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Vedelø TW, Sørensen JCH, Hall EOC, Delmar C. A fast transition: A case study of patients' experiences during the diagnostic and surgical treatment phase of an accelerated brain cancer pathway. Scand J Caring Sci 2024; 38:451-460. [PMID: 38433372 DOI: 10.1111/scs.13253] [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: 12/06/2023] [Revised: 01/27/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Patients receiving a brain cancer diagnosis may face cognitive decline and a poor prognosis. In addition, they suffer from a high symptom burden in a complex cancer pathway. The aim of this study was to investigate the early hospital experiences of brain tumour patients during the diagnostic and surgical treatment phase. METHODS A descriptive longitudinal single-case study design was used, and data were analysed via systematic text condensation. RESULTS The patients' experiences of being diagnosed with and treated for brain cancer were interpreted in terms of the central theme: a fast transition into an unknown journey. This theme consisted of the following subthemes: emotionally overwhelmed, putting life on hold and an unfamiliar dependency. CONCLUSIONS Patients diagnosed with brain cancer struggle with overwhelming emotions due to this sudden life-threatening diagnosis, their fear of brain surgery and their progressing dependence. Patients did not voice their feelings, fears or needs, so these may easily be overlooked and unmet. A proactive and continuous care approach throughout the diagnostic phase is needed to support these patients.
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Affiliation(s)
- Tina Wang Vedelø
- Department of Public Health, Nursing, Health Faculty, Aarhus University, Aarhus, Denmark
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Christian H Sørensen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Health Faculty, Aarhus University, Aarhus, Denmark
| | - Elisabeth O C Hall
- Department of Public Health, Nursing, Health Faculty, Aarhus University, Aarhus, Denmark
- Section of Health Science and Nursing, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Charlotte Delmar
- Department of Public Health, Nursing, Health Faculty, Aarhus University, Aarhus, Denmark
- VID, Oslo and Bergen, Norway
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2
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Tran S, Lapidus A, Neal A, Peters KB, Gately L, Ameratunga M. A systematic review of the impact of brain tumours on risk of motor vehicle crashes. J Neurooncol 2024; 166:395-405. [PMID: 38321326 PMCID: PMC10876497 DOI: 10.1007/s11060-024-04586-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Brain tumours are associated with neurocognitive impairments that are important for safe driving. Driving is vital to maintaining patient autonomy, despite this there is limited research on driving capacity amongst patients with brain tumours. The purpose of this review is to examine MVC risk in patients with brain tumours to inform development of clearer driving guidelines. METHODS A systematic review was performed using Medline and EMBASE. Observational studies were included. The outcome of interest was MVC or measured risk of MVC in patients with benign or malignant brain tumours. Descriptive analysis and synthesis without meta-analysis were used to summarise findings. A narrative review of driving guidelines from Australia, United Kingdom and Canada was completed. RESULTS Three studies were included in this review. One cohort study, one cross-sectional study and one case-control study were included (19,135 participants) across United States and Finland. One study evaluated the incidence of MVC in brain tumour patients, revealing no difference in MVC rates. Two studies measured MVC risk using driving simulation and cognitive testing. Patients found at higher risk of MVC had greater degrees of memory and visual attention impairments. However, predictive patient and tumour characteristics of MVC risk were heterogeneous across studies. Overall, driving guidelines had clear recommendations on selected conditions like seizures but were vague surrounding neurocognitive deficits. CONCLUSION Limited data exists regarding driving behaviour and MVC incidence in brain tumour patients. Existing guidelines inadequately address neurocognitive complexities in this group. Future studies evaluating real-world data is required to inform development of more applicable driving guidelines. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2023 CRD42023434608.
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Affiliation(s)
- Sophie Tran
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia
| | - Adam Lapidus
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia
| | - Andrew Neal
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | | | - Lucy Gately
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute for Medical Research, The University of Melbourne, Melbourne, VIC, Australia
| | - Malaka Ameratunga
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia.
- Central Clinical School, Monash University, Melbourne, VIC, Australia.
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3
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Guldager R, Nordentoft S, Poulsen I, Aadal L, Loft MI. Wants and needs for involvement reported by relatives of patients with a malignant brain tumor: a scoping review. JBI Evid Synth 2023; 21:2188-2210. [PMID: 37435678 DOI: 10.11124/jbies-22-00311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVE The objective of this scoping review was to identify and map the breadth of available evidence on relatives' wants and needs for involvement throughout the course of the disease in patients with a malignant brain tumor. INTRODUCTION Patients diagnosed with a malignant brain tumor often have a poor prognosis, including a rapid progression of the disease, with changing physical, cognitive, and psychosocial symptoms. The caregiver burden is described as multifaceted, and relatives often neglect their own physical, emotional, and social needs. INCLUSION CRITERIA This review included studies that defined or assessed the wants and needs for involvement of relatives of patients with a malignant brain tumor throughout the disease and treatment trajectory. The populations were relatives of patients with a malignant brain tumor in various settings. METHODS The JBI methodology for scoping reviews was followed in accordance with a previously published a priori protocol. An extensive search was conducted in the MEDLINE (PubMed), CINAHL (EBSCOhost), and Embase (Ovid). Gray literature was searched using Grey Matters and BASE. The initial search was conducted in February 2020 and updated in March 2022. This review was limited to studies published since January 2010 in English, German, or Scandinavian languages. The data were extracted using a data extraction tool (authors, year of publication, country of origin, setting, study methods, and findings related to wants and needs for involvement) created by the authors. Textual data mapping of wants and needs for involvement were synthesized narratively using a basic qualitative content analysis. The review findings are reported as a descriptive summary, with tables and figures to support the data. RESULTS The search identified 3830 studies, of which 10 were included. The studies were conducted in 6 countries and were published between 2010 and 2018. In total, 4 studies applied a qualitative study design that used semi-structured interviews, 2 studies applied a mixed methods design that used questionnaires and semi-structured interviews, 1 study applied a multi-method design, and 3 studies used a quantitative survey. Research was conducted in a variety of settings, including community palliative care, inpatient centers, outpatient, home, and post-bereavement. The findings showed that most of the relatives' needs were related to the caregiver role. The relatives were actively involved in the patients' disease and treatment trajectories. However, relatives were often required to adopt the caregiver role and a large amount of responsibility at short notice. Thus, they expressed a need for a stronger connection with health care professionals because their needs changed as rapidly as the disease progressed. Relatives also had a need related to maintaining hope, which was essential for their involvement. Relatives' wants for involvement in the patients' disease and treatment trajectories depended on a significant and timely amount of information. CONCLUSIONS The findings reveal that relatives are actively involved in the patients' disease and treatment trajectories. The relatives want and need support for their involvement, which is related directly to the accessibility and availability of health care professionals, as the demands placed on them change rapidly throughout the progression of the disease. One way to address relatives' wants and needs may be to further strengthen the relationship between the relatives and health care professionals. SUPPLEMENTAL DIGITAL CONTENT A Danish-language version of the abstract of this review is available as Supplemental Digital Content [ http://links.lww.com/SRX/A26 ]. A German-language version of the abstract of this review is available at Supplemental Digital Content [ http://links.lww.com/SRX/A35 ].
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Affiliation(s)
- Rikke Guldager
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Sara Nordentoft
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre Hospital, Hvidovre, Denmark
- Research Unit Nursing and Health Care, Aarhus University, Aarhus, Denmark
| | - Lena Aadal
- Hammel Neurorehabilitation and Research Centre, Hammel, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mia Ingerslev Loft
- Research Unit Nursing and Health Care, Aarhus University, Aarhus, Denmark
- Department of Neurology, Rigshospitalet, Copenhagen, Denmark
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4
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Silvaggi F, Mariniello A, Leonardi M, Silvani A, Lamperti E, Di Cosimo S, Folli S, Trapani A, Schiavolin S. Psychosocial factors associated with workability after surgery in cancer survivors: An explorative study. J Health Psychol 2023; 28:999-1010. [PMID: 36800903 PMCID: PMC10492438 DOI: 10.1177/13591053231151286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
This study aimed to evaluate the work ability and its associated factors in patients with glioma (II, III) and breast cancer after 6 (T0) and 12 (T1) months from surgery. A total of 99 patients were evaluated with self-reported questionnaires at T0 and T1. Correlation and Mann-Whitney tests were used to investigate the association between work ability and sociodemographic, clinical, and psychosocial factors. The Wilcoxon test was used to investigate the longitudinal change in work ability. Our sample showed a decrease in work ability level between T0 and T1. Work ability was associated with emotional distress, disability, resilience, and social support in glioma III patients at T0, and with fatigue, disability, and clinical treatments in patients with breast cancer at T0 and T1. Work ability levels decreased in patients with glioma and breast cancer and were associated with different psychosocial factors after surgery. Their investigation is suggested to facilitate the return to work.
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Affiliation(s)
- Fabiola Silvaggi
- Department of Neurology, Public Health, Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Italy
| | - Arianna Mariniello
- Department of Neurology, Public Health, Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Italy
| | - Matilde Leonardi
- Department of Neurology, Public Health, Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Italy
| | - Antonio Silvani
- UOC Neuro-Oncology Unit , Fondazione IRCCS Istituto Neurologico Carlo Besta, Italy
| | - Elena Lamperti
- UOC Neuro-Oncology Unit , Fondazione IRCCS Istituto Neurologico Carlo Besta, Italy
| | - Serena Di Cosimo
- Biomarkers Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | - Secondo Folli
- Breast Cancer Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | - Anna Trapani
- Breast Cancer Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | - Silvia Schiavolin
- Department of Neurology, Public Health, Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Italy
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Boele FW, Rudkin SE, Absolom K, Latchford G, Short SC, Booth TC. The experience of interval scans for adults living with primary malignant brain tumors. Support Care Cancer 2023; 31:356. [PMID: 37243744 PMCID: PMC10221741 DOI: 10.1007/s00520-023-07818-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: 01/18/2023] [Accepted: 05/15/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE People with primary malignant brain tumors (PMBT) undergo anti-tumor treatment and are followed up with MRI interval scans. There are potential burdens and benefits to interval scanning, yet high-quality evidence to suggest whether scans are beneficial or alter outcomes of importance for patients is lacking. We aimed to gain an in-depth understanding of how adults living with PMBTs experience and cope with interval scanning. METHODS Twelve patients diagnosed with WHO grade III or IV PMBT from two sites in the UK took part. Using a semi-structured interview guide, they were asked about their experiences of interval scans. A constructivist grounded theory approach was used to analyze data. RESULTS Although most participants found interval scans uncomfortable, they accepted that scans were something that they had to do and were using various coping methods to get through the MRI scan. All participants said that the wait between their scan and results was the most difficult part. Despite the difficulties they experienced, all participants said that they would rather have interval scans than wait for a change in their symptoms. Most of the time, scans provided relief, gave participants some certainty in an uncertain situation, and a short-term sense of control over their lives. CONCLUSION The present study shows that interval scanning is important and highly valued by patients living with PMBT. Although interval scans are anxiety provoking, they appear to help people living with PMBT cope with the uncertainty of their condition.
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Affiliation(s)
- Florien W Boele
- Leeds Institute of Medical Research at St James's, St James's University Hospital, University of Leeds, Leeds, UK.
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
| | - Sarah E Rudkin
- Leeds Institute of Medical Research at St James's, St James's University Hospital, University of Leeds, Leeds, UK
| | - Kate Absolom
- Leeds Institute of Medical Research at St James's, St James's University Hospital, University of Leeds, Leeds, UK
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Gary Latchford
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Susan C Short
- Leeds Institute of Medical Research at St James's, St James's University Hospital, University of Leeds, Leeds, UK
| | - Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Kings College Hospital NHS Foundation Trust, London, UK
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6
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Waller A, Hullick C, Sanson-Fisher R, Herrmann-Johns A. Optimal care of people with brain cancer in the emergency department: A cross-sectional survey of outpatient perceptions. Asia Pac J Oncol Nurs 2023; 10:100194. [PMID: 36915388 PMCID: PMC10006536 DOI: 10.1016/j.apjon.2023.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/19/2023] [Indexed: 01/27/2023] Open
Abstract
Objective People diagnosed with brain cancer commonly present to the emergency department (ED). There is uncertainty about essential components and processes of optimal care from the perspective of consumers, and few guidelines exist to inform practice. This study examined the perceptions of outpatients and their support persons regarding what constitutes optimal care for people with brain cancer presenting to the ED. Methods A cross sectional descriptive survey study was undertaken. Participants included adults attending hospital outpatient clinics (n = 181, 60% of eligible participants). Participants completed a survey assessing perceptions of optimal care for brain cancer patients presenting to emergency department and socio-demographic characteristics. Results The survey items endorsed as 'essential' by participants included that the emergency department team help patients: 'understand signs and symptoms to watch out for' (51%); 'understand the next steps in care and why' (48%); 'understand if their medical condition suggests it is likely they will die in hospital' (47%); 'ask patients if they have a substitute decision maker and want that person told they are in the emergency department' (44%); 'understand the purpose of tests and procedures' (41%). Conclusions Symptom management, effective communication and supported decision-making should be prioritised by ED teams. Further research to establish the views of those affected by brain cancer about essential care delivered in the ED setting, and to compare these views with the quality of care that is actually delivered, is warranted.
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Affiliation(s)
- Amy Waller
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Carolyn Hullick
- Emergency Department, Belmont Hospital, Hunter New England Local Health District, New Lambton Heights, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Anne Herrmann-Johns
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia.,Department for Epidemiology and Preventive Medicine, Professorship for Medical Sociology, University of Regensburg, Regensburg, Germany
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7
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Brain Tumor at Diagnosis: From Cognition and Behavior to Quality of Life. Diagnostics (Basel) 2023; 13:diagnostics13030541. [PMID: 36766646 PMCID: PMC9914203 DOI: 10.3390/diagnostics13030541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The present narrative review aims to discuss cognitive-emotional-behavioral symptoms in adults with brain tumors at the time of diagnosis. METHODS The PubMed database was searched considering glioma, pituitary adenoma, and meningioma in adulthood as pathologies, together with cognitive, neuropsychological, or behavioral aspects. RESULTS Although a significant number of studies describe cognitive impairment after surgery or treatment in adults with brain tumors, only few focus on cognitive-emotional-behavioral symptoms at diagnosis. Furthermore, the importance of an effective communication and its impact on patients' quality of life and compliance with treatment are seldom discussed. CONCLUSIONS Adults with brain tumors have needs in terms of cognitive-emotional-behavioral features that are detectable at the time of diagnosis; more research is needed to identify effective communication protocols in order to allow a higher perceived quality of life in these patients.
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8
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Guldager R, Nordentoft S, Aadal L, Loft MI, Vilhelmsen MA, Poulsen I. Interventions facilitating the involvement of relatives of patients with acquired brain injury or malignant brain tumour through the course of disease: a scoping review protocol. BMJ Open 2023; 13:e062069. [PMID: 36717149 PMCID: PMC9887697 DOI: 10.1136/bmjopen-2022-062069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Research identifying the needs of relatives of patients with an acquired brain injury or malignant brain tumours is emerging, and the importance of relative involvement is widely acknowledged. However, the intention of involvement does not seem to be present in current practice and healthcare professionals' routines. The complexity of involvement of relatives is comprehensive, and there is a lack of overview of interventions facilitating and enhancing involvement of relatives. This scoping review aims to identify and map the available evidence on interventions facilitating involvement of relatives of patients with acquired brain injury or malignant brain tumour throughout the disease trajectory. METHODS AND ANALYSIS The proposed scoping review will be performed following the Joanna Briggs Institute's methodology for scoping reviews. Published and unpublished literature in English, Scandinavian and German from January 2010 to August 2022 will be considered. The searches will be conducted using electronic bibliographic databases. This scoping review will consider studies describing interventions provided by multidisciplinary healthcare professionals. The key aspects of the interventions could, for example, be educational, informational, emotional, social or physical support aiming towards involvement of the relatives. This scoping review will consider all study designs, except for literature reviews of all types and designs. The data will be extracted using a data extraction tool developed to record specific data, including details of authors, year of publication, country, setting, study population, study design and key aspects of the intervention (mode, duration, intensity, provider) and type of primary and secondary outcomes applied to measure the interventions. The results will be presented in tabular form, accompanied by a descriptive summary related to the objective of the present scoping review. ETHICS AND DISSEMINATION This scoping review is conducted as part of a larger postdoc project, which has been approved by the Danish Data Protection Agency (ID P-2020-547). The results will be disseminated through a peer-reviewed journal and presented at local, national and international conferences on brain injuries and brain cancer.
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Affiliation(s)
- Rikke Guldager
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen East, Copenhagen, Denmark
| | - Sara Nordentoft
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen East, Copenhagen, Denmark
| | - Lena Aadal
- Department of Research, Hammel Neurorehabilitation and Research Centre, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Mia Ingerslev Loft
- Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
- Research Unit Nursing and Health Care, Aarhus University, Aarhus, Denmark
| | - Maria Amalie Vilhelmsen
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen East, Copenhagen, Denmark
- Department of Quality and Patientcare, Amager & Hvidovre Hospital, Hvidovre, Denmark
| | - Ingrid Poulsen
- Research Unit Nursing and Health Care, Aarhus University, Aarhus, Denmark
- Department of Clinical Research, Amager Hvidovre Hospital, Traumatic Brain Injury Unit, Rigshospitalet, Copenhagen, Denmark, Hvidovre, Denmark
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9
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Day J, Yust-Katz S, Cachia D, Wefel J, Tremont Lukats IW, Bulbeck H, Rooney AG. Interventions for the management of fatigue in adults with a primary brain tumour. Cochrane Database Syst Rev 2022; 9:CD011376. [PMID: 36094728 PMCID: PMC9466986 DOI: 10.1002/14651858.cd011376.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Fatigue is a common and disabling symptom in people with a primary brain tumour (PBT). The effectiveness of interventions for treating clinically significant levels of fatigue in this population is unclear. This is an updated version of the original Cochrane Review published in Issue 4, 2016. OBJECTIVES To assess the effectiveness and safety of pharmacological and non-pharmacological interventions for adults with PBT and clinically significant (or high levels) of fatigue. SEARCH METHODS For this updated review, we searched CENTRAL, MEDLINE and Embase, and checked the reference lists of included studies in April 2022. We also searched relevant conference proceedings, and ClinicalTrials.gov for ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) that investigated any pharmacological or non-pharmacological intervention in adults with PBT and fatigue, where fatigue was the primary outcome measure. We restricted inclusion specifically to studies that enrolled only participants with clinically significant levels of fatigue to improve the clinical utility of the findings. DATA COLLECTION AND ANALYSIS Two review authors (JD, DC) independently evaluated search results for the updated search. Two review authors (JD, SYK) extracted data from selected studies, and carried out a risk of bias assessment. We extracted data on fatigue, mood, cognition, quality of life and adverse events outcomes. MAIN RESULTS The original review identified one study and this update identified a further two for inclusion. One study investigated the use of modafinil, one study the use of armodafinil and one study the use of dexamfetamine. We identified three ongoing studies. In the original review, the single eligible trial compared modafinil to placebo for 37 participants with a high- or low-grade PBT. One new study compared two doses of armodafinil (150 mg and 250 mg) to placebo for 297 people with a high-grade glioma. The second new study compared dexamfetamine sulfate to placebo for 46 participants with a low- or high-grade PBT. The evidence was uncertain for both modafinil and dexamfetamine regarding fatigue outcome measures, compared to controls, at study endpoint. Two trials did not reach the planned recruitment target and therefore may not, in practice, have been adequately powered to detect a difference. These trials were at a low risk of bias across most areas. There was an unclear risk of bias related to the use of mean imputation for one study because the investigators did not analyse the impact of imputation on the results and information regarding baseline characteristics and randomisation were not clear. The certainty of the evidence measured using GRADE was very low across all three studies. There was one identified study awaiting classification once data are available, which investigated the feasibility of 'health coaching' for people with a PBT experiencing fatigue. There were three ongoing studies that may be eligible for an update of this review, all investigating a non-pharmacological intervention for fatigue in people with PBT. AUTHORS' CONCLUSIONS There is currently insufficient evidence to draw reliable and generalisable conclusions regarding potential effectiveness or harm of any pharmacological or non-pharmacological treatments for fatigue in people with PBT. More research is needed on how best to treat people with brain tumours with high fatigue.
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Affiliation(s)
- Julia Day
- Edinburgh Centre for Neuro-Oncology (ECNO), Western General Hospital, Edinburgh, UK
| | - Shlomit Yust-Katz
- Sheba Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Cachia
- University of Massachusetts, Boston, Massachusetts, USA
| | - Jeffrey Wefel
- University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Ivo W Tremont Lukats
- Kenneth R. Peak Center for Brain and Pituitary Tumors, Houston Methodist Hospital, Houston, Texas, USA
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10
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Röttgering JG, Douw L, de Witt Hamer PC, Kouwenhoven MCM, Würdinger T, van de Ven PM, Sharpe L, Knoop H, Klein M. Reducing severe fatigue in patients with diffuse glioma: a study protocol for an RCT on the effect of blended cognitive behavioural therapy. Trials 2022; 23:568. [PMID: 35841104 PMCID: PMC9287927 DOI: 10.1186/s13063-022-06485-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Fatigue is the most frequent and burdensome symptom of patients with diffuse glioma. It is closely linked to decreased health-related quality of life and symptoms such as depression and sleep disturbances. Currently, there is no evidence-based treatment that targets severe fatigue in patients with brain tumours. Cognitive behavioural therapy is aimed at fatigue-maintaining beliefs and behaviour. This therapy has been proven effective in reducing severe fatigue in cancer survivors and patients with multiple sclerosis. A blended therapy program combines sessions with a therapist with therapist-guided web-based therapy modules. The aim of this randomized controlled trial is to determine the efficacy of blended cognitive behavioural therapy in treating severe fatigue in patients with diffuse glioma. Methods We will include a maximum of 100 patients with diffuse glioma with clinically and radiologically stable disease and severe fatigue (i.e. Checklist Individual Strength, subscale fatigue severity ≥ 35). Patients will be randomized to blended cognitive behavioural therapy or a waiting list condition. The 12-week intervention GRIP on fatigue consists of five patient-therapist sessions and five to eight individualized web-based therapy modules supported by email contact. The primary outcome measure is fatigue severity. Secondary outcome measures include sleep quality, health-related quality of life, depression, anxiety, functional impairment and subjective and objective cognitive functioning. Primary and secondary outcome measures will be assessed at baseline and after 14 and 24 weeks. Magnetoencephalography and MRI will be used to evaluate potential biomarkers for intervention success. This trial has a Bayesian design: we will conduct multiple interim analyses to test for efficacy or futility of the trial. This is the first trial within the GRIP trial platform: a platform developing four to five different interventions for the most common symptoms in patients with diffuse glioma. Discussion The results of the GRIP on fatigue trial will provide information about the efficacy of this intervention on fatigue in patients with diffuse glioma. Multiple other outcomes and possible predictors of treatment success will also be explored. Trial registration Netherlands Trial Register NL8711. Registered on 14 June 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06485-5.
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Affiliation(s)
- Jantine Geertruida Röttgering
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Psychology, De Boelelaan 1117, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands. .,Amsterdam UMC location Vrije Universiteit Amsterdam, Anatomy and Neurosciences, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Linda Douw
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Anatomy and Neurosciences, De Boelelaan 1117, Amsterdam, The Netherlands.,Department of Radiology, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, 149 13th Street, Boston, MA, 02129, USA
| | - Philip C de Witt Hamer
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Neurosurgery, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mathilde C M Kouwenhoven
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Neurology, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Tom Würdinger
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Neurosurgery, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Louise Sharpe
- The School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Hans Knoop
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Psychology, De Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam UMC location University of Amsterdam, Medical Psychology, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Expert Center for Chronic Fatigue, Amsterdam, The Netherlands
| | - Martin Klein
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Psychology, De Boelelaan 1117, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands
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11
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Li H, Shi X, Yang F, Zhang X, Li F. Blood Inflammatory Cytokines as Predictors of Depression in Patients With Glioma. Front Psychiatry 2022; 13:930985. [PMID: 35757220 PMCID: PMC9218211 DOI: 10.3389/fpsyt.2022.930985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression commonly develops as a comorbid disorder related to glioma, which affects the patients' physical function and prognosis. Circulating inflammatory cytokines are potential predictors of depression in disparate cancers. However, less research has specifically investigated this aspect within the context of glioma. STUDY OBJECTIVES The objective of this study was to investigate the occurrence of depression in patients with glioma and draw a comparison of the ability to predict it through diverse inflammatory cytokines. METHODS A total of 203 patients with stage I-IV glioma were enrolled in this study. Depression was evaluated according to the Hamilton Depression Scale, and the plasma inflammatory cytokines levels were simultaneously measured. We performed the receiver operating characteristic (ROC) analysis to confirm the abilities of identified inflammatory cytokines to predict depression. RESULTS Among the 203 patients with glioma, 135 (66.5%) showed obvious depressive symptoms. Proinflammatory cytokines, including interleukin (IL)-6 (area under the curve (AUC) = 0.76) and tumor necrosis factor (TNF)-α (AUC = 0.75), showed good performance in accurately predicting depression in patients with glioma. These inflammatory cytokines indicated great potential to be depression biomarkers regardless of the patients' disparate treatment experience. CONCLUSION With their relatively simple and time-saving measurement procedures, inflammatory cytokines should be seriously considered effective clinical screening and diagnostic tools, as well as potential biomarkers for depression in patients with glioma.
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Affiliation(s)
- Huayu Li
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Xiaohan Shi
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Fan Yang
- School of Physical Education, Yantai University, Yantai, China
| | - Xinrui Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Feng Li
- Department of Neurosurgery, Affiliated Cancer Hospital of Shandong First Medical University, Jinan, China
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12
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Nordentoft S, Dieperink KB, Johansson SD, Jarden M, Piil K. Evaluation of a multimodal rehabilitative palliative care programme for patients with high-grade glioma and their family caregivers. Scand J Caring Sci 2021; 36:815-829. [PMID: 34296773 DOI: 10.1111/scs.13019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/11/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients diagnosed with high-grade glioma and their family caregivers often experience intense disease and treatment trajectories. Fluctuations in patient's symptoms lead to enormous burdens for caregivers and the risk of developing symptoms of stress, anxiety, and depression. AIM The study aim is to explore patient and caregiver experiences and evaluate the relevance of and satisfaction with a multimodal rehabilitative palliative care programme for patients diagnosed with a high-grade glioma and their family caregivers. METHODS In a longitudinal multi-methods study, adult patients with high-grade glioma (n = 17) and their family caregivers (n = 16) completed a 4-day residential programme and a 2-day follow-up programme 3 months later. Participants completed questionnaires after each programme, scoring relevance and satisfaction on a 5-point Likert scale. Qualitative data were collected during four evaluation group interviews with patients and caregivers. RESULTS The mean overall satisfaction score was 4.80 (standard deviation [SD], 0.55) for the initial 4-day programme and 4.28 (SD, 0.83) for the follow-up programme. Three themes emerged in the evaluation group interviews: (1) meeting peers strengthens social well-being, (2) the value of information and focusing on individual needs, and (3) accepting life as an unpredictable passage. CONCLUSION Participants found completing the REHPA-HGG programme feasible and rated all sessions highly for relevance and satisfaction. Qualitative findings confirm the value of individualised information, acceptance, and peer interactions. IMPLICATION FOR PRACTICE A multimodal rehabilitative palliative care programme addressed unmet patient and caregiver needs. Peer-to-peer interventions for family caregivers may address individual support needs. Similar programmes may maximise benefit by avoiding planned behaviour changes and enhancing palliative approaches.
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Affiliation(s)
- Sara Nordentoft
- Research Unit, Center for Cancer and Organ Disease, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Center for Cancer and Organ Diseases, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Karin B Dieperink
- Department of Oncology, Odense University Hospital, Odense, Denmark.,Danish Center for Rehabilitation and Palliative Care, REHPA, Nyborg, Denmark.,Family Focused Healthcare Center (FaCe), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Susan D Johansson
- Danish Center for Rehabilitation and Palliative Care, REHPA, Nyborg, Denmark
| | - Mary Jarden
- Department of Hematology, Center for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karin Piil
- Center for Cancer and Organ Diseases, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
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13
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Wibroe M, Ingersgaard MV, Larsen HB, Juhler M, Piil K. Living with the cerebellar mutism syndrome: long-term challenges of the diagnosis. Acta Neurochir (Wien) 2021; 163:1291-1298. [PMID: 32621064 DOI: 10.1007/s00701-020-04479-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/30/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND After posterior fossa tumour surgery, up to 39% of children experience postoperative cerebellar mutism syndrome (CMS) characterized by mutism and other motor and cognitive impairments. There is a lack of knowledge on the patient-reported challenges and long-term needs. Consequently, no specific recommendations exist for rehabilitative and supportive interventions for patients with CMS. The aims of this study were to explore the patients' experiences related to the sequelae of CMS, to identify challenges and needs regarding support and rehabilitation in the period of growing from child to adult and to add perspectives for future developments of supportive care and rehabilitative guidelines. METHODS Ten semi-structured interviews were conducted with young adults diagnosed with CMS as children. A thematic analysis identified four themes describing challenges impacting aspects of the participants' lives. RESULTS Four main themes were identified and highlight the rehabilitative need for focus on verbal and non-verbal communication skills in addition to the physical impairments. We found that brain tumour survivors with CMS can benefit from social and educational rehabilitation, straightforward and truthful information, support in structuring their everyday lives and increased public knowledge of CMS. CONCLUSION Children with CMS face a variety of challenges affecting many aspects of their everyday lives. They should be entitled to the elements of a current rehabilitation initiative for childhood cancer to support patients' social disability and educational decline. Finally, we identified a need for an official information publication.
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Affiliation(s)
- Morten Wibroe
- Department of Neurosurgery and Paediatric Department, 2092, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Marianne Vie Ingersgaard
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Hanne Bækgaard Larsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Bonkolab 5704, Blegdamsvej 9, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, 2092, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Karin Piil
- Department of Oncology, Center for Cancer and Organ diseases, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Public Health, Aarhus University, Aarhus, Denmark.
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14
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Jeon MS, Agar MR, Koh ES, Nowak AK, Hovey EJ, Dhillon HM. Understanding sleep disturbance in the context of malignant brain tumors: a qualitative analysis. Neurooncol Pract 2020; 8:179-189. [PMID: 33898051 DOI: 10.1093/nop/npaa081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background Sleep is an important element in health-related quality of life of cancer patients and caregivers. This study aimed to explore the experience of sleep disturbance in people with malignant brain tumors (BT) and their family caregivers. Methods Participants were recruited from ambulatory neuro-oncology clinics. Semi-structured interviews were conducted with 24 patients (67% with high-grade gliomas) and 14 caregivers. Data were analyzed thematically using a framework synthesis. Results We identified six themes relating to perceptions of the nature, impact, causal factors, and interventions for sleep disturbance, beliefs about sleep and impact, and personal coping strategies. Participants described their sleep disturbance in terms of insomnia symptoms; most commonly difficulties initiating and maintaining sleep. Participants had varied views on causal factors including the BT diagnosis and treatment and caregiver burden. However, excessive thinking and BT-related anxiety were evident in both patients and caregivers. The described impact on daytime functioning due to non-restful sleep and fatigue appeared to be significant and many participants needed daytime naps, although they understated the impact on individual functioning. Some participants were reluctant to seek help from clinicians for sleep disturbance due to previous experiences where sleep disturbance was overlooked, or because they held negative views toward pharmacological interventions. Participants reported various coping strategies, ranging from relaxation-promoting techniques to behaviors to distract thinking at night that may instead disturb sleep. Conclusions Psychological factors contribute to sleep disturbance in patients with BT and caregivers. This population may benefit from information about sleep disturbance and interventions targeting anxiety.
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Affiliation(s)
- Megan S Jeon
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Meera R Agar
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Department of Radiation Oncology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Anna K Nowak
- Medical School, QEII Medical Centre Unit, University of Western Australia, Crawley, WA, Australia.,Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Elizabeth J Hovey
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
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15
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The Art of Living With Symptoms: A Qualitative Study Among Patients With Primary Brain Tumors Receiving Proton Beam Therapy. Cancer Nurs 2020; 43:E79-E86. [PMID: 30688666 PMCID: PMC7043731 DOI: 10.1097/ncc.0000000000000692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Symptom management in conjunction with proton beam therapy (PBT) from patient's perspective has not been explored. Such knowledge is essential to optimize the care in this relatively new treatment modality.
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16
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Trejnowska A, Goodall K, Rush R, Ellison M, McVittie C. The relationship between adult attachment and coping with brain tumour: the mediating role of social support. Psychooncology 2020; 29:729-736. [PMID: 31876067 DOI: 10.1002/pon.5325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/17/2019] [Accepted: 12/23/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE A primary brain tumour diagnosis is known to elicit higher distress than other forms of cancer and is related to high depressive symptomatology. Using a cross-sectional design, the present study explored how individuals cope with this diagnosis using an attachment theory framework. Attachment anxiety and attachment avoidance were hypothesised to be positively related to helplessness/hopelessness, anxious preoccupation, and cognitive avoidance; and negatively related to fighting spirit and fatalism coping. We proposed perceived social support to play a mediating role in those associations. METHODS Four hundred and eighty participants diagnosed with primary brain tumours completed the Mini-Mental Adjustment to Cancer Scale (Mini-MAC), the Experiences in Close Relationships Questionnaire-Revised (ECR-R), and the modified Medical Outcomes Study-Social Support Scale (mMOS-SSS) online. RESULTS Lower perceived social support mediated the positive associations between both higher attachment anxiety and avoidance and higher helpless/hopeless coping. Attachment anxiety was also positively associated with anxious preoccupation. This relationship was not mediated by perceived social support. Cognitive avoidance was unrelated to both attachment dimensions and social support. CONCLUSIONS The findings highlight that the differences in coping repertoire are associated with social relatedness factors, specifically attachment security and its relationship to perceived social support. Implications of the findings are discussed.
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Affiliation(s)
- Anna Trejnowska
- Division of Psychology, Sociology and Education, Queen Margaret University, Edinburgh, UK
| | - Karen Goodall
- Department of Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | - Robert Rush
- Division of Psychology, Sociology and Education, Queen Margaret University, Edinburgh, UK
| | - Marion Ellison
- Division of Psychology, Sociology and Education, Queen Margaret University, Edinburgh, UK
| | - Chris McVittie
- Division of Psychology, Sociology and Education, Queen Margaret University, Edinburgh, UK
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17
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Schei S, Solheim O, Jakola AS, Sagberg LM. Perioperative fatigue in patients with diffuse glioma. J Neurooncol 2020; 147:97-107. [PMID: 31974804 PMCID: PMC7075831 DOI: 10.1007/s11060-020-03403-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/16/2020] [Indexed: 12/18/2022]
Abstract
Purpose Few studies have assessed fatigue in relation to glioma surgery. The purpose of this study was to explore the prevalence of pre- and postoperative high fatigue, perioperative changes, and factors associated with pre- and postoperative high fatigue in patients undergoing primary surgery for diffuse glioma. Methods A total of 112 adult patients were prospectively included. Patient-reported fatigue was assessed before and one month after surgery using the cancer-specific European Organization for Research and Treatment of Cancer questionnaire fatigue subscale. The scores were dichotomized as high fatigue (≥ 39) or low fatigue (< 39). A change in score of ≥ 10 was considered as a clinically significant change. Factors associated with pre- and postoperative high fatigue were explored in multivariable regression analyses. Results High fatigue was reported by 45% of the patients preoperatively and by 42% of the patients postoperatively. Female gender and low Karnofsky Performance Status (KPS) were associated with preoperative high fatigue, while postoperative complications, low KPS and low-grade histopathology were associated with postoperative high fatigue. In total 35/92 (38%) patients reported a clinically significant improvement of fatigue scores after surgery, 36/92 (39%) patients reported a clinically significant worsening of fatigue scores after surgery, and 21/92 (23%) patients reported no clinically significant change in fatigue scores after surgery. Patients with low-grade gliomas more often reported low fatigue before surgery and high fatigue after surgery, while patients with high-grade gliomas more often reported high fatigue before surgery and low fatigue after surgery. Conclusions Our findings indicate that fatigue is a common symptom in patients with diffuse glioma, both pre- and postoperatively. Perioperative changes were frequently seen. This is important knowledge when informing patients before and after surgery. Electronic supplementary material The online version of this article (10.1007/s11060-020-03403-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stine Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Ole Solheim
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
| | - Asgeir Store Jakola
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Lisa Millgård Sagberg
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
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18
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Rosenlund L, Degsell E, Jakola AS. Moving from clinician-defined to patient-reported outcome measures for survivors of high-grade glioma. Patient Relat Outcome Meas 2019; 10:267-276. [PMID: 31692481 PMCID: PMC6711557 DOI: 10.2147/prom.s179313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/23/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Persons with high-grade glioma face both neurological and cancer-related symptoms from the tumor itself and its treatment affecting their daily lives. Survival alone is not an adequate outcome, the quality of the survivorship experience needs to be regarded with equal importance. Patient-reported outcome (PRO) measures can be used to evaluate treatment effects and symptom management interventions. PURPOSE The aim of this review was to identify the use, challenges, and potential of PRO measures in survivors of high-grade glioma. METHODS A narrative expert opinion review was performed on the subject. In addition to our own experiences we searched PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and PsycINFO for brain tumor-specific PRO measures used in the population of adult patients with high-grade glioma, both original articles and reviews were included. RESULTS There are several PRO measures that have been validated for patients with primary brain tumors including high-grade glioma. PRO measures are used both in clinical trials to evaluate the effect of treatment on health-related quality of life, and in daily clinical practice for holistic needs assessment and symptom management. Common PRO measures used for patients with high-grade glioma are European Organization for Research and Treatment of Cancer general instrument for patients with cancer together with brain tumor module, Functional Assessment of Cancer Therapy-Brain, and MD Anderson Symptom Inventory for Brain Tumor. Neurologic and cognitive disorders often occur in patients with high-grade glioma, which affects patients' ability to self-report over time, making it more challenging in this population. PRO as a primary outcome seems underutilized. CONCLUSION For clinical research, PRO measures need to be used together with other clinical outcome measures rather than replacing traditional outcome measures. Moving to more use of PRO measures in survivorship care has potential to improve patient-caregiver-healthcare team communication, symptom management, and quality of care. Implementing PROs in survivorship care should also involve caregivers and a response based on the results.
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Affiliation(s)
- Lena Rosenlund
- Regional Cancer Centre Stockholm, Stockholm, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - Eskil Degsell
- Regional Cancer Centre Stockholm, Stockholm, Sweden
- Malignant Brain Tumor Pathway, Quality and Patient Safety Department, Karolinska University Hospital, Stockholm, Sweden
- The Swedish Brain Tumor Association, Stockholm, Sweden
| | - Asgeir Store Jakola
- Department of Clinical Neurosciences, Institute of Physiology and Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
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19
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Gill A, Chakraborty A, Selby D. What is Symptom Burden: A Qualitative exploration of Patient Definitions. J Palliat Care 2018. [DOI: 10.1177/082585971202800204] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Ashlinder Gill
- D Selby (corresponding author): Division of Palliative Care, Sunnybrook Health Sciences Centre, Room H354, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Anita Chakraborty
- A Gill, A Chakraborty: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Debbie Selby
- A Gill, A Chakraborty: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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20
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Baumstarck K, Chinot O, Tabouret E, Farina P, Barrié M, Campello C, Petrirena G, Hamidou Z, Auquier P. Coping strategies and quality of life: a longitudinal study of high-grade glioma patient-caregiver dyads. Health Qual Life Outcomes 2018; 16:157. [PMID: 30068395 PMCID: PMC6090679 DOI: 10.1186/s12955-018-0983-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/24/2018] [Indexed: 12/13/2022] Open
Abstract
Background Among a sample of patient-informal caregiver dyads in the specific context of new diagnoses of high-grade glioma in the time-frame between diagnosis and the third month following diagnosis, we examine whether the coping strategies implemented by the patients and their caregivers influenced their own quality of life (QoL) and the QoL of their relatives. Methods Thirty-eight dyads with patients having recent diagnoses of high-grade glioma were involved in this longitudinal study. The self-reported data include QoL (Patient-Generated Index, EORTC QLQ-C30, and CareGiver Oncology Quality of Life), and coping strategies (BriefCope). Data were collected at T1 corresponding to the time-frame between diagnosis and postsurgical treatment initiation and T2 corresponding to the 3-month post-inclusion follow-up. Results Coping strategies based on social support and avoidance were the least used at baseline and the 3-month follow-up, both for patients and caregivers. At the 3-month follow-up, the use of social support at baseline was significantly related to lower scores of QoL for the patients and with higher QoL for the caregivers. For the patient, the use of problem-solving or positive thinking at baseline was not related to his/her QoL, while it was related to more satisfactory QoL scores for the caregiver. The use of avoidance at baseline was linked to a higher 3-month QoL for the patients and a lower 3-month QoL for the caregivers. Using the specific dyadic analyses (actor–partner interdependence model), the 3-month patient’s QoL was lower (β = − 0.322; p = 0.03) when the patient mobilized the social support strategy at baseline, but was higher(β = 0.631; p < 10− 3) when his/her informal caregiver used this strategy. After adjustment for sex, age, and baseline PGI score, the link between high use of the social support strategy at baseline by the caregiver and the patient’s 3-month QoL, remained present (positive partner effect; β =0.675; p < 10− 3). Conclusion The QoL for patients and their informal caregivers since the time of diagnosis is directly related to the use of coping strategies based on social support at time of diagnosis.
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Affiliation(s)
- Karine Baumstarck
- EA 3279 CEReSS - Health Service Research and Quality of Life Center, Aix Marseille Université, School of medicine - La Timone Medical Campus, 27 bd Jean Moulin, F-13385, Marseille, cedex 05, France. .,National Clinical research Quality of Life in Oncology Platform, Marseille, France.
| | - Olivier Chinot
- Department of Neuro-Oncology, Assistance Publique Hôpitaux de Marseille, Timone Hospital, 13005, Marseille, France
| | - Emeline Tabouret
- Department of Neuro-Oncology, Assistance Publique Hôpitaux de Marseille, Timone Hospital, 13005, Marseille, France
| | - Patrizia Farina
- Department of Neuro-Oncology, Assistance Publique Hôpitaux de Marseille, Timone Hospital, 13005, Marseille, France
| | - Marilyne Barrié
- Department of Neuro-Oncology, Assistance Publique Hôpitaux de Marseille, Timone Hospital, 13005, Marseille, France
| | - Chantal Campello
- Department of Neuro-Oncology, Assistance Publique Hôpitaux de Marseille, Timone Hospital, 13005, Marseille, France
| | - Gregorio Petrirena
- Department of Neuro-Oncology, Assistance Publique Hôpitaux de Marseille, Timone Hospital, 13005, Marseille, France
| | - Zeinab Hamidou
- EA 3279 CEReSS - Health Service Research and Quality of Life Center, Aix Marseille Université, School of medicine - La Timone Medical Campus, 27 bd Jean Moulin, F-13385, Marseille, cedex 05, France.,National Clinical research Quality of Life in Oncology Platform, Marseille, France
| | - Pascal Auquier
- EA 3279 CEReSS - Health Service Research and Quality of Life Center, Aix Marseille Université, School of medicine - La Timone Medical Campus, 27 bd Jean Moulin, F-13385, Marseille, cedex 05, France.,National Clinical research Quality of Life in Oncology Platform, Marseille, France
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21
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SmithBattle L, Lorenz R, Reangsing C, Palmer JL, Pitroff G. A methodological review of qualitative longitudinal research in nursing. Nurs Inq 2018; 25:e12248. [DOI: 10.1111/nin.12248] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Lee SmithBattle
- School of Nursing; Saint Louis University; St. Louis Missouri
| | - Rebecca Lorenz
- UB School of Nursing; University at Buffalo; Buffalo New York
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22
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Llewellyn H, Neerkin J, Thorne L, Wilson E, Jones L, Sampson EL, Townsley E, Low JTS. Social and structural conditions for the avoidance of advance care planning in neuro-oncology: a qualitative study. BMJ Open 2018; 8:e019057. [PMID: 29391365 PMCID: PMC5878249 DOI: 10.1136/bmjopen-2017-019057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary brain tumours newly affect >260 000 people each year worldwide. In the UK, every year >10 000 people are diagnosed with a brain tumour while >5000 die annually from the disease. Prognoses are poor, cognitive deterioration common and patients have prolonged palliative needs. Advance care planning (ACP) may enable early discussion of future care decisions. Although a core commitment in the UK healthcare strategy, and the shared responsibility of clinical teams, ACP appears uncommon in practice. Evidence around ACP practice in neuro-oncology is limited. OBJECTIVES We aimed to elicit key social and structural conditions contributing to the avoidance of ACP in neuro-oncology. DESIGN A cross-sectional qualitative study design was used. SETTING One tertiary care hospital in the UK. PARTICIPANTS Fifteen healthcare professionals working in neuro-oncology participated in this study, including neuro-oncologists, neurosurgeons, clinical nurse specialists, allied healthcare professionals and a neurologist. METHOD Semi-structured interviews were conducted with participants to explore their assumptions and experiences of ACP. Data were analysed thematically using the well-established framework method. RESULTS Participants recognised the importance of ACP but few had ever completed formal ACP documentation. We identified eight key factors, which we suggest comprise three main conditions for avoidance: (1) difficulties being a highly emotive, time-intensive practice requiring the right 'window of opportunity' and (2) presence and availability of others; (3) ambiguities in ACP definition, purpose and practice. Combined, these created a 'culture of shared avoidance'. CONCLUSION In busy clinical environments, 'shared responsibility' is interpreted as 'others' responsibility' laying the basis for a culture of avoidance. To address this, we suggest a 'generalists and specialists' model of ACP, wherein healthcare professionals undertake particular responsibilities. Healthcare professionals are already adopting this model informally, but without formalised structure it is likely to fail given a tendency for people to assume a generalist role.
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Affiliation(s)
- Henry Llewellyn
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Jane Neerkin
- The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lewis Thorne
- The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Elena Wilson
- The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Emma Townsley
- The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Joseph T S Low
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
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Piil K, Nordentoft S, Larsen A, Jarden M. Bereaved caregivers of patients with high-grade glioma: a systematic review. BMJ Support Palliat Care 2018; 9:26-33. [PMID: 29363550 DOI: 10.1136/bmjspcare-2017-001386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 12/29/2017] [Accepted: 01/03/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Caregivers to patients with primary malignant brain tumours neglect their own physical and emotional needs during the disease trajectory. The aim of the systematic review was to explore how informal caregivers of patients with primary malignant brain tumour (high-grade glioma (HGG)) experience and manage their life situation after the death of the patient. METHODS A systematic literature search was carried out in December 2016 and revised in September 2017. The following six databases were searched: PubMed, Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica database, Scopus, PsycINFO and The Social Sciences Citation Index. Studies eligible for inclusion met the following criteria: (1) included bereaved caregivers to patients diagnosed with HGG ≥18 years, (2) described the caregiver's perspective at post bereavement (3) had been peer-reviewed. The papers included were assessed for methodological quality using the Critical Appraisal Skills Programme. RESULTS Four qualitative articles, published from 2004 to 2015, met the eligibility criteria. Bereaved informal caregivers expressed profound grief and had unmet needs and questions related to the disease and their role as caregiver. Moreover, they experienced depressive symptoms and fatigue, resulting in a reduced work capability and social network. CONCLUSIONS We conclude that bereaved informal caregivers experience psychosocial consequences and emotional reactions after bereavement, resulting in feelings of isolation and loneliness. This review identified limited evidence on how the bereaved caregivers prefer to be supported, and further study is warranted. We suggest incorporating systematic information on bereavement in clinical practice and a cooperation across sectors.
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Affiliation(s)
- Karin Piil
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark.,Rigshospitalet, Copenhagen, Denmark.,University Hospitals Center for Health Research (UCSF & CIRE), Copenhagen University Hospital, Copenhagen, Denmark
| | - Sara Nordentoft
- Rigshospitalet, Copenhagen, Denmark.,University Hospitals Center for Health Research (UCSF & CIRE), Copenhagen University Hospital, Copenhagen, Denmark.,Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anders Larsen
- Rigshospitalet, Copenhagen, Denmark.,University Hospitals Center for Health Research (UCSF & CIRE), Copenhagen University Hospital, Copenhagen, Denmark
| | - Mary Jarden
- Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
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Piil K, Jakobsen J, Christensen K, Juhler M, Guetterman T, Fetters M, Jarden M. Needs and preferences among patients with high-grade glioma and their caregivers - A longitudinal mixed methods study. Eur J Cancer Care (Engl) 2018; 27:e12806. [DOI: 10.1111/ecc.12806] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/30/2017] [Indexed: 12/16/2022]
Affiliation(s)
- K. Piil
- The University Hospitals Center for Health Research (UCSF), Center for Integrated Rehabilitation of Cancer Patients (CIRE) and Finsen Center; Copenhagen Denmark
- Department of Neurosurgery; The University Hospital of Copenhagen; Copenhagen Denmark
| | - J. Jakobsen
- Neuroscience Center; The University Hospital of Copenhagen; Copenhagen Denmark
| | - K.B. Christensen
- Department of Public Health; Section of Biostatistics; University of Copenhagen; Copenhagen Denmark
| | - M. Juhler
- Department of Neurosurgery; The University Hospital of Copenhagen; Copenhagen Denmark
- Department of Clinical Medicine; Section of Neurology, Psychiatry and Sensory Sciences; The University of Copenhagen; Copenhagen Denmark
| | - T.C. Guetterman
- Department of Family Medicine; The University of Michigan; Ann Arbor MI USA
| | - M.D. Fetters
- Department of Family Medicine; The University of Michigan; Ann Arbor MI USA
| | - M. Jarden
- The University Hospitals Center for Health Research (UCSF), Center for Integrated Rehabilitation of Cancer Patients (CIRE) and Finsen Center; Copenhagen Denmark
- Faculty of Health and Medical Sciences; Department of Public Health; University of Copenhagen; Copenhagen Denmark
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25
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Initial psycho-oncological counselling in neuro-oncology: analysis of topics and needs of brain tumour patients. J Neurooncol 2017; 136:505-514. [PMID: 29147859 DOI: 10.1007/s11060-017-2670-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/11/2017] [Indexed: 10/18/2022]
Abstract
Diagnosis of a brain tumour is associated with a tremendous disruption of emotional, physical and social well-being. Due to the complexity of the disease and the affection of the central organ, the brain, brain tumour patients differ from other cancer patients. The purpose of this study was to evaluate the concerns and burdens presented by brain tumour patients during their initial psycho-oncological consultation. We performed a retrospective analysis of 53 patients with the diagnosis of either benign or malignant brain tumour, seeking counsel by a neurosurgeon specialised in psycho-oncology. We performed a thematic analysis of the interviews at first consultation identifying themes and patterns and created thematic categories. The main concerns of the patients presented during the first consultations were psychological problems, reported by 40 patients (75.5%). Death and dying was mentioned by more than half of the patients (n = 30, 56.6%). In addition, 62.3% of the patients (n = 33) asked for information regarding the medical treatment and diagnosis. With our study, we created greater awareness of the psychological needs of brain tumour patients in order to define treatment strategies for this important aspect of disease. We showed that there is a need for patients to talk about death even during the initial consultation. Psycho-oncologist in a neuro-oncological setting should be prepared for topics like that and should have a neurosurgical background or collaborate with members of the surgical team in order to provide the patients with medical details and to better understand the impact of the disease.
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Emotional concerns and coping strategies in Low Grade Glioma patients and reliability of their caregivers in reporting these concerns: Findings from a cross-sectional study. Eur J Oncol Nurs 2017; 30:113-119. [PMID: 29031307 DOI: 10.1016/j.ejon.2017.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE To explore the emotional concerns and coping strategies of patients with Low Grade Glioma (LGG) and whether or not their caregivers are reliable in reporting these concerns as surrogate informants. METHODS An explorative cross-sectional study. Patients who had undergone a neurosurgical procedure at least one year before this study for LGG and who were capable of participating in a face-to-face interview were included. Each patient nominated a reference caregiver. Both the patient and the caregiver were interviewed independently, using the Beck Depression Inventory Scale, the State - Trait Anxiety Inventory, and the Jalowiec Coping Scale. MAIN RESULTS Forty-six patients and 46 caregivers were included. The average scores of the Beck scale were homogeneous between patients and caregivers (7.76 [CI 95% 5.76-9.75] vs. 6.23 [CI 95% 4.57-7.90]; p = 0.102). Patients reported significantly greater state and trait anxiety (44.26 [CI 95% 40.21-48.31] and 37.95 [CI 95% 34.97-40.94]), respectively compared to their caregivers (40.28 [CI 95% 36.64-43.91] and 35.17 [CI 95% 32.16-38.18]). The coping strategies enacted were homogeneous between patients and caregivers (82.78 [CI 95% 77.21-88.35] vs (80.93 [CI 95% 76.32-85.55]; p = 0.102) while the kind of strategies adopted were significantly diverse. CONCLUSIONS Patients suffer from depression and greater state anxiety as compared to trait anxiety; moreover, they enact less than half of the available coping strategies. Caregivers may be involved as surrogate informants when necessary for health-care professionals to detect depression while more caution is advised for what concerns anxiety and the coping strategies enacted by patients.
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Armstrong TS, Bishof AM, Brown PD, Klein M, Taphoorn MJB, Theodore-Oklota C. Determining priority signs and symptoms for use as clinical outcomes assessments in trials including patients with malignant gliomas: Panel 1 Report. Neuro Oncol 2016; 18 Suppl 2:ii1-ii12. [PMID: 26989127 DOI: 10.1093/neuonc/nov267] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Patients with primary brain tumors such as malignant gliomas are highly symptomatic, often from the time of diagnosis. Signs and symptoms (signs/symptoms) can cause functional limitations that often worsen over the disease trajectory and may impact patient quality of life. It is recognized that standard measurements of tumor response do not adequately measure this impact or the impact that a therapy may have to mitigate these signs/symptoms and potentially have clinical benefit. Identifying a core set of signs/symptoms and functional limitations is important for understanding their clinical impact and is the first step to including clinical outcomes assessment in primary brain tumor clinical trials.
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Affiliation(s)
- Terri S Armstrong
- The University of Texas Health Science Center at Houston and MD Anderson Cancer Center, Houston, Texas (T.S.A.); Patient Advocate, Bryn Mawr, Pennsylvania (A.M.B.); The University of Texas MD Anderson Cancer Center, Houston, Texas (P.D.B.); VU University Medical Center, Amsterdam, Netherlands (M.K.); VU University Medical Center, Amsterdam, and Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Genentech, South San Francisco, California (C.T.-O.)
| | - Allison M Bishof
- The University of Texas Health Science Center at Houston and MD Anderson Cancer Center, Houston, Texas (T.S.A.); Patient Advocate, Bryn Mawr, Pennsylvania (A.M.B.); The University of Texas MD Anderson Cancer Center, Houston, Texas (P.D.B.); VU University Medical Center, Amsterdam, Netherlands (M.K.); VU University Medical Center, Amsterdam, and Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Genentech, South San Francisco, California (C.T.-O.)
| | - Paul D Brown
- The University of Texas Health Science Center at Houston and MD Anderson Cancer Center, Houston, Texas (T.S.A.); Patient Advocate, Bryn Mawr, Pennsylvania (A.M.B.); The University of Texas MD Anderson Cancer Center, Houston, Texas (P.D.B.); VU University Medical Center, Amsterdam, Netherlands (M.K.); VU University Medical Center, Amsterdam, and Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Genentech, South San Francisco, California (C.T.-O.)
| | - Martin Klein
- The University of Texas Health Science Center at Houston and MD Anderson Cancer Center, Houston, Texas (T.S.A.); Patient Advocate, Bryn Mawr, Pennsylvania (A.M.B.); The University of Texas MD Anderson Cancer Center, Houston, Texas (P.D.B.); VU University Medical Center, Amsterdam, Netherlands (M.K.); VU University Medical Center, Amsterdam, and Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Genentech, South San Francisco, California (C.T.-O.)
| | - Martin J B Taphoorn
- The University of Texas Health Science Center at Houston and MD Anderson Cancer Center, Houston, Texas (T.S.A.); Patient Advocate, Bryn Mawr, Pennsylvania (A.M.B.); The University of Texas MD Anderson Cancer Center, Houston, Texas (P.D.B.); VU University Medical Center, Amsterdam, Netherlands (M.K.); VU University Medical Center, Amsterdam, and Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Genentech, South San Francisco, California (C.T.-O.)
| | - Christina Theodore-Oklota
- The University of Texas Health Science Center at Houston and MD Anderson Cancer Center, Houston, Texas (T.S.A.); Patient Advocate, Bryn Mawr, Pennsylvania (A.M.B.); The University of Texas MD Anderson Cancer Center, Houston, Texas (P.D.B.); VU University Medical Center, Amsterdam, Netherlands (M.K.); VU University Medical Center, Amsterdam, and Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Genentech, South San Francisco, California (C.T.-O.)
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Coping with a newly diagnosed high-grade glioma: patient-caregiver dyad effects on quality of life. J Neurooncol 2016; 129:155-64. [PMID: 27300523 DOI: 10.1007/s11060-016-2161-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/01/2016] [Indexed: 11/12/2022]
Abstract
Patients with high-grade gliomas (HGG) and their caregivers have to confront a very aggressive disease that produces major lifestyle disruptions. There is an interest in studying the ability of patients and their caregivers to cope with the difficulties that affect quality of life (QoL). We examine, in a sample of patient-caregiver dyads in the specific context of newly diagnosed cases of HGG, whether the QoL of patients and caregivers is influenced by the coping processes they and their relatives use from a specific actor-partner interdependence model (APIM). This cross-sectional study involved 42 dyads with patients having recent diagnoses of HGG and assessed in the time-frame between diagnosis and treatment initiation. The self-reported data included QoL (Patient-Generated Index, EORTC QLQ-C30, and CareGiver Oncology QoL), emotional status, and coping strategies (BriefCope). The APIM was used to test the dyadic effects of coping strategies on QoL. Coping strategies, such as social support, avoidance, and problem solving, exhibited evidence of either an actor effect (degree to which the individual's coping strategies are associated with their own QoL) or partner effect (degree to which the individual's coping strategies are associated with the QoL of the other member of the dyad) for patients or caregivers. For positive-thinking coping strategies, actor and partner effect were not observed. This study emphasizes that the QoL for patients and their caregivers was directly related to the coping strategies they used. This finding suggests that targeted interventions should be offered to help patients and their relatives to implement more effective coping strategies.
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Day J, Yust‐Katz S, Cachia D, Wefel J, Katz LH, Tremont Lukats IW, Bulbeck H, Armstrong T, Rooney AG. Interventions for the management of fatigue in adults with a primary brain tumour. Cochrane Database Syst Rev 2016; 4:CD011376. [PMID: 27074263 PMCID: PMC8719625 DOI: 10.1002/14651858.cd011376.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Fatigue is a common and disabling symptom in people with a primary brain tumour (PBT). The effectiveness of interventions for treating clinically significant levels of fatigue in this population is unclear. OBJECTIVES To assess the effectiveness and safety of pharmacological and non-pharmacological interventions for adults with PBT and high levels of fatigue. SEARCH METHODS In March 2016, we searched the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO and CINAHL and checked the reference lists of included studies. We also searched relevant conference proceedings, searched for ongoing trials via ClinicalTrials.gov and contacted major co-operative groups with trials in this area. SELECTION CRITERIA We included randomised controlled trials (RCTs) that investigated any pharmacological or non-pharmacological intervention in adults with PBT and fatigue, where fatigue was the primary outcome measure. We restricted inclusion specifically to studies that enrolled only participants with clinically significant levels of fatigue. DATA COLLECTION AND ANALYSIS Three review authors (JD, SYK, DC) independently evaluated search results, extracted data from selected studies and carried out a bias risk assessment. We extracted data on fatigue, cognition, mood, quality of life and adverse events outcomes. MAIN RESULTS We identified nine studies. We excluded eight of these as they did not restrict participation to people with high fatigue. The single eligible trial investigated the use of modafinil compared to placebo. Although this study found a significant improvement over time in the primary outcome of fatigue, the improvement occurred after both modafinil and placebo with no significant difference in response between the two groups. The included trial did not reach its planned recruitment target and therefore may not, in practice, have been adequately powered to detect a difference. The trial was at a low risk of bias across most areas. There was an unclear risk of bias related to the use of mean imputation because the investigators did not analyse the impact of imputation on the results. AUTHORS' CONCLUSIONS There was insufficient evidence to draw reliable and generalisable conclusions regarding potential effectiveness or harm of any pharmacological or non-pharmacological treatments for fatigue in people with PBT. More research is needed on how best to treat people with brain tumours with high fatigue.
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Affiliation(s)
- Julia Day
- Western General HospitalEdinburgh Centre for Neuro‐Oncology (ECNO)Crewe Road SouthEdinburghScotlandUKEH4 2XU
| | - Shlomit Yust‐Katz
- Rabin Medical Center, Beilinson HospitalDavidoff Cancer Center39 Jabotinski StreetNeuro‐Oncology UnitPetach TiqvaIsrael
| | - David Cachia
- Medical University of South Carolina96 Jonathan Lucas StreetCharlestonUSA29425
| | - Jeffrey Wefel
- University of Texas ‐ MD Anderson Cancer Center1515 Holcombe BoulevardNeuro‐Oncology Department, Box 431HoustonTexasUSA77030
| | - Lior H Katz
- Sheba Medical Center, and Sackler Faculty of Medicine, Tel‐Aviv UniversityDepartment of GastroenterologyTel‐AvivIsrael
| | - Ivo W. Tremont Lukats
- Houston Methodist HospitalKenneth R. Peak Center for Brain and Pituitary Tumors6445 Main24th FloorHoustonTexasUSA77030
| | - Helen Bulbeck
- BrainstrustDirector of Services4 Yvery CourtCastle RoadCowesIsle of WightUKPO31 7QG
| | - Terri Armstrong
- University of Texas ‐ MD Anderson Cancer Center1515 Holcombe BoulevardNeuro‐Oncology Department, Box 431HoustonTexasUSA77030
| | - Alasdair G Rooney
- Western General HospitalEdinburgh Centre for Neuro‐Oncology (ECNO)Crewe Road SouthEdinburghScotlandUKEH4 2XU
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Helfer JL, Wen PY, Blakeley J, Gilbert MR, Armstrong TS. Report of the Jumpstarting Brain Tumor Drug Development Coalition and FDA clinical trials clinical outcome assessment endpoints workshop (October 15, 2014, Bethesda MD). Neuro Oncol 2016; 18 Suppl 2:ii26-ii36. [PMID: 26989130 PMCID: PMC4795997 DOI: 10.1093/neuonc/nov270] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 09/22/2015] [Indexed: 11/13/2022] Open
Abstract
On October 15, 2014, a workshop was held on the use of clinical outcome assessments in clinical trials for high-grade glioma of the brain. This workshop was sponsored by the Jumpstarting Brain Tumor Drug Development Coalition, consisting of the National Brain Tumor Society, the Society for Neuro-Oncology, the Musella Foundation for Brain Tumor Research and Information, and Accelerate Brain Cancer Cure. It was planned and carried out with participation from the US Food and Drug Administration. The workshop also included stakeholders from all aspects of the brain tumor community, including clinicians, researchers, industry, clinical research organizations, patients and patient advocates, and the National Cancer Institute. This report summarizes the presentations and discussions of that workshop and the proposals that emerged to move the field forward and toward greater inclusion of these endpoints in future clinical trials for high-grade gliomas.
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Affiliation(s)
- Jennifer L Helfer
- National Brain Tumor Society, Newton, Massachusetts (J.L.H.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W.); Department of Neuro-Oncology, Johns Hopkins University, Brain Cancer Program, Baltimore, Maryland (J.B.); Center for Cancer Research, Neuro-Oncology Branch, National Cancer Institute, Bethesda, Maryland (M.R.G.); The University of Texas Health Science Center at Houston, School of Nursing, Department of Family Health, Houston, Texas (T.S.A.)
| | - Patrick Y Wen
- National Brain Tumor Society, Newton, Massachusetts (J.L.H.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W.); Department of Neuro-Oncology, Johns Hopkins University, Brain Cancer Program, Baltimore, Maryland (J.B.); Center for Cancer Research, Neuro-Oncology Branch, National Cancer Institute, Bethesda, Maryland (M.R.G.); The University of Texas Health Science Center at Houston, School of Nursing, Department of Family Health, Houston, Texas (T.S.A.)
| | - Jaishri Blakeley
- National Brain Tumor Society, Newton, Massachusetts (J.L.H.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W.); Department of Neuro-Oncology, Johns Hopkins University, Brain Cancer Program, Baltimore, Maryland (J.B.); Center for Cancer Research, Neuro-Oncology Branch, National Cancer Institute, Bethesda, Maryland (M.R.G.); The University of Texas Health Science Center at Houston, School of Nursing, Department of Family Health, Houston, Texas (T.S.A.)
| | - Mark R Gilbert
- National Brain Tumor Society, Newton, Massachusetts (J.L.H.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W.); Department of Neuro-Oncology, Johns Hopkins University, Brain Cancer Program, Baltimore, Maryland (J.B.); Center for Cancer Research, Neuro-Oncology Branch, National Cancer Institute, Bethesda, Maryland (M.R.G.); The University of Texas Health Science Center at Houston, School of Nursing, Department of Family Health, Houston, Texas (T.S.A.)
| | - Terri S Armstrong
- National Brain Tumor Society, Newton, Massachusetts (J.L.H.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W.); Department of Neuro-Oncology, Johns Hopkins University, Brain Cancer Program, Baltimore, Maryland (J.B.); Center for Cancer Research, Neuro-Oncology Branch, National Cancer Institute, Bethesda, Maryland (M.R.G.); The University of Texas Health Science Center at Houston, School of Nursing, Department of Family Health, Houston, Texas (T.S.A.)
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Pranckeviciene A, Tamasauskas S, Deltuva VP, Bunevicius R, Tamasauskas A, Bunevicius A. Suicidal ideation in patients undergoing brain tumor surgery: prevalence and risk factors. Support Care Cancer 2016; 24:2963-70. [DOI: 10.1007/s00520-016-3117-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 02/04/2016] [Indexed: 12/19/2022]
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Lazzarotto S, Baumstarck K, Loundou A, Hamidou Z, Aghababian V, Leroy T, Auquier P. Age-related hearing loss in individuals and their caregivers: effects of coping on the quality of life among the dyads. Patient Prefer Adherence 2016; 10:2279-2287. [PMID: 27853359 PMCID: PMC5106241 DOI: 10.2147/ppa.s112750] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Age-related hearing loss (ARHL) impacts the daily living and quality of life (QoL) of affected individuals and the functioning of family caregivers. In the specific context of voluntary medical checkups, we examined sample dyads (ARHL individual and the caregiver) to determine whether QoL of patients and caregivers is influenced by coping strategies implemented either by themselves or their relatives. METHODS This was a cross-sectional study with a descriptive/correlative design performed in a French preventive health center (Regional Institute for Prevention of Aging, Marseille, France) for the beneficiaries of pension funds of private sector employees. The samples included beneficiary-caregiver dyads. The beneficiaries had bilateral (mild to moderately severe) ARHL. Self-reported data were collected as follows: QoL using the World Health Organization Quality of Life questionnaire, coping strategies using the Brief Coping Orientation to Problems Experienced Scale, and anxiety and mood using visual analog scales. RESULTS The final sample comprised 44 beneficiaries and 44 caregivers. The caregiver was the partner of the beneficiary in 73% of cases. The QoL scores of the social dimension were significantly lower for beneficiaries and caregivers compared with French age- and sex-matched controls. Among beneficiaries and caregivers, coping strategies based on problem solving were the most commonly used strategies. The use of positive thinking strategies was associated with higher QoL scores. The more one member of the dyad used an avoidance coping strategy, the more the other member used a positive thinking strategy. CONCLUSION This study emphasizes that QoL of individuals with age-related hearing impairment and their natural caregivers is related to the coping strategies that they use. This finding suggests that targeted interventions should be offered to help individuals who experience emotional difficulties to implement more efficient coping strategies.
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Affiliation(s)
- Sébastien Lazzarotto
- EA 3279, Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université
- French Regional Institute for Prevention of Aging, Marseille
| | - Karine Baumstarck
- EA 3279, Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université
- Correspondence: Karine Baumstarck, EA 3279, Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, 27 Boulevard Jean Moulin, Marseille Cedex 05, F-13385, France, Tel +33 491 384 744, Fax +33 491 384 482, Email
| | - Anderson Loundou
- EA 3279, Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université
| | - Zeinab Hamidou
- EA 3279, Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université
- National Clinical Research Quality of Life in Oncology Platform, Marseille
| | - Valérie Aghababian
- EA 3279, Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université
| | - Tanguy Leroy
- EA 3279, Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université
- Social Psychology Research Group (GRePS EA 4163), Université Lumière Lyon 2, Bron, France
| | - Pascal Auquier
- EA 3279, Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université
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Piil K, Jakobsen J, Juhler M, Jarden M. The feasibility of a brain tumour website. Eur J Oncol Nurs 2015; 19:686-93. [DOI: 10.1016/j.ejon.2015.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/29/2015] [Accepted: 05/02/2015] [Indexed: 10/23/2022]
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Living with a high-grade glioma: A qualitative study of patients' experiences and care needs. Eur J Oncol Nurs 2015; 19:383-90. [DOI: 10.1016/j.ejon.2015.01.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/12/2015] [Accepted: 01/15/2015] [Indexed: 11/23/2022]
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Health-related quality of life in patients with high-grade gliomas: a quantitative longitudinal study. J Neurooncol 2015; 124:185-95. [PMID: 26026860 DOI: 10.1007/s11060-015-1821-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
The diagnosis of a high-grade glioma usual is followed by functional impairment(s), cognitive decline and an impaired psycho-social well-being. This might well have a significant and negative impact on the health related quality of life. The purpose of this study was to explore physical activity levels, prevalence and severity of anxiety and depressive symptoms and health-related quality of life among patients with a highgrade glioma. This paper is based on a longitudinal mixed methods study. Patients (n = 30) completed questionnaires at 5 time points from time of diagnosis until the final follow-up after 1 year. Scores of Karnofsky Performance Status (KPS), physical activity, anxiety and depression and health-related quality of life (FACT-Br) are obtained. Patients' physical activity level and KPS decrease during the disease- and treatment trajectory. The majority of patients did not report any depressive symptoms, eight individuals (26.7 %) being depressed at various time points. Among a sub-group of participants who completed all study requirements for the entire study period the level of anxiety decreased significantly during the study. The FACT-Br sub-scale of emotional well-being increased significant, indicating a better HRQOL attend of followup. The diagnosis of a HGG leads to an ongoing functional decline measured as a decline of the KPS and a reduced physical activity during leisure time. Supportive care combined with rehabilitative and palliative approaches might well be valuable along the trajectory especially during the post-surgery period when anxiety is at its highest peak.
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Langbecker D, Janda M. Systematic review of interventions to improve the provision of information for adults with primary brain tumors and their caregivers. Front Oncol 2015; 5:1. [PMID: 25667919 PMCID: PMC4304357 DOI: 10.3389/fonc.2015.00001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 01/07/2015] [Indexed: 01/24/2023] Open
Abstract
Background: Adults with primary brain tumors and their caregivers have significant information needs. This review assessed the effect of interventions to improve information provision for adult primary brain tumor patients and/or their caregivers. Methods: We included randomized or non-randomized trials testing educational interventions that had outcomes of information provision, knowledge, understanding, recall, or satisfaction with the intervention, for adults diagnosed with primary brain tumors and/or their family or caregivers. PubMed, MEDLINE, EMBASE, and Cochrane Reviews databases were searched for studies published between 1980 and June 2014. Results: Two randomized controlled, 1 non-randomized controlled, and 10 single group pre–post trials enrolled more than 411 participants. Five group, four practice/process change, and four individual interventions assessed satisfaction (12 studies), knowledge (4 studies), and information provision (2 studies). Nine studies reported high rates of satisfaction. Three studies showed statistically significant improvements over time in knowledge and two showed greater information was provided to intervention than control group participants, although statistical testing was not performed. Discussion: The trials assessed intermediate outcomes such as satisfaction, and only 4/13 reported on knowledge improvements. Few trials had a randomized controlled design and risk of bias was either evident or could not be assessed in most domains.
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Affiliation(s)
- Danette Langbecker
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology , Brisbane, QLD , Australia
| | - Monika Janda
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology , Brisbane, QLD , Australia
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Day J, Yust-Katz S, Cachia D, Rooney A, Katz LH, Wefel J, Tremont I, Armstrong T. Interventions for the management of fatigue in adults with a primary brain tumour. Cochrane Database Syst Rev 2014. [DOI: 10.1002/14651858.cd011376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Piil K, Juhler M, Jakobsen J, Jarden M. Controlled rehabilitative and supportive care intervention trials in patients with high-grade gliomas and their caregivers: a systematic review. BMJ Support Palliat Care 2014; 6:27-34. [PMID: 24890014 PMCID: PMC4789693 DOI: 10.1136/bmjspcare-2013-000593] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 04/30/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients diagnosed with high-grade gliomas experience a varying and complex symptom burden, and face a high mortality rate. As a consequence, patients with high-grade gliomas and their caregivers have imminent and changing rehabilitative and supportive care needs. OBJECTIVES To give a detailed overview of non-pharmacological rehabilitative and supportive care interventions for patients with high-grade gliomas and/or their caregivers, and provide an appraisal of the methodological quality of these studies. METHOD PubMed, Cumulative Index of Nursing and Allied Health Literature and Embase were searched for literature published from 1995 to May 2013. Data from eight studies were reviewed for substantive methods and results. Methodological quality was described and assessed using the scoring system for appraising mixed methods research and concomitantly appraising qualitative, quantitative and mixed methods primary studies in mixed study reviews. RESULTS The search yielded 914 unique publications, of which 9 were classified eligible for this review. There is preliminary evidence that cognitive group therapy improves memory skills in patients with high-grade gliomas, early physical training improves functional outcome and massage therapy reduces stress. Patients and caregivers found that telephone follow-up and a specialist nurse function was an effective and useful way to achieve information and support. Finally, psycho-education increased feelings of mastery among caregivers. CONCLUSIONS As evidence is beginning to emerge, there is a need for well-designed longitudinal and randomised controlled trials of non-pharmacological interventions in high-grade glioma patients and their caregivers in order to develop clinical guidelines for supportive and rehabilitative approaches in this unique population.
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Affiliation(s)
- K Piil
- Department of Neurosurgery, The University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark The University Hospitals Center for Health Research (UCSF), Center for Integrated Rehabilitation for Patients with Cancer (CIRE), Copenhagen, Denmark
| | - M Juhler
- Department of Neurosurgery, The University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark Department of Clinical Medicine, Section of Neurology, Psychiatry and Sensory Sciences, The University of Copenhagen, Copenhagen K, Denmark
| | - J Jakobsen
- The University Hospital of Copenhagen; Rigshospitalet, Neuroscience Center, Copenhagen, Denmark
| | - M Jarden
- The University Hospitals Center for Health Research (UCSF), Center for Integrated Rehabilitation for Patients with Cancer (CIRE), Copenhagen, Denmark
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Collins C, Gehrke A, Feuerstein M. Cognitive Tasks Challenging Brain Tumor Survivors at Work. J Occup Environ Med 2013; 55:1426-30. [DOI: 10.1097/jom.0b013e3182a64206] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Philip J, Collins A, Brand CA, Moore G, Lethborg C, Sundararajan V, Murphy MA, Gold M. “I'm just waiting…”: an exploration of the experience of living and dying with primary malignant glioma. Support Care Cancer 2013; 22:389-97. [DOI: 10.1007/s00520-013-1986-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/11/2013] [Indexed: 11/29/2022]
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Cornwell P, Dicks B, Fleming J, Haines TP, Olson S. Care and support needs of patients and carers early post-discharge following treatment for non-malignant brain tumour: establishing a new reality. Support Care Cancer 2013; 20:2595-610. [PMID: 22286363 DOI: 10.1007/s00520-012-1383-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 01/02/2012] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Non-malignant brain tumours have the potential to considerably affect functional outcomes and quality of life, with an associated significant burden for carers. There is a lack of knowledge about the care and support needs of patients with a brain tumour and their carers, in the early period following discharge from initial hospitalisation. The purpose of this study was to understand the early post-discharge support services and care requirements of individuals with brain tumour and their family caregivers between short-term (2 weeks) post-discharge and medium-term (3 months) following hospital discharge. METHODS A qualitative approach was utilised with semi-structured interviews of nine patients with brain tumour and five of their family caregivers. Thematic content analysis was used to generate in-depth descriptions of the participant's life experiences post-discharge following neurosurgical intervention. RESULTS The overarching theme emerging from the data analysis related to patients and carers 'establishing a new reality' underpinned by three primary categories: (1) coping with available supports, (2) adjusting to routines and relationships and (3) emotional responses. CONCLUSION Participants had a tendency to rely on informal support networks but identified unmet information and support needs particularly for carers. These findings highlight the need for more efficient and effective discharge preparation, referral to services and supports, provision of timely information and support for family caregivers of those with brain tumour.
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Affiliation(s)
- Petrea Cornwell
- Metro North Health Service District, Queensland Health, Chermside, Australia.
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Calman L, Brunton L, Molassiotis A. Developing longitudinal qualitative designs: lessons learned and recommendations for health services research. BMC Med Res Methodol 2013; 13:14. [PMID: 23388075 PMCID: PMC3598728 DOI: 10.1186/1471-2288-13-14] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 11/22/2012] [Indexed: 12/22/2022] Open
Abstract
Background Longitudinal qualitative methods are becoming increasingly used in the health service research, but the method and challenges particular to health care settings are not well described in the literature.We reflect on the strategies used in a longitudinal qualitative study to explore the experience of symptoms in cancer patients and their carers, following participants from diagnosis for twelve months; we highlight ethical, practical, theoretical and methodological issues that need to be considered and addressed from the outset of a longitudinal qualitative study. Results Key considerations in undertaking longitudinal qualitative projects in health research, include the use of theory, utilizing multiple methods of analysis and giving consideration to the practical and ethical issues at an early stage. These can include issues of time and timing; data collection processes; changing the topic guide over time; recruitment considerations; retention of staff; issues around confidentiality; effects of project on staff and patients, and analyzing data within and across time. Conclusions As longitudinal qualitative methods are becoming increasingly used in health services research, the methodological and practical challenges particular to health care settings need more robust approaches and conceptual improvement. We provide recommendations for the use of such designs. We have a particular focus on cancer patients, so this paper will have particular relevance for researchers interested in chronic and life limiting conditions.
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Affiliation(s)
- Lynn Calman
- University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK
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The impact of a high-grade glioma on everyday life: A systematic review from the patient’s and caregiver’s perspective. Eur J Oncol Nurs 2013; 17:107-17. [PMID: 22658206 DOI: 10.1016/j.ejon.2012.04.006] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 04/13/2012] [Accepted: 04/28/2012] [Indexed: 11/23/2022]
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Piil K, Jarden M, Jakobsen J, Christensen KB, Juhler M. A longitudinal, qualitative and quantitative exploration of daily life and need for rehabilitation among patients with high-grade gliomas and their caregivers. BMJ Open 2013; 3:bmjopen-2013-003183. [PMID: 23847270 PMCID: PMC3710984 DOI: 10.1136/bmjopen-2013-003183] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION High-grade gliomas (HGGs) are the most malignant type of brain tumours. The 5-year survival is 10% and a significant part of the ongoing research aims to increase survival through surgical and oncological treatments. Accordingly, there is an increasing need for investigating the HGG trajectory in order to recommend specific guidelines for rehabilitative and supportive interventions. METHOD AND ANALYSIS This study protocol (phase I) describes a longitudinal, qualitative, explorative and descriptive interview study of the life situation and need for rehabilitation among patients and their caregivers and a quantitative evaluation of health-related quality of life. Qualitative and quantitative data are collected in parallel, analysed separately and then merged. The finding of this study will, together with the existing literature, form the background for phase II, which is a feasibility study with a pre-experimental one-group design testing a rehabilitative and supportive intervention programme. The aim of this paper was to describe the design of an upcoming study. Interviews with 30 patients and 30 caregivers will provide information about how the life situation is experienced during the first year after being diagnosed with HGG. Quantitative measurements of quality of life, well-being and physical activity will provide additional information. More precisely, both qualitative and quantitative data will support the planning of the programme regarding the type of intervention(s), with or without supervision, the appropriate time along the trajectory, frequency, localisation, endpoint measurements and eligible patients and/or caregivers. ETHICS AND DISSEMINATION According to the Research Ethics Committee, approval is not needed for phase I as it is a non-intervention part of the study. Ethical approval of phase II will be sought at the time where the content of the intervention programme has been developed. Dissemination will occur through presentation and findings will be published in peer-reviewed journals.
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Affiliation(s)
- K Piil
- Department of Neurosurgery, The University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- The University Hospitals Center for Health Science Research (UCSF), Center for Integrated Rehabilitation for patients with Cancer (CIRE), Copenhagen, Denmark
| | - M Jarden
- The University Hospitals Center for Health Science Research (UCSF), Center for Integrated Rehabilitation for patients with Cancer (CIRE), Copenhagen, Denmark
| | - J Jakobsen
- The University Hospital of Copenhagen, Rigshospitalet, Neuroscience Center, Copenhagen, Denmark
| | - K Bang Christensen
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - M Juhler
- Department of Neurosurgery, The University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Section of Neurology, Psychiatry and Sensory Sciences, The University of Copenhagen, Copenhagen, Denmark
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Development of anxiety and depression in patients with benign intracranial meningiomas: a prospective long-term study. Support Care Cancer 2012; 21:1365-72. [PMID: 23238654 DOI: 10.1007/s00520-012-1675-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 11/26/2012] [Indexed: 11/12/2022]
Abstract
PURPOSE The aim of this study was to provide the first prospective longitudinal assessment of anxiety and depression in patients with a benign intracranial meningioma (WHO° I). METHODS The Hospital Anxiety and Depression Scale was applied prior to (t1) and directly after (t2) neurosurgery as well as 6 months after surgery (t3). The research was conducted in a single treatment centre in Germany. Numerous sociodemographic, medical, psychological and cognitive accompanying measures were assessed. The study population consisted of 52 meningioma patients. Additionally, a control group of 24 patients with malignant brain tumours (astrocytoma WHO° III) was assessed. RESULTS In meningioma patients, anxiety was high prior to surgery but declined significantly after successful neurosurgical treatment. Low levels of depression were observed at all times. In contrast, astrocytoma patients showed constantly high levels of anxiety whilst depression increased over the course of the disease. Numerous medical, psychosocial and psychological factors were associated with psychiatric morbidity in meningioma patients. CONCLUSIONS In conclusion, psychiatric morbidity of patients with benign intracranial meningiomas was comparable to that of the general population after successful neurosurgical treatment. Numerous associated factors suggest complex relationships within a biopsychosocial model. However, due to the small sample size and recruitment in a single institution, our results are of limited generalisability and need cross-validation in future studies.
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Palese A, Cecconi M, Moreale R, Skrap M. Pre-operative stress, anxiety, depression and coping strategies adopted by patients experiencing their first or recurrent brain neoplasm: an explorative study. Stress Health 2012; 28:416-25. [PMID: 23129561 DOI: 10.1002/smi.2472] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The main aims of this study were to evaluate the intensity of stress, anxiety and depression as well as the effectiveness of coping strategies adopted pre-operatively in brain neoplasm patients. A descriptive-explorative study design was undertaken. During 2008, patients admitted to a large Italian hospital neurosurgical unit with their first (n = 21) or recurrent (n = 15) brain neoplasm, on the day before their surgical procedure, were consecutively recruited into the study. The Perceived Stress Scale, the Hospital Anxiety and Depression Scale and the Jalowiec Coping Scale were administered via face-to-face interview. Patients with their first occurrence of neoplasm perceived the same stress intensity as those with recurrent neoplasm (mean ± standard deviation: 14.9 ± 6.7 versus 17.2 ± 8.8, p = 0.36). They also reported the same likelihood of anxiety at a borderline level (odds ratio (OR) 4.88, 95%CI 0.42 to 40.97, p = 0.06) and at a clinically relevant level (OR 0.32, 95%CI 0.01 to 5.37, p = 0.35) as well as the same likelihood of depression at a borderline level (OR 1.25, 95%CI 0.20 to 8.40, p = 0.78). Only one case of clinically relevant depression emerged among patients at their first diagnosis. Patients at their first occurrence, as well as those at recurrence, reported that they adopted optimistic coping strategies (mean 2.20, 95%CI 2.01 to 2.38 versus mean 1.96, 95%CI 1.71 to 2.20) and sought support (mean 1.81, 95%CI 1.58 to 2.05 versus mean 1.89, 95%CI 1.63 to 2.15). According to the findings of this exploratory study, on the pre-operative day, brain neoplasm patients at their first diagnosis and at recurrence wish to confront the situation: they adopt optimistic coping strategies, they seek support and they wish to take a constructive problem-solving approach. Knowledge of the intensity of stress, anxiety and depression as well as the coping strategies adopted by the patients is important for clinicians in their efforts to tailor care to patients' individual needs.
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Affiliation(s)
- Alvisa Palese
- School of Nursing, Udine University, Viale Ungheria 20, CAP 33100 Udine, Italy.
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Brunton L, Booker J, Molassiotis A. Making sense of symptoms in men with prostate cancer: a longitudinal qualitative exploration. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2012. [DOI: 10.1111/j.1749-771x.2012.01150.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Understanding the Symptom Experience of Patients with Gastrointestinal Cancers in the First Year Following Diagnosis: Findings from a Qualitative Longitudinal Study. J Gastrointest Cancer 2012; 44:60-7. [DOI: 10.1007/s12029-012-9443-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Symptom experience and regaining normality in the first year following a diagnosis of head and neck cancer: a qualitative longitudinal study. Palliat Support Care 2012; 10:197-204. [PMID: 22613011 DOI: 10.1017/s147895151200020x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Symptom experiences and their interference with life are not well-researched in head and neck cancer patients. The aim of the study was to explore and understand the experience of receiving treatment for head and neck cancer with particular focus on symptom experiences over a one year period from diagnosis. METHODS A qualitative study design was used with a heterogeneous sample of 16 patients with head and neck cancer. Interviews, conducted at four time points over 12 months, provided a total of 50 interview datasets. RESULTS Key themes derived include nutritional concerns, tiredness, and experiences related to the radiotherapy mask and regaining normality. These data highlight issues of importance in the first year of living with head and neck cancer: impact of nutritional changes on the lives of patients, including weight loss, dysphagia, xerostomia and taste changes; debilitation from ongoing fatigue; unpreparedness for and distress from the radiotherapy mask; and attempts to maintain a normal life amidst the interference of symptoms. CONCLUSION Multitude of symptoms impact the patients' life, particularly nutritional symptoms and fatigue, and interfere with the patients' survivorship and quality of life. The changing nature of symptoms over the first year from diagnosis in head and neck cancer patients and the identified issues in the attempt to normalize their lives need to be incorporated more fully into the supportive care of head and neck cancer patients in order to improve their experience and enhance their survivorship.
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