Social support for older adults with cancer: Young International Society of Geriatric Oncology review paper

Social support and physical literacy in young and middle-aged patients with hypertension: the mediating effects of sense of coherence and self-efficacy

BACKGROUND

Despite the growing recognition of the importance of social support and physical literacy in managing hypertension among young and middle-aged patients, there is a lack of research exploring the mediating effects of sense of coherence and self-efficacy in this relationship. This study aims to bridge this gap by investigating the interplay between social support, physical literacy, sense of coherence, and self-efficacy, thus contributing to a deeper understanding of effective interventions for hypertension management.

METHODS

A cross-sectional study was conducted using convenience sampling to survey 280 young and middle-aged patients diagnosed with hypertension from five community settings in Zhejiang and Anhui provinces between January and February 2024. Measurement instruments included the General Information Questionnaire, Physical Literacy Scale for Young and Middle-aged Patients with Hypertension, Sense of Coherence Scale 13, General self-efficacy Scale, and Perception Social Support Scale. Data analysis was performed using SPSS 27.0 and AMOS 28.0, with reporting following the STROBE checklist.

RESULTS

A total of 270 valid questionnaires were collected. The total score of physical literacy for young and middle-aged patients with hypertension ranged from 18 to 90, with a mean score of 62.30 ± 13.92, indicating a moderate level. There was a positive correlation between the physical literacy score and the scores of social support (r = 0.557, P<0.01), sense of coherence (r = 0.392, P<0.01), and self-efficacy (r = 0.466, P<0.01) among young and middle-aged patients with hypertension. Furthermore, social support was found to have multiple mediating effects through sense of coherence and self-efficacy on physical literacy.

CONCLUSION

This study sheds light on the interconnectedness of social support, physical literacy, sense of coherence, and self-efficacy among young and middle-aged patients with hypertension. The findings underscore the importance of considering these factors holistically in hypertension management strategies.

Social Support Buffers the Effect of Social Deprivation on Comorbidity Burden in Adults with Cancer

BACKGROUND

Adults with cancer have higher rates of comorbidity compared to those without cancer, with excess burden in people from lower socioeconomic status (SES). Social deprivation, based on geographic indices, broadens the focus of SES to include the importance of "place" and its association with health. Further, social support is a modifiable resource found to have direct and indirect effects on health in adults with cancer, with less known about its impact on comorbidity.

PURPOSE

We prospectively examined associations between social deprivation and comorbidity burden and the potential buffering role of social support.

METHODS

Our longitudinal sample of 420 adults (Mage = 59.6, SD = 11.6; 75% Non-Hispanic White) diagnosed with cancer completed measures at baseline (~6 months post-diagnosis) and four subsequent 3-month intervals for 1 year.

RESULTS

Adjusting for age, cancer type, and race/ethnicity, we found a statistically significant interaction between social support and the effect of social deprivation on comorbidity burden (β = -0.11, p = 0.012), such that greater social support buffered the negative effect of social deprivation on comorbidity burden.

CONCLUSION

Implementing routine screening for social deprivation in cancer care settings can help identify patients at risk of excess comorbidity burden. Clinician recognition of these findings could trigger a referral to social support resources for individuals high on social deprivation.

Social determinants of health and depressive symptoms before and after cancer diagnosis

Despite frequent reports of mental health needs among older women with cancer, depressive symptoms often go unrecognized and untreated, particularly in socially vulnerable survivors. Here, we examined associations of sociodemographic factors and social limitations with depressive symptoms from pre-diagnosis to post-diagnosis in older women diagnosed with breast or gynecological cancer. Using the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) linked dataset, we used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between sociodemographic factors (race, ethnicity, marital status, rurality) and social limitations (i.e., health interfering with social activities) on depressive symptoms in women aged ≥65 years with breast or gynecologic cancer (n = 1,353). Most participants had breast cancer (82.0%), stage I-II cancer (85.8%), received surgery for their cancer (94.8%), and radiation treatment (50.6%). Prior to diagnosis, 11.8% reported depressive symptoms, which nearly doubled to 22.4% at follow-up. Participants were 2.7 times more likely of reporting depressive symptoms after cancer diagnosis compared with pre-cancer diagnosis (95%CI: 2.10-3.48). Race, ethnicity, rurality, marital status, and social interference were significantly associated with an increased risk of depressive symptoms after cancer diagnosis than before their cancer diagnosis (p < 0.05). In summary, depressive symptoms increased following a cancer diagnosis. Our results suggest potential avenues for intervention that could lead to reduced depressive symptoms among older female cancer survivors.

Impact of Psychosocial Factors on the Activity of Crohn's Disease: A Cross-Sectional Analysis of Social Support, Stress, and Flare-Up Incidence

Background/Objectives: Crohn's disease is a chronic and debilitating intestinal disorder that alternates between remission and active flare-ups, often leading to hospitalization. Social support is known to enhance adaptation to the disease and modulate stress perception in patients, while stress may exacerbate symptoms. The aim of this study was to examine the roles of perceived stress and social support in Crohn's disease and their impact on the frequency of flare-ups. Methods: A cross-sectional observational study was conducted, assessing stress and social support in a cohort of 91 patients with Crohn's disease during flare-up and remission phases. The Perceived Stress Scale (PSS-14) and a Social Support Questionnaire were utilized for evaluation. We examined the relationship between stress and social support in Crohn's disease. The interaction between the variables studied was also observed, considering the stage of the disease. Finally, we carried out an analysis of the influence of these two variables on the development of flare-ups in Crohn's disease. Results: The study revealed that patients experience higher stress levels during flare-ups and that these levels are amplified by a lack of social support. A significant relationship was identified between the levels of social support and the occurrence of flare-ups, indicating that better social support is associated with fewer flare-ups. Conclusions: Patients with Crohn's disease in the flare-up phase are subject to considerable stress. A deficit in social support is linked to an increase in stress levels. The interaction between social support and stress plays a critical role in the development of flare-ups.

Tailored Self-Management App to Support Older Adults With Cancer and Multimorbidity: Development and Usability Testing

BACKGROUND

Globally, cancer predominates in adults aged older than 60 years, and 70% of older adults have ≥1 chronic condition. Cancer self-management interventions can improve symptom management and confidence, but few interventions target the complex needs of older adults with cancer and multimorbidity. Despite growing evidence of digital health tools in cancer care, there is a paucity of theoretically grounded digital self-management supports for older adults. Many apps for older adults have not been co-designed with older adults to ensure that they are tailored to their specific needs, which would increase usability and uptake.

OBJECTIVE

We aim to report on the user evaluations of a self- and symptom-management app to support older adults living with cancer and multimorbidity.

METHODS

This study used Grey's self-management framework, a design thinking approach, and involved older adults with lived experiences of cancer to design a medium-fidelity app prototype. Older adults with cancer or caregivers were recruited through community organizations or support groups to participate in co-designing or evaluations of the app. Data from interviews were iteratively integrated into the design process and analyzed using descriptive statistics and thematic analyses.

RESULTS

In total, 15 older adults and 3 caregivers (n=18) participated in this study: 10 participated (8 older adults and 2 caregivers) in the design of the low-fidelity prototype, and 10 evaluated (9 older adults and 1 caregiver) the medium-fidelity prototype (2 older adults participated in both phases). Participants emphasized the importance of tracking functions to make sense of information across physical symptoms and psychosocial aspects; a clear display; and the organization of notes and reminders to communicate with care providers. Participants also emphasized the importance of medication initiation or cessation reminders to mitigate concerns related to polypharmacy.

CONCLUSIONS

This app has the potential to support the complex health care needs of older adults with cancer, creating a "home base" for symptom management and support. The findings from this study will position the researchers to conduct feasibility testing and real-world implementation.

People-Oriented Nursing Mode on the Negative Emotions and Psychological Status of Patients with Bladder Cancer

Background

We aimed to investigate the clinical application effect of people-oriented nursing model on the negative emotions and psychological conditions of patients with bladder cancer.

Methods

Eighty patients with bladder cancer were enrolled from January 2020 to January 2022 in the Second Affiliated Hospital of Qiqihar Medical University Heilongjiang, Province, China. The patients were randomly divided into the control group, each group consisted of 40 patients (conventional nursing mode) and the experimental group (people-oriented nursing mode) according to the admission time. The differences of the anxiety, depression and quality of life scores at the time of admission and discharge were compared between the two groups.

Results

There was statistically significant differences in the Self-Rating Anxiety Scale (SAS) and Self-rating depression scale (SDS) score within each group of patients and between the two groups at the time of admission and discharge, respectively (P=0.001). In addition, there was a statistically significant difference in the scores at discharge, and the scores of the patients in the experimental group were better than those in the control group. There was a statistically significant difference in the scores at discharge, and the scores of the experimental group were lower than those of the control group P<0.001). After comparing the overall scores of admission and discharge of the two groups of patients, the differences were statistically significant, and the scores at discharge were better improved than those at admission were.

Conclusion

The people-oriented nursing model could relieve the negative emotions, relieve pain and improve the life quality of patients with bladder cancer.

Cellular therapies in older adults with hematological malignancies: A case-based, state-of-the-art review

Cellular therapies, including autologous stem cell transplant (ASCT), allogeneic hematopoietic cell transplantation (alloHCT), and chimeric antigen receptor- (CAR-) T cell therapies are essential treatment modalities for many hematological malignancies. Although their use in older adults has substantially increased within the past decades, cellular therapies represent intensive treatment approaches that exclude a large percentage of older adults due to comorbidities and frailty. Under- and overtreatment in older adults with hematologic malignancy is a challenge and many treatment decisions are influenced by chronologic age. The advent of efficient and well-tolerated newer treatment approaches for multiple myeloma has challenged the role of ASCT. In the modern era, there are no randomized clinical trials of transplant versus non-transplant strategies for patients ≥65 years. Nonetheless, ASCT is feasible for selected older patients and does not result in long-term compromise in quality of life. AlloHCT is the only curative approach for acute myeloid leukemia of intermediate and unfavourable risk but carries a significant risk for non-relapse mortality depending on comorbidities, general fitness, and transplant-specific characteristics, such as intensity of conditioning and donor choice. However, alloHCT is feasible in appropriately-selected older adults. Early referral for evaluation is strongly encouraged as this is the most obvious barrier. CAR-T cell therapies have shown unprecedented clinical efficacy and durability in relapsed and refractory diffuse large B cell lymphoma. Its use is well tolerated in older adults, although evidence comes from limited case numbers. Whether patients who are deemed unfit for ASCT qualify for CAR-T cell therapy remains elusive, but the tolerability and efficacy of CAR-T cell therapy appears promising, especially for older patients. The evidence from randomized trials is strong in favor of using a comprehensive geriatric assessment (CGA) to reduce treatment-related toxicities and guide treatment intensity in the care for solid tumors; its use for evaluation of cellular therapies is less evidence-based. However, CGA can provide useful information on patients' fitness, resilient mechanisms, and reveal potential optimization strategies for compensating for vulnerabilities. In this narrative review, we will discuss key questions on cellular therapies in older adults based on illustrative patient cases.

Anxiety and depression among cancer patients in Ethiopia: a systematic review and meta-analysis

Introduction

Anxiety and depression are among the common comorbidities of people diagnosed with cancer. However, despite the progress in therapeutic options and outcomes, mental health care and support have lagged behind for cancer patients. Estimating the extent and determinants of mental health disorders among cancer patients is crucial to alert concerned bodies for action. In view of this, we aimed to determine the pooled prevalence and determinants of anxiety and depression among cancer patients in Ethiopia.

Methods

Relevant literatures were searched on PubMed, African Journals Online, Hinari, Epistemonikos, Scopus, EMBASE, CINAHL, Cochrane Library, and Gray literature sources. Data were extracted into an Excel spreadsheet and analyzed using STATA 17 statistical software. The random effect model was used to summarize the pooled effect sizes with their respective 95% confidence intervals. The I2 statistics and Egger's regression test in conjunction with the funnel plot were utilized to evaluate heterogeneity and publication bias among included studies respectively.

Results

A total of 17 studies with 5,592 participants were considered in this review. The pooled prevalence of anxiety and depression among cancer patients in Ethiopia were 45.10% (95% CI: 36.74, 53.45) and 42.96% (95% CI: 34.98, 50.93), respectively. Primary and above education (OR= 0.76, 95% CI: 0.60, 0.97), poor social support (OR= 2.27, 95% CI: 1.29, 3.98), occupational status (OR= 0.59; 95% CI: 0.43, 0.82), advanced cancer stage (OR= 2.19, 95% CI: 1.38, 3.47), comorbid illness (OR= 1.67; 95% CI: 1.09, 2.58) and poor sleep quality (OR= 11.34, 95% CI: 6.47, 19.89) were significantly associated with depression. Whereas, advanced cancer stage (OR= 1.59, 95% CI: 1.15, 2.20) and poor sleep quality (OR= 12.56, 95% CI: 6.4 1, 24.62) were the factors associated with anxiety.

Conclusion

This meta-analysis indicated that a substantial proportion of cancer patients suffer from anxiety and depression in Ethiopia. Educational status, occupational status, social support, cancer stage, comorbid illness and sleep quality were significantly associated with depression. Whereas, anxiety was predicted by cancer stage and sleep quality. Thus, the provision of comprehensive mental health support as a constituent of chronic cancer care is crucial to mitigate the impact and occurrence of anxiety and depression among cancer patients. Besides, families and the community should strengthen social support for cancer patients.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023468621.

Low Social Well-Being in Advanced and Metastatic Prostate Cancer: Effects of a Randomized Controlled Trial of Cognitive Behavioral Stress Management

BACKGROUND

Social well-being impacts cancer patients' health-related quality of life (HRQOL) and coping style. This secondary analysis was conducted to examine whether advanced prostate cancer survivors who had experienced low social well-being would benefit from a web-based cognitive behavioral stress management (CBSM) intervention.

METHOD

APC survivors (N = 192) who had received androgen deprivation therapy (ADT) were randomized to a 10-week CBSM or a health promotion (HP) control condition. A subsample of participants (n = 61) with low pre-intervention SWB (measured by social support from and relationship satisfaction with family and friends) was included in the study. Multilevel models compared participants' PC-specific quality of life (sexual, hormonal, urinary), affect-based psychosocial burden (cancer-related anxiety and distress), and coping strategies at baseline, 6 months, and 12 months. Covariates were included in all models as appropriate.

RESULTS

Participants randomized to the CBSM condition showed significantly greater improvements in fear of cancer recurrence and cancer-related intrusive thoughts than those in the HP control condition. A significant condition by time interaction was also found, indicating that CBSM improved participants' PC-related fear in both short- (6 months) and long-term (12 months). However, the CBSM intervention did not significantly impact APC-related symptom burden. Only for the urinary domain, clinically meaningful changes (CBSM vs HP) were observed. In addition, all participants, regardless of condition, reported less coping (e.g., emotion-, problem- and avoidance-focused) over time.

CONCLUSION

As predicted, the CBSM intervention improved several affect-based psychosocial outcomes for APC survivors with low baseline SWB.

Disparities in care of older adults of color with cancer: A narrative review

This review describes the barriers and challenges faced by older adults of color with cancer and highlights methods to improve their overall care. In the next decade, cancer incidence rates are expected to increase in the United States for people aged ≥65 years. A large proportion will be older adults of color who often have worse outcomes than older White patients. Many issues contribute to racial disparities in older adults, including biological factors and social determinants of health (SDOH) related to healthcare access, socioeconomic concerns, systemic racism, mistrust, and the neighborhood where a person lives. These disparities are exacerbated by age-related challenges often experienced by older adults, such as decreased functional status, impaired cognition, high rates of comorbidities and polypharmacy, poor nutrition, and limited social support. Additionally, underrepresentation of both patients of color and older adults in cancer clinical research results in a lack of adequate data to guide the management of these patients. Use of geriatric assessments (GA) can aid providers in uncovering age-related concerns and personalizing interventions for older patients. Research demonstrates the ability of GA-directed care to result in fewer treatment-related toxicities and improved quality of life, thus supporting the routine incorporation of validated GA into these patients' care. GA can be enhanced by including evaluation of SDOH, which can help healthcare providers understand and address the needs of older adults of color with cancer who face disparities related to their age and race.

Case studies on psychosocial factors that help make exercise programmes for prostate cancer patients self-sustaining

OBJECTIVES

Patients with prostate cancer (PCa) benefit from regular exercise, but it is difficult for patients to maintain an exercise regime. We examined two exercise programmes that have proven to be self-sustaining with the goal of identifying features they share that may contribute to their success.

METHODS

We compared the FC Prostata football (soccer) league in Denmark and the 'Butts in a Boat' (BIAB) dragon-boating team in Canada. The FC Prostata Project Coordinator and the BIAB team leaders provided information on their programmes' history and structure.

RESULTS

Both programmes are team-based with regularly scheduled intense exercise at their core. In both cases, social activities evolved spontaneously, starting with the men going out for food and/or drinks after practices. The sustainability of these programmes may be driven by the regular socialisation linked to the fitness activities.

CONCLUSIONS

Our case studies suggest that exercise programmes for PCa patients may have a good chance of being self-sustaining, if they are: (1) centred around intense exercise, (2) of a team nature, (3) structured to promote egalitarianism and avoid one-on-one competition within teams, yet (4) have some competitions between teams. The data suggest that informal social activities organised by patients after team practices may be important for building fellowship and strengthening patients' commitment to exercise both for themselves and for their team members.

Sex differences in frailty among older adults

By definition, aging is a natural, gradual and continuous process. On the other hand, frailty reflects the increase in vulnerability to stressors and shortens the time without disease (health span) while longevity refers to the length of life (lifespan). The average life expectancy has significantly increased during the last few decades. A longer lifespan has been accompanied by an increase in frailty and decreased independence in older adults, with major differences existing between men and women. For example, women tend to live longer than men but also experience higher rates of frailty and disability. Sex differences prevent optimization of lifestyle interventions and therapies to effectively prevent frailty. Sex differences in frailty and aging are rooted in a complex interplay between uncontrollable (genetic, epigenetic, physiological), and controllable factors (psychosocial and lifestyle factors). Thus, understanding the underlying causes of sex differences in frailty and aging is essential for developing personalized interventions to promote healthy aging and improve quality of life in older men and women. In this review, we have discussed the key contributors and knowledge gaps related to sex differences in aging and frailty.

Experiences of Family Caregivers Providing Home Care to Older Patients With Cancer: A Qualitative Study

BACKGROUND

Older patients with cancer receive anticancer therapy in outpatient settings, and care-related issues may occur after discharge, which often requires family caregivers (FCs) to play a significant role in providing cancer care at home. However, relatively few studies have been focused on exploring the care experiences of these FCs.

PURPOSE

The aim of this study was to explore the care experiences of FCs caring for older family members with cancer at home.

METHODS

A qualitative study design and in-depth individual interviews were used to explore the at-home care experiences of FCs of older patients with cancer. The research was conducted in chemotherapy outpatient settings of a medical center in northern Taiwan. Content analysis was used to analyze data. The analyses focused on first extracting meaningful units from the text and then inducting categories from these units and determining the major themes.

RESULTS

Twenty FCs were interviewed. The three themes identified included (a) increased information needs and challenges in diet preparation and treatment decision making, (b) personal and patient-induced emotional stress, and (c) life rebalancing through the care experience.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings highlight the educational requirements, especially related to meeting personal dietary needs and obtaining psychological support, for FCs caring for older patients with cancer to help them rebalance their life.

Social media-based interventions for patients with cancer: a meta-analysis and meta-regression of randomised controlled trials

PURPOSE

This review aimed to (1) evaluate the effectiveness of social media-based interventions for improving the quality of life, anxiety and depressive symptoms of patients with cancer at post-intervention and follow-up; (2) identify the essential features of social media-based interventions and (3) explore the covariates of the treatment effect.

METHODS

All types of randomised controlled trials (RCTs) were included. Ten electronic databases, clinical trial registries and grey literature sources were searched from inception to 15 December 2021. Stata software was used to perform meta-analysis, subgroup analyses and meta-regression analyses. Individual quality assessment and certainty of evidence were assessed using Cochrane risk of bias tool version 1 and Grading of Recommendations Assessments, Development and Evaluation criteria, respectively.

RESULTS

This review included 43 RCTs, which comprised 6239 patients with a total mean age of 49.71 years old from across 11 countries. Social media-based interventions significantly improved the quality of life (g = 0.25, 95% CI = 0.05-0.45) and anxiety symptoms (g =  - 0.41, 95% CI =  - 0.76-0.07) but not depressive symptoms. The essential features based on the subgroup analysis concluded that using a mobile device with a flexible frequency had a remarkably greater effect on the quality of life and anxiety symptoms than their counterparts. The meta-regression showed the covariate features, where having more social media features in interventions significantly improved the quality of life (β = 0.21, p = 0.01). The certainty of evidence was very low for all outcomes.

CONCLUSIONS

Participants who received social media-based interventions may experience an increase in quality of life and reduction in anxiety symptoms.

IMPLICATIONS FOR CANCER SURVIVORS

Social media-based interventions may complement usual care in improving quality of life and anxiety symptoms. Registration in PROSPERO CRD42022297956.

Impact of cancer diagnosis and treatment: a qualitative analysis of strains, resources and coping strategies among elderly patients in a rural setting in Ghana

BACKGROUND

Rurality is fraught with numerous difficulties including a lack of advanced health facilities to provide health services, and an absence of specialist cancer services, and qualified personnel, among others. These factors exacerbate the challenges of elderly patients diagnosed with cancer and further pose limitations to activities/instrumental activities of daily living. Yet, there is limited scholarship on the strains that affect elderly patients diagnosed with cancer and the resources that helps them to overcome them. This study explores the strains, resources, and coping strategies of elderly patients diagnosed with cancer and undergoing treatment in rural Ghana.

METHODS

An exploratory, descriptive qualitative design was adopted. Purposive sampling was used to recruit 20 individuals to participate in in-depth interviews. The collected data was analysed inductively using Collaizi's framework. QSR NVivo-12 was used in managing the data.

RESULTS

The results were grouped into two main categories, namely: strains and resources. Within the category of strains, three main themes with their corresponding sub-themes emerged: cancer-related strains (systemic side effects from treatment, altered physical appearance and body image, and experience of pain), elderly strains (altered functional ability, limited social interactions and participation, psycho-emotional reactions, limited/restricted economic participation, and financial strains), and health system strains (negative attitude and insensitive communication, delay in diagnosis, lack of geriatric oncology care, lack of community-based specialist cancer centre and long travel distance to access care, and limited availability of essential cancer medicines and other radiations services). Four types of resources were available to cancer patients: personal resources, family resources, community resources, and healthcare systems resources.

CONCLUSION

In conclusion, elderly patients diagnosed with cancer experience physical, economic, psychological, and emotional strains that threaten their health and well-being. However, they are able to leverage family, community, and health system-related resources to navigate through the strains. There is, therefore, a need to expand advanced health facilities with geriatric oncology units and specialists to improve access to cancer care in rural areas. The government needs to assist elderly persons with costs associated with their diagnosis and treatment through the expansion of the National Health Insurance Scheme to include this as part of the benefits package.

Association of emotional support with quality of life, mental health, and survival in older adults with gastrointestinal malignancies-Results from the CARE registry

BACKGROUND

Emotional support (ES) is the most frequently reported support need among older adults with cancer. Yet, the association of ES with cancer outcomes is largely unknown. This study examined the association of ES with health-related quality of life (HRQoL), mental health, and survival among older adults with gastrointestinal (GI) malignancies.

METHODS

We included newly diagnosed older adults (≥60 years) with GI cancer undergoing self-reported geriatric assessment at their first clinic visit. ES was measured using an adaptation of the Medical Outcomes Study (dichotomized adequate ES vs. inadequate ES). Outcomes included physical and mental HRQoL, anxiety, depression, and survival. Multivariable linear regression evaluated the association between ES and HRQoL scores. Multivariable logistic regression evaluated the association of ES with anxiety and depression. All models were adjusted for age at geriatric assessments, race, sex, and cancer type/stage.

RESULTS

795 participants were included. Median patient age was 68 years (IQR: 64-74), 58% were male, and most cancers were either colorectal (37.9%) or pancreatic (30.8%). Most (77.6%) had adequate ES. Patients with inadequate ES were more likely to be Black (31.5 vs. 20.8%, p = 0.005), disabled (24.1 vs. 10.4%, p < 0.001), widowed/divorced (54.2 vs. 24.8%, p < 0.001) and had lower physical and mental HRQoL t-scores (Physical β: -3.35, 95% CI: -5.25, -1.46; Mental β: -2.46, 95% CI: -4.11, -0.81) and higher odds of depression (aOR: 2.22, CI: 1.34-3.69). This study found no difference between those with adequate ES versus inadequate ES in the proportion of deaths within 1 year of diagnosis (24.3% vs. 24.2%, p = 0.966), or within 2 years of diagnosis (32.4% vs. 33.2%, p = 0.126).

CONCLUSIONS

Older adults with inadequate ES have worse physical and mental HRQoL and higher odds of depression compared to those with adequate ES.

Social support score in patients with malignant diseases-with sociodemographic and medical characteristics

Introduction

Social support as a complex construct has a positive influence not only on a patient's condition but also on the process of the patient's emotional adjustment to cancer. The goal of this study is to investigate aspects of the level of social support in oncology patients and its interconnection with sociodemographic and medical variables.

Method

The study was conducted as a prospective observational study in 2020, including 250 patients aged 19 and over, both sexes, with a diagnosis of oncological disease. The research was conducted in the Department of General Medicine of the Health Center Trstenik, Central Serbia, after approval by the Ethics Committee of the Health Center Trstenik, Central Serbia. A social support assessment questionnaire (Oslo-3 Social Support Scale) was used as a research instrument.

Results

Data collected from the entire study population showed that bad social support was present in almost 90% of cases. Univariate and multivariate regression analysis showed a statistically significant influence of the following variables on the bad social support: education level, activity limitation, difficulties in performing daily activities, the impact of pain on the performance of activities, the need for additional help with activity, the need for help at home, unfulfilled needs for health care, means of information, anxiety score and depression score.

Conclusion

Interventions to increase social support may be important for enhancing mental health and quality of life in cancer patients.

Barriers and facilitators to physical activity prehabilitation in patients with kidney cancer

PURPOSE

Timely and effective physical activity (PA) prehabilitation is an evidence-based approach for improving a patient's health status preoperatively. Identifying barriers and facilitators to PA prehabilitation can help inform best practices for exercise prehabilitation program implementation. We explore the barriers and facilitators to PA prehabilitation in patients undergoing nephrectomy.

METHODS

A qualitative exploratory study was conducted by interviewing 20 patients scheduled for nephrectomy. Interviewees were selected via convenience sampling strategy. The interviews were semi-structured and discussed experienced and perceived barriers/facilitators to PA prehabilitation. Interview transcripts were imported to Nvivo 12 for coding and semantic content analysis. A codebook was independently created and collectively validated. Themes of barriers and facilitators were identified and summarized in descriptive findings based on frequency of themes.

RESULTS

Five relevant themes of barriers to PA prehabilitation emerged: 1) mental factors, 2) personal responsibilities, 3) physical capacity, 4) health conditions, and 5) lack of exercise facilities. Contrarily, facilitators potentially contributing to PA prehabilitation adherence in kidney cancer included 1) holistic health, 2) social and professional support, 3) acknowledgment of health benefits, 4) exercise type and guidance, and 5) Communication channels.

CONCLUSION AND KEY FINDINGS

Kidney cancer patient's adherence to physical activity prehabilitation is influenced by multiple biopsychosocial barriers and facilitators. Hence, adherence to physical activity prehabilitation requires timely adaptation of health beliefs and behavior embedded in the reported barriers and facilitators. For this reason, prehabilitation strategies should strive to be patient-centered and include health behavioral change theories as underlying frameworks for sustaining patient engagement and self-efficacy.

Determinants of poor quality of life in older patients with cancer: A longitudinal mixed methods study (PROGNOSIS-Q)

INTRODUCTION

Patient-reported outcomes are becoming more employed in oncologic research because many older patients with cancer prioritize preserved health-related quality of life (HRQoL) over prolonged survival. However, few studies have examined the determinants of poor HRQoL in older patients with cancer. This study aims to determine whether HRQoL findings are truly reflective of cancer disease and treatment, as opposed to external factors.

MATERIALS AND METHODS

This longitudinal, mixed-methods study included outpatients, age 70 years or more, with a solid cancer, who reported poor HRQoL (EORTC QLQ-C30 Global health status/QoL (GHS) score ≤ 33.3), at treatment initiation. A convergent design was employed, in which HRQoL survey data and telephone interview data was collected in parallel at baseline and three-months follow-up. Survey and interview data was analyzed separately and subsequently compared. Thematic analysis of interview data was conducted according to Braun & Clarke, and changes in patients GHS score were calculated using mixed model regression.

RESULTS

Twenty-one patients with a mean age of 74.7 years were included (12 men and 9 women) and data saturation was achieved at both time intervals. Baseline interviews (n = 21) showed that poor HRQoL at cancer treatment initiation was primarily reflective of participants' initial shock upon receiving their cancer diagnosis and their change in circumstance and sudden functional independence. At three months, three participants were lost to follow-up and two provided only partial data. Most participants experienced an increase in HRQoL, with 60% showing a clinically significant improvement in GHS scores. Interviews showed that this was due to lessening functional dependency and disease acceptance achieved by mental and physical adjustment. HRQoL measures were less reflective of cancer disease and treatment in older patients with preexisting highly disabling comorbidity.

DISCUSSION

This study showed good alignment between survey responses and in-depth interviews, demonstrating that both methodologies are highly relevant measures during oncologic treatment. However, for patients with severe comorbidity, HRQoL findings are often more reflective of the steady state of their disabling comorbidity. Response shift may play a part in how participants adjusted to their new circumstances. Promoting caregiver involvement from the time of diagnosis may increase patients´ coping strategies.

Cognitive behavioral stress management affects different dimensions of benefit finding in breast cancer survivors: a multilevel mediation model

Objective. This study aimed to confirm the multidimensionality of benefit finding (BF), or silver linings within the cancer experience, assess the effects of Cognitive Behavioral Stress Management (CBSM) on those dimensions, and test the mediating role of perceived stress management skills targeted by CBSM.Methods. This secondary analysis used data from 240 women with stage 0-III breast cancer who completed measures of BF (Benefit Finding Scale) and perceived stress management skills (PSMS) at baseline, 6-months, and 12-months post-randomization into CBSM or a psycho-education condition. We tested a six-factor BF model using Confirmatory Factor Analysis and assessed CBSM-related changes in BF and PSMS using Hierarchical Linear Models. We included significantly affected BF dimensions in mediation models.Results. A six-factor model of BF had good fit [χ2(212) = 391.5, p < .001; CFI = 0.94; RMSEA = 0.06; SRMR = 0.04]. CBSM positively affected changes in personal growth (β = 0.06, p = .01), social relations (β = 0.05, p = .05), and worldview (β = 0.05, p = .02) BF. Perceived relaxation skill increases significantly mediated changes in personal growth (β = 0.03, p = .04) and social relations (β = 0.03, p = .04).Conclusion. Some aspects of perceived stress management skills appear to account for specific BF dimensions and should be considered in future efforts to develop interventions to modulate BF.

Psychosocial needs of older patients with metastatic breast cancer treated at community centers

INTRODUCTION

Psychosocial status contributes to overall quality of life (QOL) for patients with cancer as psychosocial distress is commonly seen in this population. We sought to describe the psychosocial needs of older adults with metastatic breast cancer (MBC) treated in the community. We evaluated the correlation between the patient's psychosocial status and the presence of other geriatric abnormalities in this patient population.

MATERIALS AND METHODS

This is a secondary analysis of a completed study evaluating older adults (≥65 years) with MBC treated at community practices who received a geriatric assessment (GA). This analysis evaluated psychosocial factors collected during GA, including depression assessed by Geriatric Depression Scale (GDS), perceived social support (SS) assessed by Medical Outcomes Study Social Support Survey (MOS), and objective social supportassessed by demographic variables (living situation and marital status). Perceived SS was further subdivided into tangible social support (TSS) and emotional social support (ESS). Kruskal-Wallis tests, Wilcoxon tests, and Spearman's correlations were used to assess the relationship between psychosocial factors, patient characteristics, and geriatric abnormalities.

RESULTS

One hundred older patients with MBC were enrolled and completed GA with a median age of 73 years (65-90). Almost half of the participants (47%) were either single, divorced, or widowed and 38% lived alone, demonstrating a significant number of patients with objective social support deficits. Patients with HER2+ or triple negative MBC had lower overall SS scores compared to patients with ER/PR+ or HER2- MBC (p = 0.033). Patients on fourth line of therapy were more likely to screen positive for depression compared to patients on earlier lines of therapy (p = 0.047). About half (51%) of the patients indicated at least one SS deficit on the MOS. A higher GDS and lower MOS score correlated with greater total GA abnormalities (p = 0.016). Evidence of depression correlated with poor functional status, decreased cognition, and a high number of co-morbidities (p < 0.005). Abnormalities in functional status, cognition, and high GDS are associated with lower ESS (p = 0.025,0.031,0.006 respectively).

DISCUSSION

Psychosocial deficits are common among older adults with MBC treated in the community and are associated with the presence of other geriatric abnormalities. These deficits require a thorough evaluation and management to optimize treatment outcomes.

Social Wellbeing in Cancer Survivorship: A Cross-Sectional Analysis of Self-Reported Relationship Closeness and Ambivalence from a Community Sample

Improvements in early screening and treatment have contributed to the growth of the number of cancer survivors. Understanding and mitigating the adverse psychosocial, functional, and economic outcomes they experience is critical. Social wellbeing refers to the quality of the relationship with partners/spouses, children, or significant others. Close relationships contribute to quality of life and self-management; however, limited literature exists about social wellbeing during survivorship. This study examined positive and negative self-reported changes in a community sample of 505 cancer survivors. Fourteen items assessed changes in communication, closeness with partner/children, stability of the relationship, and caregiving burden. An exploratory factor analysis was conducted using a robust weighted least square procedure. Differences by sociodemographic and clinical characteristics were investigated. Respondents were mostly male, non-Hispanic white, and ≥4 years since diagnosis. Two factors, labeled Relationship Closeness and Ambivalence, emerged from the analysis. Women, younger survivors, individuals from minority groups, and those with lower income experienced greater negative changes in social wellbeing. Variations by treatment status, time since diagnosis, and institution were also reported. This contribution identifies groups of cancer survivors experiencing affected social wellbeing. Results emphasize the need to develop interventions sustaining the quality of interpersonal relationships to promote long-term outcomes.

Social Support, social ties, and cognitive function of women with breast cancer: findings from the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) Study

PURPOSE

This study examined associations between self-reported cognitive functioning and social support as well as social ties among women with breast cancer.

METHODS

The study included 3351 women from the Women's Health Initiative Life and Longevity After Cancer cohort who were diagnosed with breast cancer stages I-III. Social support was assessed using a modified Medical Outcomes Study (MOS) Social Support Survey, and marital status was obtained from the baseline questionnaire. We also assessed social ties (e.g., number of friends, relatives, living children) and cognitive function (Functional Assessment of Cancer Therapy-Cognitive Function [FACT-COG]) on the year-1-follow up questionnaire. Multivariable quantile regression was used to estimate the changes in median cognitive scores. Kruskal-Wallis tests were used to assess the association of cognitive function with social ties.

RESULTS

The majority of participants were non-Hispanic White (93.3%), presently married (49%), with at least a 4-year college degree (53.2%), and had been diagnosed with localized breast cancer (79%). A 10-point higher social support score correlated to a 0.32 higher (better) median cognitive score (p < 0.001). Women who were presently married tended to have better cognition than women who were divorced/separated or widowed (p = 0.01). Significant associations were also present for having close relatives (p < 0.001) or friends (p < 0.001), with cognitive scores being higher in those with at least one close relative or friend compared to none.

CONCLUSION

Women reporting higher social support and greater numbers of friends or relatives have higher cognitive functioning. Compared to divorced or separated women, married women were likely to have higher cognitive functioning. These findings suggest that social support assessments have the potential to help identify women at higher risk of cognitive decline.

Positive Psychology Approaches to Interventions for Cancer Dyads: A Scoping Review

OBJECTIVE

Positive psychology approaches (PPAs) to interventions focus on developing positive cognitions, emotions, and behavior. Benefits of these interventions may be compounded when delivered to interdependent dyads. However, dyadic interventions involving PPAs are relatively new in the cancer context. This scoping review aimed to provide an overview of the available research evidence for use of dyadic PPA-based interventions in cancer and identify gaps in this literature.

METHODS

Following PRISMA guidelines, we conducted a scoping review of intervention studies that included PPAs delivered to both members of an adult dyad including a cancer patient and support person (e.g., family caregiver, intimate partner).

RESULTS

Forty-eight studies, including 39 primary analyses and 28 unique interventions, were included. Most often (53.8%), the support person in the dyad was broadly defined as a "caregiver"; the most frequent specifically-defined role was spouse (41.0%). PPAs (e.g., meaning making) were often paired with other intervention components (e.g., education). Outcomes were mostly individual well-being or dyadic coping/adjustment.

CONCLUSIONS

Wide variability exists in PPA type/function and their targeted outcomes. More work is needed to refine the definition/terminology and understand specific mechanisms of positive psychology approaches.

Older adults with advanced cancer are selective in sharing and seeking information with social networks

BACKGROUND

Little is known about how older adults (OA) with advanced cancer interact with social network members (NM), and the nature of communication. This qualitative study aimed to characterize the processes by which OAs with cancer engage with NMs regarding their illness.

METHODS

OAs 65 + with advanced cancer and considering treatment (n = 29) and NMs (n = 18) underwent semi-structured interviews asking 1) about their illness understanding; 2) to identify NMs with whom OAs discuss health-related matters; and 3) to describe the content, process, and impact of those illness-related conversations. Three coders analyzed transcribed interviews. Codes were categorized and emergent themes were identified to generate hypotheses.

RESULTS

OAs seek NMs with medical backgrounds for cancer-related information and NMs with personal experience of a serious illness for emotional support. Patients characterize geographical location, frequency of communication, and length of NM relationship as factors that influence the nature of support the NM provides. Additionally, differences emerged between OA and NM perspectives on the depth of conversations and decision-making.

CONCLUSIONS

A better characterization of how OAs' seek and share information and support may improve medical communication, disease understanding, and support goals-concordant care.

End-of-life cancer patients' total pain: the necessity to supplement pharmacology with psycho-socio-spiritual treatments

Aim: To analyze pain considering its different bio-psycho-social-spiritual manifestations and to assess the effectiveness of the analgesic treatments in end-of-life cancer patients. Materials & methods: The study was cross-sectional. A total of 376 end-of-life cancer inpatients participated in the research. Their socio-demographic and clinical data were collected and, during the first psychological consultancy, they filled in a set of validated rating scales assessing pain, anxiety, depression and quality of life. Results: The results show that physical pain was well managed for almost all patients. Nevertheless, the majority showed clinically significant levels of psychological distress. Conclusion: Treating pain means caring for all its possible manifestations including psychological symptoms and reduced wellbeing. Thus, integrating pharmacological treatment with psycho-socio-spiritual interventions, in other words, psychological, social and spiritual support, could be effective and desirable.

Outcomes of Octogenarians with Primary Malignant Cardiac Tumors: National Cancer Database Analysis

Data concerning age-related populations affected with primary malignant cardiac tumors (PMCTs) are still scarce. The aim of the current study was to analyze mortality differences amongst different age groups of patients with PMCTs, as reported by the National Cancer Database (NCDB). The NCDB was retrospectively reviewed for PMCTs from 2004 to 2017. The primary outcome was late mortality differences amongst different age categories (octogenarian, septuagenarian, younger age), while secondary outcomes included differences in treatment patterns and perioperative (30-day) mortality. A total of 736 patients were included, including 72 (9.8%) septuagenarians and 44 (5.98%) octogenarians. Angiosarcoma was the most prevalent PMCT. Surgery was performed in 432 (58.7%) patients (60.3%, 55.6%, and 40.9% in younger age, septuagenarian, and octogenarian, respectively, p = 0.04), with a corresponding 30-day mortality of 9.0% (7.0, 15.0, and 38.9% respectively, p < 0.001) and a median overall survival of 15.7 months (18.1, 8.7, and 4.5 months respectively). Using multivariable Cox regression, independent predictors of late mortality included octogenarian, governmental insurance, CDCC grade II/III, earlier year of diagnosis, angiosarcoma, stage III/IV, and absence of surgery/chemotherapy. With increasing age, patients presented a more significant comorbidity burden compared to younger ones and were treated more conservatively. Early and late survival outcomes progressively declined with advanced age.

Loneliness, social isolation, and social support in older adults with active cancer during the COVID-19 pandemic

Introduction

The COVID-19 pandemic has had a considerable impact on mental health. The social distancing and stay-at-home orders have likely also impacted loneliness, social isolation, and social support. Older adults, particularly those with comorbidities such as cancer, have a greater potential to be impacted. Here we assessed loneliness, social isolation, and social support in older adults undergoing active cancer treatment during the pandemic.

Materials and methods

A mixed methods study in which quantitative data and qualitative response items were collected in parallel was conducted in 100 older adults with cancer. Participants completed a survey by telephone with a series of validated questionnaires to assess the domains of loneliness, social isolation, and social support as well as several open-ended questions. Baseline demographics and geriatric assessments were summarized using descriptive statistics. Bivariate associations between social isolation and loneliness and social support and loneliness were described using Spearman correlation coefficients. Conventional content analysis was performed on the open-ended questions.

Results

In a population of older adults with cancer, 3% were noted to be severely lonely, although 27% percent screened positive as having at least one indicator of loneliness by the University of California, Los Angeles (UCLA) Three Item Loneliness Scale. There was a significant positive correlation between loneliness and social isolation (r = +0.52, p < 0.05) as well as significant negative correlation between loneliness and social support (r = −0.49, p < 0.05). There was also a significant negative correlation between loneliness and emotional support (r = −0.43, p < 0.05). There was no significant association between loneliness and markers of geriatric impairments, including comorbidities, G8 score or cognition.

Discussion

Reassuringly, in this cohort we found relatively low rates of loneliness and social isolation and high rates of social support. Consistent with prior studies, loneliness, social isolation, and social support were found to be interrelated domains; however, they were not significantly associated with markers of geriatric impairments. Future studies are needed to study if cancer diagnosis and treatment may mediate changes in loneliness, social isolation, and social support in the context of the pandemic as well as beyond.

Physical activity interventions in older people with cancer: A review of systematic reviews

INTRODUCTION

Whilst there has been a wealth of research on benefits of physical activity (PA) in people with cancer, with three published reviews of reviews, no review of reviews has focused on older adults (65 years or older) who may have unique biological characteristics and barriers. We summarised PA effectiveness from reviews where majority of study participants were 65 years or older.

METHODS

Six databases were searched for systematic reviews of randomised controlled studies (RCTs)/quasi-RCTs examining any type of PA in reviews where majority of study participants were aged 65 years or older. Two reviewers conducted the search and analysis according to PRISMA and JBI guidelines.

RESULTS

Fifteen reviews involving 76 different primary studies (5404 participants) were included. The majority (3827; 71%) had prostate cancer. PA was associated with benefits across multiple physical outcomes (muscle mass, functional performance, strength), improved fatigue and health service outcomes. In contrast to younger adults, there was no improvement in anxiety and mixed findings for quality of life and depression.

CONCLUSION

PA is associated with multiple benefits in older adults with cancer, with some differences compared to younger individuals which may reflect biological or behavioural determinants. Future research should focus on mechanisms underlying PA effectiveness and underrepresented populations.

Assessing psychological health and social support in older adults with cancer, a how-to guide - A Young International Society of Geriatric Oncology and Nursing & Allied Health Interest Group initiative

Older adults with cancer frequently have several unmet needs related to overlapping vulnerabilities caused by medical and social health challenges which are often overlooked in typical oncological assessments 1. Social support and psychological health are critical considerations for older adults with cancer and are therefore key components of a geriatric assessment.

The shared uncertainty experience of older adults with advanced cancer and their caregivers

OBJECTIVE

One primary source of psychological distress in patients with cancer and their caregivers is uncertainty. However, the uncertainty trajectory and its relationship between older adults with advanced cancer and their caregivers have rarely been examined. This study describes the uncertainty trajectory in patient-caregiver dyads, explores the effect of geriatric assessment (GA) intervention on trajectory, and examines the interdependent relationship of uncertainty.

METHODS

This secondary analysis used longitudinal data from a national cluster-randomized controlled trial examining a GA intervention compared to usual care. Participants completed the modified 9-item Mishel Uncertainty in Illness Scale at enrollment, 4-6 weeks, 3 months, and 6 months. The dyadic growth model and cross-lagged actor-partner interdependence model were used.

RESULTS

A total of 397 dyads (patient age M=76.81 ± SD5.43; caregiver age M=66.69 ± SD12.52) were included. Both had a trend of decreased uncertainty over time (b=-0.16, p<.01). There was a greater decrease in uncertainty among caregivers in the GA group than those in the usual care group (b=-0.46, p=.02). For both patients and caregivers, their past uncertainty was a significant predictor of their own current uncertainty (i.e. actor effect, p<.01). The individual's past uncertainty was a significant predictor of the other dyad member's current uncertainty (i.e. partner effect, p<.05), indicating an interdependent relationship between patient and caregiver uncertainty over time.

CONCLUSIONS

Findings suggest patient and caregiver function as a unit with uncertainty levels affecting each other. Future interventions could build on GA to address uncertainty for older patients with advanced cancer and caregivers.

BACKGROUND

In the United States, there were approximately 1,898,160 new cancer cases reported in 2021; 60% of these cases are associated with individuals 65 years and older.¹ Family members and friends often assume caregiving roles to complement the roles of the healthcare team, especially for older patients.² Diagnosis and treatment of advanced cancer brings substantial stress for both patients and their caregivers.³ Prior studies have shown that older patients experience substantial adverse physical and psychological conditions, such as symptom burden, diminished quality of life, and distress.^4-7 Similarly, caregivers also suffer distress, depression, significant caregiving burden, and impaired quality of life.^2,8-10 Among the myriad psychosocial experiences, uncertainty, defined as the inability to navigate illness-related events and unfamiliar treatment strategies through decision-making or disease understanding, is a common psychological reaction in patients and caregivers.^11,12 Evidence shows that unrelieved uncertainty is associated with decreased quality of life and poor psychological adjustment in older patients with cancer.^13,14 Like other stressors, uncertainty affects both members of the patient-caregiver dyad. Previous studies identified uncertainty as a core overarching theme in the cancer experience and reported high uncertainty levels among caregivers.^12,15,16 This article is protected by copyright. All rights reserved.

Completion of Patient-Reported Outcome Questionnaires Among Older Adults with Advanced Cancer

CONTEXT

Systematic collection of patient-reported outcomes (PROs) reduces symptom burden and improves quality of life. The ability of older adults to complete PROs, however, has not been thoroughly studied.

OBJECTIVES

To determine whether older adults with advanced cancer received assistance completing PROs, the nature of the assistance, the factors associated with receiving assistance, and how the prevalence of assistance changed over time.

METHODS

Data were obtained from a multisite cluster randomized controlled study of geriatric assessment (Clinicaltrials.gov: NCT02107443). Adults ≥70 years with advanced cancer completed multiple PROs at 4 time points (enrollment, 6 weeks, 3 months, 6 months). Factors associated with receipt of assistance were assessed with bivariate and multivariate analyses.

RESULTS

The study included 541 adults (range 70-96 years, 49% female, mixed incurable cancer diagnoses). Twenty-eight percent (153/541) received assistance completing PROs. Of these, 42% received assistance from caregivers, 37% from research staff, and 15% from both. Factors associated with receiving assistance included older age [Adjusted Odds Ratio (AOR) 3.71, 95% Confidence Interval (CI) 1.03-13.38], lower education level (3.92, 2.11-7.29), impaired cognition (1.90, 1.23-2.93), impaired functional status (2.16, 1.33-3.52), and impaired hearing (1.38, 1.05-1.80). Eighty percent of individuals who received assistance were identified at study initiation. Receiving assistance decreased over time from 28% to 18%, partially due to drop-outs.

CONCLUSION

Over a quarter of older adults with advanced cancer in this study received assistance completing PROs. Completing PROs is a key aspect of many clinical programs and cancer trials; assistance in completing PROs should be offered and provided.

Optimizing Social Support in Oncology with Digital Platforms (Preprint)

Increased cancer prevalence and survival rates coupled with earlier patient discharges from hospitals have created a greater need for social support. Cancer care is both short term and long term, requiring acute treatments, treatments for remission, and long-term screenings and treatment regimens. Health care systems are already overwhelmed and often struggle to provide social support systems for everyone. Caregivers are limited in number, and even when they are available, they often lack necessary information, skills, or resources to meet the needs of patients with cancer. The act of caregiving presents various challenges, and caregivers themselves often need social support as well. Despite these needs, most social support programs are targeted toward patients alone. Given the prevalence of cancer and known needs of these patients and their caregivers, the ability to identify those who need social support is crucial. Further, the scalability and overall availability of social support programs is vital for successful patient care. This paper establishes the benefits of social support for both patients and caregivers coping with cancer treatments, explores innovative ways of identifying patients who may need social support using digital tools, and reviews potential advantages of digital social support programs.

Health-Related Quality of Life and Social Support of Elderly Lung and Gastrointestinal Cancer Patients Undergoing Chemotherapy

Introduction

Increasing life expectancy has led to a higher incidence of cancer in the elderly, thus making them vulnerable and worsening their health-related quality of life (HRQoL) and their need for support.

Objective

The aim of this study was to examine the HRQoL and social support in elderly Greek lung and gastrointestinal cancer patients undergoing chemotherapy.

Methods

This was a descriptive, cross-sectional study of 104 elderly cancer patients, who were receiving chemotherapy in the outpatient department and inpatient ward of a General Hospital in Athens. The data were collected using purposive sampling between December 2019 and May 2020, and included demographic and clinical characteristics, the HRQoL questionnaire, Short Form 36 (SF36), and the Personal Resource Questionnaire (PRQ-2000).

Results

The participants' median age was 72 years; the majority were male (62.5%) and had lung cancer (57.7%). The SF36 data revealed a relatively moderate (42.7-62.61) HRQoL in most subscales. The "Pain" subscale recorded the highest score (75.0), and the "social function" subscale the lowest (42.79). The PQR-2000 indicated a satisfactory level of social support (81.65), with values ranging between 48 and 105; married patients with higher education scored more highly (p < .05). Patients aged 65-75 years reported better HRQoL and greater social support than older patients. In addition, patients with their own family and a relatively high income reported better HRQoL and social support compared to single individuals, with low income, who were cared for by their children. Positive and statistically significant (p < .05) correlations were found between the SF36 subscales of role functioning/physical, vitality, general health, emotional well-being and the PRQ-2000.

Conclusion

The HRQoL and social support of elderly cancer patients positively affect the course of their health. Healthcare systems and social services should address the multiplying needs of these patients with targeted interventions to support their well-being.

Quality of care of consultations from the geriatric oncology clinic: "Are we addressing the needs of patients?"

INTRODUCTION

A comprehensive geriatric assessment (CGA) is recommended for older adults with cancer in the pre-treatment setting to optimize care. A CGA systematically evaluates multiple domains to develop a holistic view of the patient's health and facilitate timely interventions to ameliorate patient outcomes. For a CGA to be most effective, optimization of each abnormal domain should occur. However, there is limited literature exploring this issue.

MATERIALS AND METHODS

Consultations of patients seen in a Geriatric Oncology clinic from June 2015 to June 2018 were reviewed. The percentage of "no recommendations made" in the consultation letter following the identification of impairment in each of eight geriatric domains was calculated. Trends over time were examined by stratifying the data into three periods ("Year 1", "Year 2", and "Year 3") and conducting a logistic regression analysis.

RESULTS

A total of 365 consultation notes were reviewed. The patients were predominately older (mean age 79.9 years), male (66.9%), with genitourinary (38.6%) or gastrointestinal (23.3%) cancers. The most common stage was metastatic (40.6%). The most common treatment intent and modality were palliative (50.4%) and hormonal (50.9%), respectively. The geriatric domains that had the greatest frequency of impairments were medication optimization (76.2%), functional status (68.8%), and falls risk (64.9%). The domains that had the highest frequency of "no recommendations made" following identification of impairment were nutrition (39.8%), social support (39.5%), and mood (26.4%). The prevalence of "no recommendations made" decreased over time in social support (54.6% in Year 1 to 27.8% in Year 3, p = 0.043) and possibly nutrition (53.1% in Year 1 to 34.3% in Year 3, p = 0.088) but not for mood (p = 0.64).

CONCLUSIONS

Nutrition, social supports and mood were the CGA domains with the highest proportion of "no recommendations made" following an identification of impairment. This is the first quality assurance study to identify social supports, mood, and nutrition domains as less frequently addressed following an identification of an impairment amongst older patients with cancer. Subsequent prospective research is required to understand reasons for these observations and identification of barriers to address these geriatric domains amongst older adults with cancer.

Engaging Older Adults With Cancer and Their Caregivers to Set Research Priorities Through Cancer and Aging Research Discussion Sessions

PURPOSE

To report on the perspectives of older adults (aged older than 65 years) with cancer and their caregivers who participated in patient-oriented research priority-setting activities called the Cancer and Aging Research Discussion Sessions.

PARTICIPANTS & SETTING

35 older adults and caregivers participated in three public meetings and follow-up interviews.

METHODOLOGIC APPROACH

Qualitative descriptive.

FINDINGS

There was clear consensus from participants on research priorities related to two key areas.

IMPLICATIONS FOR NURSING

Future research should focus on addressing age-related disparities in cancer care communication and support. By capitalizing on older adults' interest in research engagement, effective solutions can be cocreated to improve cancer experiences for older adults and their caregivers.

Desesperanza y su relación con el apoyo social percibido en pacientes peruanos con neoplasias hematológicas

Objetivo: El propósito del presente estudio fue determinar la relación significativa entre el apoyo social y la desesperanza en pacientes peruanos con neoplasias hematológicas que se encuentren en alguna de las fases del tratamiento. Método: El estudio fue de tipo descriptivo-correlacional. La muestra estuvo conformada por 110 pacientes hematooncológicos de ambos sexos, con edades entre 16 a 25 años. Los instrumentos utilizados fueron la Escala Multidimensional de Apoyo Social Percibido (MSPSS) y la Escala de Desesperanza de Beck (BHS). Resultados: Se reportan niveles altos de apoyo social percibido (81%) y niveles normales de desesperanza (82%) en los pacientes hematooncológicos. El apoyo social percibido se correlaciona inversa y significativamente con la desesperanza, aunque en magnitudes bajas a moderadas. Cabe destacar que la dimensión Expectativa de desgracia en el futuro, no se correlaciona significativamente con el apoyo social percibido y sus dimensiones. Igualmente, la dimensión Creencias que los acontecimientos negativos son durables, no se correlaciona con la dimensión Apoyo de familia. Por otro lado, se encontró diferencias significativas del apoyo social percibido con el sexo y la religión, asimismo, la desesperanza con la edad, tiempo de diagnóstico y fase de tratamiento. Conclusión: El apoyo social percibido se relaciona con la desesperanza en pacientes hematooncológicos peruanos. Por tanto, se corrobora que el apoyo social que recibe el paciente ante la desesperanza de una enfermedad hematooncológica, sirve como soporte y tolerancia de dicha enfermedad y sus efectos durante el tratamiento.

Role of social support in the relationship between financial hardship and multimorbidity-a causal mediation analysis

BACKGROUND

Social disadvantage is a key determinant of multimorbidity. Pathways through which social disadvantage leads to multimorbidity are yet undefined. In this study, we first examined the causal effect of moving into financial hardship on multimorbidity among Australian adults, and then the role of social support as a mediator of the relationship between financial hardship and multimorbidity.

METHODS

Data were obtained from the Household, Income and Labour Dynamics in Australia (HILDA) Survey (2009-2013). We identified individuals who moved into financial hardship between 2010 and 2011 (n = 5775). Inverse probability treatment weighting with regression adjustment was used to examine the relationship between financial hardship and multimorbidity. Causal mediation analysis was applied to decompose the total effect of financial hardship on multimorbidity into the proportion attributable to social support and the proportion not occurring through measured pathways. We accounted for baseline covariates including age, sex, marital status, educational attainment, employment status, income, country of birth, multimorbidity and social support. Bootstrapping with 1000 replications was used to calculate 95% confidence intervals (CIs).

RESULTS

The risk of multimorbidity was higher in those with financial hardship by 19% [relative risk 1.19 (95% CI: 1.02-1.37) and absolute risk difference 0.036 (95% CI: 0.004-0.067)] than those without financial hardship. Social support accounted for 30% of the total effect of financial hardship on multimorbidity, risk difference 0.009 (95% CI: 0.003-0.018).

CONCLUSIONS

Financial hardship leads to increased risk of multimorbidity. Interventions directed at increasing social support among those in financial hardship may reduce their risk of multimorbidity.

Association Between Caregiver-Oncologist Discordance in Patient's Life Expectancy Estimates and Caregiver Perceived Autonomy Support by the Oncologist

BACKGROUND

Caregiver perceived autonomy support by the oncologist is important for caregiver well-being and may be affected by the patient's survival. We determined the association of caregiver-oncologist discordance in patient's life expectancy estimates with perceived autonomy support over time and whether the association differed by patient survival status.

MATERIALS AND METHODS

We used data from a geriatric assessment cluster-randomized trial (URCC 13070) that recruited patients aged at least 70 years with incurable cancer considering or receiving treatment, their caregivers, and their oncologists. At baseline, caregivers and oncologists were asked to estimate patient's life expectancy (0-6 months, 7-12 months, 1-2 years, 2-5 years, and >5 years; any difference in response was considered discordant). At 4-6 weeks, 3 months, and 6 months, caregivers completed the Health Care Climate Questionnaire (HCCQ), which measured perceived autonomy support by the oncologist. Generalized estimating equation modeling was conducted to assess the association of baseline caregiver-oncologist discordance with longitudinal HCCQ scores, stratified by patient 6-month survival status.

RESULTS

Discordant life expectancy estimates were present in 72.0% of dyads. In multivariate analyses, caregiver-oncologist discordance in patient's life expectancy estimates was associated with higher caregiver HCCQ scores. In stratified analysis, caregiver-oncologist discordance was associated with lower caregiver HCCQ scores (β = -3.46; 95% CI, -4.64 to -2.29) among patients who died within 6 months but with higher caregiver HCCQ scores (β = 1.33; 95% CI, 0.63-2.04) among patients who survived beyond 6 months.

CONCLUSION

Interventions aimed at mitigating discordance need to consider its association with caregiver perceived autonomy support and patient's survival in order to better inform caregiver expectations.

IMPLICATIONS FOR PRACTICE

Among patients who died within the first 6 months, caregivers who estimated a different length of life for the patient compared with oncologists were more likely to report lower support from the oncologist, whereas the opposite relationship was seen within patients who survived beyond the first 6 months. When designing interventions to improve caregiver understanding of the patient's prognosis, its relationship with caregiver-perceived support and patient's survival needs to be considered.

In-hospital complications in an acute care geriatric unit

Introduction: In-hospital complications frequently occur in hospitalized people over 65 worsening their clinical outcomes. There are, however, few studies on the factors associated with in-hospital complications in elderly patient care. Objective: To evaluate factors associated with in-hospital complications in a geriatric acute care unit in Bogotá, Colombia. Materials and methods: We conducted an analytical, observational, retrospective study in a cohort of 1,657 patients over 65 years of age who received care in the geriatric unit of a high complexity hospital in Bogotá, Colombia. The dependent variable was in-hospital complications and the independent variables, the degree of functional dependence on admission, dementia, nutritional status, social support, comorbidity, and polypharmacy. We used Poisson’s linear regression model to identify associated variables. Results: The bivariate analysis showed that functional dependence (PR=2.092, p≤0.001) and malnutrition (PR=2.850, p≤0.001) were associated with a higher rate of hospital-acquired infection. In the multivariate analysis, functional dependence (PR=1.931, p=0.003) and malnutrition (PR=2.502, p=0.002) remained independent factors for in-hospital complications. Conclusion: In acute care centers, integral assessment at admission to identify functional dependence and malnutrition predicts in-hospital complications.

Feasibility of an Online Patient Community to Support Older Women With Newly Diagnosed Breast Cancer

BACKGROUND

We conducted a feasibility study of integrating a free, online patient health community, PatientsLikeMe (PLM), into the neo/adjuvant care of older patients recently diagnosed with breast cancer. We assessed whether PLM was an appealing social forum to improve women's treatment experience during this stressful and often isolating time.

PATIENTS AND METHODS

We enrolled women ages ≥60 years with recently diagnosed nonmetastatic invasive breast cancer at a single center. Our primary endpoint was feasibility of patient engagement with PLM, with successful engagement defined as using PLM for ≥50% of the total weeks of one's chemotherapy course or 4 months (if receiving hormonal and/or radiation therapy). Participants were surveyed about their health, social support, and experiences.

RESULTS

During February 8, 2016 to June 25, 2018, 47 women enrolled; 14.9% were ages 71 to 75 years and 8.5% were ages ≥76 years; 63.8% received chemotherapy. Two women withdrew after consent; 45 were included in analyses. Overall, 1 (2.2%) patient met the feasibility endpoint, although 8 (17.8%) met engagement criteria for ≥25% of weeks on study. Over time, women submitted a total of >1200 posts to the "InstantMe" feature (rates how they feel) and >130 "MyFeed" stories. Evaluation of satisfaction with PLM was limited by the small number of end-of-study surveys.

CONCLUSION

Although our online social support intervention did not meet the prespecified criteria for feasibility (required sustained PLM utilization), many engaged with PLM. Future interventions should explore ways we can optimally support older patients, who have an increasing access to technology while facing threats of social isolation.

Caregiving burden of informal caregivers of older adults with advanced cancer: The effects of rurality and education

OBJECTIVES

Rural-urban disparities in the experiences of caregivers of older adults with advanced cancer may exist. This study examined factors associated with caregiver mastery and burden and explored whether rural-urban disparities in caregiver outcomes differed by education.

MATERIALS AND METHODS

Longitudinal data (baseline, 4-6 weeks, and 3 months) on caregivers of older adults (≥ 70) with advanced cancer were obtained from a multicenter geriatric assessment (GA) trial (ClinicalTrials.gov: NCT02107443). Rurality was determined based on 2010 Rural-Urban Commuting Area codes. Caregivers' education was categorized as ≥ some college vs ≤ high school. Caregiver outcomes included Ryff Environmental Mastery (scored 7-35) and Caregiver Reaction Assessment (including self-esteem, disrupted schedules, financial problems, lack of social support, and health problems; each scored 1-5). Separate linear mixed models with interaction term of education and rurality were performed.

RESULTS

Of 414 caregivers, 64 (15.5%) were from rural areas and 263 (63.5%) completed ≥ some college. Rurality was significantly associated with more disrupted schedules (β = 0.21), financial problems (β = 0.17), and lack of social support (β = 0.11). A significant interaction between education and rurality was found, with rurality associated with lower mastery (β = -1.27) and more disrupted schedule (β = 0.25), financial problems (β = 0.33), and lack of social support (β = 0.32) among caregivers with education ≤ high school.

CONCLUSION

Our study identifies subgroups of caregivers who are vulnerable to caregiving burden, specifically those from rural areas and with lower education. Multifaceted interventions are needed to improve caregivers' competency and reduce caregiving burden.

Caregiver-Oncologist Prognostic Concordance, Caregiver Mastery, and Caregiver Psychological Health and Quality of Life

BACKGROUND

Caregivers of adults with cancer often report a different understanding of the patient's prognosis than the oncologist. We examine the associations of caregiver-oncologist prognostic concordance with caregiver depressive symptoms, distress, and quality of life (QoL). We also explore whether these relationships differed by caregiver environment mastery, an individual's sense of control, and effectiveness in managing life situations.

MATERIALS AND METHODS

We used data from a national geriatric assessment cluster-randomized trial (URCC 13070) that recruited patients aged 70 years and older with incurable cancer considering any line of cancer treatment at community oncology practices, their caregivers, and their oncologists. At enrollment, caregivers and oncologists estimated the patient's prognosis (0-6 months, 7-12 months, 1-2 years, 2-5 years, and >5 years; identical responses were concordant). Caregivers completed the Ryff's environmental mastery at enrollment. At 4-6 weeks, caregivers completed the Patient Health Questionnaire-2 (depressive symptoms), distress thermometer, and 12-Item Short-Form Health Survey (quality of life [QoL]). We used generalized estimating equations in models adjusted for covariates. We then assessed the moderation effect of caregiver mastery.

RESULTS

Of 411 caregiver-oncologist dyads (mean age = 66.5 years), 369 provided responses and 28% were concordant. Prognostic concordance was associated with greater caregiver depressive symptoms (β = 0.30; p = .04) but not distress or QoL. A significant moderation effect for caregiver depressive symptoms was found between concordance and mastery (p = .01). Specifically, among caregivers with low mastery (below median), concordance was associated with greater depressive symptoms (β = 0.68; p = .003).

CONCLUSIONS

Caregiver-oncologist prognostic concordance was associated with caregiver depressive symptoms. We found a novel moderating effect of caregiver mastery on the relationship between concordance and caregiver depressive symptoms.

IMPLICATIONS FOR PRACTICE

Caregiver-oncologist prognostic concordance is associated with greater caregiver depressive symptoms, particularly in those with low caregiver mastery. When discussing prognosis with caregivers, physicians should be aware that prognostic understanding may affect caregiver psychological health and should assess their depressive symptoms. In addition, while promoting accurate prognostic understanding, physicians should also identify strengths and build resilience among caregivers.

Factors associated with perceived social support in older people with cancer

OBJECTIVE: To analyze factors associated with perceived social support in older people with cancer. METHODOLOGY: This is a cross-sectional, analytical study conducted with a convenience sample of 134 older people seen at a specialist cancer treatment unit in a hospital located in a municipal district in the South of Minas Gerais state, Brazil. Data collection was conducted by interview and analysis of medical records. Social support was analyzed using the Medical Outcomes Study social support scale. The Mann-Whitney and Kruskal-Wallis tests were used to analyze differences between means. Linear regression was used for analysis of associations. RESULTS: The majority of the sample of older people with cancer analyzed were male, aged from 60 to 74 years, and reported high mean scores for material support; affective support; positive social interaction; and emotional/informational support. Factors with positive associations with social support were: not living alone; income one to three times the minimum wage; having a partner; rating health as good/very good; and presence of comorbidity. Factors with negative associations were: poor/very poor perceived income and polypharmacy use. CONCLUSIONS: This sample of older people reported high mean scores for material support; affective support; positive social interaction; and emotional/informational support. Factors associated with perceived social support were: living arrangements; family income; perceived sufficiency of income; marital status; health self-assessment; comorbidity; and polypharmacy.

Capacity to Provide Geriatric Specialty Care for Older Adults in Community Oncology Practices

BACKGROUND

American Society of Clinical Oncology guidelines recommend that patients ≥65 years of age starting chemotherapy undergo a geriatric assessment (GA) to inform and guide management; however, little is known about resources available in community oncology practices to implement these guidelines and to facilitate geriatric oncology research.

MATERIALS AND METHODS

Oncology practices within the National Cancer Institute Community Oncology Research Program (NCORP) were electronically surveyed in 2017 regarding the availability of specialty providers, supportive services, and practice characteristics, as part of a larger survey of cancer care delivery research capacity.

RESULTS

Of the 943 NCORP practices, 504 (54%) responded to the survey, representing 210 practice groups. The median new cancer cases per year ≥65 years of age was 457 (interquartile range 227-939). Of respondents, only 2.0% of practices had a fellowship-trained geriatric oncologist on staff. Geriatricians were available for consultation or comanagement at 37% of sites, and of those, only 13% had availability within the oncology clinic (5% of overall). Practice size of ≥1,000 new adult cancer cases (ages ≥18) per year was associated with higher odds (1.81, confidence interval 1.02-3.23) of geriatrician availability. Other multidisciplinary care professionals that could support GA were variably available onsite: social worker (84%), nurse navigator (81%), pharmacist (77%), dietician (71%), rehabilitative medicine (57%), psychologist (42%), and psychiatrist (37%).

CONCLUSION

Only a third of community oncology practices have access to a geriatrician within their group and only 5% of community sites have access within the oncology clinic. Use of primarily self-administered GA tools that direct referrals to available services may be an effective implementation strategy for guideline-based care.

IMPLICATIONS FOR PRACTICE

Only a minority of community oncology practices in the U.S. have access to geriatric specialty care. Developing models of care that use patient-reported measures and/or other geriatric screening tools to assess and guide interventions in older adults, rather than geriatric consultations, are likely the most practical methods to improve the care of this vulnerable population.