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Sherborne V, Ejegi-Memeh S, Tod AM, Taylor B, Hargreaves S, Gardiner C. Living with mesothelioma: a systematic review of mental health and well-being impacts and interventions for patients and their informal carers. BMJ Open 2024; 14:e075071. [PMID: 38951010 DOI: 10.1136/bmjopen-2023-075071] [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] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVES Mesothelioma is an aggressive cancer predominantly affecting the lung and abdominal linings. It can have a unique impact on mental health and well-being (MHWB) due to its incurability, poor prognosis and asbestos-exposure causation. This review's aims were to identify/synthesise international evidence on mesothelioma's MHWB impacts; explore MHWB interventions used by patients and carers; and identify evidence of their effectiveness. DESIGN Systematic review. DATA SOURCES Databases, searched March 2022 and March 2024, were MEDLINE; CINAHL; PsycINFO; Cochrane Library; ASSIA. ELIGIBILITY CRITERIA We included study designs focusing on psychological impacts of living with mesothelioma and MHWB interventions used by patients and informal carers, published in English since January 2002. DATA EXTRACTION AND SYNTHESIS A team of reviewers screened included studies using standardised methods. Quality was assessed using validated tools: Mixed-Methods Appraisal tool for primary research and Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews. RESULTS Forty-eight studies met the inclusion criteria: 20 qualitative, 16 quantitative, nine reviews, two mixed-methods, one combined systematic review/qualitative study. UK studies predominated. Many MHWB impacts were reported, including traumatic stress, depression, anxiety and guilt. These were influenced by mesothelioma's causation, communication issues and carer-patient relational interactions. Participants used wide-ranging MHWB interventions, including religious/spiritual practice; talking to mental-health professionals; meaning-making. Some strategies were presented as unhelpful, for example, denial. Participants reported lack of access to support. CONCLUSIONS Most qualitative studies were rated high quality. The quality of the quantitative studies and reviews varied. The sparse literature regarding MHWB in mesothelioma means more research is needed into impacts on patients and carers, including trauma. To enable access to evidence-based support, research is recommended concerning MHWB interventions' effectiveness in mesothelioma. PROSPERO REGISTRATION NUMBER CRD42022302187.
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Affiliation(s)
- Virginia Sherborne
- Mesothelioma UK Research Centre, Division of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - Stephanie Ejegi-Memeh
- Mesothelioma UK Research Centre, Division of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - Angela Mary Tod
- Mesothelioma UK Research Centre, Division of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - Bethany Taylor
- Mesothelioma UK Research Centre, Division of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - Sarah Hargreaves
- Mesothelioma UK Research Centre, Division of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - Clare Gardiner
- Mesothelioma UK Research Centre, Division of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
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Ejegi-Memeh S, Sherborne V, Mayland C, Tod A, Taylor BH. Mental health and wellbeing in mesothelioma: A qualitative study exploring what helps the wellbeing of those living with this illness and their informal carers. Eur J Oncol Nurs 2024; 70:102572. [PMID: 38640636 DOI: 10.1016/j.ejon.2024.102572] [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: 10/24/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE Mesothelioma is an incurable, asbestos related cancer with a poor prognosis. Little is known about how patients and carers living with the condition manage their mental health and wellbeing needs. This paper reports findings on interventions being used by patients and informal carers living with mesothelioma and those which they find most helpful. METHODS In-depth interviews with patients (n = 10) and (informal) carers (n = 11) living with mesothelioma in the UK. We analysed our data inductively using a reflexive thematic analysis approach. RESULTS Participants described the importance of both smaller and larger actions and strategies which helped with their mental health. This included spending more time with family and friends and going on holidays. Professionals who participants said supported their mental health journey included not only specialist nurses and mental health professionals but also legal and Asbestos Support Group professionals. The latter demonstrates the unique needs and support required for this population. Exposure to asbestos as the cause of mesothelioma, has led to a social justice aspect of the experience of living with this cancer. Participants reported the importance of collective action to their mental health and wellbeing. The data indicate that patients and carers may have distinct mental health and wellbeing requirements and need to manage these in different ways at different times. CONCLUSIONS Findings have implications for nurses and other key professionals working in healthcare, community and legal settings supporting this client group, and for those living with mesothelioma who want to understand ways to enhance their own wellbeing.
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Affiliation(s)
- Stephanie Ejegi-Memeh
- Mesothelioma UK Research Centre, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, UK.
| | - Virginia Sherborne
- Mesothelioma UK Research Centre, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, UK
| | - Catriona Mayland
- Division of Clinical Medicine, School of Medicine & Population Health, UK
| | - Angela Tod
- Mesothelioma UK Research Centre, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, UK
| | - Bethany H Taylor
- Mesothelioma UK Research Centre, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, UK
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Sherborne V, Wood E, Mayland CR, Gardiner C, Lusted C, Bibby A, Tod A, Taylor B, Ejegi-Memeh S. The mental health and well-being implications of a mesothelioma diagnosis: A mixed methods study. Eur J Oncol Nurs 2024; 70:102545. [PMID: 38522172 DOI: 10.1016/j.ejon.2024.102545] [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: 10/31/2023] [Revised: 02/21/2024] [Accepted: 03/03/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Mesothelioma is an incurable, asbestos-related cancer with a poor prognosis. There is scant evidence about the mental health and well-being impacts on patients and carers living with the illness. This study aimed to investigate mesothelioma's impact on mental health and well-being and the scale of mental health conditions in patients and informal carers. METHODS A mixed-methods design was used: a cross-sectional survey of mesothelioma patients and informal carers plus semi-structured interviews with patients and carers. The survey used validated scales collecting data on mental health aspects of mesothelioma: the EQ5D to assess health-related quality-of-life; the Hospital Anxiety and Depression scale; the PCL-5 to assess Posttraumatic Stress; and the Posttraumatic Growth Inventory. The datasets were integrated during analysis. RESULTS 96 useable survey responses were received. A clinical level of depression was reported by 29 participants (30.21%), of anxiety by 48 (50%), of posttraumatic distress disorder by 32 (33.33%), and of posttraumatic growth by 34 (35.42%). Carers had worse scores than patients. Three main themes were developed from interviews with 10 patients and 11 carers: 'Prognosis', 'Support from services', and 'Social connections and communication'. CONCLUSIONS Healthcare professionals delivering a mesothelioma diagnosis require regular training in communication skills plus updating in current treatment options, so they provide an appropriate mix of realism and hope. Better signposting to mental health support is needed for patients and carers. Our introduction of posttraumatic growth into the mesothelioma literature is novel. We recommend specialist nurses are trained to recognise, understand, and foster posttraumatic growth.
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Affiliation(s)
- Virginia Sherborne
- Mesothelioma UK Research Centre, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield, S10 2LA, UK.
| | - Emily Wood
- Division of Population Health, School of Medicine and Population Health, The University of Sheffield, UK
| | - Catriona R Mayland
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, UK
| | - Clare Gardiner
- Mesothelioma UK Research Centre, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield, S10 2LA, UK
| | - Caitlin Lusted
- Mesothelioma UK Research Centre, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield, S10 2LA, UK
| | - Anna Bibby
- Academic Respiratory Unit, University of Bristol and North Bristol NHS Trust, Bristol, UK
| | - Angela Tod
- Mesothelioma UK Research Centre, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield, S10 2LA, UK
| | - Bethany Taylor
- Mesothelioma UK Research Centre, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield, S10 2LA, UK
| | - Stephanie Ejegi-Memeh
- Mesothelioma UK Research Centre, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield, S10 2LA, UK
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Gao Y, Mazurek JM, Li Y, Blackley D, Weissman DN, Burton SV, Amin W, Landsittel D, Becich MJ, Ye Y. Industry, occupation, and exposure history of mesothelioma patients in the U.S. National Mesothelioma Virtual Bank, 2006-2022. ENVIRONMENTAL RESEARCH 2023; 230:115085. [PMID: 36965810 PMCID: PMC10994633 DOI: 10.1016/j.envres.2022.115085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/14/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Malignant mesothelioma is associated with environmental and occupational exposure to certain mineral fibers, especially asbestos. This study aims to examine work histories of mesothelioma patients and their survival time. METHOD Using the NIOSH Industry and Occupation Computerized Coding System, we mapped occupations and industries recorded for 748 of 1444 patients in the U.S. National Mesothelioma Virtual Bank (NMVB) during the period 2006-2022. Descriptive and survival analyses were conducted. RESULTS Among the 1023 industries recorded for those having mesothelioma, the most frequent cases were found for those in manufacturing (n = 225, 22.0%), construction (138, 13.5%), and education services (66, 6.5%); among the 924 occupation records, the most frequent cases were found for those in construction and extraction (174, 18.8%), production (145, 15.7%), and management (84, 9.1%). Males (583) or persons aged >40 years (658) at the time of diagnosis tended to have worked in industries traditionally associated with mesothelioma (e.g., construction), while females (163) or persons aged 20-40 years (27) tended to have worked in industries not traditionally associated with mesothelioma (e.g., health care). Asbestos, unknown substances, and chemical solvents were the most frequently reported exposure, with females most often reporting an unknown substance. A multi-variable Cox Hazard Regression analysis showed that significant prognostic factors associated with decreased survival in mesothelioma cases are sex (male) and work experience in utility-related industry, while factor associated with increased survival are epithelial or epithelioid histological type, prior history of surgery and immunotherapy, and industry experience in accommodation and food services. CONCLUSION The NMVB has the potential of serving as a sentinel surveillance mechanism for identifying industries and occupations not traditionally associated with mesothelioma. Results indicate the importance of considering all potential sources of asbestos exposures including occupational, environmental, and extra-occupational exposures when evaluating mesothelioma patients and advising family members.
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Affiliation(s)
- Yuhe Gao
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, USA
| | - Jacek M Mazurek
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, USA
| | - Yaming Li
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, USA
| | - David Blackley
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, USA
| | - David N Weissman
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, USA
| | - Shirley V Burton
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, USA
| | - Waqas Amin
- Clinical and Translational Sciences Institute, School of Medicine, Indiana University, USA
| | - Douglas Landsittel
- Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, USA
| | - Michael J Becich
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, USA
| | - Ye Ye
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, USA.
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Johnson M, Allmark P, Tod A. Living beyond expectations: a qualitative study into the experience of long-term survivors with pleural mesothelioma and their carers. BMJ Open Respir Res 2022; 9:e001252. [PMID: 35649637 PMCID: PMC9161101 DOI: 10.1136/bmjresp-2022-001252] [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] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/14/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is characterised by poor prognosis and limited treatment options. However, a minority of patients can survive well beyond these bleak estimates. Little is known about the specific experiences and needs of long-term survivors and families. STUDY PURPOSE The study aimed to gain in-depth understanding of the experiences of patients diagnosed with MPM 3 or more years, along with their main carer, and to determine the care and support needs of this group. PARTICIPANTS AND SETTING People diagnosed with MPM 3 or more years were recruited via asbestos and mesothelioma social media and support groups. Potential participants were asked to identify someone who acted as their main carer. METHOD The study employed a cross-sectional qualitative interview design. A topic guide aided a conversational interview style, conducted remotely and recorded. Patient and carer pairs were interviewed jointly when possible, but were given an option for separate interviews if preferred. Fifteen patients, with 14 identifying a main carer, consented to participation. ANALYSIS Recorded interviews were transcribed verbatim, and then anonymised by the interviewer. Framework analysis was used to analyse the data iteratively and to develop final themes. FINDINGS Three themes were developed. Participants 'Living beyond expectations' remained acutely aware that MPM was incurable, but developed a range of coping strategies. Periods of disease stability were punctuated with crises of progression or treatment ending, straining coping. 'Accessing treatment' was important for patients and carers, despite the associated challenges. They were aware options were limited, and actively sought new treatments and clinical trials. 'Support needs' were met by healthcare professionals, voluntary groups and social media networks. CONCLUSIONS Managing patients via regional MPM multidisciplinary teams, facilitating equal access to treatment and trials, could reduce patient and carer burden. Greater awareness and support around crisis points for this group could improve care.
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Affiliation(s)
- Matthew Johnson
- Cancer Nursing, Royal Brompton and Harefield Hospitals, London, UK
- Division of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - Peter Allmark
- Division of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - Angela Tod
- Division of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
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Bibby AC, Morley AJ, Keenan E, Maskell NA, Gooberman-Hill R. The priorities of people with mesothelioma and their carers: A qualitative interview study of trial participation and treatment decisions. Eur J Oncol Nurs 2022; 57:102111. [DOI: 10.1016/j.ejon.2022.102111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 12/29/2022]
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Senek M, Robertson S, Darlison L, Creech L, Tod A. Malignant pleural mesothelioma patients’ experience by gender: findings from a cross-sectional UK-national questionnaire. BMJ Open Respir Res 2022; 9:9/1/e001050. [PMID: 35058235 PMCID: PMC8783831 DOI: 10.1136/bmjresp-2021-001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Malignant mesothelioma is an aggressive malignancy of mesothelial surfaces, most commonly those of the pleura. The aim of this study was to understand, using a national questionnaire, the gendered care experiences of patients with malignant pleural mesothelioma (MPM). Patients were asked about their experience of the diagnostic process, about information clarity, health care professionals’ knowledge, general practitioner support and overall satisfaction with care received. Setting Recruitment of patients was carried out in three UK countries (England, Wales and Scotland) via mesothelioma clinical nurse specialists. Participants In total, 503 patients completed the questionnaire. 460 had MPM, the remainder had other types of mesothelioma. In accord with the study protocol, only the MPM patients were included in this study. Primary and secondary measures were: (1) time from symptom to diagnosis, (2) satisfaction with the diagnosis and treatment, and (3) quality of life and well-being. Results There were gender differences in time from symptom to diagnosis. The time from symptom to diagnosis was significantly longer for women than men (median=152 days vs men=92 days, p=0.01). Lack of a verified source of exposure to asbestos was a hindrance to private treatment access for women (95% of those that access private treatment are men). Patients were five times more likely to be satisfied if they thought that the doctors knew enough about their condition (OR=4.4, p=0.001) and nearly three times more likely to be satisfied if information was presented in a sensitive way (OR=2.8, p=0.01). Conclusions This study has several implications for clinical practice. Our findings suggest that the diagnostic time in women might be reduced by reviewing diagnostic processes including occupational history taking, and by revising the occupational risk of mesothelioma categorisation.
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Affiliation(s)
- Michaela Senek
- Division of Nursing and Midwifery, School of Health Sciences, The University of Sheffield, Sheffield, UK
| | - Steve Robertson
- Division of Nursing and Midwifery, School of Health Sciences, The University of Sheffield, Sheffield, UK
| | | | | | - Angela Tod
- Division of Nursing and Midwifery, School of Health Sciences, The University of Sheffield, Sheffield, UK
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Park GR, Kim J. Gendered trajectories of depressive symptoms and social interactions among cancer patients. Eur J Oncol Nurs 2022; 56:102092. [PMID: 34999426 DOI: 10.1016/j.ejon.2021.102092] [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: 05/31/2021] [Revised: 10/08/2021] [Accepted: 12/29/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This study examines whether and how depressive symptoms and social interactions change before and after cancer diagnosis, and whether this pattern varies by gender. METHODS This study used data about 722 middle- and older-aged adults from seven waves (3,963 person-observations) of the Korean Longitudinal Study of Ageing spanning 12 years between 2006 and 2018. Gender-stratified fixed effects regression models were used to investigate the effect of cancer diagnosis on changes in depressive symptoms and the frequency of social interactions (with friends, relatives, acquaintances, and neighbors) before and after cancer diagnosis. RESULTS For both men and women, an increase in depressive symptoms was found in the first and second year after cancer diagnosis, though the increase in the second year was significantly greater for men than women. Only men continued to suffer higher depressive symptoms after the third year and subsequent years. This study also found a decrease in the frequency of social interactions only among men in the second year and subsequent years after cancer diagnosis. CONCLUSION Trajectories of psychosocial adjustment to cancer are gendered. The psychosocial consequences of cancer are greater and last longer for men than women.
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Affiliation(s)
- Gum-Ryeong Park
- Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada; Korea Institute for Health and Social Affairs, Sejong, Republic of Korea
| | - Jinho Kim
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea; Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea; Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, WI, USA.
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