity and utility of this framework within specific survivor populations also should be explored.

This Too Shall Pass

Considering the paucity of studies dealing with the holistic aspect of the cancer experience, this grounded theory study seeks to conceptualize the process of cancer survivorship among Filipinos. Twenty-seven Filipino cancer survivors were purposively selected, and a two-part instrument, specifically robotfoto and focus group interviews, was used to gather data. The Glaserian method of grounded theory analysis was used, and extended texts were analyzed inductively via a dendrogram. Member checking and correspondence were observed to validate the surfacing stages, leading to the conceptualization of a theoretical model termed as the Ribbon of Cancer Survivorship. The said model describes the trifling (living before), transfusing (accepting the reality), transforming (being strong), and transcending (living beyond) phases of cancer survivorship. Ten interesting substages were also identified, namely: tainting, desolating, disrupting, and embracing for the transfusing phase; tormenting, distressing, awakening, and transfiguring for the transforming phase, and trembling and enlivening for the transcending phase. The resulting theoretical model has clearly and successfully described the entire process of cancer survivorship among Filipinos. It is hoped that the model be used as a reference for future studies about cancer survivorship and as a guide for nurses in providing a more empathetic care among cancer patients.

Effectiveness of multidimensional cancer survivor rehabilitation and cost-effectiveness of cancer rehabilitation in general: a systematic review

INTRODUCTION

Many cancer survivors suffer from a combination of disease- and treatment-related morbidities and complaints after primary treatment. There is a growing evidence base for the effectiveness of monodimensional rehabilitation interventions; in practice, however, patients often participate in multidimensional programs. This study systematically reviews evidence regarding effectiveness of multidimensional rehabilitation programs for cancer survivors and cost-effectiveness of cancer rehabilitation in general.

METHODS

The published literature was systematically reviewed. Data were extracted using standardized forms and were summarized narratively.

RESULTS

Sixteen effectiveness and six cost-effectiveness studies were included. Multidimensional rehabilitation programs were found to be effective, but not more effective than monodimensional interventions, and not on all outcome measures. Effect sizes for quality of life were in the range of -0.12 (95% confidence interval [CI], -0.45-0.20) to 0.98 (95% CI, 0.69-1.29). Incremental cost-effectiveness ratios ranged from -€16,976, indicating cost savings, to €11,057 per quality-adjusted life year.

CONCLUSIONS

The evidence for multidimensional interventions and the economic impact of rehabilitation studies is scarce and dominated by breast cancer studies. Studies published so far report statistically significant benefits for multidimensional interventions over usual care, most notably for the outcomes fatigue and physical functioning. An additional benefit of multidimensional over monodimensional rehabilitation was not found, but this was also sparsely reported on. Available economic evaluations assessed very different rehabilitation interventions. Yet, despite low comparability, all showed favorable cost-effectiveness ratios. Future studies should focus their designs on the comparative effectiveness and cost-effectiveness of multidimensional programs.

"Weaving balance into life": Development and cultural adaptation of a cancer symptom management toolkit for Southwest American Indians

INTRODUCTION

Self-management of cancer symptoms has the potential to decrease the suffering of cancer survivors while improving their health and quality of life. For many racial/ethnic groups, culturally appropriate self-management instruction is not readily available. This paper reports on the first symptom management toolkit developed for American Indian cancer survivors.

METHODS

Part of a larger research study, a three-phase project tested a cancer symptom self-management toolkit to be responsive to the unique learning and communication needs of American Indians in the Southwest U.S.A. American Indian cancer survivors and family members participated in 13 focus groups to identify cultural concepts of cancer and illness beliefs, communication styles, barriers, and recommendations for self-management techniques. Sessions were audiotaped and transcriptions were coded using grounded theory.

RESULTS

Participants expressed a need for an overview of cancer, tips on management of common symptoms, resources in their communities, and suggestions for how to communicate with providers and others. The "Weaving balance into life" toolkit is comprised of a self-help guide, resource directory, and video. Preferred presentation style and content for the toolkit were pilot tested.

DISCUSSION/CONCLUSIONS

American Indian survivors favor educational materials that provide information on symptom management and are tailored to their culture and beliefs. Suggestions for adapting the toolkit materials for other American Indian populations are made.

IMPLICATIONS FOR CANCER SURVIVORS

Many cancer survivors lack effective self-management techniques for symptoms, such as pain, fatigue, and depression. The toolkit promotes self-management strategies for survivors and provides family members/caregivers tangible ways to offer support.

Toward an occupational rehabilitation policy community for cancer survivors in Singapore: a stakeholder perspective from the SME employers

INTRODUCTION

Cancer and return to work has been extensively studied in the Western context and yet it has not received much academic attention in Asia. This paper aims to review the current Singapore government rehabilitation initiatives in collaboration with the policy community, identify the socio-environmental barriers to implementing the existing programs for cancer survivors, highlights the demand-side of research development and illustrates the viewpoints of small and medium enterprise employers in Singapore from a recent study. Implications and future directions in developing evidence-based rehabilitation policies and initiatives for cancer survivors in Singapore and the Southeast Asian region are also discussed.

METHODS

A review of occupational rehabilitation literature relevant to Singapore looking at legislation, policies, initiatives and services was performed. Current state-of-art research in occupational rehabilitation from an employer perspective was also synthesized.

RESULTS

Challenges and barriers of adopting the current rehabilitation initiatives and programs for cancer survivors exist largely due to the lack of centralized effort, clear definitions and understanding between people with disabilities, chronic illness and cancer as well as an evidence-based policy community. In addition, too much emphasis on new hiring than retaining in current services and there are no specific guidelines to help employers deal with issues when retaining employees with health history, such as workplace accommodation, appraisal, discrimination and grievance handling.

CONCLUSIONS

Palpable blind spots in the current occupational rehabilitation system and policy were highlighted in this paper. Coupled with systemic improvements, continuous government resource support and developing an evidence-based policy community between the government, employers, healthcare professionals, industry and community partners and non-profit organizations, a positive change of the rehabilitation initiatives and services is promising.

Predictors of psychosocial adjustment during the postradiation treatment transition

The aim of this study was to examine the role of cognitive appraisal in predicting psychosocial adjustment during the postradiation treatment transition. A predictive correlational design was used in a convenience sample of 80 patients with breast, lung, and prostate cancer who were receiving radiation therapy. Two weeks prior to completion of treatment, participants completed instruments to measure symptom distress, uncertainty, cognitive appraisal, social support, and self-efficacy for coping. The Psychosocial Adjustment to Illness Scale was administered 1 month after therapy. Adjustment was significantly correlated with all independent variables, age, and comorbidity. Young age and high amounts of threat appraisal, harm/loss appraisal, uncertainty, and symptom distress were significantly associated with poor adjustment. The model predicted 52% of the variability in adjustment. Cognitive appraisal was not a significant explanatory variable for adjustment when controlling for uncertainty, cancer stage, age, and symptom distress. Symptom distress was the only significant predictor of adjustment.