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Mäkitie AA, Alabi RO, Pulkki-Råback L, Almangush A, Beitler JJ, Saba NF, Strojan P, Takes R, Guntinas-Lichius O, Ferlito A. Psychological Factors Related to Treatment Outcomes in Head and Neck Cancer. Adv Ther 2024; 41:3489-3519. [PMID: 39110309 DOI: 10.1007/s12325-024-02945-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/04/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Patients with head and neck cancer (HNC) often demonstrate stress, distress, anxiety, depression, and are at risk for suicide. These affect their quality of life (QoL) but less attention has been given to psychological variables that may impact response to treatment. OBJECTIVES This study aims to systematically review publications during 2013-2023 to collate evidence on the effects of psychological variables on HNC treatment outcomes. METHODS We searched Ovid Medline, PubMed, Scopus, and Web of Science for articles that examined psychological factors related to treatment outcomes in patients with HNC. RESULTS There were 29 studies (5 before treatment, 2 during, 17 after, and 5 covering the whole management trajectory) including 362,766 patients. The psychological factors were either behavioral (adjustment and coping strategy, unrealistic ideas, self-blame), cognitive (elevated risk of psychiatric co-comorbidity), or emotional (distress, depression, anxiety, nervousness, and fear of disfigurement and complications). It was found that there was a relationship between depression and decreased survival in patients with HNC. Pretreatment pain was an independent predictor of decreased survival in a large sample of patients. The distress level was approximately 54%, emotional problems ranged between 10 and 44%, while financial difficulties were identified in 54% of the patients. Sixty-nine percent of patients were reported to have used at least one cost-coping strategy within 6 months after treatment initiation. During post-treatment period, depression increased from 15% at the baseline to 29%, while the fear of recurrence was found among at least 35% of patients. DISCUSSION AND CONCLUSION Several psychological factors predict QoL and survival among HNC survivors. Distress encompasses depression and anxiety, and physical burden from HNC diagnosis and treatment. Routine screening and early interventions that target distress could improve HNC survivors' QoL. A systematic and standardized measurement approach for QoL is warranted to homogenize these findings and to understand the underlying relationships.
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Affiliation(s)
- Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O.Box 263, 00029 HUS, Helsinki, Finland.
- Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland.
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
| | - Rasheed Omobolaji Alabi
- Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Department of Industrial Digitalization, School of Technology and Innovations, University of Vaasa, Vaasa, Finland
| | | | - Alhadi Almangush
- Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Department of Pathology, University of Helsinki, Helsinki, Finland
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland
| | - Jonathan J Beitler
- Harold Alfond Center for Cancer Care, Maine General Hospital, Augusta, ME, USA
- Dept of Radiation Oncology, John J. Cochran Veterans Hospital, St. Louis, MO, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, 30322, USA
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Robert Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Beka E, Gimm O, Johansson K, Söderlund Schaller A, Drott J. Patient Experiences of Symptoms and Coping Strategies in the Early Postoperative Phase Following Hemithyroidectomy: A Qualitative Interview Study. J Patient Exp 2024; 11:23743735241273580. [PMID: 39139704 PMCID: PMC11320674 DOI: 10.1177/23743735241273580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
The aim was to explore patients' early experiences of symptoms after hemithyroidectomy and how these symptoms influenced their daily lives. An inductive explorative qualitative research design was performed. Sixteen patients from two hospitals were interviewed between two-three weeks after the surgery. All the patients experienced compression symptoms before the surgery. The study was analyzed with conventional manifest content analysis. The inductive analysis yielded two main categories and one subcategory. The two main categories were: Early postoperative symptoms that caused disadvantage in daily life and Early postoperative symptoms and coping strategies. The subcategory was: Early postoperative experiences of concerns about the future. Key points: 1. Patients experienced early postoperative symptoms that affected their lives in multiple levels, making them develop coping strategies and awaking concerns about remaining symptoms in the future. 2. The effect of hemithyroidectomy influenced patients' daily life in the early postoperative phase considerably. 3. The study shows that tailored preoperative patient information is important. The findings may guide professionals to tailored preoperative information to optimize the care for this patient group.
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Affiliation(s)
- Ervin Beka
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University Hospital and Linköping University, Linköping, Sweden
| | - Oliver Gimm
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University Hospital and Linköping University, Linköping, Sweden
| | - Kenth Johansson
- Department of Surgery, Västervik Hospital, Västervik, Sweden
| | - Anne Söderlund Schaller
- Division of Nursing Science, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Pain and Rehabilitation Center and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jenny Drott
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University Hospital and Linköping University, Linköping, Sweden
- Division of Nursing Science, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Saghafi E, Andås CA, Bernson J, Kjeller G. Patients' experiences of adverse symptoms, emotions, and coping strategies in connection to treatment of head and neck cancer - an interview study. BMC Oral Health 2023; 23:641. [PMID: 37670339 PMCID: PMC10478420 DOI: 10.1186/s12903-023-03366-4] [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: 02/02/2023] [Accepted: 08/28/2023] [Indexed: 09/07/2023] Open
Abstract
PURPOSE This study aimed to increase the understanding of emotions and coping strategies used by head and neck cancer patients before cancer treatment, and to explore their emotions and coping strategies in relation to symptoms and side effects after treatment. Furthermore, we aimed to investigate the patients' perceptions of received treatment and support. METHODS Semi-structured in-depth interviews were conducted with 10 patients who had been treated for head and neck cancer, which included radiotherapy, at the Department of Oncology and the Department of Oral and Maxillofacial Surgery at Sahlgrenska University Hospital in Gothenburg. The interviews were analyzed in accordance with the method for Qualitative Content Analysis. RESULTS The result picture revealed three head themes. The first theme "Management of simultaneously influencing mind-sets before cancer treatment" described the patients experiences of feeling "Scared and worried," "Lonely and disappointed," and "Relieved and confident", and how they tried to handle the diagnosis and preparations for treatment by "Applying a positive mind-set", "Searching for support," and "Trusting the healthcare system". The second theme "Experiences of becoming a pale shadow of oneself", illustrated experiences of affecting post-treatment symptoms and side effects. To which, the last theme "Handling contextual influencing experiences after cancer treatment" displayed post-treatment emotions of being "Shocked and disappointed" and "Concerned and unsupported" but also "Grateful and forward-thinking", where strategies such as "Appreciating Life", "Networking socially," and "Adapting to the new life" were used. CONCLUSIONS The results indicated the need for a more patient-centered care approach, with clearer structures and improved individual support both before and after treatment and in connection to rehabilitation. Patients' cognitive changes after cancer treatment should be considered in the aftercare, which should also include adaptation to situation and strengthening of patients' self-management as a goal.
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Affiliation(s)
- Ellie Saghafi
- Department of Oral and Maxillofacial Surgery, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 12A, Gothenburg, 413 90, Sweden.
- Department of Orofacial Pain, Region Västra Götaland, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Charlotte Andrén Andås
- Department of Orofacial Pain, Region Västra Götaland, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Bernson
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran Kjeller
- Department of Oral and Maxillofacial Surgery, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 12A, Gothenburg, 413 90, Sweden
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Hanna MHZ, RezkAllah SS, Shalaby AS, Hanna MZ. Efficacy of transcranial direct current stimulation (tDCS) on pain and shoulder range of motion in post-mastectomy pain syndrome patients: a randomized-control trial. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2023. [DOI: 10.1186/s43161-022-00116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Abstract
Background
Post-mastectomy pain syndrome (PMPS) is a highly prevalent complication after surgical treatment for breast cancer, and it affects the patient’s quality of life in aspects of losing shoulder full range of motion, pain, and depression. Transcranial direct current stimulation (tDCS) is non-invasive brain stimulation technique that was used in numerous clinical applications and in pain reduction in cancer patients. However, the effectiveness of tDCS on PMPS has never been evaluated in an experimental study.
Aim
To investigate the effect of bilateral anodal tDCS of motor cortex (M1) on pain, depression, and shoulder range of motion (ROM) in post-mastectomy pain syndrome.
Study design
Randomized controlled trial.
Methods
A total of 30 female patients with post-mastectomy neuropathic pain were randomized into two groups; the intervention group which received bilateral tDCS on motor cortex (M1) and the control group that received sham bilateral tDCS on M1. As pain affects shoulder range of motion (ROM), shoulder ROM was measured by electronic goniometer pre- and post-tDCS application. In addition, the levels of pain and depression have been measured pre and post treatment. Pain has been measured with visual analogue scale (VAS) and depression with Beck-Depression-Inventory-BDI questionnaire (BDI).
Results
A significant difference was noted in group A regarding pain, depression and shoulder ROM (p= 0.001, p= 0.003, and p= 0.003, respectively). Between group comparison revealed a significant difference of VAS scores and shoulder flexion ROM between groups, the study group and the control group (p=0.041 and 0.048, respectively). Pain decreased by 32% and Shoulder flexion increased by 4.8% post-treatment while there were no significant difference in group B (p=0.567 and p=0.866, respectively).
Conclusions
The application of tDCS decreases the severity of pain and improves shoulder range of motion suffered by breast cancer patients after total mastectomy surgery.
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Matthews S, Brett J, Ramluggun P, Watson E. The psychosocial experiences of human papillomavirus (HPV) positive oropharyngeal cancer patients following (chemo)radiotherapy: A systematic review and meta-ethnography. Psychooncology 2022; 31:2009-2019. [PMID: 35726440 PMCID: PMC10084069 DOI: 10.1002/pon.5984] [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: 11/29/2021] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The UK incidence of oropharyngeal cancer has risen sharply over the last 30 years with an increase in human papillomavirus (HPV) associated diagnoses, most prevalent in younger, working age populations. This meta-ethnography explores the psychosocial needs of HPV+ve oropharyngeal cancer patients during early recovery following (chemo)radiotherapy. METHODS Meta-ethnography methods were used, based on the approach of Noblit and Hare. Systematic searches for relevant qualitative studies were conducted in five electronic databases (MEDLINE, PubMed, CINAHL, PsycINFO and Cochrane database) between 2010 and 2021, followed by citation searching. RESULTS Twenty-three papers exploring the psychosocial needs of HPV+ve oropharyngeal cancer patients after treatment were included. Findings were synthesised to develop five constructs: 'gaps in continuity of support from healthcare professionals' reflecting unmet needs; 'changes to self-identity' revealing the comprehensive disruption of this disease and treatment; 'unrealistic expectations of recovery' highlighting the difficulty of preparing for the impact of treatment; 'finding ways to cope' describing the distinct complexity of this experience; and 'adjusting to life after the end of treatment' exploring how coping strategies helped patients to regain control of their lives. CONCLUSIONS Completing (chemo)radiotherapy signalled a transition from hospital-based care to home-based support, challenging patients to address the constructs identified. An unexpectedly difficult and complex recovery meant that despite a favourable prognosis, poor psychosocial well-being may threaten a successful outcome. The provision of tailored support is essential to facilitate positive adjustment.
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Affiliation(s)
- Sara Matthews
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Jo Brett
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Pras Ramluggun
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Eila Watson
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Fordham B, Smith TO, Lamb S, Morris A, Winter SC. Patient and physiotherapist perceptions of the Getting Recovery Right After Neck Dissection (GRRAND) rehabilitation intervention: a qualitative interview study embedded within a feasibility trial. BMJ Open 2022; 12:e064269. [PMID: 36375975 PMCID: PMC9664296 DOI: 10.1136/bmjopen-2022-064269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The Getting Recovery Right After Neck Dissection (GRRAND) intervention is a physiotherapy programme for patients with head and neck cancer who have undergone neck dissection. The aim of this qualitative study was to understand if the intervention was useful, acceptable and whether it was feasible to conduct a randomised controlled trial (RCT). DESIGN This qualitative study was embedded within the GRRAND-Feasibility (GRRAND-F) Study. SETTING Participants were recruited from four acute National Health Service hospitals in England between 2020 and 2021. PARTICIPANTS We interviewed four usual care and four intervention patient-participants from a single study site (Oxford). Six were male, two were female. All were white British ethnicity. We interviewed two physiotherapists from Oxford who delivered the GRRAND-F intervention, and physiotherapists from Birmingham, Poole and Norwich who were trained to deliver the intervention but were not able to deliver it within the study time frame. RESULTS The analysis identified five themes: (1) Acceptability, (2) Adherence, (3) Outcomes, (4) Feasibility and (5) Stand-alone themes (prehabilitation, video consultations, healthcare use).Patient-participants and physiotherapist-participants agreed that usual care was not meeting patients' rehabilitation needs. The GRRAND intervention provided biopsychosocial support. In comparison to the usual care group, patient-participants who received the intervention were more confident that they could perform rehabilitation exercises and were more motivated to engage in long-term adaptive behaviour change. Physiotherapists felt they needed more administrative support to participate in an RCT. CONCLUSION Participants felt that usual care was insufficient. GRRAND provided much needed, biopsychosocial support to patients. Participants were supportive that it would be feasible to test GRRAND in an RCT. TRIAL REGISTRATION NUMBER ISRCTN11979997.
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Affiliation(s)
- Beth Fordham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Sarah Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Alana Morris
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stuart C Winter
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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de Souza Moura B, Hu XS, DosSantos MF, DaSilva AF. Study Protocol of tDCS Based Pain Modulation in Head and Neck Cancer Patients Under Chemoradiation Therapy Condition: An fNIRS-EEG Study. Front Mol Neurosci 2022; 15:859988. [PMID: 35721312 PMCID: PMC9200064 DOI: 10.3389/fnmol.2022.859988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Multiple therapeutic strategies have been adopted to reduce pain, odynophagia, and oral mucositis in head and neck cancer patients. Among them, transcranial direct current stimulation (tDCS) represents a unique analgesic modality. However, the details of tDCS mechanisms in pain treatment are still unclear. Aims (1) to study the analgesic effects of a protocol that encompassed supervised-remote and in-clinic tDCS sessions applied in head and neck patients undergoing chemoradiation therapy; (2) to explore the underlining brain mechanisms of such modulation process, using a novel protocol that combined functional near-infrared spectroscopy (fNIRS), and electroencephalograph (EEG), two distinct neuroimaging methods that bring information regarding changes in the hemodynamic as well as in the electrical activity of the brain, respectively. Methods This proof-of-concept study was performed on two subjects. The study protocol included a 7-week-long tDCS stimulation procedure, a pre-tDCS baseline session, and two post-tDCS follow-up sessions. Two types of tDCS devices were used. One was used in the clinical setting and the other remotely. Brain imaging was obtained in weeks 1, 2, 5, 7, 8, and after 1 month. Results The protocol implemented was safe and reliable. Preliminary results of the fNIRS analysis in weeks 2 and 7 showed a decrease in functional connections between the bilateral prefrontal cortex (PFC) and the primary sensory cortex (S1) (p < 0.05, FDR corrected). Changes in EEG power spectra were found in the PFC when comparing the seventh with the first week of tDCS. Conclusion The protocol combining remote and in-clinic administered tDCS and integrated fNIRS and EEG to evaluate the brain activity is feasible. The preliminary results suggest that the mechanisms of tDCS in reducing the pain of head and neck cancer patients may be related to its effects on the connections between the S1 and the PFC.
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Affiliation(s)
- Brenda de Souza Moura
- Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
- Laboratório de Propriedades Mecânicas e Biologia Celular (PropBio), Departamento de Prótese e Materiais Dentários, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Xiao-Su Hu
- Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
| | - Marcos F. DosSantos
- Laboratório de Propriedades Mecânicas e Biologia Celular (PropBio), Departamento de Prótese e Materiais Dentários, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Alexandre F. DaSilva
- Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
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The experience of nutritional care according to patients with head and neck cancer involved with a combined dietitian, specialist nurse and speech pathologist clinic in a regional Australia: a qualitative longitudinal study. Support Care Cancer 2021; 29:4329-4337. [PMID: 33415362 DOI: 10.1007/s00520-020-05917-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/25/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Malnutrition is a co-morbidity of head and neck cancer (HNC) that has negative consequences for patients. Evidence-based guidelines (EBGs) provide recommendations to prevent and manage malnutrition. A clinic that combines the services of a dietitian, specialist oncology nurse and speech pathologist may promote the implementation of nutritional EBGs in regional Australia. This study aimed to explore the nutritional care experience that patients with HNC had in this setting. METHODS A qualitative longitudinal study collected data via semi-structured interviews with HNC patients who were treated in one regional cancer care network in Australia. Interviews were conducted at key points in their HNC journey from diagnosis to 4 months post-radiotherapy. Data was analysed using a grounded theory approach. RESULTS Ten participants completed a total of thirty-six interviews. The findings were grouped into four categories: "preparing for nutritional challenges", "multidisciplinary care directed by patient needs", "the battle to eat", and "incongruence between patient values and nutritional priorities". CONCLUSION These findings highlight the nutritional burden associated with HNC and barriers to patients accepting nutritional support from healthcare professionals. Information provided by doctors and nurses prior to treatment may help patients prepare for the nutritional challenges ahead and accept support from dietitians. Furthermore, clinics that promote continuity through treatment and allow dietitians to lead aspects of nutritional care, in collaboration with nurses, speech pathologists and doctors, may also enhance the nutritional care experience. More qualitative research within HNC teams would provide further insight on enhancing the implementation of nutritional EBGs to improve outcomes for these patients.
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Brooks JV, Poague C, Formagini T, Roberts AW, Sinclair CT, Keirns CC. Palliative Care's Role Managing Cancer Pain During the Opioid Crisis: A Qualitative Study of Patients, Caregivers, and Clinicians. J Pain Symptom Manage 2020; 60:1127-1135.e2. [PMID: 32645454 PMCID: PMC7680449 DOI: 10.1016/j.jpainsymman.2020.06.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 01/08/2023]
Abstract
CONTEXT Patients with cancer face symptoms because of disease and treatment, and pain is common and complex. The opioid crisis may complicate patients' and clinicians' experiences of managing pain in cancer care. OBJECTIVES In our study of perceptions and experiences with palliative care (PC) at an outpatient cancer center, we examined communication around symptom management throughout cancer care, and pain and its management emerged as particularly salient. The objective of this article is to describe, from the perspectives of patients, caregivers, and oncology health care professionals, the role of PC in navigating the complicated dynamics of pain management amidst the opioid crisis. METHODS A qualitative descriptive study with grounded theory components was designed to investigate experiences with and perceptions of specialist PC and symptom management, including pain. Interviews were audiorecorded and transcribed, and focused coding identified themes related to pain and pain management from all three perspectives. RESULTS About 44 patients, caregivers, and non-PC health care professionals completed interviews. Patients with cancer and their caregivers had many concerns about pain management and were specifically concerned about opioid use and stigma. For patients, PC improved pain management and helped to destigmatize appropriate pain management. Oncology clinicians reported that partnering with PC facilitated complex pain management and also provided moral support around difficult opioid recommendations for patients. CONCLUSION PC offers the potential to uniquely support both patients and other oncology professionals in optimally navigating the complexity around pain management for cancer care in the midst of the opioid crisis.
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Affiliation(s)
- Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA; University of Kansas Cancer Center, Kansas City, Kansas, USA.
| | - Claire Poague
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Taynara Formagini
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Andrew W Roberts
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA; University of Kansas Cancer Center, Kansas City, Kansas, USA; Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Christian T Sinclair
- Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, Kansas, USA; Division of Palliative Medicine, Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Carla C Keirns
- Division of Palliative Medicine, Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA; Department of History and Philosophy of Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
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Solvik E, Ytrehus S, Utne I, Grov EK. Pain, fatigue, anxiety and depression in older home-dwelling people with cancer. Nurs Open 2020; 7:430-438. [PMID: 31871728 PMCID: PMC6918018 DOI: 10.1002/nop2.406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/07/2019] [Indexed: 11/22/2022] Open
Abstract
Aim Globally, cancer incidence counts for more than 14 million cases and the number increases with age. The aim of this study was to investigate the occurrence of pain, fatigue, anxiety and depression in association with demographic and clinical factors. Design A cross-sectional descriptive design was used. Methods We performed descriptive statistics to analyse the questionnaires completed from 174 older home-dwelling people with cancer. Results The people with cancer reported low occurrence of pain, fatigue, anxiety and depression. We found strong correlation between anxiety and depression. Women reported significantly higher scores of anxiety and depression than men. A higher pain score was associated with higher scores of fatigue and anxiety. Conclusions Home care personnel meeting older home-dwelling people with cancer should emphasize these people' mental health problems and be aware that pain, fatigue and anxiety may occur at the same time.
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Affiliation(s)
- Elena Solvik
- Department of Emergency ReceptionOstfold Hospital Trust, KalnesGrålumNorway
| | - Siri Ytrehus
- Faculty of HealthWestern Norway University of Applied SciencesBergenNorway
| | - Inger Utne
- Faculty of Health SciencesInstitute of Nursing and Health PromotionOslo Metropolitan UniversityOsloNorway
| | - Ellen Karine Grov
- Faculty of Health SciencesInstitute of Nursing and Health PromotionOslo Metropolitan UniversityOsloNorway
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To eat is to practice-managing eating problems after head and neck cancer. J Cancer Surviv 2019; 13:792-803. [PMID: 31446592 DOI: 10.1007/s11764-019-00798-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/12/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of this qualitative study was twofold: (1) to explore head and neck cancer (HNC) survivors' experiences of everyday life with eating problems after cancer treatment and (2) to explore their experiences of participating in a multidisciplinary residential rehabilitation program with a primary focus on physical, psychological, and social aspects of eating problems after treatment. METHODS Semi-structured focus group interviews were conducted with 40 Danish HNC survivors who participated in a 5-day residential rehabilitation program with follow-up after 3 months. The transcribed interviews were analyzed through qualitative content analysis. RESULTS Physical nutrition impact symptoms and unmet needs for support were frequent. Participants experienced a feeling of loss due to impaired eating abilities. Eating had become an obligation or a training situation, and the eating problems challenged the relationship with their relatives when well-meaning encouragement was perceived as a pressure. Social eating was a challenge, and this often led to social withdrawal. The residential program was a safe and supportive environment to practice eating skills, and participants benefited from meeting peers. The program provided participants with knowledge and skills that many of them had been missing during and after treatment. CONCLUSIONS Eating problems after treatment have substantial effects on the everyday life of HNC survivors. A multidisciplinary residential rehabilitation program may be beneficial to meet their rehabilitation needs. IMPLICATIONS FOR CANCER SURVIVORS The results are useful for future planning of rehabilitation services and clinical studies that may contribute to improving current clinical practice and benefit HNC survivors.
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Kanchan S, Pushpanjali K, Tejaswini BD. Challenges Faced by Patients Undergoing Radiotherapy for Oral Cancer: A Qualitative Study. Indian J Palliat Care 2019; 25:436-439. [PMID: 31413461 PMCID: PMC6659536 DOI: 10.4103/ijpc.ijpc_40_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Oral cancer is one of the most common types of cancers in India. Radiotherapy is one of the treatment options frequently resulting in complications. These complications affect the patient's quality of life, nutritional intake, and consequently undermine the treatment outcomes. Patients' verbal accounts of experiences regarding their overall oral health during radiotherapy have not been described sufficiently. Aim The aim of the current study was to identify and analyze the issues experienced by patients while undergoing radiotherapy for oral cancer treatment. Materials and Methods A phenomenology study design was chosen, with in-depth interviews as the selected strategy for data collection. A literature search was conducted based on which an interview guide in English was prepared and modified according to inputs from subject matter experts. The interview guide comprised nine questions, including opening, key, and closing questions, and was also translated into Telugu and Kannada - the two languages predominantly spoken by the patients visiting the hospital. Interviews were conducted with each patient separately, with each interview lasting for 60 min each. The interviews were audio-recorded, transcribed, coded, and categorized, following which themes were derived from the analysis. Results The key theme that emerged from the study was the "Multifaceted experience of patients undergoing radiotherapy." Conclusion Understanding the specific issues faced by oral cancer patients undergoing radiotherapy drew our attention to the dire need for interprofessional collaboration, which could enable health professionals to share their expertise and perspectives toward achieving the common goal of restoring patients' health and improving health outcomes.
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Affiliation(s)
- Suvi Kanchan
- Department of Public Health Dentistry, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - K Pushpanjali
- Department of Public Health Dentistry, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - B D Tejaswini
- Department of Public Health Dentistry, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
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Vallerand AH, Templin TN, Hasenau SM, Maly A. Modifiable pathways from pain to functional status: Confirmatory baseline results from a randomised trial of African American patients with cancer pain. Eur J Cancer Care (Engl) 2019; 28:e12994. [PMID: 30719796 PMCID: PMC8373261 DOI: 10.1111/ecc.12994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/18/2018] [Accepted: 12/04/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study tested a model of cancer-related pain and functional status in African American patients, including beliefs about the ability to control pain as a key determinant of distress and functional status. METHODS Baseline data from a randomised clinical trial consisting of clinical and patient-reported outcomes were used. Participants were 228 African American patients experiencing moderate to severe pain within the past 2 weeks. The model comprised four latent constructs: pain, perceived control over pain, pain-related distress and functional status. Confirmatory factor analysis was used to validate the factor structure of the measurement model. Structural equation modelling was used to estimate direct and mediated effects. RESULTS The measurement model fit well (RMSEA = 0.06, SRMR = 0.05) with all loadings significant (p < 0.05). The structural model also fit well (RMSEA = 0.04, SRMR = 0.05). The complex mediated pathway from pain to functional status through perceived control over pain and pain-related distress was strong and significant (specific indirect effect = -0.456, p = 0.004). Mediation by perceived control accounted for a 47% reduction of the effects of pain on functional status. CONCLUSION If these results hold up longitudinally, interventions to increase perceived control over pain have the potential to improve functional status by decreasing pain-related distress.
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Affiliation(s)
| | | | - Susan M Hasenau
- College of Nursing, Wayne State University, Detroit, Michigan
| | - Angelika Maly
- College of Nursing, Wayne State University, Detroit, Michigan
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15
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Fitchett RC, Aldus EJ, Fitchett LR, Cross J. The lived experience of head and neck cancer patients receiving curative radiotherapy: A systematic review and meta-ethnography. Psychooncology 2018; 27:2077-2086. [DOI: 10.1002/pon.4790] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/25/2018] [Accepted: 05/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Russell C. Fitchett
- Radiotherapy Department; Norfolk and Norwich University Hospital; Norwich UK
| | - Edward J. Aldus
- Radiotherapy Department; Norfolk and Norwich University Hospital; Norwich UK
| | - Lucy R. Fitchett
- Radiotherapy Department; Norfolk and Norwich University Hospital; Norwich UK
| | - Jane Cross
- School of Health Sciences, Queen's Building; University of East Anglia; Norwich UK
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Erol O, Unsar S, Yacan L, Pelin M, Kurt S, Erdogan B. Pain experiences of patients with advanced cancer: A qualitative descriptive study. Eur J Oncol Nurs 2018; 33:28-34. [DOI: 10.1016/j.ejon.2018.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/22/2017] [Accepted: 01/08/2018] [Indexed: 01/09/2023]
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Bossi P, Cossu Rocca M, Corvò R, Depenni R, Guardamagna V, Marinangeli F, Miccichè F, Trippa F. The vicious circle of treatment-induced toxicities in locally advanced head and neck cancer and the impact on treatment intensity. Crit Rev Oncol Hematol 2017; 116:82-88. [DOI: 10.1016/j.critrevonc.2017.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/22/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022] Open
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18
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Hu XS, Fisher CA, Munz SM, Toback RL, Nascimento TD, Bellile EL, Rozek L, Eisbruch A, Worden FP, Danciu TE, DaSilva AF. Feasibility of Non-invasive Brain Modulation for Management of Pain Related to Chemoradiotherapy in Patients with Advanced Head and Neck Cancer. Front Hum Neurosci 2016; 10:466. [PMID: 27729853 PMCID: PMC5037215 DOI: 10.3389/fnhum.2016.00466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 09/05/2016] [Indexed: 11/18/2022] Open
Abstract
Patients with head and neck cancer often experience a significant decrease in their quality of life during chemoradiotherapy (CRT) due to treatment-related pain, which is frequently classified as severe. Transcranial direct current stimulation (tDCS) is a method of non-invasive brain stimulation that has been frequently used in experimental and clinical pain studies. In this pilot study, we investigated the clinical impact and central mechanisms of twenty primary motor cortex (M1) stimulation sessions with tDCS during 7 weeks of CRT for head and neck cancer. From 48 patients screened, seven met the inclusion criteria and were enrolled. Electroencephalography (EEG) data were recorded before and after tDCS stimulation as well as across the trial to monitor short and long-term impact on brain function. The compliance rate during the long trial was extremely high (98.4%), and patients mostly reported mild side effects in line with the literature (e.g., tingling). Compared to a large standard of care study from our institution, our initial results indicate that M1-tDCS stimulation has a pain relief effect during the CRT that resulted in a significant attenuation of weight reduction and dysphagia normally observed in these patients. These results translated to our patient cohort not needing feeding tubes or IV fluids. Power spectra analysis of EEG data indicated significant changes in α, β, and γ bands immediately after tDCS stimulation and, in addition, α, δ, and θ bands over the long term in the seventh stimulation week (p < 0.05). The independent component EEG clustering analysis showed estimated functional brain regions including precuneus and superior frontal gyrus (SFG) in the seventh week of tDCS stimulation. These areas colocalize with our previous positron emission tomography (PET) study where there was activation in the endogenous μ-opioid system during M1-tDCS. This study provides preliminary evidence demonstrating the feasibility and safety of M1-tDCS as a potential adjuvant neuromechanism-driven analgesic therapy for head and neck cancer patients receiving CRT, inducing immediate and long-term changes in the cortical activity and clinical measures, with minimal side-effects.
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Affiliation(s)
- Xiao-Su Hu
- Headache and Orofacial Pain Effort Lab, School of Dentistry, Department of Biologic and Materials Sciences, University of MichiganAnn Arbor, MI, USA
- Center for Human Growth and Development, University of MichiganAnn Arbor, MI, USA
| | - Clayton A. Fisher
- Headache and Orofacial Pain Effort Lab, School of Dentistry, Department of Biologic and Materials Sciences, University of MichiganAnn Arbor, MI, USA
- Division of Oral Pathology, Department of Periodontics and Oral Medicine, University of MichiganAnn Arbor, MI, USA
| | - Stephanie M. Munz
- Department of Oral and Maxillofacial Surgery/Hospital Dentistry, University of MichiganAnn Arbor, MI, USA
| | - Rebecca L. Toback
- Headache and Orofacial Pain Effort Lab, School of Dentistry, Department of Biologic and Materials Sciences, University of MichiganAnn Arbor, MI, USA
| | - Thiago D. Nascimento
- Headache and Orofacial Pain Effort Lab, School of Dentistry, Department of Biologic and Materials Sciences, University of MichiganAnn Arbor, MI, USA
| | - Emily L. Bellile
- Headache and Orofacial Pain Effort Lab, School of Dentistry, Department of Biologic and Materials Sciences, University of MichiganAnn Arbor, MI, USA
- Biostatistics Department, University of MichiganAnn Arbor, MI, USA
| | - Laura Rozek
- Biostatistics Department, University of MichiganAnn Arbor, MI, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of MichiganAnn Arbor, MI, USA
| | - Francis P. Worden
- Department of Internal Medicine Oncology, University of MichiganAnn Arbor, MI, USA
| | - Theodora E. Danciu
- Division of Oral Pathology, Department of Periodontics and Oral Medicine, University of MichiganAnn Arbor, MI, USA
| | - Alexandre F. DaSilva
- Headache and Orofacial Pain Effort Lab, School of Dentistry, Department of Biologic and Materials Sciences, University of MichiganAnn Arbor, MI, USA
- Center for Human Growth and Development, University of MichiganAnn Arbor, MI, USA
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Sciubba JJ. End-of-life care in the head and neck cancer patient. Oral Dis 2016; 22:740-744. [DOI: 10.1111/odi.12506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 01/10/2023]
Affiliation(s)
- JJ Sciubba
- The Milton J. Dance Head and Neck Center; The Johns Hopkins School of Medicine; Baltimore MD USA
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