A closer look at unmet needs at the end of primary treatment for breast cancer: a longitudinal pilot study

Needs of breast cancer survivors: a systematic review of quantitative data

This systematic review aimed to update the perceived needs of individuals with breast cancer (BC). Databases were searched for studies reporting quantitative data collected through validated assessment tools. Needs of adults with BC were reported by survivorship phase. The post-diagnosis and the post-surgery phases revealed the most needs; health system and information needs represented the greatest concern, with average Supportive Care Needs Survey-Short Form (SCNS-SF34) scores ranging from 62.0 to 75.8 post-diagnosis and from 45.0 to 67.8 post-surgery. Needs then seemed to decrease or remain stable up to within one year from diagnosis, when needs in all domains increased again; health system and information needs remained a priority. Younger age, side effects, type of treatment, and advanced stage were associated with the occurrence of unmet needs. The needs of BC survivors vary over the course of their cancer experience. This knowledge can assist the planning of appropriate assessments.

Acceptability and Feasibility of Survivorship Group Medical Visits for Breast Cancer Survivors in a Safety Net Hospital

Providing cost-effective, comprehensive survivorship care remains a significant challenge. Breast cancer survivors (BCS) who have limited income and are from marginalized racial and ethnic groups experience a worse quality of life and report higher distress. Thus, innovative care models are required to address the needs of BCS in low resource settings. Group medical visits (GMV), utilized in chronic disease management, are an excellent model for education and building skills. This single-arm intervention study was conducted at a public hospital in California. GMVs consisted of five 2-h weekly sessions focused on survivorship care planning, side effects of treatment and prevention, emotional health, sexual health, physical activity, and diet. The patient navigators recruited three consecutive GMV groups of six English-speaking BCS (N = 17). A multidisciplinary team delivered GMVs, and a patient navigator facilitated all the sessions. We used attendance rates, pre- and post-surveys, and debriefing interviews to assess the feasibility and acceptability of the intervention. We enrolled 18 BCS. One participant dropped out before the intervention started, 17 BCS consistently attended and actively participated in the GMV, and 76% (13) attended all planned sessions. Participants rated GMVs in the post-survey and shared their support for GMVs in debriefing interviews. The BCS who completed the post-survey reported that GMVs increased their awareness, confidence, and knowledge of survivorship care. GMVs were explicitly designed to address unmet needs for services necessary for survivorship care but not readily available in safety net settings. Our pilot data suggest that patient-navigator-facilitated GMVs are a feasible and acceptable model for integrating survivorship care in public hospitals.

Exploring the Unmet Supportive Care Needs of Breast Cancer Survivors Experiencing Psychological Distress: Qualitative Study

OBJECTIVES

This study aimed to explore the unmet supportive care needs of breast cancer survivors who experience psychological distress.

DATA SOURCES

A qualitative study design with inductive content analysis was used. Semistructured interviews were conducted with 18 Turkish breast cancer survivors who experienced psychological distress. The Consolidated Criteria for Reporting Qualitative Research checklist was used to report the study.

CONCLUSION

Three key themes emerged from data analysis: sources of psychological distress, unmet supportive care needs, and barriers to support. The survivors who experienced psychological distress defined a variety of unmet supportive care needs, in the areas of information support, psychological/emotional support, social support, and individualized health care support. They also described personal and health professional-related factors as barriers.

IMPLICATIONS FOR NURSING PRACTICE

Nurses should assess psychosocial well-being and supportive care needs of breast cancer survivors. Survivors should be supported to discuss their experiences of symptoms in the early survival phase, and they should be referred to an appropriate supportive care resource. A multidisciplinary survivorship services model is needed to offer posttreatment psychological support routinely in Turkey. Early, effective psychological care integrated into follow-up services for survivors can be protective against psychological morbidity.

Unmet supportive care needs of breast cancer survivors: a systematic scoping review

BACKGROUND

Breast cancer is the most common type of cancer in women worldwide. Though improved treatments and prolonged overall survival, breast cancer survivors (BCSs) persistently suffer from various unmet supportive care needs (USCNs) throughout the disease. This scoping review aims to synthesize current literature regarding USCNs among BCSs.

METHODS

This study followed a scoping review framework. Articles were retrieved from Cochrane Library, PubMed, Embase, Web of Science, and Medline from inception through June 2023, as well as reference lists of relevant literature. Peer-reviewed journal articles were included if USCNs among BCSs were reported. Inclusion/exclusion criteria were adopted to screen articles' titles and abstracts as well as to entirely assess any potentially pertinent records by two independent researchers. Methodological quality was independently appraised following Joanna Briggs Institute (JBI) critical appraisal tools. Content analytic approach and meta-analysis were performed for qualitative and quantitative studies respectively. Results were reported according to the PRISMA extension for scoping reviews.

RESULTS

A total of 10,574 records were retrieved and 77 studies were included finally. The overall risk of bias was low to moderate. The self-made questionnaire was the most used instrument, followed by The Short-form Supportive Care Needs Survey questionnaire (SCNS-SF34). A total of 16 domains of USCNs were finally identified. Social support (74%), daily activity (54%), sexual/intimacy (52%), fear of cancer recurrence/ spreading (50%), and information support (45%) were the top unmet supportive care needs. Information needs and psychological/emotional needs appeared most frequently. The USCNs was found to be significantly associated with demographic factors, disease factors, and psychological factors.

CONCLUSION

BCSs are experiencing a large number of USCNs in fearing of cancer recurrence, daily activity, sexual/intimacy, psychology and information, with proportions ranging from 45% to 74%. Substantial heterogeneity in study populations and assessment tools was observed. There is a need for further research to identify a standard evaluation tool targeted to USCNs on BCSs. Effective interventions based on guidelines should be formulated and conducted to decrease USCNs among BCSs in the future.

Patients' perceived challenges, competencies, and supportive care needs during acute clinical treatment of breast or gynecological cancer

OBJECTIVE

This study aimed to examine challenges, competencies, and supportive care needs (SCN) of women with breast or gynecological cancer during acute cancer treatment and associations to other health-related variables.

METHODS

We surveyed 120 patients with breast or gynecological cancer at the end of acute cancer treatment, either directly after surgery or during adjuvant chemotherapy. We assessed challenges, subjective competencies, and SCN using a self-developed measure comprising 25 items referring to coping tasks assigned to six domains. In addition, patients' competencies and health literacy (HL) were assessed.

RESULTS

Most patients felt at least moderately challenged by coping tasks concerning psychological distress (e.g., dealing with fears and insecurities, 70.2%; coping with cancer diagnosis, 69.6%) and physical complaints (e.g., dealing with a reduced physical capacity, 56.6%). About 42.5%-71.4% of patients who evaluated coping tasks as highly challenging felt competent to deal with these challenges themselves. Less than half of patients reported SCN, mainly regarding psychological concerns. The extent of challenging coping tasks, patients' perceived ability to overcome challenges themselves, and SCN showed associations to patient competencies and HL.

CONCLUSIONS

SCN regarding psychological concerns and health behavior should be addressed in acute cancer care and rehabilitation programs. In addition, promoting HL might be essential in strengthening patients' subjective competencies related to various coping tasks.

Psychometric properties of the Slovenian version of the Cancer Survivors’ Unmet Needs (CaSUN-SL) measure in post-treatment cancer survivors

Background

As the number of cancer survivors is growing, valid instruments for assessing cancer survivors' needs are required. Thus, the aim of this study was to translate and validate the Cancer Survivors Unmet Needs (CaSUN) scale.

Methods

Cancer survivors were recruited from 30 family medicine practices and separated into two samples (sample 1, n = 147; sample 2, n = 148). Factor structure was explored with an exploratory analysis in sample 1 and determined with a confirmatory analysis in sample 2. Psychometric properties were assessed with internal consistency, test–retest reliability and construct validity.

Results

A translation and cultural adaptation of the CaSUN scale resulted in 34 items being included in the final version. The factor structure confirmed the five-factors solution of the CaSUN-SL. Cronbach’s alpha was 0.94 for the CaSUN-SL and ranged from 0.71–0.88 for specific domains. Test–retest reliability showed moderate-high stability over time. The CaSUN-SL significantly and positively correlated with anxiety (r = 0.49), depression (r = 0.44), health-related quality of life (r = 0.36), and negatively with self-perceived health (r =  − 0.36) and resilience (r =  − 0.47), which confirms the construct validity. In addition, we found a significant correlation between unmet needs and age (r =  − 0.29), gender (r = 0.14), cancer stage (r = 0.20), cancer type (r = 0.19), and time since treatment (r =  − 0.20).

Conclusions

Results indicate that CaSUN-SL is a valid and reliable measure to assess the Slovenian cancer survivors’ unmet, met and total needs and can be used for further prospective studies.

Trial Registration: No. 0120-25/2019/6.

The unmet needs of women with breast cancer: a qualitative research

BACKGROUND AND AIM OF THE WORK

Breast cancer (CM) is the most commonly diagnosed form of cancer in Italy and the most common malignancy in women (25%) with 53,000 new cases. This disease affects all age groups (1 in 40 women <49 years, 1 in 20 between 50 and 69 years, 1 in 25 between 70 and 84 years). The percentage of patients diagnosed with cancer within 5 years of diagnosis is higher than for other cancers, and this conviction rate in these cancer patients has increased, leading to an ever-improving level of attention. The research aims to understand the main needs of women with breast cancer, compare them with those reported in the literature and in particular to identify which of these are still unsatisfied. Method The study is based on the use of the narrative interview conducted by the Case Manager, in the Breast Unit of Melegnano (Milan), selected with a sampling of convenience.The participants who joined the research project were 12 women with breast cancer, aged between 40 and 60, who are in the active treatment phase of the disease.

RESULTS

As highlighted by literature, various unmet needs have emerged, afferent to well-defined areas: emotional health, continuity of care, information, adverse effects, educational strategies, economics, information and social support. The study showed that, the needs that are most unsatisfied relate to the information area and the psychological area.

CONCLUSION

The interviews conducted underlined the importance of the role of the Case Care Manager as a facilitator of the disease path that patients are experiencing both in terms of the clinical and psychological aspects but also as a support in managing daily life. future research should investigate the role of the Case Vare manager in meeting these needs.

Determinants of quality of life in women immediately following the completion of primary treatment of breast cancer: A cross-sectional study

Backgrounds

Many breast cancer patients experience significant distress immediately following the completion of primary treatment. Women who report low levels of quality of life (QOL) early in this phase of transitional survivorship tend to experience diminished long-term adjustment. However, since most of the prior studies on survivors were conducted on patients at various times, studies on QOL of women during the end of primary treatment have been insufficient. This study aimed to identify determinants of QOL in women with breast cancer immediately following the completion of treatment.

Methods

A cross-sectional study was conducted on 140 disease-free breast cancer patients who had completed therapy in the past 1 month at university hospitals. Functional Assessment of Cancer Therapy-Breast (FACT-B), Memorial Symptom Assessment Scale-Short Form (MSAS-SF), Self-Efficacy Scale for Self-Management of Breast Cancer (SESSM-B), and Interpersonal Support Evaluation List-12 (ISEL-12) scales were used to assess predictors and QOL. The data were analyzed using the Pearson correlation, t-test, ANOVA, and hierarchical multiple regression.

Results

The mean score of QOL for breast cancer survivors was 97.23 (±20.01). Chemotherapy and perceived economic status were significantly associated with QOL in terms of sociodemographic and disease/treatment-related characteristics. Physical and psychological symptoms and social support had a significant association with QOL. The regression analyses showed that physical and psychological symptoms and belonging support were statistically significant in predicting the QOL of breast cancer survivors.

Conclusions

The variables of symptom experience and social support must be acknowledged when improving women’s QOL immediately after their completion of primary breast cancer treatment. Greater focus on the reduction of symptom distress and increasing a sense of belonging could improve QOL among breast cancer survivors.

Unmet supportive care needs of breast, colorectal and testicular cancer survivors in the first 8 months post primary treatment: A prospective longitudinal survey

Objectives

To explore the supportive care needs of cancer survivors, the characteristics of patients with high levels of unmet need, changes in unmet need after treatment ends and differences in unmet needs of breast, colorectal and testicular survivors.

Methods

The method used was a prospective longitudinal mailed survey. Unmet needs, measured by 25‐item modified Cancer Survivors Unmet Needs survey at baseline (immediately post‐treatment) and 8 months later, were analysed descriptively.

Results

Of 434 breast, 186 colorectal and 75 testicular patients responding at baseline, 56.2%, 65.6% and 50.7%, respectively, had no unmet needs, the top decile having ≥10 (breast) or seven (colorectal and testicular) different needs and seven different unmet needs. The most frequently reported unmet need (all groups) was fear of cancer recurrence. Unmet needs fell significantly at 8 months for breast patients. Some patients reported new needs. Needs were lowest amongst colorectal survivors and differed between the three groups. Higher levels of unmet needs (breast and colorectal) were associated with having had chemotherapy.

Conclusion

Most survivors reported few unmet needs, but a small proportion have persisting or emerging needs. Routine or regular monitoring of unmet needs is required so that healthcare professionals can deliver personalised care based on individual needs, preferences and circumstances.

Multicentre prospective cohort study of unmet supportive care needs among patients with breast cancer throughout their cancer treatment trajectory in Penang: a PenBCNeeds Study protocol

INTRODUCTION

Proper assessment of unmet supportive care needs of patients with breast cancer and its influencing factors at different treatment intervals will improve the rehabilitation of patients with breast cancer. Therefore, this study aims to determine the prevalence of unmet supportive care needs, changes of needs over time and associated factors during the treatment period.

METHODS AND ANALYSIS

This multicentre, prospective cohort study will be conducted in three governmental hospitals and one tertiary cancer institute in Penang, Malaysia. Adult women diagnosed with primary or recurrent tumour, node, metastases stage I-IV breast cancer based on pathological biopsy will be eligible for this study. At least 281 samples are required for this study. Participants will undergo follow-up at three time intervals: T1 at breast cancer diagnosis; T2 at 3 months after diagnosis and T3 at 6 months after diagnosis. Patients will complete a set of questionnaires at each time. The primary outcome of this study includes the changes in supportive care needs over three time points, followed by the secondary outcome examining patients' characteristics, coping behaviours and positive psychological components as they affect changes in unmet supportive care needs over time.

ETHICS AND DISSEMINATION

The study has received ethics approval from the Medical Research and Ethics Committee, Ministry of Health Malaysia (NMRR-19-268-45809 IIR) and the Human Research Ethics Committee of Universiti Sains Malaysia (USM/JEPeM/17100443). The results of the prospective study will be submitted for publication in a peer-reviewed journal.

Unmet needs from the first diagnosis of cancer until the end of medical treatment: A longitudinal study

OBJECTIVE

This study aimed to examine (1) The courses of Chinese cancer patients' unmet supportive care needs (psychological, physical and daily living, health system and information, patient care and support, and sexual) from the first cancer diagnosis until the end of medical treatment; (2) The predictive role of socio-demographic and medical characteristics (i.e., age, gender, and cancer stage) in the courses of unmet needs; and (3) The associations of courses of unmet needs with courses of depressive and anxiety symptoms.

METHODS

A longitudinal study was performed at Shaanxi Provincial Tumour Hospital in Xi'an, China. A total of 153 heterogeneous cancer patients were assessed after the first diagnosis (T1), at the beginning (T2) and the end (T3) of the receipt of medical treatment. Latent growth curve models were used to examine the research questions.

RESULTS

Psychological needs and health system and information needs showed a decrease over time, whereas physical needs, patient care needs and sexual needs remained stable. Younger and female patients tended to report higher levels of unmet psychological needs at T1 and experienced slower decreases from T1 to T3. Only the courses of unmet psychological needs were associated with the courses of depressive and anxiety symptoms from T1 to T3.

CONCLUSIONS

More attention can be given to young and female cancer patients, as they were more likely to suffer from high unmet psychological needs over the disease trajectory. Future research may focus more on addressing unmet needs reported by Chinese cancer patients.

Unmet needs in breast cancer survivors are common, and multidisciplinary care is underutilised: the Survivorship Needs Assessment Project

PURPOSE

The transition from a breast cancer patient to a survivor can be associated with significant physical, psychological, and social challenges. Development of multidisciplinary evidence-based care during the post-treatment period is a key area of cancer research. This study examined survivorship issues, unmet needs and perceptions about care among a cohort of breast cancer survivors.

METHODS

Participants were 130 women diagnosed with breast cancer for at least one year, and attending a hospital breast or oncology outpatient clinic. They completed a series of self-report questionnaires assessing demographic and clinical characteristics, unmet needs, severity of survivorship issues, use of multidisciplinary services, clinical benchmarks, survivorship care satisfaction, and suggestions for service improvements.

RESULTS

There was an average of 4.9 unmet survivorship needs, with 67% of participants reporting at least one unmet need. Fear of cancer recurrence, stress, coordination of medical care and negative iatrogenic impacts of hormonal treatments were key concerns. The cancer support team typically consisted of medical and nursing staff, and family/friends, and most were satisfied with their survivorship care. There was minimal use of other multidisciplinary clinicians and support groups. Provision of additional dietary and cancer recurrence education, and a written treatment plan were identified as key areas of service improvement.

CONCLUSION

Despite high satisfaction ratings, survivorship issues and unmet needs were relatively common, particularly among younger participants. Use of multidisciplinary care was inconsistent and overall underutilised.

IMPLICATIONS FOR CANCER SURVIVORS

Ongoing specific evaluation and optimisation of existing models of multidisciplinary survivorship care are essential in meeting the complex needs of breast cancer survivors.

Path analysis of survivorship care needs, symptom experience, and quality of life among multiethnic cancer survivors

PURPOSE

Cancer survivors continue to experience issues that persist across the survivorship trajectory. This study aims to explore the relationship among survivorship care need, symptom experience, and quality of life (QoL) of multiethnic cancer survivors by using path analytic methods.

METHODS

Participants were recruited from an academic medical center in Singapore that provides inpatient and outpatient oncology and hematology service. The Cancer Survivor Unmet Needs measure, physical effects subscale of the Cancer Survivors' Survey of Needs tool, and a Global QoL 10-point Likert scale were used to identify survivorship care needs, symptom experience, and QoL. Descriptive statistics were used to compute sociodemographic information, total survivorship needs, symptom experienced, and quality of life scores. The symptom experience model was used as the hypothetical model. The Analysis of Moment Structure was used to conduct the path analysis to evaluate the relationship between survivorship care needs, symptom experience, and quality of life.

RESULTS

Older cancer survivors were more likely to have spent a longer duration having cancer. Males were unlikely to suffer from solid tumor malignancies. Survivors with solid tumor malignancies were less likely to require supportive care. Survivors who require more supportive care were more likely to have a greater symptom burden. Cancer survivors with more symptoms have poorer QoL. The findings from this study partially supported the symptom experience model.

CONCLUSIONS

Our findings reveal that cancer survivors continue to experience symptoms across the survivorship trajectory. The results provide information for nurses during the planning and execution of survivorship care.

Risk factors of unmet needs among women with breast cancer in the post-treatment phase

OBJECTIVE

Unmet health care needs require additional care resources to achieve optimal patient well-being. In this nationwide study we examined associations between a number of risk factors and unmet needs after treatment among women with breast cancer, while taking into account their health care practices. We expected that more care use would be associated with lower levels of unmet needs.

METHODS

A multicenter, prospective, observational design was employed. Women with primary breast cancer completed questionnaires 6 and 15 months post-diagnosis. Medical data were retrieved from medical records. Direct and indirect associations between sociodemographic and clinical risk factors, distress, care use, and unmet needs were investigated with structural equation modeling.

RESULTS

Seven hundred forty-six participants completed both questionnaires (response rate 73.7%). The care services received were not negatively associated with the reported levels of unmet needs after treatment. Comorbidity was associated with higher physical and daily living needs. Higher age was associated with higher health system-related and informational needs. Having had chemotherapy and a mastectomy were associated with higher sexuality needs and breast cancer-specific issues, respectively. A higher level of distress was associated with higher levels of unmet need in all domains.

CONCLUSIONS

Clinicians may use these results to timely identify which women are at risk of developing specific unmet needs after treatment. Evidence-based, cost-effective (online) interventions that target distress, the most influential risk factor, should be further implemented and disseminated among patients and clinicians.

Breast cancer

Breast cancer is the most frequent malignancy in women worldwide and is curable in ~70-80% of patients with early-stage, non-metastatic disease. Advanced breast cancer with distant organ metastases is considered incurable with currently available therapies. On the molecular level, breast cancer is a heterogeneous disease; molecular features include activation of human epidermal growth factor receptor 2 (HER2, encoded by ERBB2), activation of hormone receptors (oestrogen receptor and progesterone receptor) and/or BRCA mutations. Treatment strategies differ according to molecular subtype. Management of breast cancer is multidisciplinary; it includes locoregional (surgery and radiation therapy) and systemic therapy approaches. Systemic therapies include endocrine therapy for hormone receptor-positive disease, chemotherapy, anti-HER2 therapy for HER2-positive disease, bone stabilizing agents, poly(ADP-ribose) polymerase inhibitors for BRCA mutation carriers and, quite recently, immunotherapy. Future therapeutic concepts in breast cancer aim at individualization of therapy as well as at treatment de-escalation and escalation based on tumour biology and early therapy response. Next to further treatment innovations, equal worldwide access to therapeutic advances remains the global challenge in breast cancer care for the future.

Transition to survivorship: can there be improvement?

PURPOSE OF REVIEW

The transition from primary cancer treatment to posttreatment follow-up care is seen as critical to the long-term health of survivors. However, relatively little attention has been paid to understanding this pivotal period. This review will offer a brief outline of the significant work surrounding this pivotal time published in the past year.

RECENT FINDINGS

The growing number of cancer survivors has stimulated an emphasis on finding new models of care, whereby responsibility for survivorship follow-up is transitioned to primary care providers. A variety of models and tools have emerged for follow-up care. Survivorship care plans are heralded as a key component of survivorship care and a vehicle for supporting transition. Uptake of survivorship care plans and implementation of evidence-based models of survivorship care has been slow, hindered by a range of barriers.

SUMMARY

Evaluation is needed regarding survivorship models in terms of feasibility, survivor friendliness, cost effectiveness, and achievement of sustainable outcomes. How, and when, to introduce plans for transition to the patient and determine transition readiness are important considerations but need to be informed by evidence. Additional study is needed to identify best practice for the introduction and application of survivorship care plans.

What Young Women with Breast Cancer Get Versus What They Want in Online Information and Social Media Supports

Purpose: Young women are high users of social media (SM), but information is lacking on whether online supports including SM meet the needs of young women (<40 years) with breast cancer (YWBC). YWBC are a vulnerable population who experience many psychosocial challenges alongside cancer diagnosis and treatment. This study aimed to gather data on what YWBC get versus what they want in online support. Methods: Semi-structured interviews explored YWBC's perceptions and use of online information/SM, including visions for ideal support. YWBC between the ages of 18-40 were recruited via two urban oncology clinics. Recruitment continued until redundancy of responses was achieved. Results: Thirteen YWBC participated in the study. Some reported benefits of online supports included connection with similar others, emotional support and ease of use. These benefits were balanced by drawbacks, such as a lack of appropriate/credible information and/or distressing information. Respondents spontaneously mentioned coping strategies such as managing information exposure and regulating SM use to mitigate against harms of online supports. Collectively, participants described nine facets of an ideal online support hub, which could function as a one stop shop for informational, practical and emotional supports for YWBC. Conclusion: Developing a multifunction online support hub may help women to find credible and useful information, rapidly, and address current limitations of online supports.

Patient-reported outcome measures among breast cancer survivors: A cross-sectional comparison between Malaysia and high-income countries

OBJECTIVES

Patient-reported outcomes (PROs) in high-income countries (HICs) suggest that physical, emotional, and psychological needs are important in cancer care. To date, there have been few inconsistent descriptions of PROs in low-income and middle-income Asian countries. Using a standard questionnaire developed by the International Consortium for Health Outcomes Measurement (ICHOM), we compared the perceived importance of PROs between patients in Malaysia and those in HICs and between clusters of Malaysian women.

METHODS

Breast cancer patients were recruited from three Malaysian hospitals between June and November 2017. We compared the proportion of patients who rated PROs as very important (scored 7-9 on a 9-point Likert scale) between Malaysian patients and data collected from patients in HICs via the ICHOM questionnaire development process, using logistic regression. A two-step cluster analysis explored differences in PROs among Malaysian patients.

RESULTS

The most important PROs for both cohorts were survival, overall well-being, and physical functioning. Compared with HIC patients (n = 1177), Malaysian patients (n = 969) were less likely to rate emotional (78% vs 90%), cognitive (76% vs 84%), social (72% vs 81%), and sexual (30% vs 56%) functioning as very important outcomes (P < 0.001). Cluster analysis suggests that older, parous, Malaysian women, who were less likely to have received breast reconstructive surgery, were more likely to rate body image and satisfaction with the breast as very important outcomes.

CONCLUSION

Taking into account the differences in PROs by cultural and socioeconomic settings could improve patient expectation of services and refine the assessment of cancer care outcomes.

Internet-Based Group Intervention for Ovarian Cancer Survivors: Feasibility and Preliminary Results

Background

Development of psychosocial group interventions for ovarian cancer survivors has been limited. Drawing from elements of cognitive-behavioral stress management (CBSM), mindfulness-based stress reduction (MBSR), and acceptance and commitment therapy (ACT), we developed and conducted preliminary testing of an Internet-based group intervention tailored specifically to meet the needs of ovarian cancer survivors. The Internet-based platform facilitated home delivery of the psychosocial intervention to a group of cancer survivors for whom attending face-to-face programs could be difficult given their physical limitations and the small number of ovarian cancer survivors at any one treatment site.

Objective

The aim of this study was to develop, optimize, and assess the usability, acceptability, feasibility, and preliminary intended effects of an Internet-based group stress management intervention for ovarian cancer survivors delivered via a tablet or laptop.

Methods

In total, 9 ovarian cancer survivors provided feedback during usability testing. Subsequently, 19 survivors participated in 5 waves of field testing of the 10-week group intervention led by 2 psychologists. The group met weekly for 2 hours via an Internet-based videoconference platform. Structured interviews and weekly evaluations were used to elicit feedback on the website and intervention content. Before and after the intervention, measures of mood, quality of life (QOL), perceived stress, sleep, and social support were administered. Paired t tests were used to examine changes in psychosocial measures over time.

Results

Usability results indicated that participants (n=9) performed basic tablet functions quickly with no errors and performed website functions easily with a low frequency of errors. In the field trial (n=19), across 5 groups, the 10-week intervention was well attended. Perceived stress (P=.03) and ovarian cancer-specific QOL (P=.01) both improved significantly during the course of the intervention. Trends toward decreased distress (P=.18) and greater physical (P=.05) and functional well-being (P=.06) were also observed. Qualitative interviews revealed that the most common obstacles participants experienced were technical issues and the time commitment for practicing the techniques taught in the program. Participants reported that the intervention helped them to overcome a sense of isolation and that they appreciated the ability to participate at home.

Conclusions

An Internet-based group intervention tailored specifically for ovarian cancer survivors is highly usable and acceptable with moderate levels of feasibility. Preliminary psychosocial outcomes indicate decreases in perceived stress and improvements in ovarian cancer-specific QOL following the intervention. A randomized clinical trial is needed to demonstrate the efficacy of this promising intervention for ovarian cancer survivors.

Defining cancer survivors, their needs, and perspectives on survivorship health care in the USA

More people are living after a diagnosis of cancer than ever before and now account for around 5% of the US population. The specialty of cancer survivorship has been developing and growing since the mid-1980s, but the term survivor is open to debate by people living with cancer and those caring for them. Regardless of the term used, many ongoing physical, psychological, and social needs affect quality of life for people who are living with cancer and those who have survived the disease. Survivors prefer to have these needs addressed by their oncologist but also want their primary care provider to have a role. However, survivors also believe there are communication and coordination barriers between care providers. The existing method for delivering cancer care is becoming unsustainable and is not adequately configured to deliver high-quality cancer care to this growing population in the USA, especially when confronted with projected health-care shortages by 2020. In this Series paper, we define the term cancer survivor, discuss survivors' ongoing needs and preferences for care over time, and consider the implications for delivering coordinated cancer care in the USA.

Between stigma and pink positivity: women's perceptions of social interactions during and after breast cancer treatment

This study explores women's perceptions of social interaction during and after their treatment for early stage breast cancer. An analysis of interviews with 24 women between 6 months and 29 years post-diagnosis reveals that interactions can be influenced by conflicting public discourses surrounding breast cancer. For example, there is the continuing association of cancer with death and the resulting potential for a stigmatised identity. In contrast is the ultra-positive discourse around cancer survivorship, with breast cancer in particular being associated with pink campaigning and a push towards positive thinking. Participants described managing conversations during treatment; sometimes playing down their private suffering and presenting a positive (public) image rather than risk alienating support. After treatment they were encouraged to move on and get back to 'normal'. While other breast cancer patients and survivors were often good sources of support, there was also a danger of assuming that all experiences would be the same. We present data to illustrate that women often present public accounts that are driven by an expectation of positivity and fear of stigmatisation at all stages of breast cancer treatment and beyond.

The Experience of Initiating Oral Adjuvant Treatment for Estrogen Receptor-Positive Breast Cancer

PURPOSE/OBJECTIVES

To describe the experience of women with estrogen receptor-positive breast cancer who are initiating oral adjuvant therapy and to determine what they describe as facilitating and/or hindering this experience. 
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RESEARCH APPROACH

Qualitative inquiry. 
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SETTING

Massachusetts General Hospital Cancer Center in Boston. 
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PARTICIPANTS

14 women aged 48-81 years. 
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METHODOLOGIC APPROACH

Qualitative, descriptive study using content analysis.
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FINDINGS

Five themes were identified.

CONCLUSIONS

Each participant who was initiating oral adjuvant treatment described many unmet needs. Women who were caregivers, were older aged, had several chronic illnesses, and were on several medications reported more difficulty transitioning to oral adjuvant therapy. 
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INTERPRETATION

This study suggests that nurses need to collaborate with other members of the healthcare team to assess the needs of and provide comprehensive care to women initiating oral adjuvant therapy. This is particularly true for women who are older aged, self-reported caregivers, and on several medications, and who have chronic comorbid conditions.

Identifying trajectory clusters in breast cancer survivors' supportive care needs, psychosocial difficulties, and resources from the completion of primary treatment to 8 months later

PURPOSE

This study aimed to chart patterns of simultaneous trajectories over 8 months in breast cancer survivors' (BCS) supportive care needs, psychological distress, social support, and posttraumatic growth. Clusters of BCS among these trajectories were identified and characterized.

METHODS

Of 426 BCS study participants, 277 (65%) provided full assessments in the last week of primary cancer treatment and 4 and 8 months later. Latent trajectories were obtained using growth mixture modeling for patients who responded to all scores for at least one time point (n = 348). Then, classification of BCS was performed by hierarchical agglomerative clustering on axes derived from a multiple factor analysis of trajectory assignments. Self-esteem, attachment security, and satisfaction with care were assessed at baseline.

RESULTS

Four trajectory clusters were identified, including two BCS subgroups (63%) with low needs and low psychological distress. Two others (37%) exhibited high or increasing needs and concerning levels of psychological distress. These latter clusters were characterized by higher insecure attachment, lower satisfaction with care, and either lower education or younger age, and having undergone chemotherapy.

CONCLUSION

More than a third of BCS present unfavorable patterns in supportive care needs over 8 months after primary cancer treatment. Identified psychosocial and cancer care characteristics point to targets for enhanced BCS supportive care.