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Rashidi A, Thapa S, Kahawaththa Palliya Guruge WS, Kaur S. Patient experiences: a qualitative systematic review of chemotherapy adherence. BMC Cancer 2024; 24:658. [PMID: 38816684 PMCID: PMC11138062 DOI: 10.1186/s12885-024-12353-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/07/2024] [Indexed: 06/01/2024] Open
Abstract
Adherence to chemotherapy treatment is recognized as a crucial health concern, especially in managing cancer patients. Chemotherapy presents challenges for patients, as it can lead to potential side effects that may adversely affect their mobility and overall function. Patients may sometimes neglect to communicate these side effects to health professionals, which can impact treatment management and leave their unresolved needs unaddressed. However, there is limited understanding of how patients' experiences contribute to improving adherence to chemotherapy treatment and the provision of appropriate support. Therefore, gaining insights into patients' experiences is crucial for enhancing the accompaniment and support provided during chemotherapy.This review synthesizes qualitative literature on chemotherapy adherence within the context of patients' experiences. Data were collected from Medline, Web of Science, CINAHL, PsychINFO, Embase, Scopus, and the Cochrane Library, systematically searched from 2006 to 2023. Keywords and MeSH terms were utilized to identify relevant research published in English. Thirteen articles were included in this review. Five key themes were synthesized from the findings, including positive outlook, receiving support, side effects, concerns about efficacy, and unmet information needs. The review underscores the importance for healthcare providers, particularly nurses, to focus on providing comprehensive information about chemotherapy treatment to patients. Adopting recommended strategies may assist patients in clinical practice settings in enhancing adherence to chemotherapy treatment and improving health outcomes for individuals living with cancer.
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Affiliation(s)
- Amineh Rashidi
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia.
| | - Susma Thapa
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia
| | | | - Shubhpreet Kaur
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia
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Yagil D, Cohen M. Self-employed workers with chronic health conditions: A qualitative study. J Health Psychol 2024:13591053241239462. [PMID: 38520040 DOI: 10.1177/13591053241239462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Abstract
Chronic health conditions affect many individuals of working age, who cope with physical, psychological, and social difficulties that often involve limited work ability. This qualitative study explored experiences of self-employed individuals with chronic health conditions to advance our understanding of the effect of chronic illness on work. In-depth semi-structured interviews were conducted with 23 self-employed individuals coping with cancer, heart disease, inflammatory bowel disease, lung disease, or asthma. Data were analyzed with thematic analysis. Analysis of the interviews revealed four themes: uncertainty in planning work and committing to customers, acceptance versus denial of reduced work abilities, disclosure of health status to workers and customers, and temporal substitutes as a source of both support and concern. The results indicate that self-employed workers with a chronic health condition cope with unique challenges due to the need to sustain their business in the face of illness and a sense of sole responsibility.
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R K, L S, P B, S G, R LP. Psychosocial experiences of breast cancer survivors: a meta-review. J Cancer Surviv 2024; 18:84-123. [PMID: 36854799 PMCID: PMC10866753 DOI: 10.1007/s11764-023-01336-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/15/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Advances in breast cancer care have led to a high rate of survivorship. This meta-review (systematic review of reviews) assesses and synthesises the voluminous qualitative survivorship evidence-base, providing a comprehensive overview of the main themes regarding breast cancer survivorship experiences, and areas requiring further investigation. METHODS Sixteen breast cancer reviews identified by a previous mixed cancer survivorship meta-review were included, with additional reviews published between 1998 and 2020, and primary papers published after the last comprehensive systematic review between 2018 and 2020, identified via database searches (MEDLINE, Embase, CINAHL, PsycINFO). Quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and the CASP (Critical Appraisal Skills Programme Qualitative) checklist for primary studies. A meta-ethnographic approach was used to synthesise data. RESULTS Of 1673 review titles retrieved, 9 additional reviews were eligible (25 reviews included in total). Additionally, 76 individual papers were eligible from 2273 unique papers. Reviews and studies commonly focused on specific survivorship groups (including those from ethnic minorities, younger/older, or with metastatic/advanced disease), and topics (including return to work). Eight themes emerged: (1) Ongoing impact and search for normalcy, (2) Uncertainty, (3) Identity: Loss and change, (4) Isolation and being misunderstood, (5) Posttraumatic growth, (6) Return to work, (7) Quality of care, and (8) Support needs and coping strategies. CONCLUSIONS Breast cancer survivors continue to face challenges and require interventions to address these. IMPLICATIONS FOR CANCER SURVIVORS Breast cancer survivors may need to prepare for ongoing psychosocial challenges in survivorship and proactively seek support to overcome these.
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Affiliation(s)
- King R
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Stafford L
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Butow P
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, Australia
| | - Giunta S
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, Australia
| | - Laidsaar-Powell R
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, Australia.
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van Roozendaal AS, Schellekens MPJ, van Woezik RAM, van der Lee ML. Exploring the dynamic interconnectedness of protective and perpetuating factors of cancer-related fatigue. Psychooncology 2023; 32:1876-1884. [PMID: 37902175 DOI: 10.1002/pon.6235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/29/2023] [Accepted: 10/18/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVE Approximately 25% of cancer patients suffer from cancer-related fatigue (CRF) after cancer treatment. CRF is a multi-factorial condition affected by several interrelated protective and perpetuating factors. As most studies merely assessed bivariate associations, more insight into the complex relationships among these constructs is needed. We applied the multivariate network approach to gain a better understanding of how patients' fatigue, perpetuating and protective factors are dynamically interconnected. METHOD Between February and August 2022, 30 cancer patients filled out a carefully developed ecological momentary assessment questionnaire (EnergyInSight) five times a day for at least 21 days while being on the waitlist for psychological care for CRF. We performed a multi-level vector autoregression analysis to examine the interconnectedness among fatigue, protective factors (allowing rest, acceptance, and self-efficacy) and perpetuating factors (worrying, catastrophizing, and feeling guilty). RESULTS In the contemporaneous network (concurrent associations), higher acceptance and self-efficacy were associated with lower fatigue, whereas all other factors were associated with higher fatigue. The strongest relationships were between worrying and feeling guilty and between acceptance and allowing rest. In the temporal network (lagged associations), fatigue was related to two factors: higher self-efficacy preceded lower fatigue, and higher fatigue preceded increased allowing rest. CONCLUSIONS Taking all included factors into account, the networks identified self-efficacy and allowing rest as key protective factors of CRF. Patients may benefit from psychological interventions that cultivate self-efficacy, as it seems to pave the way to reduced fatigue.
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Affiliation(s)
- Anne S van Roozendaal
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Bilthoven, The Netherlands
| | - Melanie P J Schellekens
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Bilthoven, The Netherlands
- Tilburg University School of Social and Behavioral Sciences, Department of Medical and Clinical Psychology, Tilburg, The Netherlands
| | - Rosalie A M van Woezik
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Bilthoven, The Netherlands
| | - Marije L van der Lee
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Bilthoven, The Netherlands
- Tilburg University School of Social and Behavioral Sciences, Department of Medical and Clinical Psychology, Tilburg, The Netherlands
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Kogan LR, Currin-McCulloch J, Cook LS. Breast cancer treatment and recovery: pets' roles as emotional buffers and stressors. BMC Womens Health 2023; 23:540. [PMID: 37848911 PMCID: PMC10583337 DOI: 10.1186/s12905-023-02662-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Research suggests pets foster affection, connection, and physical activity, yet has failed to address the challenges people diagnosed with cancer face in caring for their pets. The objective of this study was to better understand how pets serve as emotional buffers and/or stressors for people diagnosed with breast cancer, and how their ability to meet their pet's needs affects their well-being. METHODS A cross-section study of people diagnosed with breast cancer in the United States was conducted. Adults diagnosed with stages 0 (in situ) -IV breast cancer and currently the primary guardian of at least one dog or cat and owned the animal(s) for at least 6 months, were recruited for the study. A total of 211 responses, obtained between July - November 2022 were analyzed. The survey included questions about participants' demographics; attachment to their pets; physical, emotional, and functional well-being; social support received from their pet; and 'pet parenting' concerns. Descriptive statistics were calculated to describe participants' demographics. Multiple regression analyses were conducted to determine predictors of pet attachment, well-being, support from pet, and 'pet parenting' concerns. RESULTS People diagnosed with breast cancer derive substantial support from their pets (80% feel their pet makes them feel loved, needed, and offers a positive presence in the home), yet only 50% of participants feel this relationship is supported by their medical team. Controlling for owner demographics, heightened levels of pet-related guilt and concerns, along with lower perceived support from their pet, are all significant predictors of a lower quality of life. CONCLUSIONS Findings highlight the benefits pets offer people diagnosed with breast cancer, yet also the distress they feel in trying to meet their pet's needs. Assessment conversations about pet ownership, including pet-related support systems, are needed to validate people's concerns and support the identification and development of pet support teams. Medical team facilitated discussions about pet care needs is suggested to demonstrate support for the pet-parent bond and help normalize feelings of guilt related to challenges in meeting their pet's needs. These discussions could be aided through the development of research-driven intervention strategies and online, freely accessible targeted tools.
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Affiliation(s)
- Lori R Kogan
- Clinical Sciences Department, Colorado State University, 1680 Campus Delivery, Fort Collins, CO, 80523, USA.
| | - Jennifer Currin-McCulloch
- School of Social Work, Colorado State University, 1586 Campus Delivery, Fort Collins, CO, 80523, USA
| | - Linda S Cook
- Colorado School of Public Health, CU Anschutz Medical Campus, Building 500, 13001 East 17Th Place, B119, Aurora, CO, 80045-2601, USA
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Schaab M, Wijlens KAE, Bode C. Psychological Coping Factors Associated With Breast Cancer-Related Fatigue: A Systematic Review of Recent Evidence for Stages 0 to III. Clin Breast Cancer 2023; 23:e401-e411. [PMID: 37468391 DOI: 10.1016/j.clbc.2023.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/16/2023] [Indexed: 07/21/2023]
Abstract
Cancer-related fatigue (CRF) is a common, distressing, and difficult to treat symptom for both breast cancer patients and survivors. This review investigates psychological coping factors associated with breast CRF (BCRF) for women who are stage 0 to III breast cancer patients or survivors. A focus was made on active factors that can be practically targeted in a fatigue focused intervention aimed at providing immediate results. A comprehensive literature search was conducted in PsycInfo, Scopus, and PubMed using variations of the keywords Psychology, Breast cancer, Fatigue, and Coping. Guidelines for systematic reviews were followed, and inter-rater reliability between 2 raters was conducted. Seven studies were finally selected out of 1610 publications. A preliminary heuristic psychological coping model was constructed based on the following results: Sense of coherence and reassurance of worth were negatively associated with total BCRF. Subjective/perceived stress, meaning focused coping, and breast-related stereotype threat were positively associated with total BCRF. Reassurance of worth, nurturance, and optimism were negatively associated with mental fatigue. Optimism was also negatively associated with reduced motivation. This research can inform interventions, therapy, and care development by gaining insight into evidence-based factors that can facilitate or hinder BCRF and by utilizing the constructed heuristic model. The factors identified in this research are consistent with previous research and should be tested for their efficacy in practical applications. A larger timeframe and a full picture of all perspectives can lead to a comprehensive psychological coping model and core article on the topic.
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Affiliation(s)
- Michael Schaab
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
| | | | - Christina Bode
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
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Li H, Ng MSN, Jin X, Wong CL. 'Life became slow down': A descriptive qualitative study of the experiences of cancer-related fatigue amongst people with advanced lung cancer. Palliat Med 2023; 37:1168-1182. [PMID: 37395316 DOI: 10.1177/02692163231184926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
BACKGROUND Cancer-related fatigue is a complex multidimensional concept. However, little is known about the experience of cancer-related fatigue in people with advanced lung cancer. How they emotionally react to and cope with the experience of cancer-related fatigue according to cultural influences has not been extensively explored. AIM To explore the experience of cancer-related fatigue, its impacts and emotional reactions to and coping strategies for cancer-related fatigue amongst people with advanced lung cancer in China. DESIGN This was a cross-sectional, descriptive qualitative study with face-to-face semi-structured interviews. Data were analysed using content analysis. SETTING/PARTICIPANTS Twenty-one people with advanced lung cancer who experienced cancer-related fatigue were recruited in a hospital setting. RESULTS Four themes were identified: multifaceted experiences of cancer-related fatigue, impacts of cancer-related fatigue, negative perceptions of cancer-related fatigue and avoiding cancer-related fatigue. The multifaceted experience of cancer-related fatigue had physical, psychological and social impacts along the cancer trajectory. Informants regarded it as a sign of a 'bad ending', searched for root causes and had negative attitudes towards role changes. Avoiding coping strategies included not discussing cancer-related fatigue, refusing encouragement and support, hiding feelings, withdrawing from social life and attempting to control cancer-related fatigue. CONCLUSION The findings provide insights into the lack of flexibility of people with advanced lung cancer to adapt to the multidimensional experience of cancer-related fatigue. The reactions and coping towards cancer-related fatigue are profoundly influenced by Chinese culture. Developing psychological interventions based on the cultural background are highly recommended to cultivate the ability to cope flexibly with stressful events and live a meaningful cancer life.
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Affiliation(s)
- Huiyuan Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Marques Shek Nam Ng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaohuan Jin
- The School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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8
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Boley A. Initial Considerations for Accessibility in Microscopy. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2023; 29:2049. [PMID: 37612949 DOI: 10.1093/micmic/ozad067.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Allison Boley
- Arizona State University, Department of Physics, Tempe, AZ, United States
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9
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Bootsma TI, Schellekens MPJ, van Woezik RAM, van der Lee ML, Slatman J. Navigating severe chronic cancer-related fatigue: an interpretative phenomenological analysis. Psychol Health 2023; 38:494-517. [PMID: 34474619 DOI: 10.1080/08870446.2021.1973468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This article presents a phenomenological study on the embodied experiences of patients with Chronic Cancer-Related Fatigue (CCRF), aiming to better understand this complex phenomenon. DESIGN Data collection consisted of individual interviews with 25 participants who suffered from severe CCRF for at least three months after cancer treatment was finished. MAIN OUTCOME MEASURES Against the theoretical background of philosophical phenomenology, we explored embodied experiences, incorporated temporal and spatial aspects of living with CCRF. We applied interpretative phenomenological analysis (IPA) to analyze the transcripts of the interviews. RESULTS Using IPA, we identified four themes on how chronic fatigue is experienced post-cancer: (1) Worn out; (2) Diminishment of one's 'I can'; (3) Invisibility; and (4) Regaining one's 'I can'. CONCLUSION For clinical practice, these results imply that professionals could focus more on the role of the body and limitations of one's 'I can' when treating CCRF. By studying these embodied CCRF experiences in individual patients, future research could help personalize and optimize treatment.
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Affiliation(s)
- Tom I Bootsma
- Center for Psycho-Oncology, Scientific Research Department, Helen Dowling Institute, Bilthoven, The Netherlands.,School of Humanities and Digital Sciences, Department of Culture Studies, Tilburg University, Tilburg, The Netherlands
| | - Melanie P J Schellekens
- Center for Psycho-Oncology, Scientific Research Department, Helen Dowling Institute, Bilthoven, The Netherlands.,School of Social and Behavioral Sciences, Department of Medical and Clinical Psychology and Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Rosalie A M van Woezik
- Center for Psycho-Oncology, Scientific Research Department, Helen Dowling Institute, Bilthoven, The Netherlands
| | - Marije L van der Lee
- Center for Psycho-Oncology, Scientific Research Department, Helen Dowling Institute, Bilthoven, The Netherlands.,School of Social and Behavioral Sciences, Department of Medical and Clinical Psychology and Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Jenny Slatman
- School of Humanities and Digital Sciences, Department of Culture Studies, Tilburg University, Tilburg, The Netherlands
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Levkovich I, Hamama-Raz Y, Shinan-Altman S. "A kaleidoscope of relationships" - cervical cancer survivors' perspectives on their intimate relationships: A qualitative study. Palliat Support Care 2022; 21:1-10. [PMID: 35130992 DOI: 10.1017/s147895152100198x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical cancer is known to affect survivors' intimate relationships, as well as their communication and coping. Yet little is known about the perspectives of these survivors on their intimate relationships in the context of their needs during and after medical treatment. Additionally, only a few studies have focused on survivors' perceived needs or on existing psychosexual support. Understanding these perceptions can help provide a tailored response and improve dyadic interventions. The aim of this study was to examine cervical cancer survivors' perspectives on their intimate relationships during and after their treatment. METHOD The present study adopted a qualitative-phenomenological approach. In-depth, semi-structured interviews were conducted with 15 survivors of cervical cancer between the ages of 38 and 44 who were diagnosed at stages I-II and were treated with radiotherapy or chemo-radiotherapy and surgery. Data collection continued until saturation of concepts was reached. The results underwent thematic analysis. RESULTS Analysis of the findings revealed two key themes: (1) Together and apart in the shadow of cervical cancer. This theme focuses on the recovery period as a potential opportunity for changing and improving the couple relationship, such that men no longer withdraw but rather provide their partners with needed support and encouragement. (2) Changes in sexual life and couple intimacy. This theme focuses on changes in sexual relations, which have become a burden, painful, and something to avoid. SIGNIFICANCE OF RESULTS The study provides a comprehensive picture of intimate relationships during and after cervical cancer treatment and highlights the women's needs and desires for support from their intimate partners. The discussion notes that oncology providers can better facilitate supportiveness on the part of cervical cancer partners by offering better couple-oriented education and interventions to promote couple communication.
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Affiliation(s)
- Inbar Levkovich
- Faculty of Graduate Studies, Oranim Academic College of Education, Kiryat Tivon, Israel
| | - Yaira Hamama-Raz
- School of Social Work, Ariel University, Ariel Science Park, Ariel, 40700, Israel
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Schellekens MPJ, Bootsma TI, van Woezik RAM, van der Lee ML. Personalizing Psychological Care for Chronic Cancer-Related Fatigue: A Case Study on Symptom Dynamics. J Pers Oriented Res 2021; 7:1-13. [PMID: 34548915 PMCID: PMC8411882 DOI: 10.17505/jpor.2021.23447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Approximately 25% of cancer patients suffer from chronic cancer-related fatigue (CCRF), which is a complex, multifactorial condition. While there are evidence-based interventions, it remains unclear what treatment works best for the individual patient. Psychological network models can offer a schematic representation of interrelations among fatigue and protective and perpetuating factors for the individual patient. We explored whether feedback based on these individual fatigue networks can help personalize psychological care for CCRF. A 34-year old woman with CCRF was referred to our mental healthcare institute for psycho-oncology. During the waitlist period, she filled out an experience sampling app for 101 days, including five daily assessments of fatigue, pain, mood, activity and fatigue coping. The interplay between items was visualized in network graphs at the moment-level and day-level, which were discussed with the patient. For example, acceptance of fatigue in the past three hours was associated with less hopelessness and less fatigue in the following moment. At the day-level, acceptance was also being associated with less fatigue, less hopelessness, a better mood, and more motivation to do things. The patient recognized these patterns and explained how unexpected waves of fatigue can make her feel hopeless. This started a dialogue on how cultivating acceptance could potentially help her handle the fatigue. The patient would discuss this with her therapist. Feedback based on individual fatigue networks can provide direct insight into how one copes with CCRF and subsequently offer directions for treatment. Further research is needed in order to implement this in clinical practice.
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Affiliation(s)
- Melanie P J Schellekens
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Professor Bronkhorstlaan 20, 3723MB Bilthoven, the Netherlands.,Tilburg University School of Social and Behavioral Sciences, Department of Medical and Clinical Psychology, Warandelaan 2, Postbus 90153, 5000 LE Tilburg, The Netherlands
| | - Tom I Bootsma
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Professor Bronkhorstlaan 20, 3723MB Bilthoven, the Netherlands.,Tilburg University School of Humanities and Digital Sciences, Department of Culture Studies, Warandelaan 2, Postbus 90153, 5000 LE Tilburg, The Netherlands
| | - Rosalie A M van Woezik
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Professor Bronkhorstlaan 20, 3723MB Bilthoven, the Netherlands
| | - Marije L van der Lee
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Professor Bronkhorstlaan 20, 3723MB Bilthoven, the Netherlands.,Tilburg University School of Social and Behavioral Sciences, Department of Medical and Clinical Psychology, Warandelaan 2, Postbus 90153, 5000 LE Tilburg, The Netherlands
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12
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Bootsma TI, Schellekens MPJ, van Woezik RAM, Slatman J, van der Lee ML. Forming new habits in the face of chronic cancer-related fatigue: An interpretative phenomenological study. Support Care Cancer 2021; 29:6651-6659. [PMID: 33954822 PMCID: PMC8464573 DOI: 10.1007/s00520-021-06252-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/26/2021] [Indexed: 01/08/2023]
Abstract
Purpose The growing group of patients who suffer from chronic cancer-related fatigue (CCRF) after cancer have helpful and less helpful ways of responding to this long-lasting and disruptive problem. This qualitative study aimed to gain insight in essential elements of how patients respond to CCRF, with a focus on helpful responses to facilitate adaptation. Methods We conducted semi-structured interviews with a purposive sample of 25 participants who experienced severe CCRF for at least 3 months. Participants were recruited via media, patient associations, meetings, and health professionals until data saturation was attained. We used a topic guide with open-ended questions about lived experiences. Interpretative phenomenological analysis (IPA) was used for analysis of the transcripts. Results We identified five interrelated themes of how patients respond to CCRF: (1) discovering physical and emotional boundaries; (2) communicating support needs; (3) reorganizing and planning activities and rest; (4) letting go of one’s habitual identity; and (5) recognizing and accepting CCRF. Conclusion This study highlights the development of new habits and positive beliefs in the face of CCRF and the importance of (social) support in this process. This experiential knowledge on helpful responses can be used to inform patients and their significant others and improve self-efficacy. Health professionals could use these insights to improve recognition of CCRF and personalize treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06252-3.
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Affiliation(s)
- Tom I Bootsma
- Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, 3723 MB, Bilthoven, the Netherlands. .,Department of Culture Studies, School of Humanities and Digital Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, the Netherlands.
| | - Melanie P J Schellekens
- Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, 3723 MB, Bilthoven, the Netherlands.,Department of Medical and Clinical Psychology, School of Social and Behavioral Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, the Netherlands
| | - Rosalie A M van Woezik
- Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, 3723 MB, Bilthoven, the Netherlands
| | - Jenny Slatman
- Department of Culture Studies, School of Humanities and Digital Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, the Netherlands
| | - Marije L van der Lee
- Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, 3723 MB, Bilthoven, the Netherlands.,Department of Medical and Clinical Psychology, School of Social and Behavioral Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, the Netherlands
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Coping Strategies and Their Impact on Emotional Distress and Fatigue Among Breast Cancer Survivors: A Cross-sectional Survey. Cancer J 2021; 27:83-89. [PMID: 33750065 DOI: 10.1097/ppo.0000000000000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This study examined the relations between subjective stress and strategies for coping with stress (emotion control strategies and self-compassion), as well as the relations between emotional distress and fatigue. METHODS The study used a cross-sectional survey design. Participants were 170 women aged 24 to 82 years with diagnoses of breast cancer stages I to III who were 1 to 12 months postchemotherapy, with no current evidence of disease and no previous cancer diagnosis. Participants were recruited by consecutive sampling, and the overall response rate was 85%. RESULTS Higher subjective stress was associated with higher emotional control (r = 0.23, P < 0.01), and both were associated with higher emotional distress (r = 0.63, P < 0.001; r = 0.20, P < 0.05). Lower self-compassion was associated with higher emotional distress (r = -0.20, P < 0.05). Fatigue exhibited a high association with emotional distress (r = 0.67, P < 0.001), which increased as subjective stress increased. Older age was associated with emotional control (r = 0.16, P < 0.05), whereas younger age was associated with emotional distress. Time elapsed since chemotherapy was negatively associated with both emotional distress (r = -0.19, P < 0.05) and fatigue (r = -0.18, P < 0.05). A strong positive association emerged between fatigue and emotional distress (r = 0.67, P < 0.001). CONCLUSIONS The results of this study underline the importance of self-compassion as a coping strategy to decrease emotional distress among breast cancer survivors.
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Favez N, Cairo Notari S. Body image, sexual activity, and side effects of treatments across the first year after surgery in women facing breast cancer: The influence of attachment insecurity. J Psychosoc Oncol 2021; 39:749-764. [PMID: 33660590 DOI: 10.1080/07347332.2021.1890306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: The aim of this study was to assess, across the first year after surgery, the influence of attachment insecurity, that is, avoidant and anxious tendencies, on body image, sexual activity, and side effects of treatments in women diagnosed with breast cancer.Design: A total of 110 women with non-metastatic breast cancer were surveyed 2 weeks (T1), 3 months (T2), and 12 months (T3) after surgery.Methods: Self-reported questionnaires were used to assess attachment tendencies (avoidance and anxiety), medical data (cancer stage, oncological treatment), sociodemographic data (age, socioeconomic level, relational status), and the three outcomes.Results: Generalized linear modeling showed that (1) having more avoidant and anxious attachment tendencies predicted a more negative body image, as did being younger and having undergone a mastectomy; (2) having more avoidant attachment tendencies predicted being sexually inactive, as did having undergone neoadjuvant chemotherapy or adjuvant hormonal therapy, whereas being younger and in a committed relationship predicted being sexually active; and (3) attachment tendencies did not predict the intensity of side effects, whereas a higher cancer stage and being at the beginning of treatment predicted more side effects.Conclusions: Women with avoidant and anxious attachment tendencies may be especially vulnerable to the consequences of oncological treatment, in particular regarding body image and sexual activity.
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Affiliation(s)
- Nicolas Favez
- Faculty of Psychology and Educational Sciences, Department of Psychology, University of Geneva, Switzerland
| | - Sarah Cairo Notari
- Faculty of Psychology and Educational Sciences, Department of Psychology, University of Geneva, Switzerland
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Charles C, Di Meglio A, Arnedos M, Arvis J, Baciarello G, Blanchard P, Djehal N, Dumas A, Hollbecque A, Martin E, Matias M, Menvielle G, Zingarello A, Dauchy S, Vaz-Luis I. QualFatigue study: which factors influence the use of specific interventions for breast cancer survivors with fatigue? A cross-sectional exploratory study. Support Care Cancer 2021; 29:4827-4834. [PMID: 33547524 DOI: 10.1007/s00520-021-06040-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/02/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE International guidelines recommend specific interventions to reduce cancer-related fatigue (CRF). Evidence suggests underutilization of these interventions among breast cancer survivors. The QualFatigue study aimed to explore the potential factors influencing the use of specific interventions, for relief, in patients with CRF through qualitative analyses. METHODS Patients with stage I-III breast cancer, and CRF ≥4 on a 10-point numerical scale were recruited within 6-24 months at the end of their primary treatment. Semi-structured interviews were performed. Emergent themes were identified using a stepped content analysis (QDA Miner software). RESULTS Data saturation was achieved with 15 interviews. Four main themes emerged as potential sources of influence in the participants' use of specific interventions: (1) expectations regarding the management of CRF, (2) representations of the benefits provided by the interventions, (3) individual physical and psychological conditions, and (4) social and environmental situations. Six key levers came out transversally to optimize the use of specific interventions to relieve CRF: (1) listening and recognition of the individual difficulties and needs; (2) individual and global health assessments; (3) information and advice on how to manage CRF; (4) discussion groups focused on the management of CRF; (5) group activities; and (6) professional and personalized guidance. CONCLUSION This study calls for multi-level action to address many persistent barriers and exploit levers in the management of CRF.
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Affiliation(s)
- Cécile Charles
- Gustave Roussy, Université Paris-Saclay, 114 Rue Edouard Vaillant, F-94805, Villejuif Cedex, France.
- Laboratoire de Psychopathologie et Processus de Santé (EA 4057), Université Paris Descartes, Sorbonne Paris Cité, 71 avenue Edouard Vaillant, 92100, Boulogne-Billancourt, France.
| | - Antonio Di Meglio
- Inserm, Biomarqueurs prédictifs et nouvelles stratégies thérapeutiques en oncologie, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Monica Arnedos
- Département d'Oncologie Médicale, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Johanna Arvis
- Ligue nationale contre le cancer, 75013, Paris, France
| | - Giulia Baciarello
- Département d'Oncologie Médicale, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Pierre Blanchard
- Département d'Oncologie Médicale, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Nardjes Djehal
- Département d'Oncologie Médicale, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Agnès Dumas
- INSERM (National Institute for Health and Medical Research), Université de Paris, ECEVE UMR 1123, F-75010, Paris, France
| | - Antoine Hollbecque
- Département d'Oncologie Médicale, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Elise Martin
- Inserm, Biomarqueurs prédictifs et nouvelles stratégies thérapeutiques en oncologie, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Margarida Matias
- Département d'Oncologie Médicale, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Gwenn Menvielle
- Institut Pierre Louis d'Epidémiologie et Santé Publique, Sorbonne Université, Inserm, 75012, Paris, France
| | - Anna Zingarello
- Département d'Oncologie Médicale, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Sarah Dauchy
- Gustave Roussy, Université Paris-Saclay, 114 Rue Edouard Vaillant, F-94805, Villejuif Cedex, France
| | - Ines Vaz-Luis
- Inserm, Biomarqueurs prédictifs et nouvelles stratégies thérapeutiques en oncologie, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
- Département d'Oncologie Médicale, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
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16
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Martin E, Zingarello A, Di Meglio A, Baciarello G, Matias M, Charles C, Arvis J, Dumas A, Menvielle G, Vaz-Luis I. A qualitative evaluation of the use of interventions to treat fatigue among cancer survivors: A healthcare provider's view. Eur J Cancer Care (Engl) 2020; 30:e13370. [PMID: 33191520 DOI: 10.1111/ecc.13370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/16/2020] [Accepted: 10/14/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cancer-related fatigue (CRF) is among the most common and distressing side effects of cancer treatment. Different types of interventions, including physical activity (PA), psychosocial and mind-body interventions, have been shown to reduce CRF. We aimed to explore HCPs' practices and barriers to refer patients towards interventions to reduce CRF. METHODS We performed a qualitative study using key informant interviews among a sample of 20 HCPs including medical, surgical and radiation oncologists, pain specialists, nurses, psychologists, psychiatrists and physiotherapists recruited from breast, prostate and colorectal cancer disease groups from a comprehensive cancer centre. RESULTS Most interviewees reported not to address CRF spontaneously during consultations. When the topic of CRF was brought up by patients, all interviewees acknowledged to recommend PA, whereas few would recommend psychosocial or mind-body interventions. Barriers to recommend interventions to manage CRF included: lack of knowledge about CRF and its treatment, lack of time and complexity of the referral due to their accessibility and cost. CONCLUSION In a diverse sample of HCPs, most acknowledged not to address CRF proactively with their patients, but identified several actionable barriers. Specific training on screening and management of CRF and improving the referral network dedicated to interventions need to be implemented.
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Affiliation(s)
- Elise Martin
- Institut Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Anna Zingarello
- Hôpital Saint-Camille, Unité de Soins Médicaux en Oncologie (USMO), Bry-sur-Marne, France
| | - Antonio Di Meglio
- Institut Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Giulia Baciarello
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Margarida Matias
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Cécile Charles
- Psycho-Oncology Unit, Institut Gustave Roussy, Villejuif, France
| | | | - Agnès Dumas
- Inserm Unit 1123, Unité ECEVE, Université de Paris, Paris, France
| | - Gwenn Menvielle
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et Santé Publique (IPLESP), Paris, France
| | - Ines Vaz-Luis
- Institut Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France.,Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
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Photovoice-Based Assessment of Weight Management Experiences of Breast Cancer Patients Treated with Tamoxifen. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124359. [PMID: 32570717 PMCID: PMC7345025 DOI: 10.3390/ijerph17124359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022]
Abstract
In this study, an in-depth analysis of weight management experiences of breast cancer patients treated with tamoxifen is conducted, thereby providing basic data to help develop a multidimensional strategy to reduce recurrence and increase the survival rate of breast cancer patients. Study participants included nine breast cancer patients who were treated with tamoxifen at Kosin University Hospital and Saegyero Hospital in Busan Metropolitan City, Korea. This study employed the photovoice methodology. Participants described the need for family support and cooperation with weight management, provision of personalized weight management programs by medical institutions, provision of information on weight management programs by the community, and financial support for the weight management programs for breast cancer patients at the national level. This study emphasized the importance of weight management for breast cancer patients treated with tamoxifen and collected and analyzed vivid opinions of these patients using photos taken by them.
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Arizona IKLT, Sukartini T, Efendi F, Estiadewi PS, Anggraeni NPDA. The Experiences of Cancer-Related Fatigue among Adult Cancer Patients: A Systematic Review. JURNAL NERS 2019. [DOI: 10.20473/jn.v14i3.16973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Cancer-related fatigue (CRF) is one of the symptoms commonly experienced and it is a subjective feeling felt by cancer patients. The aim of this systematic review was to summarize how fatigue has been described from the perspective of adult cancer patients, the impact of fatigue on their quality of life, what the patient reported as contributing factors and potential coping strategies to reduce fatigue.Methods: A systematic review is in line with PRISMA guidelines. Five databases were systematically searched (Scopus, PubMed, Springerlink, ProQuest and Science Direct) from January 2009 to February 2019 for qualitative studies describing the experience of adult cancer patients using a predefined search strategy and any relevant keywords.Results: In total, 13 out of 4692 studies were included. The ages of the included patient cancer ranged from 26 to 84 years. The majority of studies used in-depth interviews and semi-structured interviews to elicit the participant’s experiences of fatigue. Four themes were identified: the perception of cancer-related fatigue, the etiology of cancer fatigue, impact and coping strategies.Conclusion: Fatigue is impactful on quality of life from the perspective of cancer patients. Future research should focus on the prospective exploration of the impact of fatigue on woman's and men's health and identifying approaches to reduce fatigue.
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Treatment decision-making, family influences, and cultural influences of Chinese breast cancer survivors: a qualitative study using an expressive writing method. Support Care Cancer 2019; 28:3259-3266. [DOI: 10.1007/s00520-019-05161-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
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20
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Bootsma TI, Schellekens MPJ, van Woezik RAM, van der Lee ML, Slatman J. Experiencing and responding to chronic cancer-related fatigue: A meta-ethnography of qualitative research. Psychooncology 2019; 29:241-250. [PMID: 31442340 PMCID: PMC7027742 DOI: 10.1002/pon.5213] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 11/24/2022]
Abstract
Objective One of the most prevalent and disrupting symptoms experienced by cancer patients is chronic cancer‐related fatigue (CCRF). A better understanding of the chronic nature of CCRF can provide valuable insights for theory and practice. The purpose of this meta‐ethnography was to derive an overarching interpretative narrative on patients' experiences and responses to CCRF. Methods We conducted a comprehensive systematic literature search in five databases (05‐03‐2018). In addition, papers from reference lists were retrieved. Two researchers independently screened the papers for eligibility and appraised quality (CASP‐criteria). We followed the seven phases of meta‐ethnography to extract, translate, and synthesise first‐order constructs (ie, patients' views) and second‐order constructs (ie, authors' views) from the selected studies into third‐order constructs (ie, new interpretations). Results Of the 1178 collected articles, 16 articles were included. Through synthesis, a new figure of six interrelated third‐order constructs was developed: (1) embodied experience entails the dominating presence of the body; (2) (mis)recognition includes lack of recognition of CCRF by patients, relatives, and health providers; (3) small horizon describes a resultant narrowed world; (4) role change encompasses adopting other life roles; (5) loss of self refers to the impact on one's identity; and (6) regaining one's footing describes the struggle against CCRF, adaptation to CCRF and finally acceptance of a “new normal with CCRF.” Conclusion A new embodiment figure of CCRF with social (eg, (mis)recognition), spatial (eg, small horizon) and temporal dimensions (eg, regaining one's footing) was developed. This figure can help professionals to recognise CCRF, inform patients, and personalise treatment.
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Affiliation(s)
- Tom I Bootsma
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Bilthoven, The Netherlands.,Tilburg University, School of Humanities and Digital Sciences, Culture Studies Department, Tilburg, The Netherlands
| | - Melanie P J Schellekens
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Bilthoven, The Netherlands
| | - Rosalie A M van Woezik
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Bilthoven, The Netherlands
| | - Marije L van der Lee
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Bilthoven, The Netherlands
| | - Jenny Slatman
- Tilburg University, School of Humanities and Digital Sciences, Culture Studies Department, Tilburg, The Netherlands
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21
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Cohen M, Levkovich I, Pollack S, Fried G. Stability and change of postchemotherapy symptoms in relation to optimism and subjective stress: A prospective study of breast cancer survivors. Psychooncology 2019; 28:2017-2024. [DOI: 10.1002/pon.5185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/18/2019] [Accepted: 07/21/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Miri Cohen
- School of Social WorkUniversity of Haifa Haifa Israel
| | | | - Shimon Pollack
- Institute of Clinical Immunology, Allergy and AIDSRambam Health Care Campus Haifa Israel
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22
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Zeng J, Wu J, Tang C, Xu N, Lu L. Effects of Exercise During or Postchemotherapy in Cancer Patients: A Systematic Review and Meta‐Analysis. Worldviews Evid Based Nurs 2019; 16:92-101. [PMID: 30854763 DOI: 10.1111/wvn.12341] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Jingchun Zeng
- Department of AcupunctureFirst Affiliated Hospital of Guangzhou University of Chinese Medicine Guangzhou China
| | - Jiaming Wu
- Zhongshan Affiliated Hospital Guangzhou University of Chinese Medicine Zhongshan China
| | - Chunzhi Tang
- Clinical Research Center South China Research Center for Acupuncture and Moxibustion Medical College of Acu‐Moxi and Rehabilitation Guangzhou University of Chinese Medicine Guangzhou China
| | - Nenggui Xu
- Clinical Research Center South China Research Center for Acupuncture and Moxibustion Medical College of Acu‐Moxi and Rehabilitation Guangzhou University of Chinese Medicine Guangzhou China
| | - Liming Lu
- Clinical Research Center South China Research Center for Acupuncture and Moxibustion Medical College of Acu‐Moxi and Rehabilitation Guangzhou University of Chinese Medicine Guangzhou China
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