A mixed-method systematic review of unmet care and support needs among Japanese cancer survivors

PURPOSE

To synthesize published studies regarding Japanese cancer survivors' needs/unmet needs of care/support, change of unmet needs over time, and preferred care/support providers.

METHODS

A mixed-method systematic review was conducted. MEDLINE, PsycINFO, CINAHL, and Ichu-shi were searched from inception to May 2022. Quantitative and qualitative studies were separately analyzed using narrative synthesis and meta-ethnography. Each finding was synthesized using a line of argument.

RESULTS

Twenty-four studies (13 quantitative and 11 qualitative studies) were included. Six quantitative studies reported unmet needs in survivors of adolescent and young adult (n=1) and adulthood (n=5) cancer. No longitudinal studies regarding changes in unmet needs were identified. One study reported that adults preferred care/support providers. The quantitative studies identified more help in physical (48.2-51.0%, n=2) and psychological issues (17.4-78.8%, n=5), information (27.9-58.0%, n=3), and healthcare services (25.3-67.1%, n=2) among adults. The qualitative studies emphasized more tailor-made information about life events for young cancer survivors. More empathic and trustworthy interactions with surrounding people, including healthcare professionals, were demanded, regardless of age. A line of argument illustrated that cancer survivors had insufficient resources for activities and empowerment to face life with cancer at all phases.

CONCLUSIONS

Japanese cancer survivors' unmet needs are diverse. More information and resources for psychological care/support and local healthcare services post-treatment are needed, which may hinder the optimal transition to survivorship.

IMPLICATIONS FOR CANCER SURVIVORS

The synthesized evidence should be utilized to implement a comprehensive care/support system in practice and educate people surrounding cancer survivors, regardless of age.

Does enhanced meaning after meaning-centered group psychotherapy mediate a reduction in depressive symptoms in cancer survivors? A mediation analysis in the context of a randomized controlled trial

PURPOSE

After meaning-centered group psychotherapy for cancer survivors (MCGP-CS), depressive symptoms tend to decrease. An enhanced sense of meaning may play a mediating role in this decrease. The aim of this study was to assess whether personal meaning mediates the relationship between MCGP-CS and depressive symptoms.

METHODS

Cancer survivors (n = 114) were randomly allocated to MCGP-CS or care as usual (CAU). The assessments were scheduled at baseline, postintervention, and at 3- and 6-month follow-up. Mediation models were estimated based on structural equation modeling. We computed the indirect effect of MCGP-CS on depressive symptoms at the 3-month follow-up through personal meaning, and other meaning-related mediators, measured postintervention.

RESULTS

A small but significant indirect effect of MCGP-CS on depressive symptoms at the 3-month follow-up was found through personal meaning postintervention (b = - 0.29, 95% bootstrap CI (- 0.63, - 0.03)). There were no significant indirect effects through the other meaning-related factors.

CONCLUSIONS

This study tentatively supports the MCGP-CS working model in that an enhanced sense of meaning as a result of MCGP-CS mediates a reduction in depressive symptoms. Personal meaning mediated a small effect of MCGP-CS on depressive symptoms. The longitudinal mediating effect of personal meaning occurred within a time period of 3 months after MCGP-CS.

RELEVANCE

MCGP-CS is a psychological intervention that supports cancer survivors in regaining or enhancing a sense of meaning in their lives. This enhanced sense of meaning is a protective factor against depressive symptoms.

TRIAL REGISTRATION

The RCT was registered in the Netherlands Trial Register (number NTR3571/NL3421) on August 10, 2012.

Validity and Reliability of a Simplified Chinese Version of Cancer Survivors' Unmet Needs Scale (CaSUN)

OBJECTIVE

To translate Cancer Survivors' Unmet Needs scale (CaSUN) into Simplified Chinese, and to assess the validity and reliability of this translated version among Chinese cancer survivors.

METHODS

Following the cross-cultural adaptation guidelines, the original CaSUN scale was translated from English into Simplified Chinese. To enhance the readability and comprehension of each item, a pilot study involving 40 cancer patients was carried out. Subsequently, 324 cancer survivors participating in follow-up appointments at a cancer hospital in Beijing, China completed the Simplified Chinese version of the CaSUN. The scale's validity was assessed through factor analysis. Indices including Satorra-Bentler scaled chi-square to degree of freedom ratio (χ2/df), comparative fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean squared residual (SRMR) were employed for construct validity. Average variance extracted (AVE) of each category reflected the convergent validity. Reliability was confirmed with both Cronbach's α and Guttman split-half coefficient.

RESULTS

Factor analysis suggested that a three-level hierarchical structure of the CaSUN with four first-order factors, nine second-order factors and all the 35 items assessing unmet need could fit our data well (χ2/df = 2.833, CFI = 0.902, RMSEA = 0.076, SRMR = 0.066), indicating sufficient construct validity for this model. For convergent validity, AVE of each second-order category were greater than 0.5. Regarding reliability, Cronbach's α of the 35 items was 0.968, and the Guttman split-half coefficient was 0.984. Both of these coefficients were higher than 0.8.

CONCLUSIONS

The present Simplified Chinese version of CaSUN had good cultural adaptability, appropriate validity and reliability for assessing unmet needs in different cancer survivor groups in Chinese mainland. This Simplified Chinese version of CaSUN can assist health professionals in addressing individual survivor needs and bridge the gap between patients' experiences and their expectations, thereby improving the quality of cancer survivorship care.

Use of implementation mapping to develop a multifaceted implementation strategy for an electronic prospective surveillance model for cancer rehabilitation

BACKGROUND

Electronic Prospective Surveillance Models (ePSMs) remotely monitor the rehabilitation needs of people with cancer via patient-reported outcomes at pre-defined time points during cancer care and deliver support, including links to self-management education and community programs, and recommendations for further clinical screening and rehabilitation referrals. Previous guidance on implementing ePSMs lacks sufficient detail on approaches to select implementation strategies for these systems. The purpose of this article is to describe how we developed an implementation plan for REACH, an ePSM system designed for breast, colorectal, lymphoma, and head and neck cancers.

METHODS

Implementation Mapping guided the process of developing the implementation plan. We integrated findings from a scoping review and qualitative study our team conducted to identify determinants to implementation, implementation actors and actions, and relevant outcomes. Determinants were categorized using the Consolidated Framework for Implementation Research (CFIR), and the implementation outcomes taxonomy guided the identification of outcomes. Next, determinants were mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy of strategies using the CFIR-ERIC Matching Tool. The list of strategies produced was refined through discussion amongst our team and feedback from knowledge users considering each strategy's feasibility and importance rating via the Go-Zone plot, feasibility and applicability to the clinical contexts, and use among other ePSMs reported in our scoping review.

RESULTS

Of the 39 CFIR constructs, 22 were identified as relevant determinants. Clinic managers, information technology teams, and healthcare providers with key roles in patient education were identified as important actors. The CFIR-ERIC Matching Tool resulted in 50 strategies with Level 1 endorsement and 13 strategies with Level 2 endorsement. The final list of strategies included 1) purposefully re-examine the implementation, 2) tailor strategies, 3) change record systems, 4) conduct educational meetings, 5) distribute educational materials, 6) intervene with patients to enhance uptake and adherence, 7) centralize technical assistance, and 8) use advisory boards and workgroups.

CONCLUSION

We present a generalizable method that incorporates steps from Implementation Mapping, engages various knowledge users, and leverages implementation science frameworks to facilitate the development of an implementation strategy. An evaluation of implementation success using the implementation outcomes framework is underway.

Supportive care 2030 movement: towards unifying ambitions for global excellence in supportive cancer care-an international Delphi study

Background

Supportive care to ensure optimal quality of life is an essential component of cancer care and symptom control across the lifespan. Ongoing advances in cancer treatment, increasing toxicity from many novel treatment regimes, and variations in access to care and cancer outcomes across the globe and resource settings present significant challenges for supportive care delivery. To date, no overarching framework has been developed to guide supportive care development worldwide. As an initial step of the Multinational Association of Supportive Care in Cancer (MASCC) Supportive Care 2030 Movement, we developed a targeted, unifying set of ambition statements to envision the future of supportive cancer care.

Methods

From September 2022 until June 2023, we used a modified Delphi methodology to develop and attain consensus about ambition statements related to supportive cancer care. Leaders of MASCC Study Groups were invited to participate in an Expert Panel for the first two Delphi rounds (and a preliminary round to suggest potential ambition statements). Patient Advocates then examined and provided input regarding the ambition statements.

Findings

Twenty-seven Expert Panelists and 11 Patient Advocates participated. Consensus was attained on 13 ambition statements, with two sub-statements. The ambition statements addressed global standards for guideline development and implementation, coordinated and individualized care, dedicated supportive oncology services, self-management, needs for screening and actions, patient education, behavioral support, financial impact minimization, comprehensive survivorship care, and timely palliative care, reflecting collaboration, coordination and team-based approach across all levels.

Interpretation

This study is the first to develop shared ambitions for the future of supportive cancer care on a global level. These ambition statements can facilitate a coordinated, resource-stratified, and person-centered approach and inform research, education, clinical services, and policy efforts.

Funding

This project received funding support from Prof Raymond Chan's NHMRC Investigator Grant (APP1194051).

Implementation of an electronic prospective surveillance model for cancer rehabilitation: a mixed methods study protocol

INTRODUCTION

An electronic prospective surveillance model (ePSM) uses patient-reported outcomes to monitor impairments along the cancer pathway for timely management. Randomised controlled trials show that ePSMs can effectively manage cancer-related impairments. However, ePSMs are not routinely embedded into practice and evidence-based approaches to implement them are limited. As such, we developed and implemented an ePSM, called REACH, across four Canadian centres. The objective of this study is to evaluate the impact and quality of the implementation of REACH and explore implementation barriers and facilitators.

METHODS AND ANALYSIS

We will conduct a 16-month formative evaluation, using a single-arm mixed methods design to routinely monitor key implementation outcomes, identify barriers and adapt the implementation plan as required. Adult (≥18 years) breast, colorectal, lymphoma or head and neck cancer survivors will be eligible to register for REACH. Enrolled patients complete brief assessments of impairments over the course of their treatment and up to 2 years post-treatment and are provided with a personalised library of self-management education, community programmes and when necessary, suggested referrals to rehabilitation services. A multifaceted implementation plan will be used to implement REACH within each clinical context. We will assess several implementation outcomes including reach, acceptability, feasibility, appropriateness, fidelity, cost and sustainability. Quantitative implementation data will be collected using system usage data and evaluation surveys completed by patient participants. Qualitative data will be collected through focus groups with patient participants and interviews with clinical leadership and management, and analysis will be guided by the Consolidated Framework for Implementation Research.

ETHICS AND DISSEMINATION

Site-specific ethics approvals were obtained. The results from this study will be presented at academic conferences and published in peer-reviewed journals. Additionally, knowledge translation materials will be co-designed with patient partners and will be disseminated to diverse knowledge users with support from our national and community partners.

Lifestyle and integrative oncology interventions for cancer-related fatigue and sleep disturbances

Fatigue, insomnia and sleep disturbances are common after cancer diagnosis, and have a negative impact on quality of life and function. This narrative review synthesised evidence on lifestyle and integrative oncology interventions for cancer-related fatigue, insomnia and sleep disturbances in cancer survivors. There is strong evidence in support of aerobic and strength exercise for the relief of cancer-related fatigue. Yoga, massage therapy, acupuncture, Tai Chi and qigong can also be recommended for cancer-related fatigue. The evidence on yoga, acupuncture and massage therapy for sleep disturbances in cancer is mixed, while exercise appears to have a modest favourable effect. There is insufficient evidence on nutrient supplements or dietary interventions for cancer-related fatigue or insomnia and other sleep disturbances after cancer. Beyond alleviating cancer-related fatigue and insomnia-related symptoms, integrative oncology and lifestyle interventions have potential to effect multiple other benefits, such as improvement in symptoms such as pain and menopausal symptoms. There is a need for well-designed randomised controlled trials of interventions, particularly in the areas of diet and nutrient supplements, and for implementation studies of interventions already supported by evidence.

Examining patient-reported late toxicity and its association with quality of life and unmet need for symptom management among nasopharyngeal cancer survivors: a cross-sectional survey

Introduction

Alongside the improved survival of nasopharyngeal cancer (NPC), late radiation toxicities are alarmingly hampering survivors' quality of life. A patient-reported symptom burden survey is lacking to address the unmet need for symptom management among local NPC survivors.

Methods

A single-center cross-sectional survey was conducted on 211 NPC survivors who had completed radiation therapy for three to 120 months. We employed the Chinese version M. D. Anderson Symptom Inventory - Head & Neck Module (MDASI-HN-C), Functional Assessment of Cancer Therapy - Head & Neck (FACT-HN-C), and a question extracted from the Cancer Survivors' Unmet Needs Measure (CaSUN).

Results

Two hundred valid responses were collected. Participants suffered from at least four moderate to severe symptoms (mean = 4.84, SD = 4.99). The top five severe symptoms were dry mouth, mucus problems, difficulty swallowing or chewing, teeth or gum problems, and memory problems. MDASI-HN-C subscales were negatively correlated with the physical, emotional, functional, and HN-specific domains of the FACT-HN-C. The unmet need for symptom management was positively associated with symptom burden, either general symptoms (Adjusted odds ratio [ORadj] = 1.566, 95% CI = 1.282 - 1.914, p < 0.001) or top-5 symptoms (ORadj = 1.379, 95% CI = 1.185 - 1.604, p < 0.001), while negatively associated with post-RT time (ORadj = 0.981, 95% CI [0.972, 0.991], p < 0.001).

Conclusion

Virtually all NPC survivors suffer from late toxicities, which interplay with survivors' perceptions intricately to affect their unmet needs for symptom management. Personalized supportive care strategies with regular assessments and stratifications are warranted.

Identifying the supportive care needs of people affected by non-muscle invasive bladder cancer: An integrative systematic review

PURPOSE

To understand supportive care needs among people with non-muscle invasive bladder cancer (NMIBC).

METHODS

An integrative systematic review was reported using the Preformed Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Seven electronic databases were searched for relevant studies, including all quantitative, qualitative, and mixed methods studies, irrespective of research design. The review process was managed by Covidence systematic review software. Two reviewer authors independently performed data extraction using eligibility criteria. Quality appraisal was conducted, and a narrative synthesis was performed.

RESULTS

A total of 1129 articles were screened, of which 21 studies met the inclusion criteria. The findings revealed that the frequency of supportive care needs reported by NMIBC participants included psychological/emotional (16/21:76%), physical (16/21:76%), practical (8/21:38%), interpersonal/intimacy (7/21:33%), family-related (7/21:33%), health system/information (5/21:23%), social (4/21:19%), patient-clinician communication (3/21:14%), spiritual (1/21:5%) and daily needs (1/21:5%).

CONCLUSION

People affected by NMIBC experience anxiety, depression, uncertainty, and fear of recurrence. The physical symptoms reported included urinary issues, pain, sleeping disorders and fatigue. These supportive care needs persist throughout the participants' treatment trajectory and can impact their quality of life.

IMPLICATIONS FOR CANCER SURVIVORS

Identifying supportive care needs within the NMIBC population will help inform future interventions to provide patient-centred care to promote optimal well-being and self-efficacy for people diagnosed with NMIBC.

Prospective cohort study of unmet supportive care needs, post-traumatic growth, coping strategy and social supports among patients with breast cancer: The PenBCNeeds study

PURPOSE

While the unmet healthcare needs are still being improved upon, the wellbeing of cancer patients has increasingly become a prime concern in Malaysia. The objective of this study is to ascertain the trend of unmet supportive care needs, post-traumatic growth (P T G), coping strategies, and social supports among patients with breast cancer over the three time points of treatment: T1 at early diagnosis, T2 for three months after diagnosis, and T3 for six months after diagnosis.

METHODS

A total of 240 cancer patients participated in this prospective cohort study, with follow-up visits from October 2019 until July 2021. Data were collected using several instruments: Brief COP E, the Source of Social Support Scale (SSSS), the Post-Traumatic Growth Inventory - Short Form (P T GI-SF), and a Malay version of the 34-Item Shortform Supportive Care Need Survey (SCNS-SF34).

RESULTS

The results indicated a significant change from T1 to T3 for all domains of the unmet needs (p-value < 0.001), except for the sexual domain. A lower SCNS-SF34 score resulted from more unfavorable social support. The P T GI-SF results indicated a trend toward meeting the unmet needs, and a higher SCNS-SF-34 score predicted a considerably higher P T GI-SF score.

CONCLUSIONS

Our study findings suggest that majority of the factors evaluated in terms of unmet needs among cancer patients have undergone considerable changes.

Validity and reliability of the persian version of the world health organization quality of life disabilities module

This study aimed to assess the validity and reliability of the world health organization quality of life questionnaire for people with intellectual disability (WHOQOL-DIS-ID). This was a cross-sectional study of 118 adults with intellectual disability. Internal consistency and temporal reliability were evaluated using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. Construct validity of the structure was assessed using confirmatory factor analysis. Multiple linear regression analysis was performed to determine the factors associated with the quality of life. Cronbach's alpha for all, but not for discrimination area, as well as ICC for all questions except for 23 and 6, were higher than 0.7. The variables such as periodic check-up, number of friends, entertainment outside the home, parental separation, physical activity, unmet needs score, caregiver's mental health status, and available facilities were the predictors of QOL. The Persian version of the WHOQOL-DIS-ID shows acceptable validity and reliability.

A pre-implementation examination of barriers and facilitators of an electronic prospective surveillance model for cancer rehabilitation: a qualitative study

BACKGROUND

An electronic Prospective Surveillance Model (ePSM) uses patient-reported outcomes to monitor symptoms along the cancer pathway for timely identification and treatment. Randomized controlled trials show that ePSMs can effectively manage treatment-related adverse effects. However, an understanding of optimal approaches for implementing these systems into routine cancer care is limited. This study aimed to identify barriers and facilitators prior to the implementation of an ePSM to inform the selection of implementation strategies.

METHODS

A qualitative study using virtual focus groups and individual interviews was conducted with cancer survivors, oncology healthcare providers, and clinic leadership across four cancer centres in Canada. The Consolidated Framework for Implementation Research (CFIR) guided the interviews and analysis of barriers and facilitators based on five domains (intervention characteristics, individual characteristics, inner setting, outer setting, and process).

RESULTS

We conducted 13 focus groups and nine individual interviews with 13 patient participants and 56 clinic staff. Of the 39 CFIR constructs, 18 were identified as relevant determinants to the implementation. The adaptability, relative advantage, and complexity of an ePSM emerged as key intervention-level factors that could influence implementation. Knowledge of the system was important at the individual level. Within the inner setting, major determinants were the potential fit of an ePSM with clinical workflows (compatibility) and the resources that could be dedicated to the implementation effort (readiness for implementation). In the outer setting, meeting the needs of patients and the availability of rehabilitation supports were key determinants. Engaging various stakeholders was critical at the process level.

CONCLUSIONS

Improving the implementation of ePSMs in routine cancer care has the potential to facilitate early identification and management of treatment-related adverse effects, thereby improving quality of life. This study provides insight into important factors that may influence the implementation of an ePSM, which can be used to select appropriate implementation strategies to address these factors.

Cancer survivors 75 years and older: physical, emotional and practical needs

OBJECTIVES

To describe physical, emotional and practical concerns and access to help of Canadian cancer survivors aged 75+ years following treatment.

METHODS

A survey was designed to identify concerns and access to help across three supportive care domains for cancer survivors 1-3 years post-treatment. Random samples were drawn from 10 provincial cancer registries. Survey packages were mailed to 40 790 survivors with option to reply by mail or online in French or English. Descriptive analysis was conducted.

RESULTS

In total, 3274 (25%) survivors aged 75+ years responded to the survey. Fifty-five per cent were men, 72% had not experienced metastatic spread and 75% reported comorbid conditions. Eighty-one per cent reported experiencing at least one physical concern, 63% experienced at least one emotional concern and 30% experienced at least one practical concern. The most commonly reported concerns were for two physical changes (fatigue 62% and bladder/urinary problems 39%) and one emotional change (anxiety/fear of recurrence 53%). More than 50% did not receive assistance for 15 concerns across the three domains. The most frequently cited reason for not seeking help for a concern was that they were told it was normal and they did not think anything could be done. Unmet needs existed for all physical, emotional and practical changes ranging from 41% to 88% of respondents.

CONCLUSIONS

Many older adults are at risk for experiencing physical, emotional and practical concerns following cancer treatment yet are not obtaining help. Action is needed for early identification of these individuals to mitigate the impact of unmet needs for older cancer survivors.

Prevalence of unmet supportive care needs reported by individuals ever diagnosed with cancer in Australia: a systematic review to support service prioritisation

PURPOSE

Improved health outcomes for individuals ever diagnosed with cancer require comprehensive, coordinated care that addresses their supportive care needs. Implementing interventions to address these is confounded by a lack of evidence on population needs and a large pool of potential interventions. This systematic review estimates the point prevalence of different supportive care needs stratified by the tool used to measure needs and cancer type in Australia.

METHODS

We searched MEDLINE, Embase, and Scopus from 2010 to April 2023 to identify relevant studies published on the prevalence of supportive care needs in Australia.

RESULTS

We identified 35 studies that met the inclusion criteria. The highest prevalent unmet need across all cancers was 'fear of cancer spreading' (20.7%) from the Supportive Care Needs Survey Short-Form 34 (SCNS-SF34), ranging from 9.4% for individuals ever diagnosed with haematological cancer to 36.3% for individuals ever diagnosed with gynaecological cancer, and 'concerns about cancer coming back' (17.9%) from the Cancer Survivors' Unmet Needs (CaSUN), ranging from 9.7% for individuals ever diagnosed with prostate cancer to 37.8% for individuals ever diagnosed with breast cancer. Two studies assessed needs in Aboriginal and Torres Strait Islander populations, reporting the highest needs for financial worries (21.1%).

CONCLUSIONS

Point prevalence estimates presented here, combined with estimates of the costs and effects of potential interventions, can be used within economic evaluations to inform evidence-based local service provision to address the supportive care needs of individuals ever diagnosed with cancer.

IMPLICATIONS FOR CANCER SURVIVORS

Local health services can use local evidence to prioritise the implementation of interventions targeted at unmet needs.

Impact of Income on Physical Concerns, Help Seeking, and Unmet Needs of Adult Cancer Survivors

Purpose

Cancer treatment can have consequences for individuals which may have profound impact on daily living. Accessing assistance can be problematic. This study explores associations between income and concerns, help-seeking, and unmet needs related to physical changes following cancer treatment.

Method

A national survey was conducted with cancer survivors about experiences with follow-up care one to three years after treatment. We report a trend analysis describing associations between income and cancer survivors' concerns, help-seeking, and unmet needs related to physical changes after treatment.

Results

In total 5,283 cancer survivors between 18 and 64 years responded, of which 4,264 (80.7%) indicated annual household income. The majority of respondents were survivors of breast (34.4%), colorectal (15.0%), and prostate (14.0%) cancers. Over 90% wrote about experiencing physical changes following cancer treatment. Survivors with low annual household incomes of less than $25,000 (CAN) reported the highest levels of concern about multiple physical changes and were more likely to seek help to address them.

Conclusions

Cancer survivors can experience various physical challenges and unmet needs following cancer treatment and difficulty obtaining relevant help across all income levels. Those with low income are more severely affected. Financial assessment and tailored follow-up are recommended.

Perspectives of Cancer Survivors with Low Income: A Content Analysis Exploring Concerns, Positive Experiences, and Suggestions for Improvement in Survivorship Care

The number of cancer survivors in Canada has reached 1.5 million and is expected to grow. It is important to understand cancer survivors' perspectives about the challenges they face after treatment is completed. Many factors create barriers to accessing assistance, and limited income may be a significant one. This study is a secondary analysis of data from a publicly available databank (Cancer Survivor Transitions Study) regarding the experiences of Canadian cancer survivors. The goal was to explore major challenges, positive experiences, and suggestions for improvement in survivorship care for low-income Canadian cancer survivors one to three years following treatment. A total of 1708 survey respondents indicated a low annual household income (<$25,000 CD). A content analysis was performed utilizing written comments to open-ended questions. The major challenges respondents described focused on physical capacity limits and treatment side effects; positive experiences emphasized support and attentive care; and suggestions for improvements highlighted the need for better support, information about self-care and side effect management, and timely follow-up care. The relationships between household income and the management of survivors' physical, emotional, and practical concerns require consideration. The design of follow-up care plans, programs, services, and financial assessments of patients may prepare survivors for predictable issues and costs in their transition to survivorship.

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

OBJECTIVES

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

DATA SOURCES

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

CONCLUSION

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

IMPLICATIONS FOR NURSING PRACTICE

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

The Relationship between Supportive Care Needs and Health-Related Quality of Life in Cancer Patients

The aim of this study was to analyze the relationship between quality of life (QoL) and supportive care needs (SCNs) in cancer patients. It is difficult to relate SCNs to detriments in QoL since SCNs and QoL assessment tools generally comprise different dimensions that cannot be directly related to each other. Therefore, we developed a short questionnaire with eight dimensions for uniformly measuring SCNs, QoL, and the subjective importance of these dimensions. A total of 1108 cancer patients with mixed diagnoses assessed eight dimensions of health-related QoL concerning SCNs, satisfaction, and importance. Among the eight dimensions of QoL, physical functioning received the highest SCN assessments (M = 3.4), while autonomy (M = 20.7) and social relationships (M = 1.88) were the dimensions with the lowest SCN mean scores on the 1-5 scale. For each of the eight dimensions, high levels of SCNs were reported by those patients who had low levels of satisfaction with that dimension (r between -0.32 and -0.66). The subjective importance of the dimensions was not consistently correlated with SCNs (r between -0.19 and 0.20). Females reported higher SCNs than males in six of the eight specific dimensions. Patients with prostate and male genital cancers reported the lowest SCNs. These results suggest gender-specific SCN patterns that warrant further exploration. This study highlights the value of a unified assessment instrument for SCNs and QoL, providing a robust basis for future cancer care strategies.

Unmet Supportive Care Needs after Non-Small Cell Lung Cancer Resection at a Tertiary Hospital in Seoul, South Korea

The aim of this study is to identify the prevalence and predictors of unmet needs of non-small cell lung cancer (NSCLC) patients undergoing surgical resection in Seoul, South Korea. A total of 949 patients who completed survey questionnaires that included the Cancer Survivors' Unmet Needs Korean version (CaSUN-K), fear of cancer recurrence (FCR) inventory-short form, and European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) were recruited from January to October 2020. Multivariable logistic regression was used to determine the potential correlation of significant unmet needs, defined as any moderate or strong need, for each domain of CaSUN-K. Of the 949 participants, the mean age was 63.4 ± 8.8 years old, and 529 (55.7%) were male. Overall, 91.8% of participants reported one or more unmet need. The highest domains of moderate-to-strong unmet needs were existential survivorship (59.1%), comprehensive cancer care (51.2%), and information (49.7%). High FCR and poor emotional function were associated with moderate-to-strong unmet needs across all domains of CaSUN-K. NSCLC survivors with a recent diagnosis had more frequent disease-related unmet needs. Interventions to reduce the unmet needs of NSCLC patients should focus on relieving FCR and improving emotional functioning. Furthermore, emphasis should be placed on decreasing disease-related needs, particularly for early survivors of lung cancer during the re-entry phase.

Defining research priorities and needs in cancer symptoms for adults diagnosed with cancer: an Australian/New Zealand modified Delphi study

PURPOSE

This study asked consumers (patients, carers) and healthcare professionals (HCPs) to identify the most important symptoms for adults with cancer and potential treatment interventions.

METHODS

A modified Delphi study was conducted involving two rounds of electronic surveys based on prevalent cancer symptoms identified from the literature. Round 1 gathered information on participant demographics, opinions and/or experience on cancer symptom frequency and impact, and suggestions for interventions and/or service delivery models for further research to improve management of cancer symptoms. In Round 2, respondents ranked the importance of the top ten interventions identified in Round 1. In Round 3, separate expert panels of consumers and healthcare professionals (HCPs) attempted to reach consensus on the symptoms and interventions previously identified.

RESULTS

Consensus was reached for six symptoms across both groups: fatigue, constipation, diarrhoea, incontinence, and difficulty with urination. Notably, fatigue was the only symptom to reach consensus across both groups in Round 1. Similarly, consensus was reached for six interventions across both groups. These were the following: medicinal cannabis, physical activity, psychological therapies, non-opioid interventions for pain, opioids for breathlessness and cough, and other pharmacological interventions.

CONCLUSIONS

Consumers and HCPs prioritise differently; however, the symptoms and interventions that reached consensus provide a basis for future research. Fatigue should be considered a high priority given its prevalence and its influence on other symptoms. The lack of consumer consensus indicates the uniqueness of their experience and the need for a patient-centred approach. Understanding individual consumer experience is important when planning research into better symptom management.

Correlates of common concerns in older cancer survivors of leukemia and lymphoma: results from the WHI LILAC study

PURPOSE

Older survivors of leukemia and lymphoma often experience long-term effects of chemotherapy. We described common concerns related to their cancer and treatment in older survivors of leukemia and non-Hodgkin lymphoma (NHL) and assessed correlates of these concerns.

METHODS

We utilized data from the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study that recruited post-menopausal women aged 50-79. Participants diagnosed with leukemia and NHL were included (n = 420). They were asked about 14 areas of current concerns related to their cancer and treatment and to rate each from 0 (no concern) to 2 (major concern), with total scores ranging from 0 to 28. Linear regression was used to assess factors correlated with the concern score, and logistic regression for factors correlated with the three most common concerns.

RESULTS

Mean age at assessment was 81 years (range 69-99); 72% reported at least one concern, and median concern score among these survivors was 3.5 (Q1-Q3 2-5). Factors significantly correlated with concern scores were sadness, pain, distress, higher prior symptom count, and loneliness (all p < 0.05). Significant factors correlated with common concerns were (1) fatigue/sleep: sadness/depression, distress, higher prior symptom count, greater loneliness, and worse physical functioning; (2) physical functioning/activity: older age, public insurance, higher body mass index, pain, worse QoL, and higher treatment-related comorbidities; (3) memory/concentration: prior chemotherapy or radiation, worse QoL, higher prior symptom count, and greater loneliness (all p < 0.05).

CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS

Almost three-quarters of older survivors of leukemia and lymphoma reported at least one concern; a multifaceted intervention may be needed to address these concerns.

Supportive care needs and health-related quality of life in cancer patients receiving palliative care

Objective

Cancer patients receiving palliative care experience a variety of impairments in their quality of life (QoL), and have corresponding supportive care needs (SCNs). The aim of this study was to analyze the relationship between SCNs, satisfaction with QoL dimensions, and the perceived importance of these dimensions.

Method

A sample of 152 cancer patients receiving palliative care were included in this cross-sectional study. Eight dimensions of QoL were defined and assessed concerning SCNs, satisfaction, and subjective importance using a new assessment instrument with five-point scales (range 1-5) for each dimension.

Results

Among the eight specific domains examined, the greatest SCNs were observed for absence of pain (M = 3.18; SD = 1.29). The patients were least satisfied with their physical functioning (M = 2.60; SD = 0.84), and the dimension social relationships (M = 4.14; SD = 0.72) received the highest perceived importance ratings. The eight dimensions' SCNs scores were significantly correlated with each other (r between 0.29 and 0.79); the lowest correlations were found for social relationships. The correlations between the satisfaction scores and the SCNs differed from dimension to dimension, with coefficients between -0.32 (absence of pain) and - 0.57 (sleep quality).

Conclusion

The results show that detriments in QoL do not automatically indicate high levels of SCNs in those dimensions. Health care providers should consider both factors, QoL (as measured with QoL questionnaires) and subjectively expressed SCNs, to optimize their patients' care regimens.

Top 10 Tips for Research Grant Writing: A Guide for Nurses and Allied Health Professionals

OBJECTIVES

Nurses and allied health professionals have traditionally received less of the health and medical competitive research funding pool compared with medical practitioners and basic scientists. This instructive article aims to facilitate greater success rates by providing top 10 tips on good grantsmanship, which may serve as a guide for clinician researchers with limited experience with successful grant applications.

DATA SOURCES

Expert advice was used to write this article.

CONCLUSION

A quality grant application requires considerable time and investment. The top 10 tips include: (1) understanding the grant scheme; (2) partnering with the right mentor; (3) assembling the best team; (4) providing a case for novelty, significance, and urgency; (5) maximizing feasibility, scientific quality, and innovations; (6) providing evidence and data to substantiate claims; (7) ensuring points of difference; (8) clarifying return on investment; (9) ensuring perfect presentation and formatting; and (10) incorporating critical feedback.

IMPLICATIONS FOR NURSING PRACTICE

Each grant scheme can have different focuses and selection criteria. However, these top tips can be used as a guide to consider in maximizing success for nurse-led and allied health led research.

A qualitative study of lived experiences and needs of advanced cancer patients in Malaysia: Gaps and steps forward

PURPOSE

Due to the high burden of cancer-related suffering, it is paramount to understand the gaps in cancer care that lead to suffering. Advanced cancer patients have unmet needs and challenges that differ from those with early-stage cancer due to the rapid disease progression. By exploring advanced cancer patients' lived experiences and needs from the physical, psychological, social, and spiritual aspects, this study aims to identify gaps in the Malaysian health system and propose contextualised measures to improve cancer care.

METHODS

Semi-structured, in-depth interviews were conducted to explore advanced cancer patients' lived experiences and needs from the physical, psychological, social, and spiritual aspects. The interviews were then transcribed and coded. Themes were developed from the codes using iterative thematic approach.

RESULTS

The lived experiences and needs of nineteen patients converged into four major themes: disruption to daily lives, psychosocial and spiritual support system, information needs, and financial needs. This study described predominantly how cancer impacted patients' lives and livelihood, how patients coped with their psychological conditions after diagnosis, the need for effective communication and trust in a multicultural society, and how finance affected access to and experience of cancer care.

CONCLUSION

Advanced cancer patients had different needs beyond receiving medical treatments. A concerted effort is required from clinicians, allied health professionals, social workers, support groups, and family members to understand and fulfil these needs.

Effectiveness and implementation of models of cancer survivorship care: an overview of systematic reviews

PURPOSE

To critically assess the effectiveness and implementation of different models of post-treatment cancer survivorship care compared to specialist-led models of survivorship care assessed in published systematic reviews.

METHODS

MEDLINE, CINAHL, Embase, and Cochrane CENTRAL databases were searched from January 2005 to May 2021. Systematic reviews that compared at least two models of cancer survivorship care were included. Article selection, data extraction, and critical appraisal were conducted independently by two authors. The models were evaluated according to cancer survivorship care domains, patient and caregiver experience, communication and decision-making, care coordination, quality of life, healthcare utilization, costs, and mortality. Barriers and facilitators to implementation were also synthesized.

RESULTS

Twelve systematic reviews were included, capturing 53 primary studies. Effectiveness for managing survivors' physical and psychosocial outcomes was found to be no different across models. Nurse-led and primary care provider-led models may produce cost savings to cancer survivors and healthcare systems. Barriers to the implementation of different models of care included limited resources, communication, and care coordination, while facilitators included survivor engagement, planning, and flexible services.

CONCLUSIONS

Despite evidence regarding the equivalent effectiveness of nurse-led, primary care-led, or shared care models, these models are not widely adopted, and evidence-based recommendations to guide implementation are required. Further research is needed to address effectiveness in understudied domains of care and outcomes and across different population groups.

IMPLICATIONS FOR CANCER SURVIVORS

Rather than aiming for an optimal "one-size fits all" model of survivorship care, applying the most appropriate model in distinct contexts can improve outcomes and healthcare efficiency.

Unmet supportive care needs and associated factors: Evidence from 4195 cancer survivors in Shanghai, China

BACKGROUND

Cancer survivors at different stages of life often have different needs that make it challenging for services to provide satisfactory care. Few studies have considered whether services are truly meeting the needs of cancer patients by exploring and identifying their perspectives on unmet needs.

OBJECTIVE

The aim of this study was to identify the unmet needs of cancer survivors and to further determine the potential impact of socio-demographic factors.

METHODS

A cross-sectional study that included 4195 cancer patients was conducted in Shanghai, China. Using Maslow's hierarchy of needs theory as a conceptual framework, the questionnaire included five dimensions: information, life and finances, continuing care, emotions, and self-actualization. Correlation analysis and ordered logistic regression analysis was used to explore the relationship between demographic sociological factors and unmet needs for supportive care.

RESULTS

The most common unmet supportive care needs include information needs (2.91 ± 1.32), self-actualization needs (2.69 ± 1.32) and continuing care needs (2.59 ± 1.30). Unmet needs for life and finances were more pronounced among cancer participants in the 45-69 age group. After adjusting for confounders, we found that each 6-month increase in the time since diagnosis was associated with a 0.8% (OR: 0.992, 95% CI: 0.985-0.998) reduction in high need for continuing care and a 0.9% (OR:0.991, 95% CI: 0.983-0.999) reduction in high need for self-actualization, respectively.

CONCLUSIONS

Information needs are the most important concern among the diverse unmet needs of cancer survivors. Time since diagnosis is associated with unmet supportive care needs of cancer survivors. The findings highlight the large gap between actual health services and patients' unmet need for supportive care, which will provide the basis for a patient-centered supportive care system for cancer survivors.

Factors associated with a high level of unmet needs and their prevalence in the breast cancer survivors 1-5 years after post local treatment and (neo)adjuvant chemotherapy during the COVID-19: A cross-sectional study

Objective

To assess the prevalence of unmet needs in post-treatment breast cancer survivors and identify sociodemographic, clinical, and psychosocial variables associated with reported unmet needs during the COVID-19 pandemic.

Materials and methods

In this cross-sectional study, 430 post-treatment breast cancer survivors, ranging between 1 and 5 years after the procedure, completed the Cancer Survivors' Unmet Needs (CaSUN) questionnaire from September 2021 and January 2022. The multivariate logistic analysis identified factors associated with at least one reported unmet need in the total CaSUN scale and specific domains.

Results

A total of 67% of survivors reported at least one unmet need. The most frequently reported unmet needs were the lack of accessible hospital parking (43%) and recurrence concerns (39.5%). The majority of reported unmet needs relate to comprehensive care (44%), followed by the psychological and emotional support domain (35.3%). Younger age (OR = 0.95, 95% CI = 0.92-0.99; p < 0.001), three or more comorbidities (OR = 0.27, 95% CI = 0.11-0.71, p < 0.01), a lower quality of life (OR = 0.06, 95% CI = 0.01-0.47, p < 0.01) and low resilience (OR = 0.95, 95% CI = 0.93-0.99) were associated with a high level of unmet needs in the multivariate regression model. Results are presented for factors associated with a high level of unmet needs for comprehensive cancer care and psychological and emotional support domain.

Conclusion

A high prevalence found in our study could be attributed to the COVID-19 pandemic, where patients may have missed adequate follow-up care, although comparing to studies done in non-pandemic time is difficult. Family physicians should be more attentive toward younger cancer survivors and those with more comorbidities as both characteristics can be easily recognized in the family practice.

Relationships between Canadian adult cancer survivors' annual household income and emotional/practical concerns, help-seeking and unmet needs

The objective of this study was to explore the relationship among income and emotional/practical concerns, help-seeking and unmet needs for cancer survivors aged 18 to 64 years one to three years after treatment. A cross-sectional survey was mailed in 2016 to 40,790 survivors randomly selected from 10 Canadian provincial cancer registries. Thirty-three percent responded. A trend analysis was conducted for survivors most likely to be in the workforce exploring the relationship across four income levels and emotional/practical concerns, whether help was sought for identified concerns, and whether help was received. A total of 4,264 respondents, aged 18-64, provided useable data with breast (34.4%) and colo-rectal (15.0%) accounting for the primary cancer type and 32.0% reporting annual household incomes of <$50,000. More than 94% of respondents indicated having emotional or practical concerns. Between one-third and one-half of the respondents sought help for their concerns and, of those, between one-third and one-half experienced difficulty finding help or did not obtain assistance. Significant trends across income categories indicated greater percentages of those in lower income categories experienced emotional and practical concerns, rated their concerns as 'big', sought help, and had difficulty finding help to address their concerns. Clearly adult cancer survivors experience emotional and practical concerns. Healthcare professionals have important roles monitoring these concerns and connecting those who desire help to relevant services. Opportunities should be given to individuals, regardless of income level, to indicate if they have concerns and if they would like assistance.

Development of a national health policy logic model to accelerate the integration of oncology and palliative care: a nationwide Delphi survey in Japan

BACKGROUND

Despite recommendations to deliver palliative care to cancer patients and their caregivers, their distress has not been alleviated satisfactorily. National health policies play a pivotal role in achieving a comprehensive range of quality palliative care delivery for the public. However, there is no standardised logic model to appraise the efficacy of these policies. This study aimed to develop a logic model of a national health policy to deliver cancer palliative care and to reach consensus towards specific policy proposals.

METHODS

A draft version of the logic model and specific policy proposals were formulated by the research team and the internal expert panel, and the independent external expert panel evaluated the policy proposals based on the Delphi survey to reach consensus.

RESULTS

The logic model was divided into three major conceptual categories: 'care-delivery at cancer hospitals', 'community care coordination', and 'social awareness of palliative care'. There were 18 and 45 major and minor policy proposals, which were categorised into four groups: requirement of government-designated cancer hospitals; financial support; Basic Plan to Promote Cancer Control Programs; and others. These policy proposals were independently evaluated by 64 external experts and the first to third Delphi round response rates were 96.9-98.4%. Finally, 47 policy proposals reached consensus. The priority of each proposal was evaluated within the four policy groups.

CONCLUSIONS

A national health policy logic model was developed to accelerate the provision of cancer palliative care. Further research is warranted to verify the study design to investigate the efficacy of the logic model.

Unmet supportive care needs of people with advanced cancer and their caregivers: a systematic scoping review

Examining and addressing unmet care needs is integral to improving the provision and quality of cancer services. This review explored the prevalence of unmet supportive care needs, and factors associated with unmet need, in adults with advanced cancers (solid and hematological malignancies) and their caregivers. Electronic databases (PubMed, CINAHL, EMBASE) were searched, producing 85 papers representing 81 included studies. People with advanced cancer reported the highest unmet needs in financial, health system and information, psychological, and physical and daily living domains, whereas caregivers reported the highest unmet needs in psychological, and patient care and support domains. Distress, depression, and anxiety were associated with higher unmet needs across all unmet need domains for people with advanced cancer and their caregivers. Substantial heterogeneity in study populations and methods was observed. Findings from this review can inform targeted strategies and interventions to address these unmet needs in people with advanced cancer.

Telehealth cancer-related fatigue clinic model for cancer survivors: a pilot randomised controlled trial protocol (the T-CRF trial)

INTRODUCTION

Cancer-related fatigue (CRF) is one of the most common and debilitating adverse effects of cancer and its treatment reported by cancer survivors. Physical activity, psychological interventions and management of concurrent symptoms have been shown to be effective in alleviating CRF. This pilot randomised controlled trial (RCT) will determine the feasibility of a telehealth CRF clinic intervention (T-CRF) to implement evidence-based strategies and assess the impact of the intervention on CRF and other clinical factors in comparison to usual care.

METHODS AND ANALYSIS

A parallel-arm (intervention vs usual care) pilot RCT will be conducted at the Princess Alexandra Hospital in Queensland, Australia. Sixty cancer survivors aged 18 years and over, who report moderate or severe fatigue on the Brief Fatigue Inventory and meet other study criteria will be recruited. Participants will be randomised (1:1) to receive the T-CRF intervention or usual care (ie, specialist-led care, with a fatigue information booklet). The intervention is a 24-week programme of three telehealth nurse-led consultations and a personalised CRF management plan. The primary objective of this pilot RCT is to determine intervention feasibility, with a secondary objective to determine preliminary clinical efficacy. Feasibility outcomes include the identification of recruitment methods; recruitment rate and uptake; attrition; adherence; fidelity; apathy; and intervention functionality, acceptability and satisfaction. Clinical and resource use outcomes include cancer survivor fatigue, symptom burden, level of physical activity, productivity loss, hospital resource utilisation and carer's fatigue and productivity loss. Descriptive statistics will be used to report on feasibility and process-related elements additional to clinical and resource outcomes.

ETHICS AND DISSEMINATION

This trial is prospectively registered (ACTRN12620001334998). The study protocol has been approved by the Metro South Health and Hospital Services Human Research Ethics Committee (MSHHS HREC/2020/QMS/63495). Findings will be disseminated through peer-reviewed publications, national and international conferences and seminars or workshops.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry ID: ACTRN12620001334998; Pre-results. Trial Version: Version 1.1. Last updated 10 December 2020.

Psychometric Properties of the Chinese Version of Female Self-Advocacy in Cancer Survivorship (FSACS-C) Scale

Objective

To translate Female Self-Advocacy in Cancer Survivorship (FSACS) scale and evaluate the psychometric properties of Chinese version of FSACS scale among female cancer survivors in China.

Methods

This study employed a cross-sectional design. FSACS scale was forward–backward translated and cognitive interviews were conducted for cultural adaptation. The newly translated tool was distributed to female cancer survivors to test psychometric properties, including item analysis, content validity, construct validity, criterion validity, internal consistency, and test-retest reliability.

Results

A total of 436 female cancer survivors were recruited in a Chinese tertiary cancer center from May to August in 2021. Item analysis showed statistical significance (P < 0.05) for each one and no ceiling or floor effect. The item-level content validity index ranged from 0.86 to 1.00 and the scale-level content validity index was 0.98. Three factors were extracted based on parallel analysis, and confirmatory factor analysis proved a good model fit with the original 3-factor structure. Pearson's correlation coefficient showed acceptable criterion validity. The Cronbach's α of 0.880 demonstrated the scale's internal consistency reliability, and the Alpha coefficients were 0.826, 0.763, and 0.859 for its three dimensions, respectively. The interclass correlation coefficients for test-retest reliability was 0.904 (0.870–0.891, P < 0.01) which confirmed the external reliability of the scale.

Conclusions

The Chinese version of FSACS scale proved to be a valid and reliable instrument that can be applied among Chinese female cancer survivors. Further research could be conducted in larger populations or people in different cancer stages.

Translation and psychometric testing of the Thai version of Cancer Survivors’ Unmet Needs measure among cancer survivors

Objective

To evaluate the psychometric properties of the Thai version of the Cancer Survivors’ Unmet needs (CaSUN-TH) scale among Thai cancer survivors after completion of primary treatment.

Methods

Standardized translation procedures developed the Cancer Survivors’ Unmet Needs into a Thai version (CaSUN-TH). Face validity was evaluated by a group of experts, and a pilot test on 10 cancer patients was conducted to evaluate its readability. A total of 236 cancer survivors who were attending follow-up visits at a cancer hospital in Thailand completed the CaSUN-TH. The internal consistency of the instrument was examined using Cronbach’s α. The association of the CaSUN-TH and its subscales with physical symptoms, QoL, age, gender, and type of cancer were examined for criterion validity and known-group validity. Construct validity was evaluated using confirmatory factor analysis.

Results

The CaSUN-TH showed good readability and high content validity for use as an instrument to assess unmet needs among Thai cancer survivors. Cronbach’s α for the entire scale was 0.95. Confirmatory factor analysis indicated that the five-factor structure of the CaSUN-TH was good fit to the data (CFI ​= ​0.901, SRMR ​= ​0.074, RMSEA ​= ​0.076 [90% confidence interval, 0.066–0.085]). In terms of construct validity, CaSUN-TH scores significantly correlated to other variables hypothesized to influence the level of need, including higher physical symptoms prevalence was related to poor quality of life, and poorer QOL and younger age were associated with a higher level of unmet needs. In addition, the scale was able to differentiate scores between groups, including gender, age, and type of primary cancer, with theoretically hypothesized differences.

Conclusions

The CaSUN-TH demonstrated appropriate psychometric properties for assessing unmet needs in different cancer survivor groups in Thailand. Using the CaSUN-TH can help health professionals in targeting individual survivor needs, bridging the gap between patients’ experiences and their expectations, and improving the quality of cancer survivorship care.

What factors shape quality of life for women affected by gynaecological cancer in South, South East and East Asian countries? A critical review

Background

Gynaecological cancers are among the most prevalent cancers worldwide, with profound effects on the lives of women and their families. In this critical review, we explore the impacts of these cancers on quality of life (QOL) of women in Asian countries, and highlight areas for future inquiry.

Methods

A systematic search of the literature was conducted in six electronic databases: Web of Science, Scopus, Global Health (CAB Direct), PsycINFO (Ovid), EBMR (Ovid), and Medline (Ovid). Screening resulted in the inclusion of 53 relevant articles reporting on 48 studies.

Results

Most studies were conducted in high and upper-middle income countries in East Asia and used quantitative approaches. Women had predominantly been diagnosed with cervical or ovarian cancer, and most had completed treatment. Four key interrelated domains emerged as most relevant in shaping QOL of women affected by gynaecological cancer: support, including identified needs, sources and forms; mental health, covering psychological distress associated with cancer, risk and protective factors, and coping strategies; sexual function and sexuality, focused on physiological, emotional and relational changes caused by gynaecological cancers and treatments, and the impacts of these on women’s identities; and physical health, covering the physical conditions associated with gynaecological cancers and their impacts on women’s daily activities.

Conclusion

QOL of women affected by gynaecological cancer is shaped by their mental and physical health, support, and changes in sexual function and sexuality. The limited number of studies from lower- and middle-income countries in South and Southeast Asia highlights important knowledge gaps requiring future research.

Multiple factors shape the quality of life of women affected by gynaecological cancers in Asian countries as elsewhere. We identified 53 articles reporting on 48 studies, most conducted in high- and upper-middle income East Asian countries, with much less attention to women in lower income countries in South and Southeast Asia. Most studies used quantitative research methods to gain an understanding of the impact on women diagnosed with cervical or ovarian cancer who had completed treatment. Women’s quality of life was shaped by their mental and physical health, their support needs, and the changes they experienced in sexual function and sexuality.

The relationship between hope levels and unmet needs of caregivers of advanced cancer patients†

AIM

The effects in cultural and health provisions can lead to different unmet support needs. Hope is seen as an important support, a supportive power, and an efficient coping strategy for cancer caregivers. The purpose of this study in Turkish society is to determine supportive care needs of caregivers of cancer patients, to determine the hope levels of those caring for cancer patients and foresee how variables and hope can trigger needs.

METHODS

To identify the unmet needs and hope levels of caregivers of advanced cancer patients in Turkish society. Data were collected using the Supportive Care Needs of Caregivers Scale and Herth Hope Index.

RESULTS

More than half of the advanced cancer caregivers (56.51%) reported unmet care needs. Their unmet needs and hope levels were above average. Regression analysis showed the total score for hope was related to health care and information needs, work-social needs.

CONCLUSION

Hope was related to health care and information needs and work-social needs. Oncology nurses should focus on the unmet needs of caregivers, taking into account their cultural differences in order to raise their hopes.

The effectiveness of telephone and Internet-based supportive care for patients with esophageal cancer on enhanced recovery after surgery in China: A randomized controlled trial

Objective

The aim of this study was to establish a nurse-led supportive care program based on telephone and Internet support and evaluate its efficacy in comparison with conventional care on enhanced recovery after surgery.

Methods

The study was designed as an open-label, randomized controlled trial to value the efficacy of a nurse-led supportive care program in comparison with conventional care. A convenience sampling method was employed to recruit patients with esophageal cancer in a tertiary Grade A cancer center in Beijing from November 2018 to January 2019. Patients were assigned randomly (1:1) to one of the two groups (intervention group vs control group) via a web randomization system. The control group received conventional care. Patients from the intervention group received conventional care and one-on-one phone calls from nurses following their discharge assessments and education about nutrition and symptoms. Nurses also set up a WeChat group, which they invited patients to join in before discharge for better communication during follow-up. Statistical testing, including nutritional status, quality of life, the helpfulness of the follow-up service, and the patients’ satisfaction with their care, was conducted 6 months after discharge to assess for differences between the two groups. The independent sample t, chi-squared, and Mann–Whitney tests were used to compare between the experiences of the intervention and control groups. The Spearman correlation analysis was used for the analysis of correlation of the nutritional index and quality of life.

Results

Finally, 168 patients were included in the study, with 86 patients in the intervention group and 82 in the control group. Significant differences between the intervention and control groups were found in the nutrition risk screening 2002 and simple diet self-assessment tool scores. The changes in blood albumin, prealbumin, and transferrin were also statistically significant. All (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) QLQ-C30 results of the intervention group were better than those of the control group. A significant positive correlation of the simple diet self-assessment tool (the higher, the better) and the scores for total health/quality of life were detected (r ​= ​0.214, P ​= ​0.005). A significant negative correlation of the nutrition risk screening 2002 (the lower, the better) and the scores of total health/quality of life was detected (r ​= ​−0.446, P ​= ​0.000). The patients’ scores on the helpfulness of the follow-up service and their satisfaction with it were both significantly higher in the intervention group than in the control group.

Conclusions

This study highlighted the important role of nurse-led supportive care based on telephone and Internet-based support for patients after enhanced recovery after surgery. The supportive care improved patients’ nutritional status, elevated their quality of life, and improved their satisfaction with the care provided to them.

Supportive Care Needs Assessment for Cancer Survivors at a Comprehensive Cancer Center in the Middle East: Mending the Gap

BACKGROUND

Cancer survivors are often underprepared for what to expect post-treatment, and there are knowledge gaps regarding cancer survivors' supportive care needs in Jordan and neighboring Arab countries. This study aimed to identify gaps in supportive care needs among adult cancer survivors seen at King Hussein Cancer Center in Amman, Jordan, and explore predictors of unmet needs.

METHODS

This was an observational cross-sectional study using a modified version of the Supportive Care Needs Survey 34 item short form (SCNS-SF34).

RESULTS

Two hundred and forty adult cancer survivors completed the study questionnaire. The assessed needs were highest in the financial domain, including covering living expenses, managing cancer treatment adverse effects and co-morbidities. The least prevalent reported needs were in sexuality and reproductive consultations. Late-stage diagnosis was independently associated with higher physical, psychological, health system/information, financial and overall need scores, with p-values of 0.032, 0.027, 0.052, 0.002 and 0.024, respectively. The overall quality of life score was independently and inversely associated with physical, psychological, health system/information, financial and overall need domains, with p-values of 0.015, <0.0001, 0.015, 0.004 and 0.0003, respectively.

CONCLUSIONS

This needs assessment identified problem areas for targeting interventions across the Jordanian cancer survivor population, and understanding these findings highlights opportunities for intervention to address gaps in care.

Physical Therapists in Oncology Settings: Experiences in Delivering Cancer Rehabilitation Services, Barriers to Care, and Service Development Needs

OBJECTIVE

Physical therapist-delivered rehabilitation aims to manage the side effects of cancer and its treatments. Although access to cancer rehabilitation is not yet a standard of care in many countries, physical therapists practice in many types of cancer services with different cancer populations. The purpose of this study was to explore the experiences of physical therapists in cancer care practice with regard to their role, the factors influencing service delivery and development, and physical therapists' professional development needs.

METHODS

In this qualitative study with semistructured interviews, physical therapists in cancer care settings in the Republic of Ireland were interviewed via telephone. Participants (n = 17) represented a variety of clinical settings and roles. Two researchers performed thematic analysis of transcriptions using a semantic, inductive approach. Key themes and codes were identified and illustrative quotes were selected.

RESULTS

Six main themes were found: the need for more services, barriers to service development and delivery, a lack of awareness of the role of physical therapy, facilitators to service development, goals for the future of oncology physical therapy, and training needs of staff.

CONCLUSIONS

Physical therapists provide valuable interventions across the spectrum of cancer care but experience barriers to the delivery and development of services. Investment in oncology physical therapy and developing international standards of care will allow physical therapists to meet the rehabilitation needs of survivors of cancer.

IMPACT

As international guidelines increasingly recommend development of cancer rehabilitation programs, it is important to understand physical therapists' experiences of working in cancer care to assist in the development of effective oncology physical therapy services. This study demonstrates that physical therapist-led cancer rehabilitation services need investment and public promotion to enable the provision of optimal services to all patients with cancer and to meet standards of care.

Thai oncology nurses' perspectives toward survivorship care plan components and implementation for colorectal cancer survivors

PURPOSE

To describe oncology nurses' perspectives regarding survivorship care plan (SCP) components and implementation for colorectal cancer (CRC) survivors in Thailand.

METHODS

A cross-sectional, descriptive online study was conducted between October and November 2020. Thai oncology nurses were recruited using Facebook and the Line application. Study participants (n = 160) rated the usefulness of four standard SCP components (treatment summaries, surveillance, late/long-term effects, and health promotion and psychosocial needs; n = 23 items) and gave input on the implementation of SCPs in clinical practice (n = 11 items). Data were analyzed using descriptive statistics.

RESULTS

Most oncology nurses supported providing CRC survivors with SCPs (93.2%) and felt that SCPs were an important part of their practice (93.7%). Nurses rated all four SCP components as "very useful," including treatment summaries (76.4%), surveillance (81.9%), late/long-term effects (85.7%), and health behavior and psychosocial concerns (80.2%). In terms of implementation, most nurses indicated that oncologists should prepare (84.4%) and provide SCPs (95%), but 61.9% and 69.4% of nurses, respectively, also believed that they should perform these tasks. In addition, most nurses indicated that they should play a significant role in the ongoing management of CRC survivors (95.7%) and that evidence-based surveillance guidelines are needed (96.2%).

CONCLUSION

Oncology nurses believed that the four SCP components were helpful to the long-term management of CRC survivors, supported SCP provision, and expressed their perceived responsibilities for preparing and delivering SCPs. The findings suggested opportunities for oncology nurses to play a significant role in developing and implementing SCPs. However, additional efforts are needed to expand nurses' roles in survivorship care and establish practice guidelines that will facilitate integration of SCPs into nursing practice.

Unmet Supportive Care Needs and Associated Factors: a Cross-sectional Survey of Chinese Cancer Survivors

To assess cancer survivors' unmet supportive care needs and associated factors. Limited evidence is available about the supportive care needs of Chinese cancer survivors to inform future service planning. A cross-sectional survey was conducted (STROBE cross-sectional checklist used for report). Standardized questionnaires were administered to 364 cancer survivors. Using the Supportive Care Framework as conceptual framework, factors concerning individuals' cognitive appraisals of their situation and social resources were examined to explore their association with unmet supportive care needs. The most common unmet supportive care needs included concern about the cancer coming back (51.5%), the need for up-to-date information (49.3%), collaborative management with the medical team (48.8%), and financial support (48.8%). Factors associated with greater strength of unmet supportive care needs included being female, having higher personal support, and higher self-efficacy pertaining to social relationship. Having lower support from family and friends was a contributing factor associated with greater strength of unmet needs in comprehensive cancer care and relationship, as was lower self-efficacy pertaining to uncertainty management associated with greater strength of unmet needs in quality of life, and lower self-efficacy pertaining to health professional interaction associated with greater strength of unmet needs in information. Chinese cancer survivors experience a number of unmet supportive needs. Female and rural cancer survivors, and those with lower social support level and self-efficacy are susceptible to having higher levels of unmet supportive care needs. Consistent information provision and peer support system establishment are two potentially beneficial approaches to meet cancer patients' long-term supportive care needs. Females and rural cancer survivors, those with less support from family and friends, and those with lower self-efficacy in interactions with health professionals and in managing uncertainty are especially at risk for unmet supportive care needs.

Care needs of dying patients and their family caregivers in hospice and palliative care in mainland China: a meta-synthesis of qualitative and quantitative studies

OBJECTIVE

To investigate the care needs of dying patients and their family caregivers in hospice and palliative care in mainland China.

METHODS

A search for English and Chinese quantitative and qualitative studies was performed using the following English databases: PubMed (Medline), CINAHL and PsycINFO, as well as Chinese databases: SinoMed and CNKI. The records were independently screened by two reviewers and critiqued using Joanna Briggs Institute Critical Appraisal tools. All quantitative data were transformed into qualitative data, which were converted into textual descriptions. Due to the diversity of included studies, a three-step analysis was performed: narrative summary, thematic analysis and presentation of integrated results in a narrative form. The qualitative findings were pooled using the meta-aggregation approach.

RESULTS

The literature search identified 2964 papers after removing duplicates, from which 18 were included (9 quantitative and 9 qualitative studies). All studies were conducted in mainland China. Quantitative studies involved cross-sectional surveys, and qualitative studies involved interviews for data collection. Two synthesised results of patients' needs were identified, including needs to be comfortable and experience a good death. Another two synthesised results of family caregivers' needs included needs to care for and improve the quality of life of patients, and to care for themselves well.

CONCLUSION

This study identified that patients and family caregivers have an increasing demand for professional care at the end of life. Professionals, especially nurses, should enact a patients' demand-centred practice to overcome the challenges of organisation, education, emotion and communication to provide high-quality end-of-life care.

Unmet supportive care needs associated with quality of life for people with lung cancer: A systematic review of the evidence 2007-2020

INTRODUCTION

The aim of this review was to systematically examine the evidence on the relationship between quality of life (QoL) and unmet supportive care needs in patients with lung cancer.

METHODS

Six databases were searched for studies published since 2007. Studies were included if they measured QoL using a standardised tool and examined its association with unmet supportive care needs in lung cancer patients.

RESULTS

Six studies involving 562 patients were included. Nearly two thirds of the patients had been diagnosed with advanced cancer (Stage III or IV), and the majority had been diagnosed for less than 2 years. There was a negative association between QoL and unmet needs using two different measures (Supportive Care Needs Survey[SCNS] and Cancer Survivors Unmet Needs Survey [CaSUN]). In two studies, the relationship was limited to physical and/or psychological domains.

CONCLUSIONS

Unmet supportive care needs are associated with poorer QoL for people with lung cancer: The findings suggest that unmet physical and psychological needs may have the most impact on QoL and reflect the high symptom burden and psychological distress associated with lung cancer. Further work is needed to examine these relationships to identify the services and interventions that address the range of care needs across the disease trajectory.

The Interplay between Housing Environmental Attributes and Design Exposures and Psychoneuroimmunology Profile-An Exploratory Review and Analysis Paper in the Cancer Survivors' Mental Health Morbidity Context

Adult cancer survivors have an increased prevalence of mental health comorbidities and other adverse late-effects interdependent with mental illness outcomes compared with the general population. Coronavirus Disease 2019 (COVID-19) heralds an era of renewed call for actions to identify sustainable modalities to facilitate the constructs of cancer survivorship care and health care delivery through physiological supportive domestic spaces. Building on the concept of therapeutic architecture, psychoneuroimmunology (PNI) indicators-with the central role in low-grade systemic inflammation-are associated with major psychiatric disorders and late effects of post-cancer treatment. Immune disturbances might mediate the effects of environmental determinants on behaviour and mental disorders. Whilst attention is paid to the non-objective measurements for examining the home environmental domains and mental health outcomes, little is gathered about the multidimensional effects on physiological responses. This exploratory review presents a first analysis of how addressing the PNI outcomes serves as a catalyst for therapeutic housing research. We argue the crucial component of housing in supporting the sustainable primary care and public health-based cancer survivorship care model, particularly in the psychopathology context. Ultimately, we illustrate a series of interventions aiming at how housing environmental attributes can trigger PNI profile changes and discuss the potential implications in the non-pharmacological treatment of cancer survivors and patients with mental morbidities.

Perspectives and practices regarding colorectal cancer survivorship care: Online survey results from oncology nurses in Thailand

PURPOSE

Limited research has highlighted disparities in survivorship care in low- and middle-income countries. However, such care for colorectal cancer (CRC) survivors remains unexplored, especially in Thailand. This study examined Thai oncology nurses' perceptions of responsibility, confidence levels, and frequency of survivorship care practice for CRC survivors and identified factors impeding such care.

METHODS

A cross-sectional study utilizing an online survey approach was conducted between October and November 2020. Thai oncology nurses (N = 155) completed the survey's demographic questionnaire, 29-item survivorship care scale, and 16-item impeding factor scale.

RESULTS

Oncology nurses had high levels of perceived responsibility (mean = 73.37, SD = 12.12) and confidence (mean = 65.09, SD = 14.89) for providing CRC survivorship care. However, they reported less frequency of practice (mean = 47.60, SD = 21.03), especially concerning sexual, fertility, employment, and financial issues. Nurses with higher education had significantly higher responsibility perceptions, confidence levels, and frequency of practice (all p < .05). Also, nurses with specialty training in cancer care reported higher frequency of practice (p = .013). Common factors impeding survivorship care were lack of physical facilities (60.4%), knowledge/skills (57.4%), and educational resources for family members (52.3%) and survivors (51.6%).

CONCLUSIONS

This study revealed inconsistencies between oncology nurses' responsibility perceptions, confidence levels, and frequency of survivorship care practice. The results can guide nurse researchers, educators, leaders, and policymakers in enhancing the quality of CRC survivorship care in low- and middle-income countries such as Thailand. Future efforts should focus on developing educational resources and training programs for survivorship care for oncology nurses and addressing factors impeding such care during healthcare service planning.

Unmet supportive care needs and predictor of breast cancer patients in Bangladesh: A cross-sectional study

BACKGROUND

Breast cancer survivor goes through a period of needs in their post-treatment daily life. Relatively few studies have been conducted to understand the unmet needs among breast cancer survivors in Bangladesh. Recognize and measure patterns and predictors of unmet needs of breast cancer patients was the aim of the study.

OBJECTIVE

To identify and measure patterns and predictors of unmet needs of breast cancer patients in Bangladesh.

METHOD

A cross-sectional study among 138 breast cancer patients; conveniently selected from two public and two private cancer institutes. Face-to-face interview for data collection and medical record review for checklist was done. Unmet needs have been determined by the supportive care needs survey short form 34 scale. Logistic regression analyses were performed to identify the predictors of unmet needs.

RESULTS

The study indicated the top 10 moderate-to-high needs; among which the top five needs were from the information need domain. Surprisingly, private cancer treatment centers were identified as a significant predictor for unmet needs. Patients from private cancer institutes reported more explanation needs as well as needs with their physical and daily living and sexuality. Furthermore, the type of treatment like patient receiving combine treatment therapy reported more need for help compared to the patient receiving chemotherapy alone. Moreover, housewives reported the low need for patient care and support systems as a result of their reluctant behavior towards their health.

CONCLUSION

Individual's unmet need assessment should be a part of every treatment protocol of breast cancer for a better treatment outcome.

Empowering Oncology Nurses through Knowledge and Practice to Improve Transitions Following Treatment and Survivorship Care

Following cancer treatment, individuals can be left with physical, emotional, and practical consequences which influence their quality of life. Cancer survivors frequently require added knowledge and skills to handle the demands of everyday living after treatment. Oncology nurses are in an ideal position to address the needs of cancer survivors. This article describes an online interactive workshop for oncology nurses to introduce Canadian data on unmet needs of cancer survivors, highlight the contribution oncology nurses can make to survivorship care, and introduce a self-learning resource for survivor care. Didactic presentations and small group discussions were used and feedback from participants was positive. Online learning can be an effective approach for learning with international nursing colleagues and could be utilized for nurses with limited access to cancer nursing education.

The efficacy, challenges, and facilitators of telemedicine in post-treatment cancer survivorship care: an overview of systematic reviews

BACKGROUND

Telemedicine services have been increasingly used to facilitate post-treatment cancer survivorship care, including improving access; monitoring health status, health behaviors, and symptom management; enhancing information exchange; and mitigating the costs of care delivery, especially since the COVID-19 pandemic. To inform guidance for the use of telemedicine in the post-COVID era, the aim of this overview of systematic reviews (SRs) was to evaluate the efficacy of, and survivor engagement in, telemedicine interventions in the post-treatment survivorship phase, and to consider implementation barriers and facilitators.

METHODS

PubMed, Cochrane CENTRAL, CINAHL, Embase, and Web of Science databases were searched. SRs that examined the use of telemedicine in the post-treatment phase of cancer survivorship, published between January 2010 and April 2021, were included. Efficacy data were synthesized narratively. Implementation barriers and facilitators were synthesized using the Consolidated Framework for Implementation Research.

RESULTS

Twenty-nine SRs were included. A substantive body of evidence found telemedicine to benefit the management of psychosocial and physical effects, particularly for improving fatigue and cognitive function. There was a lack of evidence on the use of telemedicine in the prevention and surveillance for recurrences and new cancers as well as management of chronic medical conditions. This overview highlights a range of diverse barriers and facilitators at the patient, health service, and system levels.

CONCLUSIONS

This review highlights the benefits of telemedicine in addressing psychosocial and physical effects, but not in other areas of post-treatment cancer survivorship care. This large review provides practical guidance for use of telemedicine in post-treatment survivorship care.

Deficient Health Care Services as Barriers to Meet Care Needs of Gynecological Cancer Survivors in Indonesia: A Qualitative Inquiry

OBJECTIVES

This study aimed to gain insight into the unmet care needs and health care service barriers experienced by Indonesian gynecological cancer survivors after cancer therapy.

DATA SOURCES

Twenty purposively selected women who had completed gynecological cancer therapy for at least 1 year participated in a descriptive qualitative study. Data were collected through in-depth interviews and thematically analyzed.

CONCLUSION

The analysis constructed two themes and seven subthemes: (a) unmet care needs (subthemes: late side effects; cancer recurrence; stigma of cancer transmission; social-economic concerns), (b) deficient functions of health care services (subthemes: short consultation time; unempathetic health professionals; and inefficient time and cost for the health care services). The gynecological cancer survivors experienced shortages of informational, psychological, and socioeconomic support after cancer therapy because of the deficient quality of the health care services.

IMPLICATION FOR NURSING PRACTICE

Nursing interventions could mitigate the unmet care needs of gynecological cancer survivors after cancer therapy through patient-centered care services and multidisciplinary collaboration.