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Berkman AM, Betts AC, Beauchemin M, Parsons SK, Freyer DR, Roth ME. Survivorship after adolescent and young adult cancer: models of care, disparities, and opportunities. J Natl Cancer Inst 2024; 116:1417-1428. [PMID: 38833671 PMCID: PMC11378318 DOI: 10.1093/jnci/djae119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/25/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
Survivors of adolescent and young adult (AYA; age 15-39 years at diagnosis) cancer are a growing population with the potential to live for many decades after treatment completion. Survivors of AYA cancer are at risk for adverse long-term outcomes including chronic conditions, secondary cancers, impaired fertility, poor psychosocial health and health behaviors, and financial toxicity. Furthermore, survivors of AYA cancer from racially minoritized and low socioeconomic status populations experience disparities in these outcomes, including lower long-term survival. Despite these known risks, most survivors of AYA cancer do not receive routine survivorship follow-up care, and research on delivering high-quality, evidence-based survivorship care to these patients is lacking. The need for survivorship care was initially advanced in 2006 by the Institute of Medicine. In 2019, the Quality of Cancer Survivorship Care Framework (QCSCF) was developed to provide an evidence-based framework to define key components of optimal survivorship care. In this commentary focused on survivors of AYA cancer, we apply the QCSCF framework to describe models of care that can be adapted for their unique needs, multilevel factors limiting equitable access to care, and opportunities to address these factors to improve short- and long-term outcomes in this vulnerable population.
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Affiliation(s)
- Amy M Berkman
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Andrea C Betts
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
| | - Melissa Beauchemin
- School of Nursing, Columbia University Irving Medical Center, New York, NY, USA
| | - Susan K Parsons
- Department of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA, USA
- Institute for Clinical Research and Health Policy Studies and Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
| | - David R Freyer
- Departments of Pediatrics, Medicine, and Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael E Roth
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Russell AC, Reid H, Coleman HG, Santin O. Understanding the treatment experiences of adults diagnosed with early-onset colorectal cancer: A qualitative study. Psychooncology 2024; 33:e6367. [PMID: 38937110 DOI: 10.1002/pon.6367] [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: 12/20/2023] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Early-onset colorectal cancer (CRC) incidence in adults aged under 50 is increasing. There is a critical lack of knowledge regarding the challenges faced by early-onset CRC patients and their experiences of treatment. The aim of this study was to explore the lived experiences of individuals receiving treatment for early-onset CRC, and the resulting impact on their lives. METHODS Semi-structured interviews of patients with early-onset CRC in the UK (n = 21) were conducted from August 2021 to March 2022. Interviews were recorded and transcribed verbatim. Data were analysed using thematic analysis. RESULTS Results identified four key themes: (1) early-onset CRC treatment results in sudden physical, psychological and social impacts in all aspects of life; (2) early-onset CRC patients have unique supportive care needs which are not recognised in current practice; (3) there is a need for tailored information; (4) a lack of support was identified in the areas of mental health, sexual health and fertility. CONCLUSIONS Our study highlights numerous unique issues experienced by the early-onset CRC patient group during treatment. There is a need for change in clinical practice, along with the development of international guidelines and tailored resources for both patients and healthcare professionals, in order to improve care.
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Affiliation(s)
| | - Helen Reid
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Helen G Coleman
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Olinda Santin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Dorfman CS, Shelby RA, Stalls JM, Thomas SM, Arrato NA, Herold B, Somers TJ, Keefe FJ, Winger JG, Vilardaga JP, Oeffinger K. Improving symptom management for survivors of young adult cancer: rationale and study protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2024; 10:87. [PMID: 38851732 PMCID: PMC11161971 DOI: 10.1186/s40814-024-01510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/14/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Young adult (YA) cancer survivors are a growing, yet underserved population who often face significant and long-lasting cancer-related physical (e.g., pain, fatigue) and emotional (e.g., psychological distress) symptoms. Post-treatment symptoms can persist, disrupting YA's abilities to complete goals consistent with their developmental stage (e.g., completing their education, achieving autonomy and independence, building their careers, establishing peer and romantic relationships, building their families). While symptom management has been identified as a significant issue in YA's transitions to survivorship, the symptom management needs of this population largely go unmet. METHODS We developed an eight-session, group-based behavioral intervention that is delivered using videoconferencing to address the unique symptom management needs of YA cancer survivors. The intervention was developed in conjunction with YA survivors, leading to the novel combination of traditional behavioral symptom coping strategies, home-based physical activity, strategies from contemporary cognitive-behavioral approaches (e.g., those derived from acceptance and commitment therapy, strategies to foster self-compassion), concepts from meaning centered psychotherapy, and behavioral strategies to improve communication and health care engagement. Participants receive printed intervention materials and access to a study-specific mobile application, both of which are used throughout the program. Herein, we report on a pilot study that is in progress. Recruitment has been completed. YA cancer survivors were recruited in cohorts of n = 10 or n = 11 (n = 61) and randomized to the intervention or waitlist control arms. All participants completed a baseline assessment and four additional assessments over 1 year, with each involving a battery of self-report measures. DISCUSSION The primary objective is to evaluate intervention feasibility and acceptability. As a secondary objective, we will examine patterns of change in intervention targets (i.e., pain, fatigue, emotional distress, symptom interference). Changes from baseline among intervention targets will be estimated for each patient and compared between arms using unadjusted statistical testing. Unadjusted and adjusted multilevel modeling will be used to estimate the effect of the intervention on changes in intervention targets. Interaction models will be used to compare the trajectory of change over time between arms. We expect that this pilot trial will inform our future approach to identify, recruit, and retain participants and provide preliminary data to support a larger, fully powered randomized controlled trial evaluating the intervention. TRIAL REGISTRATION NCT04035447 at clinicaltrials.gov; registered July 29, 2019.
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Affiliation(s)
- Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, NC, USA.
- Duke Cancer Institute, Durham, NC, USA.
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Juliann M Stalls
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Nicole A Arrato
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Brianna Herold
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Jennifer Plumb Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Kevin Oeffinger
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, NC, USA
- Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, USA
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Cho D, Roth M, Peterson SK, Jennings K, Kim S, Weathers SP, Ahmed S, Livingston JA, Barcenas C, You YN, Milbury K. Associations Between Stress, Health Behaviors, and Quality of Life in Young Couples During the Transition to Survivorship: Protocol for a Measurement Burst Study. JMIR Res Protoc 2024; 13:e53307. [PMID: 38652520 PMCID: PMC11077407 DOI: 10.2196/53307] [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: 10/09/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Cancer is a life-threatening, stressful event, particularly for young adults due to delays and disruptions in their developmental transitions. Cancer treatment can also cause adverse long-term effects, chronic conditions, psychological issues, and decreased quality of life (QoL) among young adults. Despite numerous health benefits of health behaviors (eg, physical activity, healthy eating, no smoking, no alcohol use, and quality sleep), young adult cancer survivors report poor health behavior profiles. Determining the associations of stress (either cancer-specific or day-to-day stress), health behaviors, and QoL as young adult survivors transition to survivorship is key to understanding and enhancing these survivors' health. It is also crucial to note that the effects of stress on health behaviors and QoL may manifest on a shorter time scale (eg, daily within-person level). Moreover, given that stress spills over into romantic relationships, it is important to identify the role of spouses or partners (hereafter partners) in these survivors' health behaviors and QoL. OBJECTIVE This study aims to investigate associations between stress, health behaviors, and QoL at both within- and between-person levels during the transition to survivorship in young adult cancer survivors and their partners, to identify the extent to which young adult survivors' and their partners' stress facilitates or hinders their own and each other's health behaviors and QoL. METHODS We aim to enroll 150 young adults (aged 25-39 years at the time of cancer diagnosis) who have recently completed cancer treatment, along with their partners. We will conduct a prospective longitudinal study using a measurement burst design. Participants (ie, survivors and their partners) will complete a daily web-based survey for 7 consecutive days (a "burst") 9 times over 2 years, with the bursts spaced 3 months apart. Participants will self-report their stress, health behaviors, and QoL. Additionally, participants will be asked to wear an accelerometer to assess their physical activity and sleep during the burst period. Finally, dietary intake (24-hour diet recalls) will be assessed during each burst via telephone by research staff. RESULTS Participant enrollment began in January 2022. Recruitment and data collection are expected to conclude by December 2024 and December 2026, respectively. CONCLUSIONS To the best of our knowledge, this will be the first study that determines the interdependence of health behaviors and QoL of young adult cancer survivors and their partners at both within- and between-person levels. This study is unique in its focus on the transition to cancer survivorship and its use of a measurement burst design. Results will guide the creation of a developmentally appropriate dyadic psychosocial or behavioral intervention that improves both young adult survivors' and their partners' health behaviors and QoL and potentially their physical health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53307.
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Affiliation(s)
- Dalnim Cho
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Michael Roth
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kristofer Jennings
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Seokhun Kim
- The Center for Clinical Research and Evidence-Based Medicine, The University of Texas McGovern Medical School, Houston, TX, United States
| | - Shiao-Pei Weathers
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sairah Ahmed
- Department of Lymphoma-Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - J Andrew Livingston
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Carlos Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Y Nancy You
- Department of Colon & Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kathrin Milbury
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Holme IK, Hollund HA, Vandraas K, Kiserud CE, Reinertsen KV, Loge JH, Lie HC. Sexual Problems as Late Effects: Awareness and Information Needs Among 1870 Long-term Norwegian Childhood, Adolescent, and Young Adult Cancer Survivors (The NOR-CAYACS Study). J Adolesc Young Adult Oncol 2024; 13:203-212. [PMID: 37579257 DOI: 10.1089/jayao.2023.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Purpose: Treatment-related sexual problems are common, but understudied, among survivors of Childhood, Adolescent, and Young Adult Cancer Survivors (CAYACS). We investigated awareness of, and information needs regarding, sexual problems as late effects in a nation-wide sample of long-term CAYACS. Methods: Five-year survivors were identified by the Cancer Registry of Norway, diagnosed between 1985 and 2009 with any childhood cancer (0-18 years of age, excluding central nervous system tumors), leukemia, colorectal cancer, breast cancer, non-Hodgkin lymphoma, or malignant melanoma (19-39 years of age). Malignant melanoma survivors treated with local surgery only served as an unmatched reference group. Survivors were mailed a survey, including items on awareness and information needs. Descriptive statistics and logistic regression analyses were used for data analyses. Results: Of 5361 CAYACS invited, 2104 responded (39%), of which 1870 were eligible for inclusion. In all, 62% were aware of sexual problems as late effects (46% aware only, 16% experienced it) and 31% reported information needs. Of all groups, childhood cancer survivors reported the lowest level of awareness (43% aware, 7% experienced it) and the highest information needs (38%). In multivariable models, awareness was associated with higher education, shorter time since treatment, more intense treatments, and experiencing hormonal changes and reduced fertility. Information needs were associated with having experienced sexual problems, female gender, higher treatment intensity, chronic fatigue, and increased depressive symptoms. Conclusions: A substantial proportion of long-term CAYACS report being unaware of, and have information needs regarding sexual problems as late effects decades beyond treatment. Addressing such issues during follow-up care is important.
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Affiliation(s)
- Ida K Holme
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Henrikke A Hollund
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kathrine Vandraas
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Cecilie E Kiserud
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Kristin V Reinertsen
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Jon Håvard Loge
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hanne Cathrine Lie
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
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Sebastian D, Joseph J, Mathews E. The prevalence and correlates of comorbidities among patients with cancer attending a tertiary care cancer center in South India: An analytical cross-sectional study. CANCER RESEARCH, STATISTICS, AND TREATMENT 2023; 6:526-533. [PMID: 38826774 PMCID: PMC7616054 DOI: 10.4103/crst.crst_93_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
Background Comorbidities in patients with cancer can affect treatment, and should, therefore, be prioritized and managed. Objectives Our primary aim was to assess the prevalence of comorbidities among patients with cancer. The secondary objective was to identify the association of comorbidities with various sociodemographic and clinical variables. Materials and Methods This was a cross-sectional study conducted between December 2019 and March 2020 among patients with cancer, seeking treatment at Malabar Cancer Center, in Kannur District of northern Kerala in South India. Semi-structured interviews were conducted, and comorbidities were assessed using the Charlson Comorbidity Index. The anthropometric measurements were recorded using a standardized instrument and protocol. Results We enrolled 242 patients in this study. There were 148 (61.2%) female patients; 106 (43.8%) were aged between 41 and 50 years. Cancers of the head-and-neck and breast accounted for the majority of cases (23.1% each, n = 56), followed by the digestive system (18.6%, n = 45) and female reproductive system (11.2%, n = 27). The most common primary cancers in the head-and-neck, digestive, and female reproductive systems were oral, colorectal, and cervical, respectively. The prevalence of comorbidities among patients with cancer was 70.2% (n = 170). Common comorbidities were hypertension (n = 82 ; 33.9%), arthritis (n = 57; 23.6%), and diabetes (n = 53; 21.6%). After controlling for potential confounders, the factors noted to be independently associated with the presence of comorbidities were advanced age, family history of comorbidity, normal weight or underweight, and cancer treatment for more than 6 months' duration. Conclusions The high prevalence of comorbidities among patients with cancer suggests the need for an integrated system of care and management as the comorbidities affect the overall management of cancer treatment and care.
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Affiliation(s)
- Divya Sebastian
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod
| | | | - Elezebeth Mathews
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod
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Son YJ, Nam KH, Shim J. Factors influencing the supportive care needs of female patients with genital cancer in South Korea. Medicine (Baltimore) 2023; 102:e36650. [PMID: 38134056 PMCID: PMC10735129 DOI: 10.1097/md.0000000000036650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
Genital cancers are particularly important compared to other cancers because of the psychological impact they have on the individual. This study investigated the complexity in illness and quality of life among female genital cancer patients and determined the effects of these factors on supportive care needs to provide evidential data for the development of nursing intervention strategies to reduce supportive care needs in female genital cancer patients. This cross-sectional study collected data from July 22 to August 17, 2021. The study subjects were 103 female outpatients and inpatients aged 19 years or older who were treated for cervical cancer, endometrial cancer, ovarian cancer, or other female genital cancers such as vulvar cancer and vaginal cancer in a university hospital in Korea. The data were analyzed with t-tests and Scheffé's test using SPSS 26.0. The factors affecting supportive care needs were examined using hierarchical regression. The average age of the subjects was 56.41 (±9.91) years. Cervical cancer was the most common diagnosis at 42.7%, followed by ovarian cancer at 34.0%, and endometrial cancer at 21.4%. The factors affecting supportive care needs included a middle school education or below (β = 0.21, P = .028), unemployment (β = 0.23, P = .018), complexity in illness (β = 0.32, P < .001), and quality of life (β = -0.68, P < .001). Developing a strategy for managing the complexity in illness and quality of life caused by various variables including disease stage and type of treatment is necessary to reduce the supportive care needs of female genital cancer patients. Improving their quality of life through effective communication with healthcare providers is essential.
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Affiliation(s)
- Yu-Jung Son
- Research Institute of Holistic Nursing Science in College of Nursing, Kosin University, Busan, South Korea
| | - Keum-Hee Nam
- College of Nursing, Kosin University, Busan, South Korea
| | - JaeLan Shim
- College of Nursing, Dongguk University, WISE Campus, South Korea
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Quinn M, Wright N, Scherdt M, Barton DL, Titler M, Armin JS, Naughton MJ, Wenzel J, Percac-Lima S, Mishra P, Danner SM, Friese CR. A descriptive study of policy and system-level interventions to address cancer survivorship issues across six United States health systems. J Cancer Surviv 2023:10.1007/s11764-023-01440-y. [PMID: 37544977 DOI: 10.1007/s11764-023-01440-y] [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: 04/25/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE To describe policy and system-level interventions with potential to improve cancer care at six sites. METHODS In 2016, six institutions received foundation support to develop unique multi-component interventions aimed at improving cancer care for underserved populations. These organizations, located across the United States, participated in a cross-site evaluation to assess the overall initiative impact and to identify potentially promising policy and system-level solutions for dissemination and broader implementation. A health system and policy tracking tool was developed to collect data from each site and included a description of their efforts, strategies employed, and changes achieved (e.g., new policies, clinical protocols). Tracking tool data were analyzed using rapid qualitative analyses and a matrix approach. Semi-structured interviews were conducted with site leaders (N = 65) and were analyzed by thematic analysis. RESULTS Sites reported 20 system and policy efforts, which resulted in improvements to electronic health records and telehealth strategies, changes to hospital/health system policies, and standardized clinical protocols/guidelines, among others. Efforts were aimed at: (1) coordinating care across multiple providers, supported by patient navigators; (2) expanding psychosocial and supportive care; (3) improving patient-provider communication; and (4) addressing barriers to accessing care. Interview analyses provided insights into successful strategies, challenges, and implications of the COVID-19 pandemic on cancer care. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS Despite advances in diagnosis and treatment, cancer care remains inequitable. System-level improvements aimed at eliminating common barriers faced by underserved populations offer opportunities to improve the delivery of equitable, effective, and efficient care.
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Affiliation(s)
- Martha Quinn
- School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - Nathan Wright
- School of Nursing, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Marylee Scherdt
- School of Nursing, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Debra L Barton
- School of Nursing, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Marita Titler
- School of Nursing, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Julie S Armin
- College of Medicine, The University of Arizona, Tucson, AZ, 85711, USA
| | | | - Jennifer Wenzel
- Schools of Nursing and Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | | | | | - Sankirtana M Danner
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Christopher R Friese
- School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
- School of Nursing, University of Michigan, Ann Arbor, MI, 48109, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48109, USA
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Wang IY, Jane SW, Hsu HC, Lin YC, Tsai WS, Young CY, Beaton RD, Huang HP. The Longitudinal Trends of Care Needs, Psychological Distress, and Quality of Life and Related Predictors in Taiwanese Colorectal Cancer Survivors. Semin Oncol Nurs 2023; 39:151424. [PMID: 37100635 DOI: 10.1016/j.soncn.2023.151424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/26/2023] [Accepted: 03/15/2023] [Indexed: 04/28/2023]
Affiliation(s)
- I-Ya Wang
- Department of Nursing, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Sui-Whi Jane
- Department of Nursing, Chang Gung University of Science and Technology, Taiwan; Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Lin-Kou, Taiwan
| | - Hung-Chih Hsu
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Lin-Kou, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan City, Taiwan
| | - Yung-Chang Lin
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Lin-Kou, Taiwan
| | - Wen-Sy Tsai
- Division of Colorectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Lin-Kou, Taiwan
| | - Chia-Yung Young
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Lin-Kou, Taiwan
| | - Randal D Beaton
- Psychosocial & Community Health and Health Services, Schools of Nursing and Public Health, University of Washington, Seattle
| | - Hsiang-Ping Huang
- Department of Nursing, Chang Gung University of Science and Technology, Taiwan.
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10
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Kim SJ, Shin H. [The Experience of Gynecologic Cancer in Young Women: A Qualitative Study]. J Korean Acad Nurs 2023; 53:115-128. [PMID: 36898689 DOI: 10.4040/jkan.22119] [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: 09/22/2022] [Revised: 01/13/2023] [Accepted: 02/13/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE This study aimed to understand the experiences of women under 40 years of age with gynecologic cancer. METHODS Semi-structured individual in-depth interviews were conducted with 14 Korean female patients aged 21~39 years with gynecologic cancer. The data were analyzed using Corbin and Strauss' grounded theory approach, including open coding, context analysis, and integrating categories. RESULTS Grounded theory analysis revealed nine categories and a core category of 'the journey to find my life after losing the life as a typical woman.' The categories that emerged as the conditions are 'Unwelcomed guest, cancer,' 'Completely devastated life as an ordinary woman,' 'Uncertain future,' 'Losing my physical characteristics as a woman,' and 'Life tied with treatments.' The actions/interactions were'Decrease of interpersonal relationships,' 'A lonely battle to overcome alone,' and 'The power to overcome hardships.' The consequence was 'Live my own life.' CONCLUSION This study contributes to the development of a substantive theory of the experience of gynecologic cancer in young women, which has been on the rise in recent years. The study's results are expected to be used as a basis for providing nursing care to help young women with gynecologic cancer adapt to their disease.
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Affiliation(s)
- Sung-Jin Kim
- Department of Hemato-Oncology, Samsung Medical Center, Seoul, Korea.,College of Nursing, Korea University, Seoul, Korea
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Frietsch JJ, Flossdorf S, Beck JF, Kröger N, Fleischhauer K, Dreger P, Schetelig J, Bornhäuser M, Hochhaus A, Hilgendorf I. Outcomes after allogeneic haematopoietic stem cell transplantation in young adults in Germany. Br J Haematol 2022; 201:308-318. [PMID: 36573337 DOI: 10.1111/bjh.18610] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/28/2022]
Abstract
Young adults (YA) represent a minority among recipients of allogeneic haematopoietic stem cell transplantation (HSCT). In order to describe the outcome of YA following HSCT in Germany, 9299 patients who were registered with the German Registry for Stem Cell Transplantation were included in this retrospective analysis of the years 1998-2019. The impact of the variables, such as patient age and sex, sex differences, stem cell source, donor type, conditioning, year of HSCT, the diagnosis, and the achieved remission status were tested in univariable and multivariable analysis for overall, event-free and relapse-free survival as well as for the cumulative incidences of non-relapse and therapy-related mortality. Altogether, the outcome of YA after HSCT improved over time and was determined by the underlying disease, the age at disease onset, stem cell source, and donor type. Patients were most likely to die from relapse, and survival of HSCT recipients after 10 years was reduced by more than half in comparison to the general population of YA. Deeper understanding of modifiable risk factors may be gained by studies comparing the outcome of YA post-HSCT with that of children, adolescents and elderly patients. A deliberate and strong patient selection may further improve mortality rates.
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Affiliation(s)
- Jochen J. Frietsch
- Klinik für Innere Medizin II, Hämatologie und internistische Onkologie Universitätsklinikum Jena Jena Germany
- Medizinische Klinik und Poliklinik II Universitätsklinikum Würzburg Würzburg Germany
| | - Sarah Flossdorf
- Deutsches Register für Stammzelltransplantationen e.V., DRST Ulm Germany
- Institut für Medizinische Informatik, Biometrie und Epidemiologie Universitätsklinikum Essen Essen Germany
| | - James F. Beck
- Klinik für Kinder‐ und Jugendmedizin Universitätsklinikum Jena Jena Germany
| | - Nicolaus Kröger
- Deutsches Register für Stammzelltransplantationen e.V., DRST Ulm Germany
- Klinik für Stammzelltransplantation Universitätsklinikum Hamburg‐Eppendorf Hamburg Germany
| | - Katharina Fleischhauer
- Deutsches Register für Stammzelltransplantationen e.V., DRST Ulm Germany
- Institut für Zelltherapeutische Forschung Universitätsklinikum Essen Essen Germany
| | - Peter Dreger
- Deutsches Register für Stammzelltransplantationen e.V., DRST Ulm Germany
- Medizinische Klinik V Universitätsklinikum Heidelberg Heidelberg Germany
| | - Johannes Schetelig
- Deutsches Register für Stammzelltransplantationen e.V., DRST Ulm Germany
- Medizinische Klinik I Universitätsklinikum Carl Gustav Carus an der TU Dresden Dresden Germany
| | - Martin Bornhäuser
- Medizinische Klinik I Universitätsklinikum Carl Gustav Carus an der TU Dresden Dresden Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Hämatologie und internistische Onkologie Universitätsklinikum Jena Jena Germany
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, Hämatologie und internistische Onkologie Universitätsklinikum Jena Jena Germany
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12
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Chen M, Li R, Chen Y, Ding G, Song J, Hu X, Jin C. Unmet supportive care needs and associated factors: Evidence from 4195 cancer survivors in Shanghai, China. Front Oncol 2022; 12:1054885. [PMID: 36530993 PMCID: PMC9748420 DOI: 10.3389/fonc.2022.1054885] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/10/2022] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Cancer survivors at different stages of life often have different needs that make it challenging for services to provide satisfactory care. Few studies have considered whether services are truly meeting the needs of cancer patients by exploring and identifying their perspectives on unmet needs. OBJECTIVE The aim of this study was to identify the unmet needs of cancer survivors and to further determine the potential impact of socio-demographic factors. METHODS A cross-sectional study that included 4195 cancer patients was conducted in Shanghai, China. Using Maslow's hierarchy of needs theory as a conceptual framework, the questionnaire included five dimensions: information, life and finances, continuing care, emotions, and self-actualization. Correlation analysis and ordered logistic regression analysis was used to explore the relationship between demographic sociological factors and unmet needs for supportive care. RESULTS The most common unmet supportive care needs include information needs (2.91 ± 1.32), self-actualization needs (2.69 ± 1.32) and continuing care needs (2.59 ± 1.30). Unmet needs for life and finances were more pronounced among cancer participants in the 45-69 age group. After adjusting for confounders, we found that each 6-month increase in the time since diagnosis was associated with a 0.8% (OR: 0.992, 95% CI: 0.985-0.998) reduction in high need for continuing care and a 0.9% (OR:0.991, 95% CI: 0.983-0.999) reduction in high need for self-actualization, respectively. CONCLUSIONS Information needs are the most important concern among the diverse unmet needs of cancer survivors. Time since diagnosis is associated with unmet supportive care needs of cancer survivors. The findings highlight the large gap between actual health services and patients' unmet need for supportive care, which will provide the basis for a patient-centered supportive care system for cancer survivors.
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Affiliation(s)
- Minxing Chen
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Ruijia Li
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Yujie Chen
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Gang Ding
- Oncology Department, Shanghai International Medical Center, Shanghai, China
| | - Jie Song
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Xiaojing Hu
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Chunlin Jin
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
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13
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Liang Y, Hao G, Wu M, Hou L. Social isolation in adults with cancer: An evolutionary concept analysis. Front Psychol 2022; 13:973640. [PMID: 36262430 PMCID: PMC9574202 DOI: 10.3389/fpsyg.2022.973640] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/31/2022] [Indexed: 12/24/2022] Open
Abstract
Background In extant literature, the concept of social isolation has been explored primarily in the context of older adults. However, people with cancer may also experience social isolation, and there is a need for increased clarity regarding this phenomenon in this population. Objective To conceptualize social isolation in adult cancer care. Methods PubMed, Web of Science, PsycINFO, CINAHL, China National Knowledge Infrastructure, Wanfang Data, and the Chinese Biomedical Literature Database were systematically searched using the key terms “cancer,” “social isolation,” “social alienation,” and “social exclusion” for studies (from the earliest date available to June 2022). The main disciplines involved were psychology, nursing, medicine, and public health. Rodgers’ evolutionary concept analysis was employed to clarify the antecedents, attributes, and consequences of social isolation in adults with cancer. Results A total of 60 eligible articles were reviewed entirely and the main findings were categorized into antecedents, attributes, and consequences. The antecedents of social isolation were classified into six categories: cancer-related physiological changes, cognitive beliefs, psychological wellbeing, unsatisfactory social supports or relationships, restrictions associated with receiving treatments, and social-level barriers. Attributes were characterized according to behavior or social avoidance and negative affective experiences, while consequences were attributed to low therapeutic compliance, poor health conditions and mental health problems, and low quality of life. White’s heuristic model is a potential theoretical context applicable to social isolation in adults with cancer. Conclusion This concept analysis provides a basis for developing multidimensional assessment tools and measures to alleviate social isolation in adults with cancer, a complex and varied phenomenon. However, while this review contributes to the current knowledge on social isolation in people with cancer, studies should further investigate the relationships among attributes associated with social isolation.
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Affiliation(s)
- Yanjing Liang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
- Nursing Department, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guihua Hao
- Nursing Department, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mei Wu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Lili Hou
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
- Nursing Department, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Lili Hou,
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14
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Larsen EH, Mellblom AV, Ruud E, Wahl AK, Lie HC. Prepared for survivorship? Multidisciplinary healthcare professionals' experiences with adolescents’ transition off cancer treatment: A focus group study. Eur J Oncol Nurs 2022; 58:102150. [DOI: 10.1016/j.ejon.2022.102150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/26/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
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15
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Evaluating the Feasibility and Acceptability of an Artificial-Intelligence-Enabled and Speech-Based Distress Screening Mobile App for Adolescents and Young Adults Diagnosed with Cancer: A Study Protocol. Cancers (Basel) 2022; 14:cancers14040914. [PMID: 35205663 PMCID: PMC8870320 DOI: 10.3390/cancers14040914] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/21/2022] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Adolescent and young adult (AYA) patients diagnosed with cancer are at a higher risk of psychological distress, which requires regular monitoring throughout their cancer journeys. Paper-and-pencil or digital surveys for psychological stress are often cumbersome to complete during a patient’s visit, and many patients find completing the same survey multiple times repetitive and boring. Recent advances in mobile technology and speech science have enabled flexible and engaging ways of monitoring psychological distress. This paper describes the scientific process we will use to evaluate an artificial intelligence (AI)-enabled mobile app to monitor depression and anxiety among AYAs diagnosed with cancer. Abstract Adolescents and young adults (AYAs) diagnosed with cancer are an age-defined population, with studies reporting up to 45% of the population experiencing psychological distress. Although it is essential to screen and monitor for psychological distress throughout AYAs’ cancer journeys, many cancer centers fail to effectively implement distress screening protocols largely due to busy clinical workflow and survey fatigue. Recent advances in mobile technology and speech science have enabled flexible and engaging methods to monitor psychological distress. However, patient-centered research focusing on these methods’ feasibility and acceptability remains lacking. Therefore, in this project, we aim to evaluate the feasibility and acceptability of an artificial intelligence (AI)-enabled and speech-based mobile application to monitor psychological distress among AYAs diagnosed with cancer. We use a single-arm prospective cohort design with a stratified sampling strategy. We aim to recruit 60 AYAs diagnosed with cancer and to monitor their psychological distress using an AI-enabled speech-based distress monitoring tool over a 6 month period. The primary feasibility endpoint of this study is defined by the number of participants completing four out of six monthly distress assessments, and the acceptability endpoint is defined both quantitatively using the acceptability of intervention measure and qualitatively using semi-structured interviews.
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16
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Lehmann V, Laan ETM, den Oudsten BL. Sexual health-related care needs among young adult cancer patients and survivors: a systematic literature review. J Cancer Surviv 2021; 16:913-924. [PMID: 34669141 PMCID: PMC9300501 DOI: 10.1007/s11764-021-01084-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/02/2021] [Indexed: 01/05/2023]
Abstract
Purpose Young adult cancer patients and survivors have age-specific care needs, but care needs related to sexual health are poorly understood. A systematic literature review was conducted to examine sexual health-related care needs among patients/survivors diagnosed with cancer during young adulthood (age: 18–39 years). The prevalence and types needs were assessed along with associated patient factors. Methods Four major databases were screened to identify relevant studies, which were also assessed for risk of bias; all following PRISMA guidelines. Results Identified studies (N = 35) often assessed sexual health-related care needs by whether participants experienced a generic need for support from providers. The prevalence of such needs ranged between 8 and 61.7% and was higher in female survivors and those with more health impairments. The type of diagnosis could also play a role in these varying prevalence rates, but was not systematically tested in included studies. Types of sexual health-related care needs were clustered into practical/emotional support needs (e.g., coping with physical side effects), information needs (e.g., more details), and communication needs (e.g., providers should initiate conversations, validate concerns, be empathetic/open). Needs should be addressed in-person and/or online. Conclusions The extent of needs related to sexual health varies among young adult patients and survivors, but types of needs center around improving provision of support and information by providers. Implications for Cancer Survivors Sexual health should routinely be addressed alongside other potential effects of cancer treatment to allow for constructive conversations between patients and providers. Referrals to (online) resources or specialists should be tailored to individual preferences. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01084-w.
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Affiliation(s)
- Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Center, Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.
| | - Ellen T M Laan
- Department of Sexology and Psychosomatic Gynecology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - Brenda L den Oudsten
- Department of Medical and Clinical Psychology, Center of Research On Psychological and Somatic Disorders, Tilburg University, Tilburg, Netherlands
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17
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Lidington E, Darlington AS, Din A, Stanway S, Banerjee S, Szucs Z, Gonzalez M, Sharma A, Sirohi B, van der Graaf WTA, Husson O. Describing Unmet Supportive Care Needs among Young Adults with Cancer (25-39 Years) and the Relationship with Health-Related Quality of Life, Psychological Distress, and Illness Cognitions. J Clin Med 2021; 10:jcm10194449. [PMID: 34640467 PMCID: PMC8509768 DOI: 10.3390/jcm10194449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 12/16/2022] Open
Abstract
Few studies describe supportive care needs among young adults (YAs) with cancer ages 25 to 39 using validated questionnaires. Previous findings identified the need for psychological and information support and suggest that gender, age, psychological distress, and coping may be associated with greater need for this support. To substantiate these findings, this study aimed to (1) describe the supportive care needs of YAs in each domain of the Supportive Care Needs Survey and (2) explore the relationship between unmet supportive care needs and clinical and demographic factors, health-related quality of life, psychological distress, illness cognitions, and service needs using latent class analysis. Clinical teams from six hospitals in England invited eligible patients to a cross-sectional survey by post. A total of 317 participants completed the survey online or on paper. YAs expressed the most need in the psychological and sexuality domains. Using latent class analysis, we identified three classes of YAs based on level of supportive care need: no need (53.3%), low need (28.3%), and moderate need (18.4%). In each class, median domain scores in each domain were similar. Low and moderate need classes were associated with worse health-related quality of life and greater helplessness. Unmet service needs were associated with the moderate-need class only. Patients with unmet supportive care needs should be offered holistic care across supportive care domains.
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Affiliation(s)
- Emma Lidington
- The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK; (E.L.); (S.S.); (S.B.); (W.T.A.v.d.G.)
| | - Anne-Sophie Darlington
- Health Sciences, University of Southampton, University Road, Highfield, Southampton SO17 1BJ, UK; (A.-S.D.); (A.D.)
| | - Amy Din
- Health Sciences, University of Southampton, University Road, Highfield, Southampton SO17 1BJ, UK; (A.-S.D.); (A.D.)
| | - Susannah Stanway
- The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK; (E.L.); (S.S.); (S.B.); (W.T.A.v.d.G.)
| | - Susana Banerjee
- The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK; (E.L.); (S.S.); (S.B.); (W.T.A.v.d.G.)
- Division of Clinical Studies, Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK
| | - Zoltan Szucs
- East Suffolk and North Essex NHS Foundation Trust, Ipswich Hospital, Health Road, Ipswich IP4 5PD, UK;
| | - Michael Gonzalez
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, Hammersmith, London W6 8RF, UK;
| | - Anand Sharma
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood HA6 2RN, UK;
| | - Bhawna Sirohi
- Barts Health NHS Trust, St Bartholomew’s Hospital, W Smithfield, London EC1A 7BE, UK;
- Apollo Proton Cancer Centre, 4/661, Dr Vikram Sarabai Instronic Estate 7th St., Dr. Vasi Estate, Phase II, Tharamani, Chennai 600096, India
| | - Winette T. A. van der Graaf
- The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK; (E.L.); (S.S.); (S.B.); (W.T.A.v.d.G.)
- Department of Medical Oncology, Netherlands Cancer Institute–Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Olga Husson
- Division of Clinical Studies, Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK
- Department of Medical Oncology, Netherlands Cancer Institute–Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Correspondence:
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18
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Fayyaz R, Ahmed FA, Abid A, Akhtar A, Jarwar R, Jasmine A, Khan SA, Shahid S, Khan I, Yousuf AM, Jehan I. The quality of patient care in oncology departments in Karachi, Pakistan: patients' perceptions. Int J Health Care Qual Assur 2021; ahead-of-print. [PMID: 33381957 DOI: 10.1108/ijhcqa-12-2019-0201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study aims to assess the quality of care among adult oncology patients in tertiary care hospitals in Karachi by using an international standard of quality of care and to identify domains where improvement is needed. DESIGN/METHODOLOGY/APPROACH This is a cross-sectional study carried out at two tertiary care hospitals of Karachi, Pakistan, belonging to private and public sector, respectively, between February and April 2018. Face-to-face interviews were conducted using a modified questionnaire having five-point Likert scale questions regarding satisfaction of patients with doctors, nursing staff, information provided and the hospital standards. SPSS 20 was used for statistical analysis, and the results were expressed using mean, frequencies, percentages and p-values. FINDINGS The authors approached 415 patients, out of which 389 patients agreed to participate in the study. For both hospitals, the lowest mean scores were for sections pertaining to satisfaction with psychosocial support and information provided. The mean satisfaction score of patients from the private hospital were found to be significantly higher as compared to patients from the public hospital for all domains of patient care (p-value < 0.01 using t-test for two independent samples). The data showed an increasing trend of "satisfied" responses as the household income increased. RESEARCH LIMITATIONS/IMPLICATIONS A comparative study should be conducted with the aim of pinpointing the differences in areas in which there is a significant difference in positive satisfaction levels between private and public sectors. Similar research could also be expanded adding other variables that affect quality of care such as doctor's approach to their patients, time given during each consultation and patient's understanding of doctor's knowledge. Further studies can be done to bridge the gaps between what a doctor views as standard care and what the patient knows will help them receive a more holistic approach to care. PRACTICAL IMPLICATIONS Assessing the quality of care helps determine gaps in care and allocating health resources accordingly. In clinical practice, emphasis needs to be given on increased duration and improved quality of patient counselling to improve the low satisfaction levels of patients regarding the psychosocial support. Addressing patients' concerns should be made part of clinical teaching from an undergraduate level. As far as patient access to doctors of the specific speciality is concerned, hospital managements should adopt systems to ensure continuum of care and come up with mechanisms to bridge the discrepancy between a patient's needs and doctor availability. SOCIAL IMPLICATIONS After being identified as a major deficiency, training doctors in the sensitivities of the population and demographics, especially with respect to socio-economic statuses, can aid in enhancing patient satisfaction to the treatment. Implementation of patient-centred care leads to greater satisfaction with care, which, in turn, increases a patient's self efficacy in managing important aspects of their care and improves health care-related quality of life. ORIGINALITY/VALUE Cancer patients have long-term exposure to the hospital environment. A patient's satisfaction with the quality of care is an important determinant in patient compliance to the treatment protocol and required hospital visits. There is a dearth of research on the outpatient quality of care in the oncology departments in Karachi. This study provides an overview of the quality of care available to cancer patients in Karachi both in public and private sectors. The results of our study identify the gaps in the quality of care being provided to the patients in a developing country like Pakistan, which can be used to improve the quality of care, leading to better patient outcomes.
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Affiliation(s)
- Risha Fayyaz
- Medical College, Aga Khan University, Karachi, Pakistan
| | | | - Adeel Abid
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Afshan Akhtar
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Rabail Jarwar
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Anila Jasmine
- Medical College, Aga Khan University, Karachi, Pakistan
| | | | | | - Iraj Khan
- Medical College, Aga Khan University, Karachi, Pakistan
| | | | - Imtiaz Jehan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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19
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Sender A, Friedrich M, Leuteritz K, Stuckenberg E, Richter D, Stöbel-Richter Y, Lordick F, Geue K. Psychosocial aftercare of adolescent and young adult cancer survivors in Germany: Awareness, utilisation, satisfaction and associated factors. Psychooncology 2021; 30:1311-1321. [PMID: 33739567 DOI: 10.1002/pon.5678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/02/2021] [Accepted: 02/25/2021] [Indexed: 11/10/2022]
Abstract
AIM This study systematically assesses the awareness of, utilisation of and satisfaction with psychosocial care for adolescents and young adult (AYA) cancer survivors in aftercare. METHODS Survivors between 18 and 39 years were surveyed in aftercare. Awareness of, utilisation of and satisfaction with psychological counselling (PC), social-legal counselling (SLC) and other psychosocial care (OPC) were measured using self-developed questionnaires. Multivariate analyses were conducted to determine factors correlated with awareness and use of psychosocial care. RESULTS Five hundred and fourteen survivors participated; the mean age at diagnosis was 29.6 years (SD = 6.14). 54% of cancer survivors were aware of PC, 45% of SLC and 24% of OPC. Those who possessed knowledge about these services used it to a considerable extent (63%-74%), and the majority (66%-75%) was highly satisfied. No common factors could be found that increase the likelihood of being aware of these three services (R2 = 0.028-0.138). Female gender (OR = 2.08-2.18) and high anxiety (OR = 1.19-1.38) were identified as common factors that increase the likelihood of utilising psychosocial services (R2 = 0.160-0.395). CONCLUSION AYA who are aware of psychosocial services in aftercare are motivated to use them and express high satisfaction with use. For the utilisation of psychosocial services, anxiety and female gender can be identified as common factors. The visibility of psychosocial services for aftercare should be increased given the high number of unaware AYA survivors. The active and repeated addressing of psychosocial issues and regular provision of information (e.g., written guides on survivorship) by caregivers should be made a standard of care for AYA cancer survivors.
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Affiliation(s)
- Annekathrin Sender
- Department of Mental Health, Medical Psychology & Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Michael Friedrich
- Department of Mental Health, Medical Psychology & Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Katja Leuteritz
- Department of Mental Health, Medical Psychology & Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Erik Stuckenberg
- St. Elisabeth and St. Barbara Hospital, Medical Clinic II, Halle (Saale), Germany
| | - Diana Richter
- Department of Mental Health, Medical Psychology & Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Yve Stöbel-Richter
- University of Leipzig, Integrated Research and Treatment Center, Behavioral Medicine, Leipzig, Germany.,University of Zittau/Goerlitz, Faculty of Managerial and Cultural Studies, Goerlitz, Germany
| | - Florian Lordick
- University of Leipzig, Medical Center, University Cancer Center Leipzig, Leipzig, Germany
| | - Kristina Geue
- Department of Mental Health, Medical Psychology & Medical Sociology, University of Leipzig, Leipzig, Germany
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20
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"There Should Have Been a More Holistic Approach"-A Qualitative Study of Young Adult Cancer Survivors' Experiences of Follow-up After Cancer Treatment. Cancer Nurs 2021; 45:E299-E308. [PMID: 33481409 DOI: 10.1097/ncc.0000000000000924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Young adult cancer survivors (YACSs) are in a vulnerable period of life with increased risk of severe physical and psychosocial late effects. However, limited research exists on follow-up of YACSs after cancer treatment. OBJECTIVE The aim of this study was to explore how YACSs experience follow-up from the healthcare system after finishing cancer treatment. METHODS Using a qualitative method with an interpretive descriptive design, 20 YACSs were interviewed 4 times over a period of 6 months. The transcribed interviews were analyzed using Systematic Text Condensation. RESULTS Four main themes were identified: "They should have prepared me better," "The GP (general practitioner) does not understand my challenges," "My check-ups are all about cancer relapse," and "I do not know who's in charge." CONCLUSION The findings indicate deficiency in the healthcare system's follow-up of YACSs in terms of preparation for the survival phase, interdisciplinary cooperation, and acknowledgement of late effects, as well as organization of follow-up care within the healthcare system. IMPLICATIONS FOR PRACTICE A more holistic perspective on follow-up care that addresses YACSs' multidimensional challenges is suggested, including a multidisciplinary approach where cancer nurses should play an active role.
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21
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Okamura M, Fujimori M, Sato A, Uchitomi Y. Unmet supportive care needs and associated factors among young adult cancer patients in Japan. BMC Cancer 2021; 21:17. [PMID: 33402126 PMCID: PMC7786954 DOI: 10.1186/s12885-020-07721-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 12/09/2020] [Indexed: 12/18/2022] Open
Abstract
Background Young adult cancer patients often face unique challenges and have potential unmet needs. This study aimed (1) to describe unmet supportive care needs among young adults with cancer in Japan, and (2) to identify its associated factors. Methods In a cross-sectional web-based survey, 206 young adults with cancer were assessed for supportive care needs. Multiple regression analysis examined whether demographics, clinical variables and social support were associated with unmet supportive care needs. Results A total of 206 patients (180 female) with a mean age of 33.7 years (SD = 4.3, range: 22–39) participated. One hundred and fifty-eight participants (76.7%) reported at least one unmet supportive care needs. The top 20 unmet needs included 9 of the 10 psychological needs, 3 of the 5 physical and daily living needs, 8 of the 11 health system and information needs and 1 of the 5 sexuality needs. Multiple regression analysis revealed that perceived poorer PS, experience of change in work/school after a cancer diagnosis and poor social support were significantly associated with higher supportive care needs. The total score of supportive care needs was significantly associated with both psychological distress and QOL. Conclusions More than 70% of young adult cancer patients reported unmet supportive care needs and most of those were psychological needs. The findings suggest potential opportunities for intervention in addressing psychological needs rather than physical and information needs.
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Affiliation(s)
- Masako Okamura
- Division of Behavioral Science Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Tokyo, 104-0045, Japan.,Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
| | - Maiko Fujimori
- Division of Behavioral Science Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Tokyo, 104-0045, Japan. .,Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan.
| | - Ayako Sato
- Division of Behavioral Science Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Tokyo, 104-0045, Japan.,Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
| | - Yosuke Uchitomi
- Division of Behavioral Science Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Tokyo, 104-0045, Japan.,Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
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