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Talty A, Morris R, Deighan C. Home-based self-management multimodal cancer interventions & cardiotoxicity: a scoping review. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:12. [PMID: 38424647 PMCID: PMC10903028 DOI: 10.1186/s40959-024-00204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Due to advancements in methods of cancer treatment, the population of people living with and beyond cancer is dramatically growing. The number of cancer survivors developing cardiovascular diseases and heart failure is also rising, due in part to the cardiotoxic nature of many cancer treatments. Guidelines are being increasingly released, emphasising the need for interdisciplinary action to address this gap in survivorship care. However, the extent to which interventions exist, incorporating the recommendations of cardio-oncology research, remains undetermined. OBJECTIVE The aim of this scoping review is to assess the nature, extent and remit of existing cancer care interventions and their integration of cardio-oncology principles. METHODS The review was conducted in accordance with the PRISMA Extension for Scoping Reviews Guidelines. Databases were independently searched for articles from 2010 to 2022, by two members of the research team. Data were charted and synthesised using the following criteria: (a) the focus of the intervention (b) the medium of delivery (c) the duration (d) the modalities included in the interventions (e) the research articles associated with each intervention (f) the type of studies conducted (g) key measures used (h) outcomes reported. RESULTS Interventions encompassed six key modalities: Psychological Support, Physical Activity, Nutrition, Patient Education, Lifestyle and Caregiver Support. The focus, medium of delivery and duration of interventions varied significantly. While a considerable number of study protocols and pilot studies exist documenting HSMIs, only 25% appear to have progressed beyond this stage of development. Of those that have, the present review did not identify any 'feasible' interventions that covered each of the six modalities, while being generalisable to all cancer survivors and incorporating the recommendations from cardio-oncology research. CONCLUSION Despite the substantial volume of research and evidence from the field of cardio-oncology, the findings of this scoping review suggest that the recommendations from guidelines have yet to be successfully translated from theory to practice. There is an opportunity, if not necessity, for cardiac rehabilitation to expand to meet the needs of those living with and beyond cancer.
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Affiliation(s)
- Anna Talty
- The Heart Manual Department, Astley Ainslie Hospital, Grange Loan, Edinburgh, Scotland, UK, EH9 2HL
| | - Roseanne Morris
- The Heart Manual Department, Astley Ainslie Hospital, Grange Loan, Edinburgh, Scotland, UK, EH9 2HL
| | - Carolyn Deighan
- The Heart Manual Department, Astley Ainslie Hospital, Grange Loan, Edinburgh, Scotland, UK, EH9 2HL.
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Vagnini D, Grassi MM, Saita E. Evaluating Somatic Experiencing ® to Heal Cancer Trauma: First Evidence with Breast Cancer Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6412. [PMID: 37510644 PMCID: PMC10380079 DOI: 10.3390/ijerph20146412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
Somatic Experiencing® is a bio-psychological method for the treatment and prevention of trauma and chronic stress, which has never been investigated with breast cancer (BC) survivors. Eight weeks of web-based synchronous group sessions were structured between April and June 2022. Potential participants were recruited using a convenience sampling approach and through the collaboration of a public hospital in northern Italy and a non-profit association of BC women. Thirty-five eligible participants were enrolled and divided into an intervention group (n = 21) and a control group (n = 14). Anxiety, depression, distress (HADS), coping strategies (Mini-MAC), trauma reworking skills (PACT), and body image (BIS) were assessed at T0 and after 8 weeks (T1). Qualitative items concerning the most significant moments and learnings were completed at T1 by the intervention group. An independent t-test confirmed no between-group psychological differences at T0. As hypothesized, paired-sample t-tests showed decreases in anxiety, depression, distress (p < 0.05), and anxious preoccupation coping strategy (p < 0.001), but also improvements in forward focus (p < 0.05) and body image (p < 0.001) in the intervention group. The controls worsened over time with increases in hopeless/helplessness (p < 0.001) and avoidance (p < 0.05) coping strategies. Textual analyses extracted five dominant themes that summarized the meaning of the experience for participants. The preliminary results suggest the effectiveness of the intervention.
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Affiliation(s)
- Denise Vagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | | | - Emanuela Saita
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
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Telemedicine and cancer care in India: promises, opportunities and caveats. Future Sci OA 2022; 8:FSO821. [PMID: 36788987 PMCID: PMC9912275 DOI: 10.2144/fsoa-2022-0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023] Open
Abstract
Telemedicine has revolutionized areas of medical practice and care. It has a potential in field of continuum of cancer care in India. SARS-CoV-2 has highlighted the potential use of this tool effectively. Scope of newer applications of telemedicine in field of cancer is reviewed in current paper enlisting benefits to patient, healthcare providers and centers in a developing country like India. Each of them is supported by appropriate evidence and examples. An analysis of strengths and opportunities when compared with weakness and threats brings out how telemedicine can redistribute oncology work force in a rational way and minimize disruption caused by the pandemic. Telemedicine can be utilized in cancer management starting from prevention, screening, diagnosis, treatment and rehabilitation to palliative care.
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Satisfaction with Telemedicine for Cancer Pain Management: A Model of Care and Cross-Sectional Patient Satisfaction Study. Curr Oncol 2022; 29:5566-5578. [PMID: 36005177 PMCID: PMC9406413 DOI: 10.3390/curroncol29080439] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 01/19/2023] Open
Abstract
Background: Since cancer pain requires complex modalities of care, the proper strategy for addressing its telemedicine-based management should be better defined. This study aimed to trace a pathway for a progressive implementation of the telemedicine process for the treatment of pain in the setting of cancer patients. Methods: The features of the model were investigated to dissect the dropout from the telemedicine pathway. A cross-sectional patient satisfaction study was conducted. The degree of satisfaction was evaluated through a developed 22-item questionnaire (Likert scale 0−7). Results: A total of 375 video consultations for 164 patients (mean age 62.9 years) were performed through remote consultations for cancer pain management between March 2021 and February 2022. After the exclusion of 72 patients, 92 (56.1%) were included in the analysis. The dropout ratio was 8.7%. The number of visits and pharmacological therapies for neuropathic pain correlated with the risk for readmission (p < 0.05). Overall, the satisfaction was very high (mean > 5.5 for all items). Conclusion: Feedback from patients reflected high satisfaction rates with the care provided. A methodological approach based on the degree of satisfaction combined with the analysis of the pathways can help to implement the quality of a service provided through telemedicine. While not without limitations, our hybrid protocol can be useful for addressing cancer pain through a patient-centered approach.
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Telehealth Delivery of a Multi-Disciplinary Rehabilitation Programme for Upper Gastro-Intestinal Cancer: ReStOre@Home Feasibility Study. Cancers (Basel) 2022; 14:cancers14112707. [PMID: 35681687 PMCID: PMC9179413 DOI: 10.3390/cancers14112707] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Throughout the COVID-19 pandemic, many cancer care services have safely been delivered via telehealth. Multi-disciplinary rehabilitation programmes can help address the complex physical, nutritional and quality of life needs of upper gastrointestinal (UGI) cancer survivors, but it is unknown how well these multi-component programmes translate to a telehealth model of delivery. Therefore, we assessed the feasibility of running a 12-week exercise and nutrition rehabilitation programme for UGI cancer via telehealth. Participants found the telehealth model safe, convenient and highly satisfactory. Lower levels of technology skills were a barrier to recruitment, and some participants needed help with using the technology. Some adaptations to how the exercise programme was delivered were required. Participants recommended that future versions of the programme would have some element of in-person contact. Cancer survivors should receive all possible supports to enable their participation in telehealth programmes. Abstract Background: Telehealth has enabled access to rehabilitation throughout the pandemic. We assessed the feasibility of delivering a multi-disciplinary, multi-component rehabilitation programme (ReStOre@Home) to cancer survivors via telehealth. Methods: This single-arm mixed methods feasibility study recruited participants who had completed curative treatment for oesophago-gastric cancer for a 12-week telehealth rehabilitation programme, involving group resistance training, remotely monitored aerobic training, one-to-one dietetic counselling, one-to-one support calls and group education. The primary outcome was feasibility, measured by recruitment rates, attendance, retention, incidents, acceptability, Telehealth Usability Questionnaire (TUQ) and analysis of semi-structured interviews. Results: Characteristics of the twelve participants were: 65.42 ± 7.24 years; 11 male; 10.8 ± 3.9 months post-op; BMI 25.61 ± 4.37; received neoadjuvant chemotherapy 7/12; received adjuvant chemotherapy 4/12; hospital length of stay 16 days (median). Recruitment rate was 32.4%, and retention rate was 75%. Mean attendance was: education 90%; dietetics 90%; support calls 84%; resistance training 78%. Mean TUQ score was 4.69/5. Adaptations to the planned resistance training programme were required. Participants reported that ReStOre@Home enhanced physical and psychological wellbeing, and online delivery was convenient. Some reported a preference for in-person contact but felt that the online group sessions provided adequate peer support. Conclusion: Telehealth delivery of ReStOre@Home was most feasible in individuals with moderate to high levels of digital skills. Low level of digitals skills was a barrier to recruitment and retention. Participants reported high levels of programme adherence and participant satisfaction. Adaptations to future programmes, including introducing elements of in-person contact, are required.
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Cascella M, Miceli L, Cutugno F, Di Lorenzo G, Morabito A, Oriente A, Massazza G, Magni A, Marinangeli F, Cuomo A. A Delphi Consensus Approach for the Management of Chronic Pain during and after the COVID-19 Era. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413372. [PMID: 34948983 PMCID: PMC8706033 DOI: 10.3390/ijerph182413372] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/29/2022]
Abstract
Due to a lack of published evidence on the topic, a modified Delphi approach was used to develop recommendations useful for chronic pain management during and after the COVID-19 pandemic. Focusing on the available literature and personal clinical expertise, an Italian board of nine professionals from different disciplines identified four main topics: prevention of chronic pain, treatment of chronic pain, consequences of inadequate treatment, and perspectives. They elaborated a semi-structured questionnaire. A multidisciplinary panel of experts in the field of pain management was requested to comment on the statements. Based on the answers provided, a structured questionnaire was prepared (Round 1). It included 21 statements divided into three categories (organizational issues; diagnosis and therapies; telemedicine and future perspectives). A five-point Likert scale was adopted. The threshold for consensus was set at a minimum of 70% of the number of respondents (level of agreement ≥ 4, Agree or Strongly Agree). A final questionnaire with rephrasing of the statements that did not reach the consensus threshold was elaborated (Round 2). A total of 29 clinicians were included in the panel. Twenty clinicians (69%) responded in both the first and second round. After two rounds, consensus (≥70%) was achieved in 20 out of 21 statements. The lack of consensus was recorded for the statement regarding the management of post-COVID pain (55%; Median 4; IQR 2.3). Another statement on telemedicine reached the threshold in the first round (70%), but the value was not confirmed in Round 2 (65%; Median 4; IQR 2). Most of the proposed items reached consensus, suggesting the need to make organizational changes, the structuring of careful diagnostic and therapeutic pathways, and the application of new technologies in pain medicine. Long-COVID-19 care is an issue that needs further research. Remote assistance for chronic pain must be regulated.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, 80100 Napoli, Italy;
- Department of Electrical Engineering and Information Technologies, Università di Napoli “Federico II”, 80100 Napoli, Italy;
- Correspondence:
| | - Luca Miceli
- Department of Pain Medicine, IRCCS C.R.O. National Cancer Institute of Aviano, 33081 Aviano, Italy;
| | - Francesco Cutugno
- Department of Electrical Engineering and Information Technologies, Università di Napoli “Federico II”, 80100 Napoli, Italy;
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
- Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80100 Napoli, Italy;
| | - Alfonso Oriente
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, 80100 Napoli, Italy;
| | - Giuseppe Massazza
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University di Torino, 10121 Torino, Italy;
| | - Alberto Magni
- Italian College of General Practitioners and Primary Care (SIMG), Via Del Sansovino 179, 50142 Firenze, Italy;
| | - Franco Marinangeli
- Department of Life, Health & Environmental Sciences, University of l’Aquila, 67100 l’Aquila, Italy;
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, 80100 Napoli, Italy;
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Pal T, Hull PC, Koyama T, Lammers P, Martinez D, McArthy J, Schremp E, Tezak A, Washburn A, Whisenant JG, Friedman DL. Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery. BMC Cancer 2021; 21:1262. [PMID: 34814868 PMCID: PMC8609269 DOI: 10.1186/s12885-021-08949-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/01/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite lower cancer incidence rates, cancer mortality is higher among rural compared to urban dwellers. Patient, provider, and institutional level factors contribute to these disparities. The overarching objective of this study is to leverage the multidisciplinary, multispecialty oncology team from an academic cancer center in order to provide comprehensive cancer care at both the patient and provider levels in rural healthcare centers. Our specific aims are to: 1) evaluate the clinical effectiveness of a multi-level telehealth-based intervention consisting of provider access to molecular tumor board expertise along with patient access to a supportive care intervention to improve cancer care delivery; and 2) identify the facilitators and barriers to future larger scale dissemination and implementation of the multi-level intervention. METHODS Coordinated by a National Cancer Institute-designated comprehensive cancer center, this study will include providers and patients across several clinics in two large healthcare systems serving rural communities. Using a telehealth-based molecular tumor board, sequencing results are reviewed, predictive and prognostic markers are discussed, and treatment plans are formulated between expert oncologists and rural providers. Simultaneously, the rural patients will be randomized to receive an evidence-based 6-week self-management supportive care program, Cancer Thriving and Surviving, versus an education attention control. Primary outcomes will be provider uptake of the molecular tumor board recommendation and patient treatment adherence. A mixed methods approach guided by the Consolidated Framework for Implementation Research that combines qualitative key informant interviews and quantitative surveys will be collected from both the patient and provider in order to identify facilitators and barriers to implementing the multi-level intervention. DISCUSSION The proposed study will leverage information technology-enabled, team-based care delivery models in order to deliver comprehensive, coordinated, and high-quality cancer care to rural and/or underserved populations. Simultaneous attention to institutional, provider, and patient level barriers to quality care will afford the opportunity for us to broadly share oncology expertise and develop dissemination and implementation strategies that will enhance the cancer care delivered to patients residing within underserved rural communities. TRIAL REGISTRATION Clinicaltrials.gov , NCT04758338 . Registered 17 February 2021 - Retrospectively registered, http://www.clinicaltrials.gov/.
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Affiliation(s)
- Tuya Pal
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 536 Robinson Research Building, Nashville, TN, 37232, USA
| | - Pamela C Hull
- University of Kentucky Markey Cancer Center, 800 Rose Street, Lexington, KY, 40536, USA
- Department of Behavioral Science, University of Kentucky College of Medicine, Rural and Underserved Health Research Center, Healthy Kentucky Research Building, 760 Press Avenue, Lexington, KY, 40536, USA
| | - Tatsuki Koyama
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End, Suite 1100, Nashville, TN, 37203, USA
| | - Phillip Lammers
- Baptist Cancer Center, 80 Humphreys Center Suite 330, Memphis, TN, 38120, USA
| | - Denise Martinez
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Jacob McArthy
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Emma Schremp
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Ann Tezak
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 536 Robinson Research Building, Nashville, TN, 37232, USA
| | - Anne Washburn
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Jennifer G Whisenant
- Division of Hematology & Oncology, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Debra L Friedman
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA.
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA.
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Durosier Mertilus DS, Lengacher CA, Rodriguez CS. A Review and Conceptual Analysis of Cancer Pain Self-Management. Pain Manag Nurs 2021; 23:168-173. [PMID: 34006496 DOI: 10.1016/j.pmn.2021.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES In this concept analysis article, we will clarify the concept "self-management of cancer pain" by identifying related antecedents, attributes, and consequences to further refine the conceptual and operational definitions of the concept. DESIGN A review was conducted. REVIEW/ANALYSIS METHODS The Walker and Avant method was used for this concept analysis. DATA SOURCES CINAHL, PubMed, and PsycInfo were searched systemically.A total of eight studies on "self-management of cancer pain or self-care of cancer pain" published between 2004 and 2019 were identified. RESULTS Attributes for self-management of cancer pain include self-efficacy, integration of methods for pain relief into daily life, decision-making related to pain management, process for solving pain-related issues, and initiation of interactions with healthcare professionals. Antecedents include knowledge regarding pain assessment and management, cognitive abilities, motivation, undergoing pain treatment, patient education and counseling, social support, and accountability from all parties involved. Consequences include pain control, improved quality of life, and increased opioid intake. CONCLUSIONS Self-management of cancer pain was reported to be a self-regulation process with the aim to encourage patients to use skills attained through development of self-efficacy, so they can actively participate in their pain management. This outcome may enhance their quality of life by decreasing their pain, depression, and anxiety and increasing the availability of social support.
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Foust Winton RE, Draucker CB, Von Ah D. Pain Management Experiences Among Hospitalized Postcraniotomy Brain Tumor Patients. Cancer Nurs 2021; 44:E170-E180. [PMID: 32657900 PMCID: PMC7794082 DOI: 10.1097/ncc.0000000000000851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Brain tumors account for the majority of central nervous system tumors, and most are removed by craniotomies. Many postcraniotomy patients experience moderate or severe pain after surgery, but patient perspectives on their experiences with pain management in the hospital have not been well described. OBJECTIVE The aim of this study was to describe how patients who have undergone a craniotomy for brain tumor removal experience pain management while hospitalized. METHODS Qualitative descriptive methods using semistructured interviews were conducted with patients on a neurological step-down unit in an urban teaching hospital in the Midwest United States. Interviews focused on how patients experienced postcraniotomy pain and how it was managed. Narratives were analyzed with standard content analytic procedures. RESULTS Twenty-seven participants (median age, 58.5 years; interquartile range, 26-41 years; range, 21-83 years) were interviewed. The majority were white (n = 25) and female (n = 15) and had an anterior craniotomy (n = 25) with sedation (n = 17). Their pain experiences varied on 2 dimensions: salience of pain during recovery and complexity of pain management. Based on these dimensions, 3 distinct types of pain management experiences were identified: (1) pain-as-nonsalient, routine pain management experience; (2) pain-as-salient, routine pain management experience; and (3) pain-as-salient, complex pain management experience. CONCLUSIONS Many postcraniotomy patients experience their pain as tolerable and/or pain management as satisfying and effective; others experience pain and pain management as challenging. IMPLICATIONS FOR PRACTICE Clinicians should be attuned to needs of patients with complex pain management experiences and should incorporate good patient/clinician communication.
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Affiliation(s)
- Rebecca E Foust Winton
- Author Affiliation: Department of Community and Health Systems, Indiana University School of Nursing, Indianapolis
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Chen YT, Murphy SL. Associations of Coexisting Pain and Fatigue Severity with Physical Performance and Quality of Life among Middle-Aged and Older Individuals with Chronic Knee Pain: A randomized controlled trial. PAIN MEDICINE 2021; 22:2575-2583. [PMID: 33772557 DOI: 10.1093/pm/pnab115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine associations of combined pain and fatigue severity with physical performance and quality of life in people with chronic knee pain. DESIGN Cross-sectional. SETTING General community. PARTICIPANTS Adults (N = 193) aged ≥ 50 years with chronic knee pain. METHODS Physical performance measures included Six-Minute Walk test, Timed Up and Go test, and 20-feet timed walk test. Quality of life (QOL) was measured by the Medical Outcomes Study Short Form-12 Health Survey. Brief Pain Inventory (BPI) and Brief Fatigue Inventory (BFI) were used to evaluate pain and fatigue. Multiple linear regression analyses were conducted to examine associations of coexisting pain and fatigue severity with physical performance and quality of life. RESULTS Based on BPI and BFI scores, participants were categorized into four severity groups: mild pain/fatigue; moderate pain/mild fatigue; mild pain/moderate fatigue; and moderate pain/fatigue (which included severe pain/fatigue). The moderate pain/fatigue group had significantly worse physical performance on Six Minute Walk (standardized beta (β) = - 0.22, 95% confidence interval (CI) [-.38, -.06], P < 0.05), poorer physical (β = - 0.41, 95% CI [-.61, -.20], P < 0.001) and mental QOL (β = - 0.26, 95% CI [-.46, -.07], P < 0.05) compared to the mild pain/fatigue group. Moreover, the mild pain/moderate fatigue group had significantly lower levels of mental QOL (β = - 0.27, 95% CI [-.44, -.10], P < 0.05) when compared to the mild pain/fatigue group. The moderate pain/mild fatigue group did not differ statistically compared to the mild pain/fatigue group. CONCLUSIONS Coexisting moderate pain and moderate fatigue were related to worse physical performance and QOL. Fatigue contributed to lower levels of mental QOL. Clinical assessment of fatigue in addition to pain should be included as a standard examination for chronic knee pain.
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Affiliation(s)
- Yen Tzu Chen
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Susan Lynn Murphy
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.,Veterans Affairs Ann Arbor Health Care System, Geriatric Research, Education, and Clinical Center, GRECC, Ann Arbor, MI
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Haase KR, Sattar S, Hall S, McLean B, Wills A, Gray M, Kenis C, Donison V, Howell D, Puts M. Systematic review of self-management interventions for older adults with cancer. Psychooncology 2021; 30:989-1008. [PMID: 33724608 DOI: 10.1002/pon.5649] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/20/2021] [Accepted: 02/01/2021] [Indexed: 12/26/2022]
Abstract
AIM The purpose of this systematic review was to determine the effectiveness of self-management interventions for older adults with cancer and to determine the effective components of said interventions. METHODS We conducted a systematic review of self-management interventions for older adults (65+) with cancer guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. We conducted an exhaustive search of the following databases: Ageline, AMED, ASSIA, CINAHL, Cochrane, Embase, Medline, PsychINFO, and Sociological Abstracts. We assessed for quality using the Cochrane Risk of Bias tool and Down & Black for quasi-experimental studies, with data synthesized in a narrative and tabular format. RESULTS Sixteen thousand nine hundred and eight-five titles and abstracts were screened, subsequently 452 full-text papers were reviewed by two independent reviewers, of which 13 full-text papers were included in the final review. All self-management interventions included in this review measured Quality of Life; other outcomes included mood, self-care activity, supportive care needs, self-advocacy, pain intensity, and analgesic intake; only one intervention measured frailty. Effective interventions were delivered by a multidisciplinary teams (n = 4), nurses (n = 3), and mental health professionals (n = 1). Self-management core skills most commonly targeted included: problem solving; behavioural self-monitoring and tailoring; and settings goals and action planning. CONCLUSIONS Global calls to action argue for increased emphasize on self-management but presently, few interventions exist that explicitly target the self-management needs of older adults with cancer. Future work should focus on explicit pathways to support older adults and their caregivers to prepare for and engage in cancer self-management processes and behaviours.
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Affiliation(s)
- Kristen R Haase
- Faculty of Applied Science, School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Schroder Sattar
- College of Nursing, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Steven Hall
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Bianca McLean
- De Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Aria Wills
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Mikaela Gray
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Cindy Kenis
- Department of General Medical Oncology and Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
| | - Valentina Donison
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Doris Howell
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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12
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Morrison KS, Paterson C, Toohey K. The Feasibility of Exercise Interventions Delivered via Telehealth for People Affected by Cancer: A Rapid Review of the Literature. Semin Oncol Nurs 2020; 36:151092. [PMID: 33223409 DOI: 10.1016/j.soncn.2020.151092] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The prevalence of exercise as an adjunct therapy to cancer treatments including chemotherapy, radiation therapy, and surgery is growing rapidly and has been shown to improve health outcomes, treatment completion rates, and quality of life in people affected by cancer. Given the complexity of delivering cancer services during coronavirus disease (COVID-19), many people who are undergoing cancer treatment are unable to access exercise services. This review aims to investigate: (1) the feasibility of exercise telehealth interventions for individuals diagnosed with cancer; and (2) the impact of exercise telehealth interventions for people affected by cancer on physical and psychosocial outcomes. METHODS/DATA SOURCES The literature search was conducted in four electronic databases (CINAHL, Cochrane, Medline, and Psych Info) from January 1, 2010 until May 1, 2020. All peer-reviewed qualitative and quantitative studies were included irrespective of study design. Studies that investigated adults (aged ≥18 years) with a diagnosis of any cancer, irrespective of treatment type, cancer stage or primary/secondary nature of disease were included. RESULTS Twenty-nine studies (a total of 3698 participants across the included studies) were synthesized. Across the included studies the interventions were broadly classified into four main areas of telehealth: web-based, mobile applications, SMS messaging, and telephone interventions. CONCLUSION Participants across the studies showed good compliance, symptom relief and reported an overall positive experience using telehealth for exercise. There were no adverse events reported in these studies. Given the current COVID-19 pandemic, more research is required to assess the feasibility of telehealth platforms such as Zoom, Skype, Microsoft Teams, or FaceTime, and to determine the overall participant and exercise professional telehealth exercise delivery experience. IMPLICATIONS FOR NURSING PRACTICE Telehealth uses telecommunications technology as a tool to deliver health care to populations with limited access to cancer care. Quality care of a person living with cancer requires multidisciplinary team-based care and telecommunications technology can support interprofessional care. This review has underscored that telecommunications is a critical tool in the delivery of cancer care to enable timely ongoing support for exercise interventions for those affected by cancer. It remains important for people affected by cancer to continue to engage in and maintain regular exercise under the guidance of qualified health professionals in keeping with evidence-based clinical guidelines.
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Affiliation(s)
| | - Catherine Paterson
- Faculty of Health, University of Canberra, Bruce, ACT, Australia; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, ACT, Australia; School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, ACT, Australia; Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, Canberra Hospital, Garran, ACT, Australia; Robert Gordon University, Aberdeen, Scotland, UK
| | - Kellie Toohey
- Faculty of Health, University of Canberra, Bruce, ACT, Australia; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, ACT, Australia.
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Aapro M, Bossi P, Dasari A, Fallowfield L, Gascón P, Geller M, Jordan K, Kim J, Martin K, Porzig S. Digital health for optimal supportive care in oncology: benefits, limits, and future perspectives. Support Care Cancer 2020; 28:4589-4612. [PMID: 32533435 PMCID: PMC7447627 DOI: 10.1007/s00520-020-05539-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Digital health provides solutions that capture patient-reported outcomes (PROs) and allows symptom monitoring and patient management. Digital therapeutics is the provision to patients of evidence-based therapeutic interventions through software applications aimed at prevention, monitoring, management, and treatment of symptoms and diseases or for treatment optimization. The digital health solutions collecting PROs address many unmet needs, including access to care and reassurance, increase in adherence and treatment efficacy, and decrease in hospitalizations. With current developments in oncology including increased availability of oral drugs and reduced availability of healthcare professionals, these solutions offer an innovative approach to optimize healthcare resource utilization. DESIGN This scoping review clarifies the role and impact of the digital health solutions in oncology supportive care, with a view of the current segmentation according to their technical features (connection to sensors, PRO collection, remote monitoring, self-management in real time…), and identifies evidence from clinical studies published about their benefits and limitations and drivers and barriers to adoption. A qualitative summary is presented. RESULTS Sixty-six studies were identified and included in the qualitative synthesis. Studies supported the use of 38 digital health solutions collecting ePROs and allowing remote monitoring, with benefits to patients regarding symptom reporting and management, reduction in symptom distress, decrease in unplanned hospitalizations and related costs and improved quality of life and survival. Among those 38 solutions 21 provided patient self-management with impactful symptom support, improvement of QoL, usefulness and reassurance. Principal challenges are in developing and implementing digital solutions to suit most patients, while ensuring patient compliance and adaptability for use in different healthcare systems and living environments. CONCLUSIONS There is growing evidence that digital health collecting ePROs provide benefits to patients related to clinical and health economic endpoints. These digital solutions can be integrated into routine supportive care in oncology practice to provide improved patient-centered care.
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Affiliation(s)
- M Aapro
- Medical Oncology, Genolier Cancer Center, Clinique de Genolier, Genolier, Switzerland.
- Institut Multidisciplinaire d'Oncologie (IMO), Clinique de Genolier, Case Postale (PO Box) 100, 1 Route de Muids, CH-1272, Genolier, Switzerland.
| | - P Bossi
- Department of Medical Oncology, University of Brescia, Brescia, Italy
| | - A Dasari
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - L Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - P Gascón
- Department of Hematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - M Geller
- Gynecologic Oncology, Department of Obstetrics, Gynecology and Women's Health (OBGYN), University of Minnesota, Minneapolis, MN, USA
| | - K Jordan
- Department of Medicine, Haematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - J Kim
- Medical Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - K Martin
- Gyneco-oncology, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - S Porzig
- Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Dickerson JC, Ragavan MV, Parikh DA, Patel MI. Healthcare delivery interventions to reduce cancer disparities worldwide. World J Clin Oncol 2020; 11:705-722. [PMID: 33033693 PMCID: PMC7522545 DOI: 10.5306/wjco.v11.i9.705] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/07/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
Globally, cancer care delivery is marked by inequalities, where some economic, demographic, and sociocultural groups have worse outcomes than others. In this review, we sought to identify patient-facing interventions designed to reduce disparities in cancer care in both high- and low-income countries. We found two broad categories of interventions that have been studied in the current literature: Patient navigation and telehealth. Navigation has the strongest evidence base for reducing disparities, primarily in cancer screening. Improved outcomes with navigation interventions have been seen in both high- and low-income countries. Telehealth interventions remain an active area of exploration, primarily in high income countries, with the best evidence being for the remote delivery of palliative care. Ongoing research is needed to identify the most efficacious, cost-effective, and scalable interventions to reduce barriers to the receipt of cancer care globally.
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Affiliation(s)
- James C Dickerson
- Department of Internal Medicine, Stanford University, Stanford, CA 94305, United States
| | - Meera V Ragavan
- Department of Internal Medicine, Stanford University, Stanford, CA 94305, United States
| | - Divya A Parikh
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, United States
| | - Manali I Patel
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, United States
- Center for Health Policy/Primary Care Outcomes Research, Stanford University, Stanford, CA 94305, United States
- VA Palo Alto Health Care System, Palo Alto, CA 94306, United States
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Abstract
BACKGROUND Patient engagement (PE) is a key factor for early-stage breast cancer survivors during survivorship, yet little is known about what factors may contribute to PE. OBJECTIVES The aims of this study were to describe the relationship between sociodemographic factors, survivorship variables, and PE and explore how variations in these variables might contribute to PE in breast cancer survivors. METHODS A cross-sectional, web-based self-report national survey was conducted to assess sociodemographic factors and survivorship variables: health-related quality of life (HRQOL) as measured by 7-item Functional Assessment of Cancer Therapy-General, fear of cancer recurrence, cancer health literacy, and 2 measures of PE (Patient Activation and Knowing Participation in Change) in breast cancer survivors. One open-ended question assessed additional survivorship concerns. Data were analyzed via bivariate associations and backward linear regression modeling in SPSS. RESULTS The sample (N = 303), equally dispersed across the United States, was predominantly middle-aged (mean, 50.70 [SD, 14.01]), white, non-Hispanic women. Knowing Participation in Change and Patient Activation regression models indicate HRQOL was significantly associated with PE (P ≤ .001), whereas findings related to fear of cancer recurrence lacked significance. In the Knowing Participation in Change regression model, HRQOL, social support, and level of education were all significantly associated with PE (P ≤ .001). CONCLUSIONS Breast cancer survivors with higher HRQOL, greater social support, and higher levels of education were more likely to have higher levels of PE. IMPLICATIONS FOR PRACTICE Findings may provide insight as to which survivors may be ready to engage in SC and those who may need more specific tailoring of resources and support.
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Moving beyond symptom management towards cancer rehabilitation for older adults: Answering the 5W's. J Geriatr Oncol 2018; 9:543-549. [DOI: 10.1016/j.jgo.2017.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/12/2017] [Accepted: 11/22/2017] [Indexed: 12/16/2022]
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Bradford NK, Henney R, Walker R, Walpole E, Kennedy G, Nicholls W, Pinkerton R. Queensland Youth Cancer Service: A Partnership Model to Facilitate Access to Quality Care for Young People Diagnosed with Cancer. J Adolesc Young Adult Oncol 2018; 7:339-348. [PMID: 29746187 DOI: 10.1089/jayao.2017.0080] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Global recognition of the need to improve outcomes for adolescents and young adults (AYA) with cancer has led to the development of specific oncology programs and services. In Australia, Youth Cancer Services (YCS) are now established across the country. While each service has been shaped by nationally agreed principles, program development has been influenced by local policy and geographic differences. Queensland is a vast state with a widely dispersed population; coordination of cancer services for young people across this landscape presents unique challenges. The Queensland YCS (QYCS) work in a consultative partnership model with primary treating teams, across both pediatric and adult tertiary cancer services. Understanding how cancer services approach challenges and service development can provide guidance for other developing services. In this article, we describe the goals and development of QYCS and review the outcomes achieved in the service to date. We reviewed referral data and retrieved statewide clinical activity from the web-based data system. We compared these data with cancer registry data to identify disparities and areas for service development. While the service has achieved notable outcomes, challenges remain. These include recruitment of appropriately skilled and trained health professionals for this newly developing area of oncology. In addition, there is an ongoing need to advocate for this relatively small patient group, and to promote awareness and understanding of the need for AYA-specific services. With the dispersed population and concentration of services in metropolitan Brisbane, identifying and testing new innovative models, including telehealth, to reach all AYA diagnosed with cancer regardless of location of care are priorities.
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Affiliation(s)
- Natalie K Bradford
- 1 Queensland Youth Cancer Service, Children Health Queensland , Brisbane, Australia .,2 School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology , Brisbane, Australia
| | - Roslyn Henney
- 1 Queensland Youth Cancer Service, Children Health Queensland , Brisbane, Australia
| | - Rick Walker
- 1 Queensland Youth Cancer Service, Children Health Queensland , Brisbane, Australia .,3 Oncology Services Group , Children's Health Queensland, Brisbane, Australia .,4 School of Medicine, The University of Queensland , Brisbane, Australia
| | - Euan Walpole
- 4 School of Medicine, The University of Queensland , Brisbane, Australia .,5 Cancer Services, Princess Alexandra Hospital , Brisbane, Queensland, Australia
| | - Glen Kennedy
- 4 School of Medicine, The University of Queensland , Brisbane, Australia .,6 Cancer Care Services, Royal Brisbane and Women's Hospital , Brisbane, Australia
| | - Wayne Nicholls
- 3 Oncology Services Group , Children's Health Queensland, Brisbane, Australia .,4 School of Medicine, The University of Queensland , Brisbane, Australia
| | - Ross Pinkerton
- 3 Oncology Services Group , Children's Health Queensland, Brisbane, Australia .,4 School of Medicine, The University of Queensland , Brisbane, Australia
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