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Springer F, Mehnert-Theuerkauf A, Gebhardt C, Stolzenburg JU, Briest S. Unmet supportive care needs among cancer patients: exploring cancer entity-specific needs and associated factors. J Cancer Res Clin Oncol 2024; 150:190. [PMID: 38607426 PMCID: PMC11009727 DOI: 10.1007/s00432-024-05715-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Recognizing unmet care needs among cancer patients is crucial for improving a person-centered and tailored approach to survivorship care. This study aimed to explore the prevalence of unmet supportive care needs, pinpointing entity-specific areas of burden, and to identify factors associated with unmet needs within a diverse sample of cancer patients. METHODS In this cross-sectional sub-study of a large multicenter study, 944 adult cancer patients reported supportive care needs via the well-validated SCNS. Most frequent diagnoses included breast (n = 276), prostate (n = 237), hematological (n = 90) and gynecological cancer (n = 74), which were analyzed for entity-specific care needs. RESULTS Across most cancer entities, health system and information, and psychological needs were most commonly reported, with fear of the cancer spreading and information regarding cancer control/diminishment ranking as the most prevalent individual concerns. Notable differences in entity-specific needs emerged for gynecological cancer patients, who exhibited more psychological (p = 0.007, OR = 2.01) and physical needs (p = 0.005, OR = 2.02), and prostate cancer patients, who showed higher sexuality needs (p < 0.001, OR = 2.95) but fewer psychological (p < 0.001, OR = 0.55), physical (p < 0.001, OR = 0.31) and patient care needs (p = 0.006, OR = 0.62). Non-distressed participants had fewer supportive care needs in each domain (all p < 0.001). Patients with functional impairments and female respondents reported increased unmet needs across most domains. CONCLUSION The high prevalence of patients feeling inadequately informed about their disease and care aspects, particularly among those with functional impairments, reflects a key challenge in the healthcare system. Specific interventions and improvements in patient-doctor communication are essential to address cancer entity-specific care needs.
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Affiliation(s)
- Franziska Springer
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany (CCCG), University Medical Center Leipzig, Leipzig, Germany.
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany (CCCG), University Medical Center Leipzig, Leipzig, Germany
| | - Claudia Gebhardt
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany (CCCG), University Medical Center Leipzig, Leipzig, Germany
| | - Jens-Uwe Stolzenburg
- Department of Urology, Comprehensive Cancer Center Central Germany (CCCG), University Medical Center Leipzig, Leipzig, Germany
| | - Susanne Briest
- Department of Gynecology, Comprehensive Cancer Center Central Germany (CCCG), University Medical Center Leipzig, Leipzig, Germany
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Zeng K, Zhong Y, Chen X, Zhang L. Perceived communication efficacy and unmet needs for chemotherapy-associated symptom management in patients with lung and colorectal cancer: a cross-sectional study. BMC Palliat Care 2024; 23:71. [PMID: 38481297 PMCID: PMC10936018 DOI: 10.1186/s12904-024-01376-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Understanding cancer patients' unmet needs for chemotherapy-related symptom management will assist clinicians in developing tailored intervention programs. Little is known about the association between perceived communication efficacy and unmet care needs for symptom management in patients with lung and colorectal cancer. OBJECTIVES To examine the unmet care needs for symptom management of patients with lung and colorectal cancer and their association with perceived communication efficacy. METHODS A cross-sectional survey was conducted in a tertiary hospital in China from July to November 2020. A convenience sample of 203 patients with lung and colorectal cancer undergoing chemotherapy completed survey questionnaires, including the MD Anderson Symptom Inventory Scale and the Perceived Efficacy in Patient‒Physician Interactions Scale. RESULTS Approximately 43% of participants had at least one symptom with unmet needs. Fatigue was reported as the symptom with the highest occurrence (66%), the highest demand for supportive care (36%), and the highest prevalence of unmet needs (19%). Low levels of perceived communication efficacy independently predicted participants' unmet needs for symptom management (β=-0.13, p = 0.011). CONCLUSIONS This study highlights the necessity of introducing clinical assessment tools and guidelines to address fatigue and other chemotherapy-induced symptoms in patients with lung and colorectal cancer. Clinical programs designed to actively engage cancer patients to voice their needs and strengthen their communication efficacy are also warranted.
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Affiliation(s)
- Kai Zeng
- School of Nursing, Southern Medical University, No.1023-1063 Shatai South Road, Baiyun District, Guangzhou, 510515, China
| | - Yaping Zhong
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Xiaofang Chen
- The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Lili Zhang
- School of Nursing, Southern Medical University, No.1023-1063 Shatai South Road, Baiyun District, Guangzhou, 510515, China.
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Raggini E, Mattavelli D, Zigliani G, Bossi P, Piazza C. Measuring financial toxicity in head and neck cancer: a systematic review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:1-12. [PMID: 38420716 PMCID: PMC10914354 DOI: 10.14639/0392-100x-n2762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/26/2023] [Indexed: 03/02/2024]
Abstract
Objective The current study systematically reviews the literature about financial toxicity (FT) in head and neck cancer patients. Three databases were reviewed: PubMed, Scopus and Web of Science. Methods Full text English papers published from 2000 to 2022 reporting on quantitative results about FT in head and neck cancer survivors collected through structured questionnaires or interviews were included. Results Twenty-seven articles were included. Most of the articles were published after 2015 and from United States. There was a slight prevalence of papers dealing with oropharyngeal cancer, squamous-cell carcinoma and locally advanced head and neck cancer. Measures of FT were obtained through validated questionnaires like COST, FIT and FDQ. Collected data were mostly referrable to financial spending, financial resources, psychosocial aspect, support seeking, coping care and coping lifestyle subdomain. FT scores by COST were found to be worse in the COVID era. Financial counseling and adequate information about the costs of treatment were two effective strategies to mitigate FT. Conclusions FT is a relatively new challenge in head and neck cancer treatment, whose expenses are higher than therapies for other cancers. A universal method to assess FT and a unified guideline for the administration of questionnaires are needed to mitigate FT and to improve patient outcomes.
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Affiliation(s)
- Elisa Raggini
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Gabriele Zigliani
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
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Day AT, Sood A, Emmet TR, Eary RL, Prestwood CA, Salley J, Huffman A, Doenges J, Mayfield Arnold E, Tiro JA, Lee SC. Supportive Care Needs Among Head and Neck Cancer Patients Prior to Oncologic Treatment: A Prospective, Nested Cross-Sectional Qualitative Analysis. Ann Otol Rhinol Laryngol 2023; 132:1443-1452. [PMID: 37005576 DOI: 10.1177/00034894231162686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
OBJECTIVES To qualitatively characterize pretreatment head and neck cancer (HNC) patients' supportive care (SC) needs, attitudes toward SC, and barriers to SC utilization. MATERIALS AND METHODS A prospective, nested, bi-institutional, cross-sectional pilot study design was employed. Participants were sub-selected from a representative sample of 50 patients newly diagnosed with mucosal or salivary gland HNC or sarcoma of the head and neck. Eligibility criteria included reporting ≥2 unmet needs (according to the Supportive Care Needs Survey-Short Form 34) or clinically-significant distress (National Comprehensive Cancer Network Distress Thermometer score ≥4). Semi-structured interviews were performed prior to initiation of oncologic treatment. Audio-recorded interviews were transcribed and thematically analyzed using NVivo 12.0 (QSR Australia). Thematic findings and representative quotes were interpreted by the entire research team. RESULTS Twenty-seven patients were interviewed. One-third were treated at the county safety-net hospital and the remainder were treated at the university health system. An equal proportion of patients presented with oral cavity, oropharyngeal, and laryngeal or other tumors. Two significant findings were identified on semi-structured interviews. First, patients did not perceive the relevance of SC prior to treatment. Second, anxiety surrounding the HNC diagnosis and impending treatment dominated in the pretreatment phase. CONCLUSION Improved HNC patient education about the relevance and importance of SC in the pretreatment setting is needed. Integration of social work or psychological services in HNC clinics is warranted to address patients' cancer-related worry-a discrete, dominant pretreatment SC need.
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Affiliation(s)
- Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Anubha Sood
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Thomas R Emmet
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rebecca L Eary
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Courtney A Prestwood
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jordan Salley
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Alexandra Huffman
- Support Services, Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Jacquelyn Doenges
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Jasmin A Tiro
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Simon Craddock Lee
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
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Day AT, Prestwood CA, Emmett TR, Eary RL, Salley JR, Cerda V, Mayfield Arnold E, Lee SC, Tiro JA. Unmet Needs and Receipt of Supportive Care Services in Head and Neck Cancer Patients Prior to Oncologic Treatment: A Prospective, Cross-Sectional Pilot Study. Ann Otol Rhinol Laryngol 2023; 132:1361-1372. [PMID: 36890749 DOI: 10.1177/00034894231154182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
OBJECTIVE To characterize the supportive care (SC) needs and receipt of SC services among head and neck cancer (HNC) patients prior to oncologic treatment and to explore the influence of social determinants of health on these outcomes. MATERIALS AND METHODS Newly diagnosed HNC patients were surveyed via telephone prior to oncologic treatment between 10/2019 and 1/2021 using a prospective, cross-sectional, bi-institutional, pilot study design. The primary study outcome was unmet SC needs (Supportive Care Needs Survey-Short Form34 [SCNS-SF34]). Hospital type (university- vs county safety-net) was explored as an exposure. Descriptive statistics were performed using STATA16 (College Station, TX). RESULTS Among 158 potentially eligible patients, 129 were successfully contacted, 78 met the study criteria, and 50 completed the survey. The mean age was 61, 58% exhibited clinical stage III-IV disease, and 68% and 32% were treated at the university and county safety-net hospital, respectively. Patients were surveyed a median of 20 days after their first oncology visit and 17 days prior to initiation of oncology treatment. They had a median of 24 total needs (11 were met and 13 were unmet) and preferred to see a median of 4 SC services but received care from none. County safety-net patients had comparatively more unmet needs than university patients (14.5 vs 11.5, P = .04). CONCLUSION Pretreatment HNC patients at a bi-institutional academic medical center report a high number of unmet SC needs with corollary poor receipt of available SC services. Novel interventions to address this significant gap in care are needed.
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Affiliation(s)
- Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Courtney A Prestwood
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Thomas R Emmett
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rebecca L Eary
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jordan R Salley
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Vanessa Cerda
- Department of Population and Data Sciences; UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Simon Craddock Lee
- Department of Population and Data Sciences; UT Southwestern Medical Center, Dallas, TX, USA
| | - Jasmin A Tiro
- Department of Population and Data Sciences; UT Southwestern Medical Center, Dallas, TX, USA
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Crowe L, Brown M, Bojke A, Bojke R, Greystoke A, Lecouturier J, Richardson J, Wells M, Todd A, Sharp L. Assessing the unmet needs of patients with advanced cancer treated by biological and precision therapies: protocol for TARGET, a mixed methods study. BMJ Open 2023; 13:e066229. [PMID: 37142322 PMCID: PMC10163501 DOI: 10.1136/bmjopen-2022-066229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Biological and precision therapies are increasingly used in cancer treatment. Although they may improve survival, they are also associated with various-and unique-adverse effects, which can be long lasting. Little is known about the experiences of people treated with these therapies. Moreover, their supportive care needs have not been fully explored. Consequently, it is unclear whether existing instruments adequately capture the unmet needs of these patients. The TARGET study seeks to address these evidence gaps by exploring the needs of people treated with these therapies with the aim of developing an unmet needs assessment instrument for patients on biological and precision therapies. METHODS AND ANALYSIS The TARGET study will adopt a multi-methods design involving four Workstreams (1) a systematic review to identify, describe and assess existing unmet needs instruments in advanced cancer; (2) qualitative interviews with patients on biological and precision therapies, and their healthcare professionals, to explore experiences and care needs; (3) development and piloting of a new (or adapted) unmet needs questionnaire (based on the findings of Workstream 1 and Workstream 2) designed to capture the supportive care needs of these patients; and finally, (4) a large-scale patient survey using the new (or modified) questionnaire to determine (a) the psychometric properties of the questionnaire, and (b) the prevalence of unmet needs in these patients. Based on the broad activity of biological and precision therapies, the following cancers will be included: breast, lung, ovarian, colorectal, renal and malignant melanoma. ETHICS AND DISSEMINATION This study was approved by National Health Service (NHS) Heath Research Authority Northeast Tyne and Wear South Research Ethics Committee (REC ref: 21/NE/0028). Dissemination of the research findings will take several formats to reach different audiences, including patients, healthcare professionals and researchers.
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Affiliation(s)
- Lisa Crowe
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Morven Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Andy Bojke
- Patient and Public Involvement, Newcastle upon Tyne, UK
| | - Rona Bojke
- Patient and Public Involvement, Newcastle upon Tyne, UK
| | - Alastair Greystoke
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jan Lecouturier
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James Richardson
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mary Wells
- Nursing Directorate, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
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Mavragani A, Imanguli M, Kashy D, Pesanelli M, Frederick S, Van Cleave JH, Paddock L, Hudson S, Steinberg M, Clifford P, Domider M, Singh N. Enhancing Self-care Among Oral Cancer Survivors: Protocol for the Empowered Survivor Trial. JMIR Res Protoc 2023; 12:e39996. [PMID: 36662561 PMCID: PMC9898837 DOI: 10.2196/39996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Survivors of oral cavity and oropharyngeal cancer frequently experience difficulties in swallowing; tasting; speaking; chewing; and maintaining comfortable movements of the head, neck, and shoulder. Engagement in regular self-care can reduce further loss of function and mitigate late effects. Despite the substantial self-care requirements, there are no empirically based interventions to enhance the skills and confidence of these survivors in managing their ongoing care. OBJECTIVE The aim of this study is to describe the rationale and methodology for a randomized controlled trial evaluating Empowered Survivor (ES) versus Springboard Beyond Cancer, a general web-based program for cancer survivors, on self-efficacy in managing care, preparedness for managing survivorship, and health-related quality of life (QOL). METHODS This study will recruit a total of 600 individuals who were diagnosed with oral cavity or oropharyngeal cancer in the past 3 years and are currently cancer free primarily from state cancer registries; these individuals will be randomly assigned to either the ES or Springboard Beyond Cancer condition. The participants complete measures of self-efficacy in managing care, preparedness for survivorship, health-related QOL, and engagement in oral self-examination and head and neck strengthening and flexibility exercises at baseline and 2 and 6 months after baseline. The primary aim of this study is to evaluate the impact of ES versus Springboard Beyond Cancer on self-efficacy, preparedness, and health-related QOL. The secondary aim is to examine the mediators and moderators of ES's impact on self-efficacy in managing care, preparedness, and health-related QOL at 6 months. The exploratory aim is to conduct a process evaluation of ES to identify potential oncology or community settings for future implementation. RESULTS Multilevel modeling will be used to examine whether there are significant differences between the ES and Springboard Beyond Cancer interventions over time. Mediational models will evaluate the indirect effects of ES on outcomes. Quantitative analyses will evaluate the predictors of ES use, and qualitative analyses will evaluate the preferred timing and settings for the implementation of ES. CONCLUSIONS This randomized controlled trial evaluates a completely web-based intervention, ES, versus a general web-based program for cancer survivors, Springboard Beyond Cancer, on self-efficacy in managing care, preparedness for managing survivorship, and health-related QOL and identifies the putative mediators and moderators of the intervention's effects. If an effect on the primary outcomes is illustrated, the next step could be an implementation trial to evaluate the intervention's uptake in and impact on an oncology care setting or nonprofit organizations. TRIAL REGISTRATION ClincalTrials.gov NCT04713449; https://clinicaltrials.gov/ct2/show/NCT04713449. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39996.
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Affiliation(s)
| | - Matin Imanguli
- Division of Head and Neck Oncologic and Reconstructive Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Deborah Kashy
- College of Social Science, Department of Psychology, Michigan State University, Lansing, MI, United States
| | - Morgan Pesanelli
- School of Public Health, Rutgers State University of New Jersey, Piscataway, NJ, United States
| | - Sara Frederick
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Janet H Van Cleave
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Lisa Paddock
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Shawna Hudson
- Department of Family Medicine and Community Health, Institute for Health Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Michael Steinberg
- Department of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Patrick Clifford
- Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers State University of New Jersey, Piscataway, NJ, United States
| | - Mara Domider
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Neetu Singh
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
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8
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Manne SL, Hudson SV, Kashy DA, Imanguli M, Pesanelli M, Frederick S, Van Cleave J. Self-efficacy in managing post-treatment care among oral and oropharyngeal cancer survivors. Eur J Cancer Care (Engl) 2022; 31:e13710. [PMID: 36151904 PMCID: PMC9788355 DOI: 10.1111/ecc.13710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/25/2022] [Accepted: 09/07/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Physical and psychosocial effects of oral cancer result in long-term self-management needs. Little attention has been paid to survivors' self-efficacy in managing their care. Study goals were to characterise self-care self-efficacy and evaluate socio-demographics, disease, attitudinal factors and psychological correlates of self-efficacy and engagement in head and neck self-exams. METHODS Two hundred thirty-two oral cancer survivors completed measures of socio-demographics, self-care self-efficacy, head and neck self-exams and attitudinal and psychological measures. Descriptive statistics characterised self-efficacy. Hierarchical regressions evaluated predictors of self-efficacy. RESULTS Survivors felt moderately confident in the ability to manage self-care (M = 4.04, SD = 0.75). Survivors with more comorbidities (β = -0.125), less preparedness (β = 0.241), greater information (β = -0.191), greater support needs (β = -0.224) and higher depression (β = -0.291) reported significantly lower self-efficacy. Head and neck self-exam engagement (44% past month) was relatively low. Higher preparedness (OR = 2.075) and self-exam self-efficacy (OR = 2.606) were associated with more engagement in self-exams. CONCLUSION Many survivors report low confidence in their ability to engage in important self-care practices. Addressing unmet information and support needs, reducing depressive symptoms and providing skill training and support may boost confidence in managing self-care and optimise regular self-exams.
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Affiliation(s)
- Sharon L. Manne
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
| | - Shawna V. Hudson
- Institute for Health, Health Care Policy and Aging ResearchRobert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Deborah A. Kashy
- Department of PsychologyMichigan State UniversityEast LansingMichiganUSA
| | - Matin Imanguli
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA,Department of Otolaryngology‐Head and Neck SurgeryRobert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Morgan Pesanelli
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
| | - Sara Frederick
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
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9
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Salley JR, Day AT, Balachandra S, Mehr J, Sumer BD, Sher DJ, Mayfield Arnold E, Danphuong Ho E, Lee SC, Eary R. Adherence to the American Cancer Society Head and Neck Cancer Survivorship Care Guideline According to Chart Review: A Nested Retrospective Cohort Pilot Study. Ann Otol Rhinol Laryngol 2022; 132:481-491. [PMID: 35723192 DOI: 10.1177/00034894221098471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this study was to explore adherence to the American Cancer Society (ACS) Head and Neck Cancer (HNC) Survivorship Care Guideline and their outlined 33 recommendations among posttreatment HNC survivors. METHODS A bi-institutional, retrospective, nested cohort study of mucosal or salivary gland HNC survivors diagnosed in 2018 was designed. Guideline adherence was assessed via retrospective chart review between 0 and 13 months after completion of oncologic treatment according to 4 categories: (1) problem assessed, (2) problem diagnosed, (3) management offered; (4) problem treated. Adherence was defined as meeting a recommendation subcategory at least once over the 13-month period. RESULTS Among 60 randomly selected HNC survivors, a total of 38 were included in the final cohort after exclusion of individuals with ineligible cancers and those who died or were lost to follow-up over the study period. Approximately 95% of HNC survivors were assessed for HNC recurrence and screened for lung cancer. Certain common problems such as xerostomia, dysphagia, and hypothyroidism were screened for and managed in ≥70% of eligible survivors. Conversely, screening for other second primary cancers and assessment of a majority of other physical and psychosocial harms occurred in <70% of survivors, and in many cases none to a slim minority of survivors (eg, sleep apnea and sleep disturbance, body and self-image concerns). Only 5% of survivors received a survivorship care plan. CONCLUSION Overall adherence to the ACS HNC Survivorship Care Guideline in early posttreatment survivors was suboptimal. Interventions are needed to better implement and operationalize these guideline recommendations.
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Affiliation(s)
- Jordan R Salley
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Joshua Mehr
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Baran D Sumer
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - David J Sher
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Esther Danphuong Ho
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Simon Craddock Lee
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rebecca Eary
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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10
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McDowell L, Rischin D, Gough K, Henson C. Health-Related Quality of Life, Psychosocial Distress and Unmet Needs in Older Patients With Head and Neck Cancer. Front Oncol 2022; 12:834068. [PMID: 35242716 PMCID: PMC8885992 DOI: 10.3389/fonc.2022.834068] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/24/2022] [Indexed: 01/22/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the most common cancer involving the mucosal surfaces of the head and neck and is associated with a number of etiological factors, including cigarette smoking, alcohol and betel nut consumption and exposure to high-risk human papillomavirus. The risk of HNSCC increases with age, peaking in the seventh and eighth decade, but this varies by anatomical and histological subtype. While several advancements have been made in the treatment of head and neck cancer (HNC) in recent decades, undertaking curative treatment still subjects the majority of HNSCC patients to substantial treatment-related toxicity requiring patients to tolerate a gamut of physical, psychological, and emotional demands on their reserves. In conjunction with other patient-related factors, clinicians involved in treating patients with HNSCC may incorporate advancing chronological age into their decision-making process when determining treatment recommendations. While advancing chronological age may be associated with increased concerns regarding physical treatment tolerability, clinicians may also be concerned about heightened vulnerability in various health and wellbeing outcomes. The available literature, however, does not provide evidence of this vulnerability in patients with advancing age, and, in many instances, older patients self-report greater resilience compared to their younger counterparts. While this data is reassuring it is limited by selection bias and heterogeneity in trial and study design and the absence of a consistent definition of the elderly patient with HNSCC. This narrative review article also includes a review of the measures used to assess HRQL, psychosocial outcomes and unmet needs in elderly or older patients with HNSCC.
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Affiliation(s)
- Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Danny Rischin
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Karla Gough
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, VIC, Australia
| | - Christina Henson
- Department of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, United States
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11
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Goyal N, Day A, Epstein J, Goodman J, Graboyes E, Jalisi S, Kiess AP, Ku JA, Miller MC, Panwar A, Patel VA, Sacco A, Sandulache V, Williams AM, Deschler D, Farwell DG, Nathan C, Fakhry C, Agrawal N. Head and neck cancer survivorship consensus statement from the American Head and Neck Society. Laryngoscope Investig Otolaryngol 2022; 7:70-92. [PMID: 35155786 PMCID: PMC8823162 DOI: 10.1002/lio2.702] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To provide a consensus statement describing best practices and evidence regarding head and neck cancer survivorship. METHODS Key topics regarding head and neck cancer survivorship were identified by the multidisciplinary membership of the American Head and Neck Society Survivorship, Supportive Care & Rehabilitation Service. Guidelines were generated by combining expert opinion and a review of the literature and categorized by level of evidence. RESULTS Several areas regarding survivorship including dysphonia, dysphagia, fatigue, chronic pain, intimacy, the ability to return to work, financial toxicity, lymphedema, psycho-oncology, physical activity, and substance abuse were identified and discussed. Additionally, the group identified and described the role of key clinicians in survivorship including surgical, medical and radiation oncologists; dentists; primary care physicians; psychotherapists; as well as physical, occupational, speech, and respiratory therapists. CONCLUSION Head and neck cancer survivorship is complex and requires a multidisciplinary approach centered around patients and their caregivers. As survival related to head and neck cancer treatment improves, addressing post-treatment concerns appropriately is critically important to our patient's quality of life. There continues to be a need to define effective and efficient programs that can coordinate this multidisciplinary effort toward survivorship.
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Affiliation(s)
- Neerav Goyal
- Department of Otolaryngology—Head and Neck SurgeryThe Pennsylvania State University, College of MedicineHersheyPennsylvaniaUSA
| | - Andrew Day
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Joel Epstein
- Department of SurgeryCedars SinaiLos AngelesCaliforniaUSA
- City of HopeCaliforniaDuarteUSA
| | - Joseph Goodman
- Ear, Nose and Throat CenterGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Evan Graboyes
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Scharukh Jalisi
- Department of OtolaryngologyBeth Israel DeaconessBostonMassachusettsUSA
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Jamie A. Ku
- Head and Neck InstituteCleveland ClinicClevelandOhioUSA
| | - Matthew C. Miller
- Department of OtolaryngologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Aru Panwar
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer CenterNebraska Methodist HospitalOmahaNebraskaUSA
| | - Vijay A. Patel
- Department of OtolaryngologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Assuntina Sacco
- Department of Medical OncologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Vlad Sandulache
- Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Amy M. Williams
- Department of Otolaryngology—Head and Neck SurgeryHenry Ford Health SystemDetroitMichiganUSA
| | - Daniel Deschler
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| | - D. Gregory Farwell
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California DavisDavisCaliforniaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State UniversityShreveportLouisianaUSA
| | - Carole Fakhry
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology—Head and Neck SurgeryUniversity of Chicago Pritzker School of MedicineChicagoIllinoisUSA
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12
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Alonso I, Lopez-Perez L, Martin Guirado JC, Fernanda Cabrera-Umpierrez M, Arredondo MT, Fico G. Data analytics for predicting quality of life changes in head and neck cancer survivors: a scoping review. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:2262-2265. [PMID: 34891737 DOI: 10.1109/embc46164.2021.9629619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Head and neck cancer is the seventh most common cancer worldwide. The incidence of this cancer is increasing, but at the same time, the cancer-related mortality rate has decreased over time, leaving more head and neck cancer survivors. More emphasis is needed on quality-of-life research in the head and neck cancer field to improve their daily lives and reduce the disease and treatment response burden. To achieve this, we conducted a scoping review to find and learn which predictors and data analysis techniques have been used in previous studies. This work is undertaken in the context of the BD4QoL EU Research project.
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13
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de Heus E, van der Zwan JM, Husson O, Frissen AR, van Herpen CML, Merkx MAW, Duijts SFA. Unmet supportive care needs of patients with rare cancer: A systematic review. Eur J Cancer Care (Engl) 2021; 30:e13502. [PMID: 34409667 DOI: 10.1111/ecc.13502] [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: 04/09/2021] [Revised: 06/04/2021] [Accepted: 07/27/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Patients with rare cancers may experience different unmet needs than those with common cancer. The objective of this systematic review was to (1) investigate unmet supportive care needs of rare cancer patients throughout the disease trajectory and (2) identify predictive factors for these unmet needs. METHODS PubMed, PsycINFO and CINAHL were searched for publications (January 2011 to March 2021) focusing on unmet needs of patients with rare cancer. Two reviewers independently selected studies, extracted data and performed quality assessment. Findings were synthesised. RESULTS The search yielded 4,598 articles, of which 59 articles met eligibility criteria and 57 were of medium or high quality. Rare cancer patients most frequently reported unmet needs in the healthcare system and information domain (up to 95%), followed by the psychological domain (up to 93%) and the physical and daily living domain (up to 80%). Unmet needs were mainly reported in the posttreatment phase. The most frequently identified predictors were higher anxiety, younger age and higher neuroticism. CONCLUSION Patients with rare cancer have unmet needs throughout their disease trajectory. Supportive care needs of rare cancer patients should be addressed individually, depending on the rare cancer subdomain and phase of disease and from diagnosis onwards.
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Affiliation(s)
- Eline de Heus
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Maarten van der Zwan
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Olga Husson
- Division of Psychosocial Research and Epidemiology and Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anne-Roos Frissen
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matthias A W Merkx
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Saskia F A Duijts
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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14
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Mazhari F, Khoshnood Z. Exploring the care needs of Iranian patients with cancer: a qualitative content analysis. BMC Nurs 2021; 20:138. [PMID: 34372854 PMCID: PMC8351099 DOI: 10.1186/s12912-021-00659-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/24/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND: Cancer is currently one of the most critical health problems worldwide. Different studies have shown that disease can reduce people's ability to take care of themselves and this makes them face many needs. Therefore, this study aimed to investigate unmet needs faced by patients with cancer. METHODS: This study employed a conventional, qualitative content analysis method. Data saturation was achieved after interviewing 13 participants in 15 interview sessions. With the in-depth semi-structured approach, the participants were asked to narrate their experiences of self-care needs in the process of disease. The collected data were analyzed using Graneheim and Lundman's method through the following steps: Construction of the units of analysis, construction of codes of meaning, condensation, extracting codes, and categorization (subcategories, categories, and the core category) . RESULTS: Data analysis revealed two main categories. The first category was "Deficiency in disease management" with three subcategories: "the need to get rid of annoying physical symptoms"," the need for a caregiver to help with the daily routine", and "feeling frustrated and giving up treatment". The second main category covered "the need for sympathetic and knowledgeable caregivers" with the following five subcategories:" the need for sympathy and interaction with the nurse", "the need to hear the truth about the illness ", "the need for appropriate therapeutic interaction from physicians", "Inadequate qualification of medical secretaries about the patient", and" need for advice from psychologists for psychological adaptation". CONCLUSION: The most critical need reported by the patients was the need for compassionate and informed caregivers. So nursing management and care with kindness, competence, and conscience is the fundamental right of patients with cancer. Identifying patients' needs and problems can be used as a background for increasing the knowledge and experience of nurses and providing care for patients with cancer.
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Affiliation(s)
- Fariba Mazhari
- Department of Fundamental Nursing, Geriatric Care Research Center, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Zohreh Khoshnood
- Nursing Research Center, Razi School Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran.
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15
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Namin S, Zhou Y, Neuner J, Beyer K. Neighborhood Characteristics and Cancer Survivorship: An Overview of the Current Literature on Neighborhood Landscapes and Cancer Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7192. [PMID: 34281129 PMCID: PMC8297243 DOI: 10.3390/ijerph18137192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/21/2021] [Accepted: 07/02/2021] [Indexed: 12/18/2022]
Abstract
There is a growing literature on the association between neighborhood contexts and cancer survivorship. To understand the current trends and the gaps in the literature, we aimed to answer the following questions: To what degree, and how, has cancer survivorship research accounted for neighborhood-level effects? What neighborhood metrics have been used to operationalize neighborhood factors? To what degree do the neighborhood level metrics considered in cancer research reflect neighborhood development as identified in the Leadership for Energy and Environmental Design for Neighborhood Development (LEED-ND) guidelines? We first conducted a review guided by PRISMA extension for scoping review of the extant literature on neighborhood effects and cancer survivorship outcomes from January 2000 to January 2021. Second, we categorized the studied neighborhood metrics under six main themes. Third, we assessed the findings based on the LEED-ND guidelines to identify the most relevant neighborhood metrics in association with areas of focus in cancer survivorship care and research. The search results were scoped to 291 relevant peer-reviewed journal articles. Results show that survivorship disparities, primary care, and weight management are the main themes in the literature. Additionally, most articles rely on neighborhood SES as the primary (or only) examined neighborhood level metric. We argue that the expansion of interdisciplinary research to include neighborhood metrics endorsed by current paradigms in salutogenic urban design can enhance the understanding of the role of socioecological context in survivorship care and outcomes.
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Affiliation(s)
- Sima Namin
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (Y.Z.); (K.B.)
| | - Yuhong Zhou
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (Y.Z.); (K.B.)
| | - Joan Neuner
- General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Kirsten Beyer
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (Y.Z.); (K.B.)
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16
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Biopsychosocial Factors Associated with Supportive Care Needs in Canadian Adolescent and Young Adult Cancer Survivors. J Clin Med 2021; 10:jcm10122628. [PMID: 34203795 PMCID: PMC8232806 DOI: 10.3390/jcm10122628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 12/16/2022] Open
Abstract
Adolescents and young adults (AYAs) represent an overlooked population in cancer survivorship care. Identifying the needs of AYAs can guide the development of tailored programs for this population. We conducted a cross-sectional descriptive analysis to identify biopsychosocial factors associated with AYA post-treatment supportive care needs and unmet needs using data obtained from the Experiences of Cancer Patients in Transitions Study of the Canadian Partnership Against Cancer, in collaboration with cancer agencies in the 10 Canadian provinces. The analysis focused on data from n = 530 AYAs between the ages of 18 and 34 who had undergone treatment within the past 5 years. Respondents reported a median of two moderate to big (MTB) physical needs (out of 9) and one unmet physical need, two MTB emotional needs (out of 6) with two unmet MTB emotional needs, and one (out of 5) practical need reported and one unmet MTB practical need. We found some common associations across supportive care domains. Income (lower) and more complex treatment were associated with high needs and unmet needs across the three domains. Respondents with a family doctor who was “very involved” in their cancer care had a lower number of unmet physical and emotional needs. Identifying those at risk of supportive care needs and developing tailored pathways in which they are proactively connected with tailored and appropriate resources and programs may help to reduce the number of unmet needs and improve cancer survivors’ quality of life.
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17
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Fischer S, Seibaek L. Patient perspectives on relatives and significant others in cancer care: An interview study. Eur J Oncol Nurs 2021; 52:101964. [PMID: 33906053 DOI: 10.1016/j.ejon.2021.101964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 03/19/2021] [Accepted: 04/13/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE In this study, patient perspectives on their relative's involvement in gynaecological cancer treatment and care are investigated. METHODS In total 17 women participated in two qualitative research interviews each during their treatment period. By applying a phenomenological-hermeneutic text interpretation methodology, the findings were systematically identified, interpreted, and discussed. This process gave rise to two main themes: "Relatives include more than family members" and "Interactions with relatives and significant others". RESULTS The findings showed that, besides family members, in particular neighbours and people who had experienced cancer themselves were an important and valuable support to the patients. Help with daily activities and errands, and providing informal company, represented a substantial support in difficult times, and generated a sense of social belonging and the experience of fellowship. Interactions with relatives were influenced by the patients' personal reflections and experiences and posed several positive as well as negative challenges. Firstly, the patients had many concerns about passing on the news of their cancer disease to their social network. Loneliness, in various representations, was a persistent theme, which reflected various experiences of vulnerability. CONCLUSION Positive family relations represented a unique resource during cancer treatment; however, due to relatives' worries or lack of support, patients could experience strain. This perspective on relatives' involvement - from the patient's point of view - seems to be understudied.
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Affiliation(s)
- Sine Fischer
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark.
| | - Lene Seibaek
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark; Institute for Nursing and Health Research, University of Greenland, Nuuk, Greenland.
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18
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van Hinte G, Leijendekkers RA, Merkx MAW, Takes RP, Nijhuis-van der Sanden MWG, Speksnijder CM. Identifying unmet needs and limitations in physical health in survivors of Head and Neck Cancer. Eur J Cancer Care (Engl) 2021; 30:e13434. [PMID: 33709466 PMCID: PMC8519003 DOI: 10.1111/ecc.13434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/10/2021] [Accepted: 02/25/2021] [Indexed: 12/24/2022]
Abstract
Objective To gain insight into the level of unmet needs and limitations in physical health experienced by survivors of head and neck cancer, and to evaluate whether unmet needs in physical health and limitations in physical performance are associated. Materials and methods In this cross‐sectional study, unmet needs were measured with Supportive Care Needs Surveys (SCNS‐SF34, SCNS‐HNC). Limitations in physical health were measured for maximal mouth opening, neck and shoulder function, hand grip strength and lower body strength, level of mobility and walking ability. Results The SCNSs showed that 48% had a cancer generic unmet need and 46% had at least one HNC‐specific unmet need. In total, 76% of sHNC had a cancer generic limitation in physical health and that 58% had an HNC‐specific limitation in the mobility of neck and shoulders or maximum mouth opening. The domain of physical and daily living needs showed a weak association with lateral flexion of the neck to the left (R = −0.319; p = 0.024). Conclusion Survivors of HNC might benefit from the use of both SCNSs and physical performance measurements during usual care follow‐up for early and optimal identification of unmet needs and limitations in physical health.
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Affiliation(s)
- Gerben van Hinte
- Department of Rehabilitation, Radboud university medical center, Nijmegen, The Netherlands
| | - Ruud A Leijendekkers
- Department of Rehabilitation, Radboud university medical center, Nijmegen, The Netherlands.,Orthopaedic Research Laboratory, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Radboud university medical center, Radboud Institute for health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Matthias A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud university medical center, Nijmegen, The Netherlands.,Comprehensive Cancer Organisation Netherlands, Utrecht, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology, Head and Neck Surgery, Radboud university medical center, Nijmegen, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Department of Rehabilitation, Radboud university medical center, Nijmegen, The Netherlands.,Radboud university medical center, Radboud Institute for health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery, Radboud university medical center, Nijmegen, The Netherlands.,Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, University Medical Center Utrecht Cancer Center, University of Utrecht, Utrecht, The Netherlands
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19
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Essue BM, Iragorri N, Fitzgerald N, de Oliveira C. The psychosocial cost burden of cancer: A systematic literature review. Psychooncology 2020; 29:1746-1760. [PMID: 32783287 PMCID: PMC7754376 DOI: 10.1002/pon.5516] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 12/21/2022]
Abstract
Background and Objective Psychosocial costs, or quality of life costs, account for psychological distress, pain, suffering and other negative experiences associated with cancer. They contribute to the overall economic burden of cancer that patients experience. But this category of costs remains poorly understood. This hinders opportunities to make the best cancer control policy decisions. This study explored the psychosocial cost burden associated with cancer, how studies measure psychosocial costs and the impact of this burden. Methods A systematic literature review of academic and grey literature published from 2008 to 2018 was conducted by searching electronic databases, guided by the Institute of Medicine’s conceptualization of psychosocial burden. Results were analyzed using a narrative synthesis and a weighted proportion of populations affected was calculated. Study quality was assessed using the Ottawa‐Newcastle instrument. Results A total of 25 studies were included. There was variation in how psychosocial costs were conceptualized and an inconsistent approach to measurement. Most studies measured social dimensions and focused on the financial consequences of paying for care. Fewer studies assessed costs associated with the other domains of this burden, including psychological, physical, and spiritual dimensions. Fourty‐four percent of cancer populations studied were impacted by psychosocial costs and this varied by disease site (38%‐71%). Two studies monetized the psychosocial cost burden, estimating a lifetime cost per case ranging from CAD$427753 to CAD$528769. Studies were of varying quality; 60% of cross‐sectional studies had a high risk of bias. Conclusions Consistency in approach to measurement would help to elevate this issue for researchers and decision makers. At two‐thirds of the total economic burden of cancer, economic evaluations should account for psychosocial costs to better inform decision‐making. More support is needed to address the psychosocial cost burden faced by patients and their families.
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Affiliation(s)
- Beverley M Essue
- Health Economics and Organization Performance, The Canadian Partnership Against Cancer, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nicolas Iragorri
- Health Economics and Organization Performance, The Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Natalie Fitzgerald
- Health Economics and Organization Performance, The Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Health Economics and Organization Performance, The Canadian Partnership Against Cancer, Toronto, Ontario, Canada.,University of York, York, England
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20
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O'Connor M, Waller J, Gallagher P, O'Donovan B, Clarke N, Keogh I, MacCarthy D, O'Sullivan E, Timon C, Martin C, O'Leary J, Sharp L. Barriers and facilitators to discussing HPV with head and neck cancer patients: A qualitative study using the theoretical domains framework. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30318-9. [PMID: 32565003 DOI: 10.1016/j.pec.2020.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/11/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The incidence of human papillomavirus-associated head and neck cancers (HPV-HNC) is increasing worldwide. Research in other clinical contexts has shown that healthcare professionals (HCPs) can find discussing HPV with patients challenging. However, limited research has been conducted in HNC. This study aimed to investigate barriers and facilitators to, discussing HPV among HCPs caring for patients with HNC in Ireland. METHODS Semi-structured telephone/face-to-face interviews were conducted with HCPs. Barriers and facilitators to discussing HPV with patients were identified using the Theoretical Domains Framework (TDF). RESULTS 20 HCPs (8 clinicians, 3 nurses, 9 allied healthcare professionals) were interviewed. Barriers to discussing HPV included professionals' lack of HPV knowledge, difficulties in talking about sexual issues with patients and lack of privacy to discuss HPV in busy clinic settings. Facilitators included increasing public and patient awareness of the link between HPV and HNC and professional education and skills development. CONCLUSIONS This is the first theoretically informed study to identify barriers and facilitators to discussing HPV with HNC patients. HCPs consider HPV discussions to be an essential part of HNC patient care. PRACTICE IMPLICATIONS Understanding the issues associated with patient-provider HPV communication will help develop effective interventions to support HCPs in their HPV discussions.
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Affiliation(s)
- M O'Connor
- National Cancer Registry Ireland, Kinsale Road, Cork, Ireland
| | - J Waller
- Department of Behavioural Science and Health, University College London, London, UK
| | - P Gallagher
- School of Psychology, Dublin City University, Dublin, Ireland
| | - B O'Donovan
- National Cancer Registry Ireland, Kinsale Road, Cork, Ireland.
| | - N Clarke
- School of Psychology, Dublin City University, Dublin, Ireland
| | - I Keogh
- College of Medicine Nursing & Health Sciences, National University of Ireland Galway, Ireland
| | - D MacCarthy
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Dublin, Ireland
| | - E O'Sullivan
- Cork University Dental School and Hospital, Cork, Ireland
| | - C Timon
- St. James's Hospital, James's Street, Dublin, Ireland
| | - C Martin
- Department of Histopathology, University of Dublin, Trinity College, Ireland; Department of Pathology, Coombe Women and Infants University Hospital, Ireland
| | - J O'Leary
- Department of Histopathology, University of Dublin, Trinity College, Ireland; Department of Pathology, Coombe Women and Infants University Hospital, Ireland
| | - L Sharp
- Institute of Health & Society, Newcastle University, UK
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21
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Shunmugasundaram C, Rutherford C, Butow PN, Sundaresan P, Dhillon HM. Content comparison of unmet needs self-report measures used in patients with head and neck cancer: A systematic review. Psychooncology 2019; 28:2295-2306. [PMID: 31654540 DOI: 10.1002/pon.5257] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Morbidity from head and neck cancers (HNCs) and their treatment are significant, given their proximity to anatomical sites impacting facial appearance and function. Assessing the needs of HNC patients throughout their cancer journey is critical to informing quality care and improving quality of life. We aimed to identify available unmet needs measures in the HNC setting and appraise their content and psychometric properties. METHODS We conducted a systematic search of five electronic databases (July 2007-July 2019) to identify studies of unmet needs in patients with HNC. In addition, three web-based patient-reported outcome measures (PROMs) databases were searched for unmet needs measures. Citations were screened for eligibility and identified measures reviewed for content coverage and psychometric properties. From identified measures and literature, a conceptual framework with 12 clinically relevant aspects of unmet needs was developed and used to assess the conceptual coverage of available unmet needs measures. RESULTS Literature search identified 273 records of which 28 studies assessing unmet needs in HNC cancer met eligibility criteria. Seven unmet needs measures were identified from retrieved studies and seven additional measures from PROM databases. Thus, 14 measures in total were reviewed. Content mapping revealed that three measures demonstrated excellent content validity (greater than 80% conceptual coverage): Patient Concerns Inventory (PCI), Needs Assessment for Advanced Cancer Patients (NA-ACP), and James Supportive Care Screening (JSCS). CONCLUSION We recommend PCI be used to measure unmet needs in the HNC setting considering the importance of content validity over quantitative psychometric properties.
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Affiliation(s)
- Chindhu Shunmugasundaram
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Camperdown, New South Wales, Australia.,Psycho-Oncology Cooperative Research Group, University of Sydney, Camperdown, New South Wales, Australia
| | - Claudia Rutherford
- Quality of Life Office, School of Psychology, Faculty of Science, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Nursing School, Cancer Nursing Research Unit (CNRU), University of Sydney, Camperdown, New South Wales, Australia
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Camperdown, New South Wales, Australia.,Psycho-Oncology Cooperative Research Group, University of Sydney, Camperdown, New South Wales, Australia
| | - Puma Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, North Parramatta, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Camperdown, New South Wales, Australia.,Psycho-Oncology Cooperative Research Group, University of Sydney, Camperdown, New South Wales, Australia
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22
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Understanding survivors' needs and outcomes: the role of routinely collected data. Curr Opin Support Palliat Care 2019; 12:254-260. [PMID: 29916842 DOI: 10.1097/spc.0000000000000352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW The number of cancer survivors is growing due to population ageing, earlier detection and more effective therapies. Routinely collected data (RCD), generally cancer registry data, has been used to investigate survivors' needs and outcomes. We reviewed uses of RCD since 2017, identifying novel findings and research directions. RECENT FINDINGS Survival is improving internationally but continues to vary between subgroups. Longitudinal survivor surveys suggest malignancy-specific temporal patterns in unmet needs and health-related quality-of-life (HRQoL). Unmet needs are a risk factor for future depression and depression predicts poorer HRQoL in all domains. Emerging evidence suggests links between posttraumatic stress and poor HRQoL and posttraumatic growth and improved HRQoL. Evidence for a link between cancer-related financial hardship and poor HRQoL is accumulating. Surveys and linkage studies continue to show poorer work outcomes in survivors. Among survivors of childhood and young adult cancers, large linkage studies demonstrate significant risk of late effects, including hospitalization, pregnancy and labour complications, and cardiac death. SUMMARY RCD plays a significant role in understanding survivors' needs and outcomes. New approaches which overlay different types of data - including detailed clinical and treatment data, biomarker data and nonhealth administrative data - have the potential to generate considerable new knowledge.
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23
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Miroševič Š, Prins JB, Selič P, Zaletel Kragelj L, Klemenc Ketiš Z. Prevalence and factors associated with unmet needs in post-treatment cancer survivors: A systematic review. Eur J Cancer Care (Engl) 2019; 28:e13060. [PMID: 31008544 DOI: 10.1111/ecc.13060] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/20/2019] [Accepted: 03/25/2019] [Indexed: 12/24/2022]
Abstract
Cancer survivors may experience unmet needs beyond the end of their treatment. This paper aimed to explore the prevalence and most frequently found unmet needs and to identify factors associated with higher levels of total unmet needs and with each domain separately. Five databases were searched using the keywords neoplasms, survivors, needs assessment, health services' needs and demands. The results were presented based on the strength of the evidence (strong, moderate and weak association) and the categorisation of the pooled prevalence of at least one unmet need (high, moderate, low). Twenty-six studies were included in the review. A higher prevalence of at least one reported unmet need was observed in survivors with less time since treatment and in women with breast cancer. The most frequently reported unmet needs were fear of cancer recurrence and requesting up to date information. Strong evidence was found for an association between a higher number of unmet needs and younger age, higher anxiety and poorer quality of life. Future studies on unmet needs should report how unmet needs are associated with each domain separately. This might solve the inconclusive evidence found for the stage of the disease at diagnosis and depression.
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Affiliation(s)
- Špela Miroševič
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Polona Selič
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Liljana Zaletel Kragelj
- Department of Public Health, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Zalika Klemenc Ketiš
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor, Slovenia.,Community Health Centre Ljubljana, Ljubljana, Slovenia
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24
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Jansen F, Eerenstein SEJ, Lissenberg‐Witte BI, Uden‐Kraan CF, Leemans CR, Verdonck‐de Leeuw IM. Unmet supportive care needs in patients treated with total laryngectomy and its associated factors. Head Neck 2018; 40:2633-2641. [DOI: 10.1002/hed.25358] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 02/16/2018] [Accepted: 05/16/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Femke Jansen
- Department of Otolaryngology ‐ Head and Neck Surgery, Cancer Center Amsterdam (CCA)VU University Medical Center Amsterdam The Netherlands
| | - Simone Elisabeth Jacoba Eerenstein
- Department of Otolaryngology ‐ Head and Neck Surgery, Cancer Center Amsterdam (CCA)VU University Medical Center Amsterdam The Netherlands
| | | | - Cornelia Foekje Uden‐Kraan
- Department of Clinical Psychology, Faculty Behavioural and Movement Sciences, Amsterdam Public Health Research InstituteVrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Charles René Leemans
- Department of Otolaryngology ‐ Head and Neck Surgery, Cancer Center Amsterdam (CCA)VU University Medical Center Amsterdam The Netherlands
| | - Irma Maria Verdonck‐de Leeuw
- Department of Otolaryngology ‐ Head and Neck Surgery, Cancer Center Amsterdam (CCA)VU University Medical Center Amsterdam The Netherlands
- Department of Clinical Psychology, Faculty Behavioural and Movement Sciences, Amsterdam Public Health Research InstituteVrije Universiteit Amsterdam Amsterdam The Netherlands
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25
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An assessment of patient burdens from head and neck cancer survivorship care. Oral Oncol 2018; 82:115-121. [DOI: 10.1016/j.oraloncology.2018.04.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/26/2018] [Accepted: 04/29/2018] [Indexed: 02/06/2023]
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26
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Cahir C, Thomas AA, Dombrowski SU, Bennett K, Sharp L. Urban-Rural Variations in Quality-of-Life in Breast Cancer Survivors Prescribed Endocrine Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14040394. [PMID: 28387748 PMCID: PMC5409595 DOI: 10.3390/ijerph14040394] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 03/31/2017] [Accepted: 04/05/2017] [Indexed: 01/13/2023]
Abstract
The number of breast cancer survivors has increased as a result of rising incidence and increased survival. Research has revealed significant urban-rural variation in clinical aspects of breast cancer but evidence in the area of survivorship is limited. We aimed to investigate whether quality of life (QoL) and treatment-related symptoms vary between urban and rural breast cancer survivors prescribed endocrine therapy. Women with a diagnosis of stages I-III breast cancer prescribed endocrine therapy were identified from the National Cancer Registry Ireland and invited to complete a postal survey (N = 1606; response rate = 66%). A composite measure of urban-rural classification was created using settlement size, population density and proximity to treatment hospital. QoL was measured using the Functional Assessment of Cancer Therapy (FACT-G) and an endocrine subscale. The association between urban-rural residence/status and QoL and endocrine symptoms was assessed using linear regression with adjustment for socio-demographic and clinical covariates. In multivariable analysis, rural survivors had a statistically significant higher overall QoL (β = 3.81, standard error (SE) 1.30, p < 0.01), emotional QoL (β = 0.70, SE 0.21, p < 0.01) and experienced a lower symptom burden (β = 1.76, SE 0.65, p < 0.01) than urban survivors. QoL in breast cancer survivors is not simply about proximity and access to healthcare services but may include individual and community level psychosocial factors.
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Affiliation(s)
- Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
| | | | | | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Newcastle NE1 7RU, UK.
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