Social support in cancer: How do patients want us to help?

Healthcare provider assessments of caregiver communication behaviors during gynecologic Cancer treatment appointments

Objective

Caregivers often accompany patients to cancer-related medical appointments. Limited research exists on healthcare providers' (HCPs) evaluation of how caregiver communication influences interactions between healthcare providers and patients, particularly during gynecologic treatment visits. HCPs may perceive caregiver communication as helpful or challenging, and these triadic interactions may influence patient outcomes.

Methods

Interviews with ten cancer specialist HCPs (medical assistants/technicians, nurse practitioners/registered nurses, oncologists) addressed experiences interacting with patients and caregivers.

Results

Analyses revealed two themes concerning helpful communication: caregivers managing information and managing patient emotions. Three challenging themes include caregiver communication unsettling healthcare interactions, caregiver presence limiting patient communication, and caregiver engagement challenges.

Conclusion

HCPs evaluate caregiver communication as helpful and challenging. Findings suggest benefits of communication training for gynecologic cancer patients such as requesting privacy when interacting with HCPs, for caregivers to promote awareness of effects of their behavior, and for HCPs to help manage triadic interactions while supporting patient needs.

Innovation

HCP assessment of caregiver communication during gynecologic treatment visits offers unique insights regarding helpful and challenging behaviors contributing to implications for patient care and well-being. Applications may extend to other triadic interactions and cancer settings.

Cancer Patients: Forgiveness, Discomfort Intolerance and Psychiatric Symptoms

Objectives: Cancer patients try to find answers in the light of their individual experiences and if they cannot adapt in line with the answers, various psychiatric symptoms may occur. There are studies supporting that "forgiveness" helps reduce the emotional burden of patients with cancer in their ability to discomfort intolerance of the disease, find meaning in the life. The aim of this study is to evaluate forgiveness, discomfort intolerance, and psychiatric symptoms in cancer patients. Methods: The data of this study, which was conducted with 208 cancer patients receiving outpatient chemotherapy treatment, Personal Information Form was collected with Heartland Forgiveness Scale, Brief Symptom Inventory, and Discomfort Intolerance Scale. Result: It has been determined that cancer patients have a high level of forgiveness, a moderate tolerance to tolerate discomfort, and enable low level of occurrence of psychiatric symptoms. As the level of self-forgiveness and forgiveness of patients increases, the incidence of psychiatric symptoms decreases. Conclusion: In line with the findings, it can be thought that the high level of forgiveness of cancer patients towards their illness allows them to experience less psychiatric symptoms and increase their tolerance to the disorder. Awareness of both patients and healthcare personnel can be increased by preparing training programs that address forgiveness in individuals diagnosed with cancer in healthcare institutions.

Examining the role of resilience in the relationship between social support and fear of recurrence among patients with gastric cancer on chemotherapy: a cross-sectional study in Jiangsu, China

OBJECTIVES

The objective of this study is to investigate the relationships between fear of cancer recurrence (FCR), social support and resilience, and further determine whether resilience mediates social support and FCR among Chinese patients with gastric cancer undergoing chemotherapy.

DESIGN

Multicentre cross-sectional survey.

SETTING

Four hospitals in Jiangsu Province, China, with grade-A tertiary hospital settings.

PARTICIPANTS

755 patients with gastric cancer on chemotherapy across four hospitals in China were included from March 2021 to September 2022.

OUTCOME MEASURES

The Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Connor-Davidson Resilience Scale (CD-RISC) and Social Support Rating Scale (SSRS) were used to test the model's constructs. Statistical analyses were conducted by using IBM SPSS V.26.0 software. PROCESS V.3.4 macro was used to analyse the mediating role of resilience in the relationship between social support and FCR.

RESULTS

The mean scores for SSRS, CD-RISC and FoP-Q-SF in patients with gastric cancer receiving chemotherapy were 41.55±7.79, 54.83±18.46 and 30.91±10.11, respectively. 43.3% (n=327) had psychological dysfunction, 56.8% (n=429) had low to medium resilience and 99.1% (n=748) had medium to robust social support. Significant differences exist among three variables, resilience positively correlated with social support, while FCR negatively correlated with resilience and social support (p<0.001). Resilience fully mediated the relationship between social support and FCR (a*b-path=-0.126, 95% CI -0.169 to -0.086).

CONCLUSIONS

Mediation analysis shows resilience mediates social support and FCR in patients with gastric cancer as the negative effect of social support on FCR was fully mediated by resilience. Interventions targeting these variables may reduce FCR in patients with gastric cancer undergoing chemotherapy.

Exploring the reasons for wanting a peer partner to be physically active among women living with and beyond a cancer diagnosis: a content analysis

BACKGROUND

Initiating and maintaining exercise is challenging for women during and post-cancer treatment. Adopting a peer partner model to provide social support to be active may contribute to lasting behaviour change of both partners. Despite this, finding a "like peer" can be challenging.

PURPOSE

To explore women's reasons for seeking an online exercise partner following a diagnosis with cancer (through  www.activematch.ca ). We also examined women's potential sociodemographic and cancer-related differences by reported reasons for wanting an exercise partner.

METHODS

Individuals creating an ActiveMatch profile completed demographic and physical activity questions (N = 199, Mage(SD) = 51.9(10.8) years), including an open-ended question regarding their "reason for wanting an exercise partner". An inductive content analysis was completed focusing on the participants' peer exercise partner preferences. Additional chi-square tests were run to assess whether participants differed based on sociodemographic and cancer-related characteristics and their motivations to be active by category of "reason for wanting an exercise partner" endorsed in the open-ended question.

RESULTS

The participants' reasons for wanting an exercise partner were coded into seven categories, with most participants highlighting the reasons of motivation (52.3%), social support (48.7%), and accountability and adherence (26.6%). Women < 50 years of age were more likely to report accountability and adherence-related preferences for a partner. Those reporting endorsing weight loss as their primary reason for becoming active were more likely to be categorized as wanting a peer partner for motivation.

CONCLUSIONS

While finding a peer partner can be challenging, matching women living with and beyond a cancer diagnosis based on their reason for wanting an exercise partner, as well as their reasons for wanting to be active, may be important to build successful peer exercise partnerships.

Factors Influencing Social Isolation among Cancer Patients: A Systematic Review

(1) Background: Social isolation, which has numerous adverse effects on health status, is prevalent among cancer patients. This review proposes to identify the influencing factors of social isolation among cancer patients. (2) Methods: Articles published in English or Chinese from six electronic databases before December 2023 were identified via a systematic search. A manual search was also performed. (3) Results: Twenty-eight studies were identified in this systematic review. The factors associated with social isolation can be summarized into the following categories: demographic characteristics, having cancer, health status, coping, social support and social interaction. Despite the heterogeneity, 20 factors were significantly associated with social isolation, including age, gender, comorbidity burden, education level, residence, medical insurance, occupation status, personality, race, smoking status, having children, not living alone, household income level, marital status, the role of primary caregiver, physical health status, mental health status, social health status, coping styles, and the level of social support and social interaction. (4) Conclusions: The systematic review showed that cancer patients' social isolation was influenced by their demographic characteristics, cancer-related factors, physical condition, psychological status, social health status, coping styles, and level of social support and social interaction. In addition, future group intervention could be considered to improve social isolation.

Associations of illness perception and social support with fear of progression in young and middle-aged adults with digestive system cancer: A cross-sectional study

PURPOSE

While Fear of progression (FoP) is a natural reaction in cancer, elevated FoP can impact life quality and social function. Our study aims to explore how illness perception, social support, and posttraumatic growth influence patients' FoP.

METHODS

This study enrolled 243 young and middle-aged adults with digestive system cancer at a hospital in Guangzhou from November 2022 to November 2023. In this study, the measurement instruments utilized included The Fear of Progression Questionnaire-Short Form, The Brief Illness Perception Questionnaire, The 12-item Perceived Social Support Scale, and The 21-item Posttraumatic Growth Inventory. Data was analyzed employing polynomial regression and response surface analyses.

RESULTS

The mean score of FoP was 35.45 ± 10.05, and 59.3% of the cancers (scores≥34) had clinically dysfunctional levels of FoP. Regarding congruence, patients' FoP was higher when the levels of illness perception and social support were both low or high than when the levels were both intermediate. Regarding incongruence, patients' FoP was lower when the level of illness perception was low and social support was high compared with when the level of illness perception was high and social support was low. Additionally, posttraumatic growth moderated the (in)congruence effect of illness perception-social support on the FoP of patients.

CONCLUSIONS

Low or high illness perception-social support congruence was detrimental to the FoP of patients. Low illness perception-high social support incongruence was beneficial to patients' FoP. Posttraumatic growth can be a positive factor for enhancing the impact of low illness perception-high social support incongruence on patients' FoP.

Decision regret of cancer patients after radiotherapy: results from a cross-sectional observational study at a large tertiary cancer center in Germany

PURPOSE

The decision-making process regarding cancer treatment is emotionally challenging for patients and families, harboring the risk of decision regret. We aimed to explore prevalence and determinants of decision regret following radiotherapy.

METHODS

This cross-sectional observational study was conducted at a tertiary cancer center to assess decision regret following radiotherapy. The study employed the German version of the Ottawa Decision Regret Scale (DRS) which was validated in the study population. Decision regret was categorized as absent (0 points), mild (1-25 points), and strong (> 25 points). Various psychosocial outcome measures were collected using validated questionnaires to identify factors that may be associated with decision regret.

RESULTS

Out of 320 eligible patients, 212 participated, with 207 completing the DRS. Median age at start of radiotherapy was 64 years [interquartile range (IQR), 56-72], genders were balanced (105 female, 102 male), and the most common cancer types were breast (n = 84; 41%), prostate (n = 57; 28%), and head-and-neck cancer (n = 19; 9%). Radiotherapy was applied with curative intention in 188 patients (91%). Median time between last radiotherapy fraction and questionnaire completion was 23 months (IQR, 1-38). DRS comprehensibility was rated as good or very good by 98% (196 of 201) of patients. Decision regret was reported by 43% (n = 90) as absent, 38% (n = 78) as mild, and 18% (n = 38) as strong. In the multiple regression analysis, poor Eastern Cooperative Oncology Group performance status, low social support, and dissatisfaction with care were independent risk factors for higher decision regret after radiotherapy.

CONCLUSIONS

The German version of the DRS could be used to assess decision regret in a diverse cohort of cancer patients undergoing radiotherapy. Decision regret was prevalent in a considerable proportion of patients. Further studies are necessary to validate these findings and obtain causal factors associated with decision regret after radiotherapy.

Postpartum depression and partner support during the period of lactation: Correlation research and its influencing factors

BACKGROUND

Postpartum depression (PPD) not only affects the psychological and physiological aspects of maternal health but can also affect neonatal growth and development. Partners who are in close contact with parturient women play a key role in communication and emotional support. This study explores the PPD support relationship with partners and its influencing factors, which is believed to establish psychological well-being and improve maternal partner support.

AIM

To explore the correlation between PPD and partner support during breastfeeding and its influencing factors.

METHODS

Convenience sampling was used to select lactating women (200 women) who underwent postpartum examinations at the Huzhou Maternity and Child Health Care Hospital from July 2022 to December 2022. A cross-sectional survey was conducted on the basic information (general information questionnaire), depression level [edinburgh postnatal depression scale (EPDS)], and partner support score [dyadic coping inventory (DCI)] of the selected subjects. Pearson's correlation analysis was used to analyze the correlation between PPD and DCI in lactating women. Factors affecting PPD levels during lactation were analyzed using multiple linear regression.

RESULTS

The total average score of EPDS in 200 lactating women was (9.52 ± 1.53), and the total average score of DCI was (115.78 ± 14.90). Dividing the EPDS, the dimension scores were: emotional loss (1.91 ± 0.52), anxiety (3.84 ± 1.05), and depression (3.76 ± 0.96). Each dimension of the DCI was subdivided into: Pressure communication (26.79±6.71), mutual support (39.76 ± 9.63), negative support (24.97 ± 6.68), agent support (6.87 ± 1.92), and joint support (17.39 ± 4.19). Pearson's correlation analysis demonstrated that the total mean score and individual dimension scores of EPDS during breastfeeding were inversely correlated with the total score of partner support, stress communication, mutual support, and co-support (P < 0.05). The total mean score of the EPDS and its dimensions were positively correlated with negative support (P < 0.05). Multiple linear regression analysis showed that the main factors affecting PPD during breastfeeding were marital harmony, newborn health, stress communication, mutual support, negative support, co-support, and the total score of partner support (P < 0.05).

CONCLUSION

PPD during breastfeeding was associated with marital harmony, newborn health, stress communication, mutual support, negative support, joint support, and the total DCI score.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS FOR CANCER SURVIVORS

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

Re-imagining metastatic breast cancer care delivery: a patient-partnered qualitative study

PURPOSE

While significant progress in metastatic breast cancer (MBC) treatment has prolonged survival and improved prognosis, there remain substantial gaps in providing patient-centered supportive care. The specific care delivery needs for metastatic cancer differ from that of early-stage cancer due to the incurable nature and lifelong duration of the condition. The objective of this study was to assess how patients living with MBC would re-imagine cancer care delivery.

METHODS

This qualitative study was conducted in partnership with patient-led organizations Guiding Researchers and Advocates to Scientific Partnerships (GRASP) and Project Life, a nonprofit, online wellness community founded by patients with MBC for patients living with MBC. Virtual semi-structured interviews (n = 36) were conducted with Project Life members purposively sampled from the groups' overall membership. The interview guide contained items surrounding patients' lived experiences of MBC, greatest unmet needs related to care, and perspectives on virtual wellness community involvement. Interviews were coded using two-stage deductive and inductive analysis.

RESULTS

Three major themes for re-imagining cancer care delivery were identified, including holistic care, information needs, and conceptual shifts. Within these several subthemes emerged with patients re-imagining referrals to non-oncological services, caregiver support, acceptance of integrative medicine, streamlined clinical trial enrollment, curated quality patient resources, MBC-specific terminology and approaches, long-term life and goal-of-care planning, and patient-centered voice throughout.

CONCLUSION

People living with metastatic cancers have specific supportive care needs. These findings highlight patient-driven areas for re-imagination that are most salient for individuals with MBC.

Changes in unmet care needs, social support and distress from initial diagnosis to post-surgery in patients with gynecological cancer: A longitudinal study

PURPOSE

This study aimed to explore the changes in unmet care needs, perceived social support, and levels of distress experienced by newly diagnosed Greek patients with gynecological cancer during the phase after diagnosis and before surgical treatment (T0), and 4 months after surgical treatment at the first postoperative follow-up visit (T1).

METHODS

This was a prospective, longitudinal, descriptive study based on the framework of stress and coping theory. The Needs Evaluation Questionnaire, Depression, Anxiety and Stress Scale (DASS-21), Multidimensional Scale of Perceived Social Support (MSPSS), and a demographic and clinical data questionnaire were distributed to a convenience sample of 86 patients.

RESULTS

A convenience sample of 86 patients newly diagnoised with gynecological cancer participated in the study. The mean age of the participants was 60.7 years (SD = 10.9 years) while 57.6% of them were married. Overall, patients' needs and social support had significantly decreased at T1 compared to T0 (p = 0.005 and p = 0.029, respectively). DASS-21 subscale scores did not change significantly at T1, whereas anxiety levels were significantly lower at follow-up (p = 0.048). Changes in anxiety levels were associated with changes in needs related to family (p < 0.001), need for assistance/care (p = 0.013) and support (p = 0.004), and total needs (p = 0.004).

CONCLUSION

The phase following cancer diagnosis and awaiting surgery is a high-risk period for the mental health of women with gynecological cancer, and one that requires special attention from healthcare professionals. By identifying unmet needs, addressing anxiety and providing appropriate social support, healthcare professional can contribute significantly to improving patients' quality of life throughout their cancer journey.

The Impact of a Narrative Medicine Life Story Pilot Program on Press Ganey™ Scores in an Outpatient Cancer Center

Oncology patients face challenges beyond those directly affecting their cancer management. Guided personal narrative programs have been shown to help patients with chronic conditions and life-framing events. Few such narrative programs have been reported for cancer patients or analyzed for their impact on patient experience. We established our Life Story Narrative Program, modeled on the United States Veterans Affairs' "My Life, My Story" for outpatient oncology patients in our hospital's cancer center. Press Ganey™ patient experience scores from program participants were compared retrospectively with scores from patients who were not participants. Over an eight-month period, we invited 30 cancer center outpatients to participate. Twenty-seven individuals accepted, and 18 had their stories edited, approved, and scanned into their electronic health record. Cohort matching yielded a control arm consisting of 255 responses from 48 surveys, while the intervention arm consisted of 68 responses from 12 surveys. 78.4% of responses from the control arm were rated 5 compared with 100% in the intervention arm. The mean Press Ganey™ score response in the control arm was 4.71 compared with 5.00 from the intervention arm. Wilcoxon U value was 10,540 with p < .001. An outpatient narrative medicine program for cancer patients to tell their life stories can easily be organized. Patients were willing to participate, enrollment was brisk, and the use of resources was limited. Although our sample size was small, participation in our Life Story Narrative Pilot Program resulted in a statistically significant improvement in Press Ganey™ scores.

The Mediating Role of Self-Perceived Burden Between Social Support and Fear of Progression in Renal Transplant Recipients: A Multicenter Cross-Sectional Study

Purpose

To explore the mechanism of social support and fear of progression (FoP) in renal transplant recipients (RTRs) and the self-perceived burden that acts as a mediator between social support and FoP.

Patients and Methods

Sociodemographic and clinical characteristics, the Social Support Rating Scale (SSRS), the Self-Perceived Burden Scale (SPBS), and the Fear of Progression-Questionnaire-Short Form (FoP-Q-SF) were used. Structural equation modeling (SEM) was used to examine the mediating role of self-perceived burden.

Results

Our results showed that social support was negatively related to the self-perceived burden (r = -0.28, p < 0.001) and FoP (r = -0.37, p < 0.001). Moreover, we determined that self-perceived burden was positively related to FoP (r = 0.58, p < 0.001) and that the indirect effect of social support on FoP via self-perceived burden was significant (β = -0.172, 95% CI: -0.253, -0.097), and with a mediating effect value of 36.9%.

Conclusion

The FoP in RTRs is a concern. Higher social support and lower self-perceived burden can reduce the risk of FoP. Healthcare professionals (HCPs) should assist RTRs in correctly evaluating an individual's social support system, helping them optimize social support to reduce the self-perceived burden and the development of FoP.

Psychometric Properties of the Peruvian Version of the MOS Scale for Social Support in Cancer Patients and Convergent Network with Quality of Life

Introduction

One of the key psychosocial factors that impact mental and emotional health is social support. While much research has been conducted on the role of social support in the lives of cancer patients, there is a lack of studies that consider populations who need specific tools to assess this concept.

Purpose

The aim of this study was to evaluate the psychometric properties of the MOS Social Support Scale (1991) in 499 Peruvian cancer patients between the ages of 18 and 87 (M= 46.30, SD = 15.747).

Methods

In this study, three models of the MOS were analyzed based on 19-item versions (four factor, second order and bifactor model).

Results

The results showed a better psychometric fit in the 19-item bifactor model with optimal fit indices through the structural equation method (SB-χ2/df = 1.94, CFI = 0.966, TLI= 0.955, SRMR = 0.038 and RMSEA = 0.058). Additionally, there was evidence of configural, metric and scalar invariance with this instrument according to the gender of the surveyed cancer patients. Convergent validity using a network analysis approach revealed positive associations between social support dimensions and quality of life.

Conclusion

Emotional support and positive interactions dimensions were found to be important interconnections in the overall network, as indicated by their greater centralities. Therefore, this instrument could be suggested as a reliable way to evaluate cancer patients and their perceived support.

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

Introduction

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

Method

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

Results

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

Conclusion

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

Health professionals' preferences with the use of pegfilgrastim on-body injector at oncology centers in 8 cities in Colombia

BACKGROUND

Febrile neutropenia associated with some chemotherapy regimens can lead to potentially fatal complications and high health care costs. Administration of pegfilgrastim using an On-Body Injector (OBI) may be more convenient for cancer patients and physicians in countries with limited access to high-complexity healthcare. This study aims to describe physician and nurse preferences regarding different options for administration of pegfilgrastim at cancer centers, the chemotherapy schemes for which pegfilgrastim is most frequently prescribed and how healthcare providers prioritize certain administration schemes according to patients' access to healthcare services.

METHODS

Observational, descriptive, cross-sectional study and survey, conducted between 2019 and 2020, to describe physician and nurse preferences regarding options for administration of pegfilgrastim at cancer centers, the demographics of the study population and characteristics of participating cancer centers. It included 60 healthcare professionals practicing at oncology centers from 8 cities in Colombia who were contacted and surveyed via telephone. Quantitative continuous variables were summarized using central tendency and dispersion measures.

RESULTS

It was found that 35% of participants are haemato-oncologists, oncologists or hematologists, 30% are general practitioners, and 35% are other healthcare professionals (i.e., nurse, oncology nurse and head nurse). Our study shows that 48% of physicians prefer the use of OBI, particularly in the scheme of 24 h after myelosuppressive chemotherapy administrations. Regardless of patient frailty and travel time to the clinic, over 90% of healthcare providers (HCPs) prefer to prioritize preventing the patient from having to return to the clinic for pegfilgrastim administration as well as to increase healthcare staff availability through the use of OBI.

CONCLUSIONS

The present study is the first one in Colombia that sought the reasons behind HCPs' choice to use OBI pegfilgrastim. Our results indicate that most professionals prefer to avoid the patient having to re-enter the care center for pegfilgrastim administration to facilitate access to healthcare for patients; patient characteristics and ease of transport are determining factors for respondents when choosing an option for drug administration. We found OBI is the preferred alternative by most HCPs and a good resource optimization strategy in the context of cancer patients' health care in Colombia.

A NEw MOdel of individualized and patient-centered follow-up for women with gynecological cancer (the NEMO study)-protocol and rationale of a randomized clinical trial

BACKGROUND

Follow-up programs for gynecological cancer patients are currently under revision. There is limited evidence that traditional follow-up and clinical examinations improve survival in an early-stage gynecological setting. Further, traditional follow-up programs fail to accommodate the patient's need for psychosocial and sexual supportive care and to actively involve patients and their relatives in the follow-up process. Individualized programs may replace traditional routine follow-up with fixed intervals and length. Focusing on alarm-symptoms and self-reporting may ensure detection of recurrence while allowing a continuous attention to the patient's well-being and return to daily life. In this study, a nurse-led, individualized, and need-based intervention with a specific focus on patient empowerment is tested against a standard physician-led model primarily focusing on the detection of recurrence.

METHODS

The study is designed as a clinical, randomized trial conducted in one of four national onco-gynecological centers in Denmark. Patients with early-stage cervical or endometrial cancer are eligible for inclusion. The intervention group undergoes individualized, nurse-led follow-up supporting patient empowerment including repeated use of electronic patient-reported outcome measures (ePROMs) before each contact as a dialogue support tool. The follow-up contacts are mainly conducted by telephone. All project nurses attended a special training program before project start and are all well-educated and dedicated onco-gynecological nurses. The control group receives standard, physician-led, follow-up without use of ePROMs or specific focus on empowerment. The effect of the intervention is evaluated by questionnaires completed by patients at baseline (3 months after surgery) and 12, 18, and 36 months after surgery. Outcomes include empowerment using the Skill and technique subscale of the HEI-Q questionnaire as the primary outcome while fear of cancer recurrence and health-related quality of life as well as the remaining subscales of the HEI-Q represent secondary outcomes. Data is collected by use of the REDCap technology, which also provides a customized visual support function for the dialogue tool.

DISCUSSION

This study will provide new information about follow-up in early-stage gynecological cancer settings and thereby contribute to improvement of future follow-up programs. Importantly, the study will provide knowledge about the impact of specific focus on patient empowerment in follow-up programs and, further, how to facilitate empowerment among patients.

TRIAL REGISTRATION

The study is registered at clinicaltrials.gov: ID no. NCT03838861. Registered on 6 February 2019. Protocol version 2, issue date 21 November 2022.

Vivencia de la espiritualidad en el paciente con cáncer en quimioterapia ambulatoria

Objetivo: Analizar la vivencia de la espiritualidad en el paciente con cáncer en tratamiento con quimioterapia ambulatoria. Materiales y métodos: Se realizó una investigación cualitativa con enfoque histórico hermenéutico. Participaron seis personas con diagnóstico de cáncer que se encontraban en tratamiento de quimioterapia ambulatoria en tres centros asistenciales de la ciudad de Medellín, Colombia entre julio de 2020 y julio de 2021.  La información se recolectó a través de entrevistas semiestructuradas. El proceso de análisis se realizó utilizando técnicas de la teoría fundamentada de Strauss y Corbin, tales como: microanálisis, codificación abierta, codificación axial y comparación constante. Resultado: La forma como los pacientes con cáncer en tratamiento de quimioterapia ambulatoria viven la espiritualidad se representa a través de las siguientes categorías: “Emociones vividas durante el tratamiento como impulso para seguir adelante”, “Las redes de apoyo, una fuente de fortaleza y esperanza”, “El cáncer, una prueba divina entre las limitaciones y el aprendizaje”, “La empatía del personal de salud, un mecanismo para afrontar la enfermedad y generar bienestar” y “La espiritualidad, una fuerza que cambia la perspectiva de la enfermedad”. Conclusiones: Pese a la connotación negativa del diagnóstico de cáncer, la dimensión espiritual en el paciente con cáncer en tratamiento de quimioterapia ambulatoria contribuye a que la persona vea la enfermedad desde una perspectiva positiva, aumente la fe y la esperanza para continuar luchando, le dé un sentido de que todo ha valido la pena, permite ver más allá y proporciona tranquilidad para enfrentar las adversidades ocasionadas por el cáncer.

A Model of Social Support for a Patient–Informal Caregiver Dyad

Background

Close persons (informal caregivers) are the most important providers of support indicated by cancer patients. Cancer affects couples as a codependent system. The aim of this study was to investigate the factors influencing the multidimensional aspect of social support in a cancer patient–informal caregiver dyad.

Methods

The research project was cross-sectional. The diagnostic survey method and the survey technique were used. The study was conducted using standardised research tools: BSSS, POS, SSCS, TIPI, ET, SPT, and the authors' own tool for sociodemographic assessment.

Results

Patients and caregivers experienced injustice, exclusion, and a sense of loss with a similar intensity. Statistically significant differences between the examined patients and their caregivers were obtained for the support currently received (p < 0.01), emotional support (p < 0.05), and the general level of protective buffering support (p < 0.001). A higher level of information support for caregivers increases the need for support and a sense of support for patients.

Conclusion

The quality of functioning and mental well-being of patients is directly influenced by the way their caregivers experience the situation of caring for them; negative or positive states of caregivers, affecting the condition of patients, may affect the course of treatment and contribute to or delay the improvement of the state of health. The subjective sense of support in patients during treatment depends on the need for help that is shown to their caregivers. The sense of support variable is subjective and sometimes disproportionate to the support received and given. Therefore, both the patient and their loved one should be provided with care during the treatment process. In the treatment process, both patients and their caregivers need more protective buffering support that allows them to overcome difficulties related to stress, anxiety, and insecurity, thus weakening their negative effects rather than functional support: emotional, information, instrumental, or material.

Social Support and Fear of Cancer Recurrence Among Chinese Breast Cancer Survivors: The Mediation Role of Illness Uncertainty

Objective

To examine the relations between social support, illness uncertainty (IU), and fear of cancer recurrence (FCR).

Methods

Using data from a convenience sample of 231 breast cancer survivors in China to perform structural equation modeling with bootstrapping estimation. Participants were recruited from a general hospital in Shenyang, China. Participants completed the Perceived Social Support Scale, Mishel Uncertainty in Illness Scale, and Fear of Cancer Recurrence Inventory- Shorter Form.

Results

The majority of breast cancer survivors have FCR (67.5%). FCR was significantly negatively associated with social support, and was significantly positively associated with IU (both P < 0.01). Moreover, IU was found to mediate the relationship between social support and FCR (standardized indirect effect = -0.18; bias-corrected 95% confidence interval: -0.255, -0.123).

Conclusion

The findings support the final model. Good social support can directly mitigate FCR, while illness uncertainty can play a mediation role between social support and FCR. Further studies should be conducted to explore effective interventions for social support and IU to ultimately mitigate FCR in cancer survivors.

Optimizing Social Support in Oncology with Digital Platforms (Preprint)

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

Attentes du patient atteint de cancer vis-à-vis de son aidant principal au Burkina Faso

Cette étude a pour objectif d’analyser les attentes des patients atteints de cancer vis-à-vis de leurs aidants principaux dans un contexte de pays à ressources limitées, et de déterminer la concordance entre ces attentes et les rôles assumés par leurs aidants principaux. Au total 72 patients ainsi que l’aidant principal de chacun d’eux ont été inclus. Les attentes des patients variaient selon le lieu (hôpital, domicile ou commerces). La concordance entre ces attentes et les rôles assumés par leur aidant principal était mauvaise.

Model of Social Support for Patients Treated for Cancer

Social support can be one of the main factors in better assessing the quality of life at any stage of the recovery process. It should meet the patient's needs so that they can develop constructive methods of coping with the disease. In order to explain the factors influencing social support for cancer patients, a theoretical research model was formulated. It is presented in a graphic form in this article. In order to verify the model, the authors' questionnaire and other standardised questionnaires were used. The experimental group consisted of 170 hospitalised oncological patients being treated for cancer. Personality structure, through its relationship with state of health (0.40) and attitude developed to the disease (0.64), influenced the support experienced by the treated patients (0.40). The surveyed patients, who were characterised by positive self-esteem and experience of life satisfaction despite various difficult situations, perceived to a greater degree the emotional and instrumental support provided to them. During cancer treatment, those patients who showed a need for help and did not experience negative emotions were characterised by an increased need for support. The research results can be introduced into evidence-based medical practice, which could significantly improve the quality of nursing and medical care for patients.

Health-Related Quality of Life: Longitudinal Analysis From the Time of Breast Biopsy Into the Post-treatment Period

Background: The physical, psychological, social, and spiritual quality of life (QoL) may be affected by breast cancer diagnosis and treatment, with mixed findings for psychological quality of life and cognitive ability performance. The present study aimed to evaluate QoL in women over 1 year from biopsy for a breast abnormality. Methods: Self-reported measures of physical, psychological, social, and spiritual QoL were obtained after biopsy results but prior to treatment initiation (baseline), 4 and 12 months later. CogState computerized neuropsychological screening battery also provided an evaluation of psychological QoL. Three groups of women including those with benign biopsy results, those with malignancy treated with chemotherapy, and those with malignancy not treated with chemotherapy were compared at 4 and 12 months after adjusting for baseline to isolate the effects of treatment. Additional covariates included are age, level of education, and income. Results: Benign biopsy results group included 72 women, whereas malignancy was found in 87 women of whom 33 were treated with chemotherapy and 54 without chemotherapy. At the time of diagnosis, women with cancer had worse psychological and social QoL but better spiritual QoL than those with benign biopsy results. Only CogState monitoring accuracy was worse for women with cancer compared with the controls at the time of biopsy results. After adjusting for QoL at baseline, women treated for cancer had worse physical and social QoL at 4 and 12 months later. Psychological well-being was worse for women with cancer at 4th month but improved at 1 year. No differences in cognition were found at 4 and 12 months when adjusted for baseline cognition and covariates. Discussion: Breast cancer is a traumatic life event for women, affecting psychological and social QoL domains, yet increasing spiritual QoL. Later, cancer treatment worsens physical, psychological, and social QoL compared with those without cancer. Conclusions: These findings suggest that interventions to improve psychological QoL may be especially important at the time of cancer diagnosis, while interventions to improve physical well-being are the most needed during and following cancer treatment. Support to improve social QoL is needed from the time of diagnosis into post-treatment survivorship.

Patient perspectives on relatives and significant others in cancer care: An interview study

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.

Changes in lifestyle among prostate cancer survivors: A nationwide population-based study

Objective

Long‐term information on lifestyle changes among prostate survivors is lacking. In this nationwide, population‐based study we investigated the prevalence of lifestyle changes, factors associated with lifestyle changes and associations between lifestyle changes and general quality of life.

Methods

All men registered in the National Prostate Cancer Register of Sweden diagnosed in 2008 with low‐risk prostate cancer at age 70 years or younger were sent a questionnaire. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals for factors potentially associated with lifestyle change.

Results

Out of 1288, 1720 men (75%) were responded. A total of 279 (22%) reported a positive lifestyle change regarding diet or exercise. Poor functional outcomes after treatment was associated with exercising less (OR 1.6, 95% CI 1.2‐2.1) and less interest in social activities and relationships (OR 1.8, 95% CI 1.5‐2.1). Men who exercised more (OR 7.9, 95% CI 4.4‐14) and men who had an increased interest in relationships and social activities (OR 5.2, 95% CI 2.1‐13) reported higher general quality of life.

Conclusions

A considerable proportion of men reported making positive lifestyle changes after the prostate cancer diagnosis. The time after diagnosis may be a teachable moment that facilitates lifestyle interventions. Poor functional outcomes after treatment may reduce the willingness to engage in positive lifestyle change, which need be considered when supporting men after treatment. Men who made a positive lifestyle change, regardless of whether it was exercise or regarding relationships and social activities more often reported a high level of general quality of life.

Trajectories of social resource use among informal lung cancer caregivers

BACKGROUND

Social support is a key component in maintaining cancer caregiver well-being, and many resources exist to facilitate caregivers' use of social support (eg, cancer support groups). This study sought to determine how informal cancer caregivers use social resources over the course of caregiving.

METHODS

The data are from the Comprehensive Health Enhancement Support System study of informal caregivers (n = 202) of patients with recently diagnosed lung cancer. Caregivers self-reported their sociodemographic and caregiving characteristics and social resource use over 6 months. Generalized additive models were used to assess social resource use over time, and generalized estimating equation logistic regression models were used to assess the correlates of social resource use.

RESULTS

Nearly two-thirds of caregivers reported any social resource use. The most prevalent social resources were faith-based groups (38%) and social clubs (30%). Only 1 in 4 caregivers participated in a formal resource such as counseling (11%) or a cancer support group (6%). Social resource use was lowest immediately after the diagnosis and increased over time. Formal resource use exhibited a nonlinear association with time such that formal resource use peaked approximately 9 to 10 months after the cancer diagnosis. Caregivers were more likely to report social resource use if the patient also reported social engagement.

CONCLUSIONS

This study has found that many cancer caregivers do not use social resources, although social resource use increases over time after the cancer diagnosis. Because of the association between social engagement and well-being, this information may inform future research and interventions to improve outcomes for cancer caregivers and their families.

A Validation Study of the Mini-IPIP Five-Factor Personality Scale in Adults With Cancer

The Mini International Personality Item Pool (Mini-IPIP) is a brief measure of the Five-Factor Model of personality with documented validity in healthy samples of adults and could be useful for assessing personality in patient populations such as individuals with cancer. The purpose of this study was to examine the psychometric properties of the Mini-IPIP in 2 samples of adults with cancer. A sample of 369 (Sample 1) and a sample of 459 (Sample 2) adults with cancer completed an online survey including the Mini-IPIP. To assess criterion validity, Sample 2 completed measures of emotional distress. Analyses included internal consistency (Samples 1 and 2), confirmatory factor analyses (CFAs; Samples 1 and 2), and correlations and a structural regression model to examine the associations between the 5 personality factors and emotional distress (Sample 2 only). Results showed that the Mini-IPIP demonstrated levels of internal consistency and CFA model fit that were similar to previous validation studies conducted in the general population. Consistent with prior research and theory, this study also found that personality factors measured by the Mini-IPIP were associated with measures of emotional distress in Sample 2. These findings suggest the potential utility of the Mini-IPIP in both research and clinical settings involving individuals with cancer.