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Gavin NC, Northfield S, Mihala G, Somerville M, Kleidon T, Marsh N, Larsen E, Campbell J, Rickard CM, Ullman AJ. Central Venous Access Device-Associated Skin Complications in Adults with Cancer: A Prospective Observational Study. Semin Oncol Nurs 2024; 40:151618. [PMID: 38622044 DOI: 10.1016/j.soncn.2024.151618] [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: 10/08/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES To identify the prevalence and type of central venous access device-associated skin complications for adult cancer patients, describe central venous access device management practices, and identify clinical and demographic characteristics associated with risk of central venous access device-associated skin complications. METHODS A prospective cohort study of 369 patients (626 central venous access devices; 7,682 catheter days) was undertaken between March 2017 and March 2018 across two cancer care in-patient units in a large teaching hospital. RESULTS Twenty-seven percent (n = 168) of participants had a central venous access device-associated skin complication. In the final multivariable analysis, significant (P < .05) risk factors for skin complications were cutaneous graft versus host disease (2.1 times greater risk) and female sex (1.4 times greater risk), whereas totally implanted vascular access device reduced risk for skin complications by two-thirds (incidence risk ratio 0.37). CONCLUSION Central venous access device-associated skin complications are a significant, potentially avoidable injury, requiring cancer nurses to be aware of high-risk groups and use evidence-based preventative and treatment strategies. IMPLICATIONS FOR PRACTICE This study has confirmed how common these potentially preventable injuries are. Therefore, the prevalence of these complications could be reduced by focusing on improvements in skin assessment, reductions in central venous access device dressing variation and improving clinician knowledge of this injury.
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Affiliation(s)
- Nicole C Gavin
- Nurse Researcher, Cancer Care Services, Royal Brisbane and Women's Hospital, Herston; Researcher, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Adjunct Associate Professor, School of Nursing, Queensland, Australia University of Technology, Kelvin Grove; Senior Research Fellow, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Senior Research Fellow, School of Medicine, University of Queensland, Herston; School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.
| | - Sarah Northfield
- Clinical Nurse Consultant, Specialist Palliative Care Service, Toowoomba Hospital, Queensland, Australia
| | - Gabor Mihala
- Biostatistician, School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Margarette Somerville
- Clinical Nurse Research, Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Tricia Kleidon
- Paediatrics and Neonatal Researcher, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Research Fellow, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Research Fellow, School of Nursing and Midwifery, Griffith University, Nathan; Nurse Practitioner, Vascular Access Management Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Nicole Marsh
- Acute/Critical Care Professor, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Professor, School of Nursing, Queensland, Australia University of Technology, Kelvin Grove; Professor, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Professor, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Emily Larsen
- Researcher, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; School of Nursing and Midwifery, Griffith University, Nathan; Research Fellow, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jill Campbell
- Adjunct Senior Research Fellow, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Claire M Rickard
- Infection Prevention Professor, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Professor, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Professor, School of Nursing and Midwifery, Griffith University, Nathan; Professor, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston; Professor, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast Campus; and Herston Infectious Diseases Institute, Metro North Health, Herston, Queensland, Australia
| | - Amanda J Ullman
- Professor, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Professor, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Professor, Vascular Access Management Service, Queensland Children's Hospital, South Brisbane; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston; Professor, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia
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Humphreys L, Myers A, Frith G, Thelwell M, Pickering K, Mills GH, Kerr K, Fisher P, Kidder J, Keen C, Hodson S, Phillips G, Smith R, Evans L, Thornton S, Dale E, Maxwell L, Greenfield DM, Copeland R. The Development of a Multi-Modal Cancer Rehabilitation (Including Prehabilitation) Service in Sheffield, UK: Designing the Active Together Service. Healthcare (Basel) 2024; 12:742. [PMID: 38610164 PMCID: PMC11011813 DOI: 10.3390/healthcare12070742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer patients undergoing major interventions face numerous challenges, including the adverse effects of cancer and the side effects of treatment. Cancer rehabilitation is vital in ensuring cancer patients have the support they need to maximise treatment outcomes and minimise treatment-related side effects and symptoms. The Active Together service is a multi-modal rehabilitation service designed to address critical support gaps for cancer patients. The service is located and provided in Sheffield, UK, an area with higher cancer incidence and mortality rates than the national average. The service aligns with local and regional cancer care objectives and aims to improve the clinical and quality-of-life outcomes of cancer patients by using lifestyle behaviour-change techniques to address their physical, nutritional, and psychological needs. This paper describes the design and initial implementation of the Active Together service, highlighting its potential to support and benefit cancer patients.
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Affiliation(s)
- Liam Humphreys
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK; (A.M.); (G.F.); (M.T.); (K.P.)
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Anna Myers
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK; (A.M.); (G.F.); (M.T.); (K.P.)
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Gabriella Frith
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK; (A.M.); (G.F.); (M.T.); (K.P.)
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Michael Thelwell
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK; (A.M.); (G.F.); (M.T.); (K.P.)
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Katie Pickering
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK; (A.M.); (G.F.); (M.T.); (K.P.)
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Gary H. Mills
- Critical Care Directorate, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield S1 1WB, UK; (G.H.M.)
| | - Karen Kerr
- Critical Care Directorate, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield S1 1WB, UK; (G.H.M.)
| | - Patricia Fisher
- Specialised Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (P.F.); (D.M.G.)
| | - John Kidder
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Carol Keen
- Therapeutics and Palliative Care Directorate, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (C.K.); (S.H.); (R.S.); (L.E.)
| | - Suzanne Hodson
- Therapeutics and Palliative Care Directorate, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (C.K.); (S.H.); (R.S.); (L.E.)
| | - Gail Phillips
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Rachel Smith
- Therapeutics and Palliative Care Directorate, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (C.K.); (S.H.); (R.S.); (L.E.)
| | - Laura Evans
- Therapeutics and Palliative Care Directorate, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (C.K.); (S.H.); (R.S.); (L.E.)
| | - Sarah Thornton
- Dietetic Service, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK;
| | - Emma Dale
- Department of Psychological Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK;
| | - Louise Maxwell
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK;
| | - Diana M. Greenfield
- Specialised Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (P.F.); (D.M.G.)
- Department of Oncology and Metabolism, University of Sheffield, Medical School Beech Hill Road, Sheffield S10 2RX, UK
| | - Robert Copeland
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
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Holm M, Lövgren M, Alvariza A, Eklund R, Kreicbergs U. Experiences of being a severely ill parent of dependent children receiving care at home: Hopes and challenges. Palliat Support Care 2024; 22:169-173. [PMID: 36987845 DOI: 10.1017/s1478951523000184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVES Multiple studies have focused on severely ill patients in the role as parents of dependent children, yet few have explored the thoughts and feelings within this group during palliative home care. METHODS This qualitative study derives from a pilot intervention study, the Family Talk Intervention (FTI), in specialized palliative home care. The FTI is a support program with the main goal to increase family communication about illness-related topics. The study is based on field notes from 104 sessions with 20 parents taken by an interventionist during intervention delivery. The field notes were analyzed using the principles of qualitative content analysis. RESULTS The field notes revealed several challenging situations for parents with severe illness. A major issue was how to find ways to talk to their children about their illness and prognosis. The parents expressed guilt for being unable to fulfill their roles as parents and partners. Existing family conflicts had escalated with the illness, according to some parents. Despite being affected by illness, parents tried to have hope, if only for small things - such as a period of ordinary family life. SIGNIFICANCE OF RESULTS Severely ill parents in specialized palliative home care seek support regarding how to communicate and stay connected to their roles in the family, which is a struggle when a parent is cared for at home, while it in contrast may promote normality and hope. Communication with children is vital and needs to be brought to the attention of health-care professionals. A family-centered focus, involving both parents and children, should be embraced.
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Affiliation(s)
- Maja Holm
- Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Advanced Pediatric Home Care, Karolinska University Hospital, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Research and Development Unit/Palliative Care, Stockholm, Sweden
| | - Rakel Eklund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Department of Women and Child's Health, Karolinska Institutet, Stockholm, Sweden
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Alam S, Lee J, Sahebkar A. Curcumin in Cancer Prevention: Insights from Clinical Trials and Strategies to Enhance Bioavailability. Curr Pharm Des 2024; 30:1838-1851. [PMID: 38808709 DOI: 10.2174/0113816128303514240517054617] [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: 01/10/2024] [Revised: 04/04/2024] [Accepted: 04/17/2024] [Indexed: 05/30/2024]
Abstract
Cancer remains a leading cause of death worldwide, and current cancer drugs often have high costs and undesirable side effects. Additionally, the development of drug resistance can reduce their effectiveness over time. Natural products have gained attention as potential sources for the treatment and prevention of various diseases. Curcumin, an extract from turmeric (Curcuma longa), is a natural phenolic compound with diverse pharmacological properties, including antioxidant, anti-inflammatory, antiviral, antibacterial, antifungal, antiprotozoal, antidiabetic, antivenom, antiulcer, anticarcinogenic, antimutagenic, anticoagulant, and antifertility activities. Given the increasing interest in curcumin for cancer prevention, this review aims to comprehensively examine clinical trials investigating the use of curcumin in different types of cancer. Additionally, effective techniques and approaches to enhance the bioavailability of curcumin are discussed and summarized. This review article provides insights into the properties of curcumin and its potential as a future anticancer drug.
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Affiliation(s)
- Shabaz Alam
- Department of Chemical Engineering and Applied Chemistry, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Jaewon Lee
- Department of Chemical Engineering and Applied Chemistry, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Amirhossein Sahebkar
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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Akdemir A, Smith AB, Wu VS, Rincones O, Russell H, Lyhne JD, Kemp E, David M, Bamgboje-Ayodele A. Guided versus non-guided digital psychological interventions for cancer patients: A systematic review and meta-analysis of engagement and efficacy. Psychooncology 2024; 33:e6290. [PMID: 38282223 DOI: 10.1002/pon.6290] [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: 12/19/2022] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To evaluate engagement with and efficacy of guided versus non-guided digital interventions targeting psychological symptoms of cancer via a systematic review of current evidence. METHODS PubMed, Scopus, PsychINFO, MEDLINE, and CINAHL databases were searched. Eligible publications were randomised controlled trials of guided or non-guided digital psychological interventions used in cancer settings reporting intervention efficacy and/or engagement. Study methodological quality was assessed using the Cochrane risk of bias (RoB) tool. Random effects meta-analyses were performed on outcomes with sufficient data, with sub-group analyses of intervention type and follow-up period. RESULTS Forty-three studies were included. Studies varied by level of guidance, type of technology used, duration, and outcomes assessed. Most studies had a high overall RoB. Meta-analysis indicated that guided interventions significantly reduced distress, anxiety, and fatigue, while non-guided did not. For depression and quality of life, both guided and non-guided interventions produced significant improvements. Guided interventions reported higher levels of intervention engagement than non-guided. CONCLUSIONS Guided digital psychological interventions were likely to be more effective than non-guided ones for cancer patients, particularly in reducing distress, anxiety, and fatigue. Whilst both types were found to improve depression and life quality, guided interventions were associated with higher patient engagement. These findings suggest digital interventions could supplement traditional cancer care, warranting further research concerning long-term effects and cost-efficiency.
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Affiliation(s)
- Aleyna Akdemir
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, New South Wales, Australia
| | - Allan Ben Smith
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Verena Shuwen Wu
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, New South Wales, Australia
| | - Orlando Rincones
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, New South Wales, Australia
| | - Hayley Russell
- Ovarian Cancer Australia, Melbourne, Victoria, Australia
| | - Johanne Dam Lyhne
- Department of Clinical Oncology, University Hospital of Southern Denmark, Vejle, Denmark
| | - Emma Kemp
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Michael David
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Adeola Bamgboje-Ayodele
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, New South Wales, Australia
- Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Oprea N, Ardito V, Ciani O. Implementing shared decision-making interventions in breast cancer clinical practice: a scoping review. BMC Med Inform Decis Mak 2023; 23:164. [PMID: 37612645 PMCID: PMC10463920 DOI: 10.1186/s12911-023-02263-8] [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: 02/08/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) is a collaborative process whereby patients and clinicians jointly deliberate on the best treatment option that takes into account patients' preferences and values. In breast cancer care, different treatment options have become available to patients in the last decade. Various interventions, including patient decision aids (PtDAs), have been designed to promote SDM in this disease area. This study aimed at investigating the factors that influence the successful adoption and implementation of SDM interventions in real-world healthcare delivery settings. METHODS A scoping review of scientific and grey literature was conducted for the period 2006-2021 to analyse the support for SDM interventions and their adoption in breast cancer clinical practice. The interpretation of findings was based on the Practical, Robust Implementation and Sustainability Model (PRISM) for integrating research findings into practice. RESULTS Overall, 19 studies were included for data synthesis, with more than 70% published since 2017. The availability of SDM tools does not automatically translate into their actual use in clinical settings. Factors related to users' co-creation, the clinical team's attitude and knowledge, organisational support and regulatory provisions facilitate the adoption of SDM interventions. However, overlooking aspects such as the re-organisation of care pathways, patient characteristics, and assigning of resources (human, financial, and facilities) can hinder implementation efforts. CONCLUSIONS Compared to the mounting evidence on the efficacy of SDM interventions, knowledge to support their sustained implementation in daily care is still limited, albeit results show an increasing interest in strategies that facilitate their uptake in breast cancer care over time. These findings highlight different strategies that can be used to embed SDM interventions in clinical practice. Future work should investigate which approaches are more effective in light of organisational conditions and external factors, including an evaluation of costs and healthcare system settings.
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Affiliation(s)
- Natalia Oprea
- Centre for Research on Health and Social Care Management (CeRGAS), SDA Bocconi School of Management, Milan, 20136, Italy.
| | - Vittoria Ardito
- Centre for Research on Health and Social Care Management (CeRGAS), SDA Bocconi School of Management, Milan, 20136, Italy
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management (CeRGAS), SDA Bocconi School of Management, Milan, 20136, Italy
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Li S, Zeng W, Ni X, Liu Q, Li W, Stackpole ML, Zhou Y, Gower A, Krysan K, Ahuja P, Lu DS, Raman SS, Hsu W, Aberle DR, Magyar CE, French SW, Han SHB, Garon EB, Agopian VG, Wong WH, Dubinett SM, Zhou XJ. Comprehensive tissue deconvolution of cell-free DNA by deep learning for disease diagnosis and monitoring. Proc Natl Acad Sci U S A 2023; 120:e2305236120. [PMID: 37399400 PMCID: PMC10334733 DOI: 10.1073/pnas.2305236120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/16/2023] [Indexed: 07/05/2023] Open
Abstract
Plasma cell-free DNA (cfDNA) is a noninvasive biomarker for cell death of all organs. Deciphering the tissue origin of cfDNA can reveal abnormal cell death because of diseases, which has great clinical potential in disease detection and monitoring. Despite the great promise, the sensitive and accurate quantification of tissue-derived cfDNA remains challenging to existing methods due to the limited characterization of tissue methylation and the reliance on unsupervised methods. To fully exploit the clinical potential of tissue-derived cfDNA, here we present one of the largest comprehensive and high-resolution methylation atlas based on 521 noncancer tissue samples spanning 29 major types of human tissues. We systematically identified fragment-level tissue-specific methylation patterns and extensively validated them in orthogonal datasets. Based on the rich tissue methylation atlas, we develop the first supervised tissue deconvolution approach, a deep-learning-powered model, cfSort, for sensitive and accurate tissue deconvolution in cfDNA. On the benchmarking data, cfSort showed superior sensitivity and accuracy compared to the existing methods. We further demonstrated the clinical utilities of cfSort with two potential applications: aiding disease diagnosis and monitoring treatment side effects. The tissue-derived cfDNA fraction estimated from cfSort reflected the clinical outcomes of the patients. In summary, the tissue methylation atlas and cfSort enhanced the performance of tissue deconvolution in cfDNA, thus facilitating cfDNA-based disease detection and longitudinal treatment monitoring.
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Affiliation(s)
- Shuo Li
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA90095
| | - Weihua Zeng
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA90095
| | - Xiaohui Ni
- EarlyDiagnostics Inc., Los Angeles, CA90095
| | - Qiao Liu
- Department of Statistics, Stanford University, Stanford, CA94305
| | - Wenyuan Li
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA90095
- Institute for Quantitative & Computational Biosciences, University of California at Los Angeles, Los Angeles, CA90095
| | - Mary L. Stackpole
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA90095
- EarlyDiagnostics Inc., Los Angeles, CA90095
| | - Yonggang Zhou
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA90095
| | - Arjan Gower
- Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA90095
| | - Kostyantyn Krysan
- Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA90095
- Veterans Administration (VA) Greater Los Angeles Health Care System, Los Angeles, CA90073
| | - Preeti Ahuja
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA90095
| | - David S. Lu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA90095
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA90095
| | - Steven S. Raman
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA90095
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA90095
- Department of Surgery, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA90095
| | - William Hsu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA90095
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA90095
| | - Denise R. Aberle
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA90095
- Department of Bioengineering, University of California, Los Angeles, CA90095
| | - Clara E. Magyar
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA90095
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA90095
| | - Samuel W. French
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA90095
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA90095
| | - Steven-Huy B. Han
- Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA90095
| | - Edward B. Garon
- Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA90095
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA90095
| | - Vatche G. Agopian
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA90095
- Department of Surgery, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA90095
| | - Wing Hung Wong
- Department of Statistics, Stanford University, Stanford, CA94305
- Department of Biomedical Data Science, Stanford University, Stanford, CA94305
| | - Steven M. Dubinett
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA90095
- Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA90095
- Veterans Administration (VA) Greater Los Angeles Health Care System, Los Angeles, CA90073
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA90095
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA90095
| | - Xianghong Jasmine Zhou
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA90095
- Institute for Quantitative & Computational Biosciences, University of California at Los Angeles, Los Angeles, CA90095
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA90095
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Crico C, Sanchini V, Casali PG, Pravettoni G. Ethical issues in oncology practice: a qualitative study of stakeholders' experiences and expectations. BMC Med Ethics 2022; 23:67. [PMID: 35773683 PMCID: PMC9248199 DOI: 10.1186/s12910-022-00803-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Clinical Ethics Support Services (CESS) have been established to support healthcare professionals in addressing ethically sensitive issues in clinical practice and, in many countries, they are under development. In the context of growing CESS, exploring how healthcare professionals experience and address clinical ethics issues in their daily practice represents a fundamental step to understand their potential needs. This is even more relevant in the context of extremely sensitive diseases, such as cancer. On this basis, we carried out a qualitative study conducting in-depth semi-structured interviews with stakeholders of a major comprehensive cancer centre in Italy, with the twofold aim of investigating what ethical issues arise in the context of clinical oncology and how they are addressed, as well as stakeholders’ expectations about a potential CESS to be implemented within the Institution. Methods The study was conducted within the theoretical framework of Grounded Theory. Participants were healthcare professionals and other key stakeholders working within the cancer centre. The semi-structured interview aimed at exploring common ethical aspects of oncology, investigating stakeholders’ professional experience in dealing with clinical ethics issues, their expectations and requests regarding ethics support services. Transcripts of the interviews were coded and analysed according to the principles of Grounded Theory. Results Twenty-one stakeholders were interviewed. Our analysis showed a wide consensus on the identification of ethically relevant issues, above all those concerning communication, end-of-life, and resource allocation. The absence of institutional tools or strategies to address and manage ethical issues at the patient bedside emerged, and this is reflected in the widespread request for their development in the future. The ideal support service should be fast and flexible in order to adapt to different needs and clinical cases. Conclusions The interviewees showed a limited degree of ‘ethical awareness’: despite having reported many issues in clinical practice, they could hardly identify and describe the ethical aspects, while complaining about a lack of ethical resources in their management. To build a truly effective support service, it therefore seems appropriate to take such context into consideration and address the emerged needs. Ethical sensitivity seems to be key and it becomes even more relevant in critical clinical areas, such as the therapeutic pathways of terminally ill patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00803-x.
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Affiliation(s)
- Chiara Crico
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.,Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Virginia Sanchini
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. .,Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium.
| | - Paolo G Casali
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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9
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"Who can I ring? Where can I go?" Living with advanced cancer whilst navigating the health system: a qualitative study. Support Care Cancer 2022; 30:6817-6826. [PMID: 35536328 PMCID: PMC9213291 DOI: 10.1007/s00520-022-07107-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/29/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND People with advanced cancer often experience greater physical and psychosocial morbidity compared to those with early disease. Limited research has focused on their experiences within the Australian health system. The aim of this study was to explore the lived experiences of adults receiving care for advanced cancer. METHODS A qualitative design with a descriptive phenomenological approach was used to explore the lived experiences of people with advanced cancer following their diagnosis. Twenty-three people living with an advanced solid malignancy receiving care were referred by their oncologists to take part in an interview conducted at their home, the hospital, or over the phone. RESULTS Three key themes emerged relating to participants' experiences of living with advanced cancer: (1) living with a life-limiting diagnosis and uncertainty, (2) living with symptom burden and side effects, and (3) living within the health system, with two subthemes, the patient-clinician relationship, and care coordination. Participant relationships with their health professionals were particularly important and had a defining impact on whether patient experiences living with cancer were positive or negative. CONCLUSION People with advanced cancer experienced broad variation in their experiences navigating the health system, and their relationships with clinicians and other health professionals were important factors affecting their perceptions of their experiences. Attention to the coordination of care for people with advanced cancer is necessary to improve their experiences and improve symptom control and the management of their psychosocial burden.
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10
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Sapio L, Naviglio S. Innovation through Tradition: The Current Challenges in Cancer Treatment. Int J Mol Sci 2022; 23:ijms23105296. [PMID: 35628105 PMCID: PMC9141447 DOI: 10.3390/ijms23105296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 12/01/2022] Open
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11
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Abbas Q, Kanwal U, Saeed W, Khan MU, Shahzadi M, Faran M. Relationship of Muslim Religiosity and Death Anxiety with the Mediating Effect of Optimism and Depression Among Cancer Patients in Pakistan. JOURNAL OF RELIGION AND HEALTH 2022; 61:1418-1436. [PMID: 34514549 DOI: 10.1007/s10943-021-01415-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 06/13/2023]
Abstract
Optimism and the practice of any religion are known to reduce depression and anxiety in cancer patients. In the present study, the specific role of Muslim religiosity, optimism, depression, and death anxiety in cancer patients has been explored. The sample of this study consisted of 200 cancer patients from different hospitals of the districts Faisalabad and Lahore (Pakistan). The sample's average age was 26.6 years. Parallel mediation findings show that optimism and depression are significant mediators between Muslim religiosity and death anxiety among cancer patients. Muslim religiosity is positively associated with optimism, and it helps to decrease the level of death anxiety, while depression is negatively associated with Muslim religiosity, and high depression increases the death anxiety level of cancer patients. In conclusion, Muslim religiosity and optimism play significant roles in managing depressive symptoms and death anxiety among cancer patients.
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Affiliation(s)
- Qasir Abbas
- Department of Applied Psychology, Government College University, Faisalabad, Faisalabad, Pakistan.
| | - Uzma Kanwal
- Department of Applied Psychology, Government College University, Faisalabad, Faisalabad, Pakistan
| | - Wizra Saeed
- Department of Professional Psychology, Bahria University Islamabad, Islamabad, Pakistan
| | - Muhammad Umar Khan
- Department of Applied Psychology, Government College University, Faisalabad, Faisalabad, Pakistan
| | - Mafia Shahzadi
- Department of Applied Psychology, Government College University, Faisalabad, Faisalabad, Pakistan
| | - Muhammad Faran
- Institute of Applied Psychology, University of the Punjab, Lahore, Pakistan
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12
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Besle S, Sarradon-Eck A. Chronicity and the patient's decision-making work. The case of an advanced cancer patient. Anthropol Med 2022; 29:76-91. [PMID: 35306943 DOI: 10.1080/13648470.2022.2041546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This paper focuses on the particular situation of an advanced cancer patient whose condition has taken a chronic turn. We argue that chronicity of this kind sometimes falls at the frontier of Evidence Based Medicine because the uncertainty about the patient's condition can lead physicians to resort to clinical trials or non-licensed drugs to prevent the disease from progressing. This situation leaves plenty of scope for individual adjustments between patients and their doctors. Advanced cancer is regarded here not just as a biological event but as a chronic illness and a 'negotiated reality'. We argue that the chronicity of advanced cancer patients' situation broadens the patients' scope for 'work', and we have called this specific type of patient's work 'decision-making work'. This paper is based on a case study focusing on Patrick, a middle-aged Frenchman with metastatic lung cancer who underwent oncological treatment for seven years and was strongly determined to find new therapeutic options even if this meant having to go abroad. He actively orchestrated his therapeutic itinerary by reorganising his relationships with the medical world and coordinating the physicians' work. His particular social position enabled Patrick to bypass some of the current medical rules and to reorganise the usual pattern of distribution of medical responsibilities. The chronicity of his condition placed him at the very frontier of the health care system.
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Affiliation(s)
- Sylvain Besle
- Universite Claude Bernard Lyon, Villeurbanne, France.,Human and Social Sciences Department, Centre Léon Bérard, Lyon, France
| | - Aline Sarradon-Eck
- SESSTIM UMR 1252, CANBIOS, Marseille, France.,Paoli-Calmettes Institute, Marseille, France
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13
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Arnaboldi P. The caregiving cancer patient: a new expanding category among the cancer population? J Psychosoc Oncol 2022; 41:133-136. [PMID: 35193471 DOI: 10.1080/07347332.2022.2039833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Paola Arnaboldi
- Psychiatry and Psychology Medical Service (SPPM), Savosa, Switzerland.,Ticino Cancer League, Bellinzona, Switzerland
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14
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Umaefulam V, Kleissen T, Barnabe C. The representation of Indigenous peoples in chronic disease clinical trials in Australia, Canada, New Zealand, and the United States. Clin Trials 2022; 19:22-32. [PMID: 34991361 PMCID: PMC8847750 DOI: 10.1177/17407745211069153] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Indigenous peoples are overrepresented with chronic health conditions and experience suboptimal outcomes compared with non-Indigenous peoples. Genetic variations influence therapeutic responses, thus there are potential risks and harm when extrapolating evidence from the general population to Indigenous peoples. Indigenous population-specific clinical studies, and inclusion of Indigenous peoples in general population clinical trials, are perceived to be rare. Our study (1) identified and characterized Indigenous population-specific chronic disease trials and (2) identified the representation of Indigenous peoples in general population chronic disease trials conducted in Australia, Canada, New Zealand, and the United States. METHODS For Objective 1, publicly available clinical trial registries were searched from May 2010 to May 2020 using Indigenous population-specific terms and included for data extraction if in pre-specified chronic disease. For identified trials, we extracted Indigenous population group identity and characteristics, type of intervention, and funding type. For Objective 2, a random selection of 10% of registered clinical trials was performed and the proportion of Indigenous population participants enrolled extracted. RESULTS In total, 170 Indigenous population-specific chronic disease trials were identified. The clinical trials were predominantly behavioral interventions (n = 95). Among general population studies, 830 studies were randomly selected. When race was reported in studies (n = 526), Indigenous individuals were enrolled in 172 studies and constituted 5.6% of the total population enrolled in those studies. CONCLUSION Clinical trials addressing chronic disease conditions in Indigenous populations are limited. It is crucial to ensure adequate representation of Indigenous peoples in clinical trials to ensure trial data are applicable to their clinical care.
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Affiliation(s)
- Valerie Umaefulam
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tessa Kleissen
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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15
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Mirzaei R, Sabokroo N, Ahmadyousefi Y, Motamedi H, Karampoor S. Immunometabolism in biofilm infection: lessons from cancer. Mol Med 2022; 28:10. [PMID: 35093033 PMCID: PMC8800364 DOI: 10.1186/s10020-022-00435-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Biofilm is a community of bacteria embedded in an extracellular matrix, which can colonize different human cells and tissues and subvert the host immune reactions by preventing immune detection and polarizing the immune reactions towards an anti-inflammatory state, promoting the persistence of biofilm-embedded bacteria in the host. MAIN BODY OF THE MANUSCRIPT It is now well established that the function of immune cells is ultimately mediated by cellular metabolism. The immune cells are stimulated to regulate their immune functions upon sensing danger signals. Recent studies have determined that immune cells often display distinct metabolic alterations that impair their immune responses when triggered. Such metabolic reprogramming and its physiological implications are well established in cancer situations. In bacterial infections, immuno-metabolic evaluations have primarily focused on macrophages and neutrophils in the planktonic growth mode. CONCLUSION Based on differences in inflammatory reactions of macrophages and neutrophils in planktonic- versus biofilm-associated bacterial infections, studies must also consider the metabolic functions of immune cells against biofilm infections. The profound characterization of the metabolic and immune cell reactions could offer exciting novel targets for antibiofilm therapy.
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Affiliation(s)
- Rasoul Mirzaei
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
- Venom and Biotherapeutics Molecules Lab, Medical Biotechnology Department, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran.
| | - Niloofar Sabokroo
- Department of Microbiology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Yaghoub Ahmadyousefi
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Hamadan University of Medical Sciences, Hamadan, Iran
- Research Center for Molecular Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hamid Motamedi
- Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sajad Karampoor
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran.
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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16
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García-Caballero M, Torres-Vargas JA, Marrero AD, Martínez-Poveda B, Medina MÁ, Quesada AR. Angioprevention of Urologic Cancers by Plant-Derived Foods. Pharmaceutics 2022; 14:pharmaceutics14020256. [PMID: 35213989 PMCID: PMC8875200 DOI: 10.3390/pharmaceutics14020256] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 02/05/2023] Open
Abstract
The number of cancer cases worldwide keeps growing unstoppably, despite the undeniable advances achieved by basic research and clinical practice. Urologic tumors, including some as prevalent as prostate, bladder or kidney tumors, are no exceptions to this rule. Moreover, the fact that many of these tumors are detected in early stages lengthens the duration of their treatment, with a significant increase in health care costs. In this scenario, prevention offers the most cost-effective long-term strategy for the global control of these diseases. Although specialized diets are not the only way to decrease the chances to develop cancer, epidemiological evidence support the role of certain plant-derived foods in the prevention of urologic cancer. In many cases, these plants are rich in antiangiogenic phytochemicals, which could be responsible for their protective or angiopreventive properties. Angiogenesis inhibition may contribute to slow down the progression of the tumor at very different stages and, for this reason, angiopreventive strategies could be implemented at different levels of chemoprevention, depending on the targeted population. In this review, epidemiological evidence supporting the role of certain plant-derived foods in urologic cancer prevention are presented, with particular emphasis on their content in bioactive phytochemicals that could be used in the angioprevention of cancer.
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Affiliation(s)
- Melissa García-Caballero
- Department of Molecular Biology and Biochemistry, Faculty of Sciences, University of Malaga, Andalucía Tech, E-29071 Malaga, Spain; (M.G.-C.); (J.A.T.-V.); (A.D.M.); (B.M.-P.); (M.Á.M.)
- IBIMA (Biomedical Research Institute of Malaga), E-29071 Malaga, Spain
| | - José Antonio Torres-Vargas
- Department of Molecular Biology and Biochemistry, Faculty of Sciences, University of Malaga, Andalucía Tech, E-29071 Malaga, Spain; (M.G.-C.); (J.A.T.-V.); (A.D.M.); (B.M.-P.); (M.Á.M.)
- IBIMA (Biomedical Research Institute of Malaga), E-29071 Malaga, Spain
| | - Ana Dácil Marrero
- Department of Molecular Biology and Biochemistry, Faculty of Sciences, University of Malaga, Andalucía Tech, E-29071 Malaga, Spain; (M.G.-C.); (J.A.T.-V.); (A.D.M.); (B.M.-P.); (M.Á.M.)
- IBIMA (Biomedical Research Institute of Malaga), E-29071 Malaga, Spain
| | - Beatriz Martínez-Poveda
- Department of Molecular Biology and Biochemistry, Faculty of Sciences, University of Malaga, Andalucía Tech, E-29071 Malaga, Spain; (M.G.-C.); (J.A.T.-V.); (A.D.M.); (B.M.-P.); (M.Á.M.)
- IBIMA (Biomedical Research Institute of Malaga), E-29071 Malaga, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), E-28019 Madrid, Spain
| | - Miguel Ángel Medina
- Department of Molecular Biology and Biochemistry, Faculty of Sciences, University of Malaga, Andalucía Tech, E-29071 Malaga, Spain; (M.G.-C.); (J.A.T.-V.); (A.D.M.); (B.M.-P.); (M.Á.M.)
- IBIMA (Biomedical Research Institute of Malaga), E-29071 Malaga, Spain
- CIBER de Enfermedades Raras (CIBERER), E-29071 Malaga, Spain
| | - Ana R. Quesada
- Department of Molecular Biology and Biochemistry, Faculty of Sciences, University of Malaga, Andalucía Tech, E-29071 Malaga, Spain; (M.G.-C.); (J.A.T.-V.); (A.D.M.); (B.M.-P.); (M.Á.M.)
- IBIMA (Biomedical Research Institute of Malaga), E-29071 Malaga, Spain
- CIBER de Enfermedades Raras (CIBERER), E-29071 Malaga, Spain
- Correspondence:
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17
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Cincidda C, Pizzoli SFM, Pravettoni G. Remote Psychological Interventions for Fear of Cancer Recurrence: Scoping Review. JMIR Cancer 2022; 8:e29745. [PMID: 35014956 PMCID: PMC8790693 DOI: 10.2196/29745] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients with cancer and survivors may experience the fear of cancer recurrence (FCR), a preoccupation with the progression or recurrence of cancer. During the spread of COVID-19 in 2019, patients and survivors experienced increased levels of FCR. Hence, there is a greater need to identify effective evidence-based treatments to help people cope with FCR. Remotely delivered interventions might provide a valuable means to address FCR in patients with cancer. OBJECTIVE The aim of this study is to first discuss the available psychological interventions for FCR based on traditional cognitive behavioral therapies (CBTs) or contemporary CBTs, in particular, mindfulness and acceptance and commitment therapy, and then propose a possible approach based on the retrieved literature. METHODS We searched key electronic databases to identify studies that evaluated the effect of psychological interventions such as CBT on FCR among patients with cancer and survivors. RESULTS Current evidence suggests that face-to-face psychological interventions for FCR are feasible, acceptable, and efficacious for managing FCR. However, there are no specific data on the interventions that are most effective when delivered remotely. CONCLUSIONS CBT interventions can be efficacious in managing FCR, especially at posttreatment, regardless of whether it is delivered face to face, on the web, or using a blended approach. To date, no study has simultaneously compared the effectiveness of face-to-face, web-based, and blended interventions. On the basis of the retrieved evidence, we propose the hypothetical program of an intervention for FCR based on both traditional CBT and contemporary CBT, named Change Of Recurrence, which aims to improve the management of FCR in patients with cancer and survivors.
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Affiliation(s)
- Clizia Cincidda
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Silvia Francesca Maria Pizzoli
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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18
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Wantonoro W, Suryaningsih EK, Anita DC, Nguyen TV. Palliative Care: A Concept Analysis Review. SAGE Open Nurs 2022; 8:23779608221117379. [PMID: 35966230 PMCID: PMC9364202 DOI: 10.1177/23779608221117379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Palliative care is critically important for the world's aging population and can change illness trajectories and promote advances in health care technologies. As health care team members, nurses have the most contact with palliative care patients. However, misconceptions about which patients need to receive palliative care may be an obstacle to meeting patients' needs for palliative care. Objectives This study aimed to describe preceding events, characteristics and outcomes of patients in palliative care according to current concept analysis studies. Methods A literature review was conducted. Inclusion criteria were: (1) concept analysis studies, (2) use of the term palliative care or palliative nursing care, (3) palliative care explanation including antecedents, attributes, and consequences, and (4) articles written in English published between 2004 and 2021. Results Four concept analysis studies on palliative care were included in this review. Palliative care was described as an approach to alleviating physical and psychological suffering and improving patients' and families' quality of life in the early stages of diagnosed illness. Terminal illnesses, acute or chronic diseases, and actual or potentially life-threatening illnesses were confirmed as the events preceding palliative care. Characteristics of palliative care include holistic care, interdisciplinary teamwork, and compassionate, patient- and family-centered care. Improved patient and family quality of life, enhanced human dignity, improved self-care, and strengthened coping abilities are outcomes of palliative care. Conclusions/Implications for Practice Palliative care is a concept that is related to the early stage of an illness, the timing of illness diagnosis, and the onset of symptoms. Including palliative care terms in nursing education and training and developing palliative care models in clinical practice are recommended to ensure nurses understand the services of the palliative care needs of patients and their families. Future reviews, including grounded qualitative studies on the concept of palliative care, are recommended.
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Affiliation(s)
- Wantonoro Wantonoro
- Department of Nursing, Universitas ‘Aisyiyah Yogyakarta, Yogyakarta, Indonesia
| | | | - Diyah Chandra Anita
- Department of Nursing, Universitas ‘Aisyiyah Yogyakarta, Yogyakarta, Indonesia
| | - Tuan Van Nguyen
- Department of Nursing, Faculty of Nursing and Medical Technology, Can Tho University of Medicine and
Pharmacy, Can Tho City, Vietnam
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19
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Xu L, Sanders L, Li K, Chow JCL. Chatbot for Health Care and Oncology Applications Using Artificial Intelligence and Machine Learning: Systematic Review. JMIR Cancer 2021; 7:e27850. [PMID: 34847056 PMCID: PMC8669585 DOI: 10.2196/27850] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/02/2021] [Accepted: 09/18/2021] [Indexed: 01/01/2023] Open
Abstract
Background Chatbot is a timely topic applied in various fields, including medicine and health care, for human-like knowledge transfer and communication. Machine learning, a subset of artificial intelligence, has been proven particularly applicable in health care, with the ability for complex dialog management and conversational flexibility. Objective This review article aims to report on the recent advances and current trends in chatbot technology in medicine. A brief historical overview, along with the developmental progress and design characteristics, is first introduced. The focus will be on cancer therapy, with in-depth discussions and examples of diagnosis, treatment, monitoring, patient support, workflow efficiency, and health promotion. In addition, this paper will explore the limitations and areas of concern, highlighting ethical, moral, security, technical, and regulatory standards and evaluation issues to explain the hesitancy in implementation. Methods A search of the literature published in the past 20 years was conducted using the IEEE Xplore, PubMed, Web of Science, Scopus, and OVID databases. The screening of chatbots was guided by the open-access Botlist directory for health care components and further divided according to the following criteria: diagnosis, treatment, monitoring, support, workflow, and health promotion. Results Even after addressing these issues and establishing the safety or efficacy of chatbots, human elements in health care will not be replaceable. Therefore, chatbots have the potential to be integrated into clinical practice by working alongside health practitioners to reduce costs, refine workflow efficiencies, and improve patient outcomes. Other applications in pandemic support, global health, and education are yet to be fully explored. Conclusions Further research and interdisciplinary collaboration could advance this technology to dramatically improve the quality of care for patients, rebalance the workload for clinicians, and revolutionize the practice of medicine.
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Affiliation(s)
- Lu Xu
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Leslie Sanders
- Department of Humanities, York University, Toronto, ON, Canada
| | - Kay Li
- Department of English, York University, Toronto, ON, Canada
| | - James C L Chow
- Department of Medical Physics, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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20
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Tremblay D, Touati N, Bilodeau K, Prady C, Usher S, Leblanc Y. Risk-Stratified Pathways for Cancer Survivorship Care: Insights from a Deliberative Multi-Stakeholder Consultation. Curr Oncol 2021; 28:3408-3419. [PMID: 34590587 PMCID: PMC8482148 DOI: 10.3390/curroncol28050295] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/23/2022] Open
Abstract
Risk-stratified pathways of survivorship care seek to optimize coordination between cancer specialists and primary care physicians based on the whole person needs of the individual. While the principle is supported by leading cancer institutions, translating knowledge to practice confronts a lack of clarity about the meaning of risk stratification, uncertainties around the expectations the model holds for different actors, and health system structures that impede communication and coordination across the care continuum. These barriers must be better understood and addressed to pave the way for future implementation. Recognizing that an innovation is more likely to be adopted when user experience is incorporated into the planning process, a deliberative consultation was held as a preliminary step to developing a pilot project of risk-stratified pathways for patients transitioning from specialized oncology teams to primary care providers. This article presents findings from the deliberative consultation that sought to understand the perspectives of cancer specialists, primary care physicians, oncology nurses, allied professionals, cancer survivors and researchers regarding the following questions: what does a risk stratified model of cancer survivorship care mean to care providers and users? What are the prerequisites for translating risk stratification into practice? What challenges are involved in establishing these prerequisites? The multi-stakeholder consultation provides empirical data to guide actions that support the development of risk-stratified pathways to coordinate survivorship care.
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Affiliation(s)
- Dominique Tremblay
- Faculté de Médecine et des Sciences de la Santé, Campus de Longueuil-Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (C.P.); (S.U.)
- Centre de Recherche Hôpital Charles-Le Moyne, Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre, Longueuil, QC J4K 0A8, Canada;
- Correspondence: ; Tel.: +1-450-466-5000 (ext. 2885)
| | - Nassera Touati
- École Nationale d’Administration Publique, 4750 Henri-Julien Avenue, Montréal, QC H2T 3E5, Canada;
| | - Karine Bilodeau
- Faculté des Sciences Infirmières et Centre D’Innovation en Formation Infirmière, Université de Montréal, Montréal, QC H3T 1A8, Canada;
| | - Catherine Prady
- Faculté de Médecine et des Sciences de la Santé, Campus de Longueuil-Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (C.P.); (S.U.)
- Centre de Recherche Hôpital Charles-Le Moyne, Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre, Longueuil, QC J4K 0A8, Canada;
- Centre Intégré de Cancérologie de la Montérégie, 3120 Boulevard Taschereau, Greenfield Park, QC J4V 2H1, Canada
| | - Susan Usher
- Faculté de Médecine et des Sciences de la Santé, Campus de Longueuil-Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (C.P.); (S.U.)
- École Nationale d’Administration Publique, 4750 Henri-Julien Avenue, Montréal, QC H2T 3E5, Canada;
| | - Yves Leblanc
- Centre de Recherche Hôpital Charles-Le Moyne, Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre, Longueuil, QC J4K 0A8, Canada;
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21
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Assessing unmet needs in advanced cancer patients: a systematic review of the development, content, and quality of available instruments. J Cancer Surviv 2021; 16:960-975. [PMID: 34363187 PMCID: PMC9489568 DOI: 10.1007/s11764-021-01088-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/13/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Advances in treatment, including biological and precision therapies, mean that more people are living with advanced cancer. Supportive care needs likely change across the cancer journey. We systematically identified instruments available to assess unmet needs of advanced cancer patients and evaluated their development, content, and quality. METHODS Systematic searches of MEDLINE, CINAHL, Embase, PubMed, and PsycINFO were performed from inception to 11 January 2021. Independent reviewers screened for eligibility. Data was abstracted on instrument characteristics, development, and content. Quality appraisal included methodological and quality assessment, GRADE, feasibility, and interpretability, following consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines. RESULTS Thirty studies reporting 24 instruments were identified. These were developed for general palliative patients (n = 2 instruments), advanced cancer (n = 8), and cancer irrespective of stage (n = 14). None focused on patients using biological or precision therapies. The most common item generation and reduction techniques were amending an existing instrument (n = 11 instruments) and factor analysis (n = 8), respectively. All instruments mapped to ≥ 5 of 11 unmet need dimensions, with Problems and Needs in Palliative Care (PNPC) and Psychosocial Needs Inventory (PNI) covering all 11. No instrument reported all of the COSMIN measurement properties, and methodological quality was variable. CONCLUSIONS Many instruments are available to assess unmet needs in advanced cancer. There is extensive heterogeneity in their development, content, and quality. IMPLICATIONS FOR CANCER SURVIVORS Given the growth of precision and biological therapies, research needs to explore how these instruments perform in capturing the needs of people using such therapies.
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22
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Kaur B, Goyal B, Daniel E. A survey on Machine learning based Medical Assistive systems in Current Oncological Sciences. Curr Med Imaging 2021; 18:445-459. [PMID: 33596810 DOI: 10.2174/1573405617666210217154446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/04/2020] [Accepted: 01/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cancer is one of the life threatening disease which is affecting a large number of population worldwide. The cancer cells multiply inside the body without showing much symptoms on the surface of the skin thereby making it difficult to predict and detect at the onset of disease. Many organizations are working towards automating the process of cancer detection with minimal false detection rates. INTRODUCTION The machine learning algorithms serve to be a promising alternative to support health care practitioners to rule out the disease and predict the growth with various imaging and statistical analysis tools. The medical practitioners are utilizing the output of these algorithms to diagnose and design the course of treatment. These algorithms are capable of finding out the risk level of the patient and can reduce the mortality rate concerning to cancer disease. METHOD This article presents the existing state of art techniques for identifying cancer affecting human organs based on machine learning models. The supported set of imaging operations are also elaborated for each type of Cancer. CONCLUSION The CAD tools are the aid for the diagnostic radiologists for preliminary investigations and detecting the nature of tumor cells.
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Affiliation(s)
| | | | - Ebenezer Daniel
- City of Hope, National Medical Centre, California. United States
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23
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Marton G, Bailo L, Pravettoni G. Exploring the possible application of implementation intention on prospective memory of cancer patients. COGENT PSYCHOLOGY 2021. [DOI: 10.1080/23311908.2021.1880303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Giulia Marton
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Luca Bailo
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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24
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Marton G, Monzani D, Vergani L, Pizzoli SFM, Pravettoni G. “Optimism Is a Strategy for Making a Better Future”. EUROPEAN PSYCHOLOGIST 2020. [DOI: 10.1027/1016-9040/a000422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Cancer is a deadly disease that can lead to psychological suffering and decreased quality of life (QoL). Personality has been proven to have an effect on QoL and, in particular, Dispositional Optimism (DO) has been studied in relation to overcoming health crisis. The aim of this systematic review is to deepen the state of art of the relationship between QoL and DO in cancer patients. PubMed and Embase databases were systematically searched. Fifteen studies were included with a total of 5,249 cancer patients. All of the studies consider the relationship between DO and QoL, some studies analyze the correlation between the two variables and found a positive association. The majority of the studies investigate the predictive power of DO over QoL and most of them found DO to be predictive of a higher QoL. Results confirmed the association between DO and QoL in a sample of cancer patients. These results could influence the clinical practice as DO has been proven to have a beneficial effect on mental and physical health.
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Affiliation(s)
- Giulia Marton
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Dario Monzani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Laura Vergani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Silvia Francesca Maria Pizzoli
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Italy
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25
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De Clercq E, Rost M, von der Weid N, Ansari M, Elger BS. To be or not to be in the social media arena? The perspective of healthcare providers working within adolescent and young adult oncology in Switzerland. Int J Adolesc Med Health 2020; 34:417-429. [PMID: 32860667 DOI: 10.1515/ijamh-2020-0137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/28/2020] [Indexed: 12/23/2022]
Abstract
Background Given that social media is quickly penetrating clinical practice, it is essential to explore how these technologies can be used to improve patient-centered care. This is particularly important for healthcare professionals caring for adolescents and young adults (AYA), amid whom the use of social media is nearly universal and whose medical and psychosocial needs are often underestimated by the pediatric or adult oncology settings in which they are treated. Objectives To examine the perspectives of various medical professionals on the emerging role of social media in AYA oncology. Methods Three focus groups were performed with Swiss healthcare professionals involved in the care of AYA patients with cancer. The focus groups were analyzed using thematic coding. Results Healthcare professionals caring for AYA cancer patients in Switzerland are reluctant to step into the social media sphere because they find it difficult to navigate professional boundaries in an unfamiliar space where different contexts collapse. Nurses and younger healthcare professionals who tend to have a more intimate relationship with AYA, often lack virtual mentorship to know how to maintain online professionalism. Adolescents and young adults cancer-related social media presence was unknown to our participants which resulted in missed occasions to inform, educate and care for this often underserved population of cancer patients. Conclusions More practical guidance is needed to help healthcare professionals with how to integrate social media into clinical practice. Setting up fruitful collaborations between medical institutions and existing AYA support groups online might be the best way forward.
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Affiliation(s)
- Eva De Clercq
- University of Basel, Institute for Biomedical Ethics, Basel, Switzerland
| | - Michael Rost
- University of Basel, Institute for Biomedical Ethics, Basel, Switzerland
| | | | - Marc Ansari
- Hôpitaux Universitaires de Genève, Département de l'Enfant et de l'Adolescent, Onco-hématologie pédiatrique, Genève, Switzerland
| | - Bernice S Elger
- University of Basel, Institute for Biomedical Ethics, Basel, Switzerland
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Hewison A, Atkin K, McCaughan D, Roman E, Smith A, Smith G, Howell D. Experiences of living with chronic myeloid leukaemia and adhering to tyrosine kinase inhibitors: A thematic synthesis of qualitative studies. Eur J Oncol Nurs 2020; 45:101730. [PMID: 32169687 PMCID: PMC7167512 DOI: 10.1016/j.ejon.2020.101730] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the experiences of adults living with chronic myeloid leukaemia and treated with tyrosine kinase inhibitors, with particular reference to factors influencing adherence. METHODS A thematic synthesis of all published qualitative studies examining adults with chronic myeloid leukaemia, receiving tyrosine kinase inhibitors. Eligible publications were identified by searching five electronic databases using defined criteria. The synthesis involved complete coding of extracted data and inductive theme development. RESULTS Nine studies were included and three overarching themes defined. Overarching themes were: 1) Disease impacts whole life; 2) Disease management strategies; and 3) Valued aspects of care. Side-effects often required physical and psychological adaptation. Patients developed individual decision-making processes to promote adherence and manage side effects. Unintentional non-adherence occurred due to forgetfulness and system failures. Intentional omission also occurred, which together with side effects, was unlikely to be reported to healthcare professionals (HCPs). HCP reassurance about missed doses could reinforce non-adherence. Information needs varied over time and between individuals. Knowledge among patients about treatment was often lacking and could lead to misunderstandings. Patients valued psychological support from HCPs and suggested an individualised approach, facilitating discussion of symptoms, adherence and their perspectives about living with chronic myeloid leukaemia, would improve care. CONCLUSIONS Patients with chronic myeloid leukaemia experienced significant side-effects from treatment and changes to their psychological and physical well-being. They developed their own strategies to manage their disease and treatment. This should be recognised in interventions to improve education, support and the delivery of care that is compassionate and adequately resourced.
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Affiliation(s)
- Ann Hewison
- Corresponding author. ECSG, Health Sciences, Seebohm Rowntree Building, University of York, York, YO10 5DD, UK.
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Abstract
Background: Cancer survivors who have completed active treatments experience challenges in the survivorship phase of cancer care. Survivors transitioning through an illness experience negotiate former roles and relationships and reevaluate their self-identity. Reintegration of post-treatment cancer survivors has not been analyzed; however, nurses with a clear understanding of reintegration influence holistic care. Purpose: The goal of this artricle is to provide a theoretical definition of the concept of reintegration for cancer survivors post-treatment. The definition is derived and supported from a multidisciplinary literature review. Method: The discussion was organized using the Walker and Avant approach to concept analysis. Findings: This concept analysis defined reintegration as a dynamic process involving the reorganization of former performance roles concurrent with the reevaluation of personal abilities. Survivors are involved in creating a new normal and post-treatment cancer survivor identity. Reintegration is characterized by transitional phases that may be cyclical and evolve with time. Finally, desired outcomes are based on perceived subjective and objective criteria of importance and are strengthened through multidimensional supportive networks. Conclusion: Incorporating the physical, social, emotional, spiritual, and community/environmental aspects of the cancer survivorship experience enhances reintegration.
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