Validation of the Chinese version of the 'caring ability of family caregivers of patients with cancer scale (CAFCPCS)' in family caregivers of elderly patients with cancer: A study protocol

AIM

This study aims to translate the English version of the 'caring ability of family caregivers of patients with cancer scale (CAFCPCS)' into Chinese and validate its psychometric properties in the family caregivers of elderly patients with cancer.

DESIGN

A methodological study.

METHODS

Based on the Brislin translation model, the original scale will be translated and back-translated, the Delphi expert consultation method will be adopted for cross-cultural adaptation, and the pilot will be carried out in 20-30 family caregivers of elderly patients with cancer. Then, a dual-centre prospective study will be conducted by recruiting 371-542 family caregivers of elderly patients with cancer to validate the psychometric properties of the Chinese version of CAFCPCS.

RESULTS

The scale's content validity will be evaluated using the Delphi expert inquiry method, and the face validity will be evaluated using a pre-experiment. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) will be used to assess structural validity, while internal consistency reliability and split-half reliability will be used to assess reliability.

PATIENT OR PUBLIC CONTRIBUTION

Public involvement is of great significance for this study. Participants will be used in a pre-test to give feedback on whether the contents of the clinical pilot version of CAFCPCS after expert consultation can reflect real problems and whether the sentences can be well understood. Based on their opinions, the research group will further refine the scale.

Experiences of Family Caregivers Providing Home Care to Older Patients With Cancer: A Qualitative Study

BACKGROUND

Older patients with cancer receive anticancer therapy in outpatient settings, and care-related issues may occur after discharge, which often requires family caregivers (FCs) to play a significant role in providing cancer care at home. However, relatively few studies have been focused on exploring the care experiences of these FCs.

PURPOSE

The aim of this study was to explore the care experiences of FCs caring for older family members with cancer at home.

METHODS

A qualitative study design and in-depth individual interviews were used to explore the at-home care experiences of FCs of older patients with cancer. The research was conducted in chemotherapy outpatient settings of a medical center in northern Taiwan. Content analysis was used to analyze data. The analyses focused on first extracting meaningful units from the text and then inducting categories from these units and determining the major themes.

RESULTS

Twenty FCs were interviewed. The three themes identified included (a) increased information needs and challenges in diet preparation and treatment decision making, (b) personal and patient-induced emotional stress, and (c) life rebalancing through the care experience.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings highlight the educational requirements, especially related to meeting personal dietary needs and obtaining psychological support, for FCs caring for older patients with cancer to help them rebalance their life.

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.

Patient-Reported Financial Distress in Cancer: A Systematic Review of Risk Factors in Universal Healthcare Systems

Simple Summary

A comprehensive understanding of risk factors associated with experiencing subjective financial distress is needed to inform the development of valid instruments and effective interventions to tackle financial toxicity. Several studies from the US indicate a strong correlation of the US-healthcare system’s systematic organisation and its particular socioeconomic risk factors for cancer patients experiencing financial toxicity. It is assumed that risk factors differ in other high-income countries due to the different structure of universal healthcare coverage. As an exhaustive analysis for other countries is lacking, this review aims to identify risk factors for subjective financial distress in universal healthcare systems.

Abstract

Financial toxicity is a side effect of cancer that results from the perceived financial distress an individual may experience in the course of the disease. The purpose of this paper is to analyse underlying factors related to subjective financial distress in high-income countries with universal healthcare coverage. A systematic literature review was conducted to identify qualitative and quantitative studies of cancer patient-reported subjective financial distress by performing a search in the databases of PubMed, PsycINFO and CINAHL up to December 2020. A qualitative synthesis was performed linking the time-dependent occurrence of risk factors to derived categories of risk factors. Out of 4321 identified records, 30 quantitative and 16 qualitative studies were eligible. Classification of risk factors resulted in eight categories with a total of 34 subcategories. Subjective financial distress is primarily determined by pre-diagnosis sociodemographic- factors as well as financial and work factors that might change during the course of the disease. The design of healthcare and social security systems shapes the country-specific degree of subjective financial distress. Further research should focus on evolving multidisciplinary intervention schemes and multidimensional instruments for subjective financial distress to account for identified risk factors in universal healthcare systems more precisely.

Impact of age in health-related quality of life in older adults with cancer

OBJECTIVE: To evaluate the impact of age in health-related quality of life (HRQoL) in older adults with cancer. METHODS: This was a cross-sectional study of 608 older adults diagnosed with cancer. Age groups were considered an independent variable. For the analysis of HRQoL, the mean scores of age groups were compared by analysis of variance and the Scheffé comparison test. For measuring the association between age and HRQoL, we used simple and multiple linear regression analyses. RESULTS: Cognitive function showed the highest scores (average 87.94 ± 26.87), while physical function showed the lowest ones (68.04 ± 28.63). The highest symptom score was observed for financial difficulties (34.21 ± 39.06), followed by pain (29.47 ± 33.92) and insomnia (28.51 ± 37.03). After adjustment, we observed a decrease in physical function (p = 0.028) and an improvement in emotional function (p = 0.003) with increasing age. Conclusions: In older patients with cancer, age negatively impacted physical function and positively impacted emotional function.

Prospective Analysis of Health-Related Quality of Life in Older Adults With Cancer

OBJECTIVE

The aim of the present study was to evaluate health-related quality of life (HRQoL) changes at 6 to 12 months after cancer diagnosis and to assess the impact of age in older adults with cancer.

METHODS

A cohort study using patients ≥60 years old diagnosed with cancer. Health-related quality of life scores were calculated according to the European Organisation for Research and Treatment of Cancer questionnaire. Student's t tests for paired samples and a binomial logistic regression were performed.

RESULTS

The study included 241 patients. At diagnosis, the affected HRQoL functions were physical and emotional functions, financial difficulties, pain, and insomnia. At follow-up, cognitive function (P < .001) and dyspnea (P = .004) worsened, while emotional function improved (P = .003).

DISCUSSION

At the 6 to 12 months of follow-up, older adult cancer patients showed worsening cognitive function and dyspnea and improved emotional function. These HRQoL changes were not associated with age.

Impact of individual background on the unmet needs of cancer survivors and caregivers - a mixed-methods analysis

BACKGROUND

Cancer survivors and their caregivers may have various unmet needs that are medically difficult to solve. Previous studies have suggested the relations between individuals' backgrounds and their unmet needs. We conducted a large-scale analysis to clarify the influence of individuals' backgrounds, primarily cancer type, on specific types of unmet needs.

METHODS

Using a mixed-methods approach, we analyzed records of first-time callers to a cancer-focused telephone consultation service that was provided by the Kanagawa Cancer Clinical Research Information Organization from October 2006 to May 2014. The qualitative approach concerned extracting unmet needs mentioned in each consultation and classifying them into themes of specific needs, while the quantitative approach comprised multi-variated analysis of the relationships between the frequency by which the needs in each theme arose and the associated callers' backgrounds.

RESULTS

A total of 1938 consultation cases were analyzed. In the qualitative analysis, the needs were classified into 16 themes. The mean number of unmet needs for each caller was 1.58 (standard deviation = 0.86). In the multi-variated analysis, caregivers for colorectal cancer survivors had a lower frequency of "emotional/mental health" needs (OR: 0.31, 95%CI: 0.11-0.88, p = 0.028) than did caregivers for breast-cancer survivors. Nevertheless, this was the only significant difference in needs frequency among callers (including survivors and their caregivers) with specific cancer types. Meanwhile, there significant difference in the frequency of occurrence of each unmet need theme was found among items concerning other background elements. Among survivors, sex was related to the frequency of needs among "physical" and "resources" themes, and "emotions/mental health"; their age group with "employment"; treatment course with "physical" and "resources" themes and "cure"; residence with "physical" themes; presence of symptom with "physical," "education/information," "resources," "emotions/mental health," and "cure" themes.

CONCLUSIONS

This large-scale study suggests that cancer type is not a significant factor for specific unmet needs and that individuals' backgrounds and presence of symptoms play a more important role. Through this study, it was found that instruments to predict people's needs and a system to provide individualized cancer care across cancer types should be developed in the future.

Expectations of and recommendations for a cancer survivorship guideline in Japan: a literature review of guidelines for cancer survivorship

BACKGROUND

Optimal cancer survivorship care needs its comprehensive guidelines. We aimed to identify English and Japanese guidelines that include cancer survivorship in their title, the issues highlighted in such guidelines, and any existing oncology practice guidelines in Japan that address these issues.

METHODS

This literature review was performed in three stages. First, guidelines published in English or Japanese that included cancer survivorship in the title were identified. Then, the issues that each cancer survivorship guideline addressed were defined. Lastly, Japanese guidelines that include survivorship issues were sought.

RESULTS

Six guidelines published in English addressed 31 cancer survivorship issues. No specific cancer survivorship guideline was available in Japanese. Thirty-four Japanese guidelines mentioned cancer survivorship issues. These guidelines addressed screening/surveillance for detecting recurrence or secondary cancer but did not address coordination of care, implications for practice, or inclusion of family. At present, Japanese guidelines poorly address the issue of promotion of a healthy lifestyle in cancer survivors. Also, poorly addressed were long-term and late effects such as pain, psychological distress, fatigue, cognitive dysfunction, cardiovascular effects (including anthracycline-induced cardiac toxicity), sleep disorders, and sexual dysfunction in cancer survivors.

CONCLUSION

There is a need for guidelines on optimal coordination of care between oncologists and other health care providers to support patients along the cancer care continuum and specifically to encourage a healthy lifestyle as part of cancer survivorship. The development of a comprehensive Japanese guideline that addresses these issues would help to improve the clinical outcome for cancer survivors in Japan.

Distress and Supportive Care Needs of Ethnically Diverse Older Adults With Advanced or Recurrent Cancer

OBJECTIVES

To assess the prevalence of supportive care needs (SCNs) and distress and to describe relationships among these and patient characteristics for ethnically diverse older adults with advanced or recurrent cancer.

SAMPLE & SETTING

Cross-sectional survey in five outpatient oncology clinics in an urban academic medical center involving 100 participants receiving cancer care in an economically challenged community.

METHODS & VARIABLES

The supportive care framework for cancer care guided this study, and participants completed the SCN Survey Short Form 34 and the Distress Thermometer. Study variables are cancer diagnosis, gender, helping to raise children, number of comorbid diseases, race or ethnicity, treatment status, and zip code.

RESULTS

Clinically meaningful distress was found in about a third of patients. Distress was not affected by race or ethnicity. Many ethnically diverse older patients with advanced or recurrent cancer report distress and SCNs; those with high distress are more likely to report multiple SCNs.

IMPLICATIONS FOR NURSING

Nursing assessment of patient SCNs and distress is integral to establishing individualized patient-centered care plans and to delivering optimal care.

Clinical and care intensity differences among patients suffering from somatic diseases electively referred to a consultation and liaison service

Background This investigation mainly explores possible care differences among patients hospitalized because of medical conditions being electively referred to a psychiatric-psychosomatic consultation and liaison service. Methods A four-year survey ( N = 2518 individuals) based on clinical and care variables selected from the basic documentation.

STATISTICS

Chi-square tests, analysis of variance, logistic and multivariate regression analyses, considering statistical modeling assumptions. Results A current psychiatric comorbidity has been found in 75% (less in cancer patients), mainly adjustment and anxiety (45%), mood (22%), and organic mental disorders (12%). The functioning score (Global Assessment of Functioning) was 59.4 and was especially low in patients suffering from unclear medical conditions. The performance status (Eastern Cooperative Oncology Group) amounted to 1.63 and was especially high in patients suffering from orthopedic conditions, infections, and cancer. Each patient received on average of 2.26 (SD = 2.81) contacts and 111 minutes (SD = 160) of total treatment time. In multivariate models, care differences among medical conditions are reduced. Men and older people have received less than the average amount of treatment, but psychiatrically comorbid patients and those with lower functionality and performance status have received more intensive psychological support. Conclusions As a quality feature of consultation and liaison service, patients suffering from psychiatric comorbidity, lower functionality, and lower performance status receive more intensive care and more post-discharge recommendations. Cancer patients and patients with pain as a leading diagnosis as well as strained mothers of hospitalized children have received more intensive treatment by consultation and liaison service despite lower psychiatric comorbidity levels. More attention has to be paid to men and older people independently of their physical condition.

Systematic review of care needs for older patients treated with anticancer drugs

OBJECTIVE

When treated with anticancer therapies, a number of issues are raised for older patients such as physical needs (coping with symptoms and side-effects) or psychological needs. Geriatric tailored interventions addressing these needs may be effective in terms of improving quality of life of our patients.

METHODS

A systematic review was performed in September 2017 in MEDLINE. All reports assessing older patients with cancer care needs in the context of anticancer systemic therapy were reviewed.

RESULTS

A total of 357 articles were analyzed. From these, 35 studies were included in the analysis. Compared to younger patients, the elderly had less supportive care needs. While older patients asked for less information than their younger counterparts, they still requested information on diagnosis, seriousness of the disease, chances of cure, spread of the disease, recovery, courses of illness, possible consequences, treatment procedures, treatment options, possible side effects and how to deal with them, and what they could do in daily life. When taking into consideration the various needs as assessed by the "Supportive Care Needs Survey", physical and daily living were the most frequently reported needs with emphasis on nutrition, coping with physical symptoms, dealing with side effects of treatment, and performing usual physical tasks and activities.

CONCLUSION

Information demand seemed moderate but a great deal of attention was paid to nutrition and well-being.

Predictors affecting quality of life in patients with upper aerodigestive tract cancers: a case-control study from India

OBJECTIVE

The aim of this study was to measure quality of life (QOL) in patients with upper aerodigestive tract (UADT) cancer in comparison with hospital-based controls. We also assessed the impact of various clinical predictors at time of diagnosis of disease/cancer on QOL in these patients.

STUDY DESIGN

A case-control study was conducted (N = 480) with 240 UADT cancer cases and 240 controls matched by gender and age (≥5 years) from 2 different hospitals in Pune, India. The University of Washington Quality of Life Questionnaire was used to measure QOL and was administered through face-to-face interviews. Various QOL domains were analyzed by using one-way analysis of variance and Bonferroni adjustments for post hoc comparisons.

RESULTS

Cases had significantly lower scores across all domains of QOL compared with controls. Overall, the most affected domains were anxiety and mood. Cancer site significantly influenced QOL, with patients with cancers of the oropharynx and hypopharynx having the worst mean scores across all domains. Patients with stage IV cancer had the worst mean scores across the majority of the QOL domains. Our findings highlight the complex interactions between individual and clinical predictors that have an impact on QOL.

CONCLUSIONS

QOL needs to be incorporated as an important outcome measure in an individualized approach to therapeutic and palliative care planning to enable a better quality of survival of patients with UADT cancers.

Distress do paciente oncológico: prevalência e fatores associados na opinião de familiares

Este estudo verificou a prevalência e fatores associados ao distress de pacientes oncológicos, na opinião de familiares. Foram entrevistados 140 familiares responsáveis pelo cuidado de pacientes com câncer. O Termômetro de Distress foi adaptado para uso em familiares. Estes consideraram que 72,9% dos pacientes estavam com distress relacionado a preocupações (80,4%), nervosismo (78,4%), tristeza (74,5%), dor (67,6%), fadiga (67,6%) e problemas com alimentação (57,8%). Modelos de regressão logística hierárquica mostraram que, enquanto familiares do sexo masculino (OR=0,025) e idades mais avançadas (OR=0,006 a 0,059) tiveram menor risco de perceber o distress, indivíduos protestantes, comparados a católicos, tiveram chance 12,77 vezes maior de percebê-lo. Quanto aos fatores associados, nervosismo (OR=10,8) contribuiu significativamente mais com a percepção de distress pelos familiares quando comparado a fadiga (OR=3,38) ou ter plano de saúde privado (OR=2,55). Familiares podem ser grandes aliados na avaliação e acompanhamento do distress de pacientes com câncer.

Do age and quality of life of patients with cancer influence quality of life of the caregiver?

OBJECTIVE

There are significant burdens associated with providing care for loved ones with cancer. However, caregiver quality of life (QOL) is often overlooked. With the increasing number of older adults with cancer, it is important to determine whether a patient's age and QOL have any association with the caregiver's QOL. The objective of our study was to describe caregiver QOL and explore whether patient age and other psychosocial factors impact caregiver QOL.

MATERIALS AND METHODS

Baseline information from patients with advanced cancer undergoing radiation and their caregivers, who were enrolled in a randomized, controlled clinical trial to test the effectiveness of a structured, multidisciplinary QOL intervention, was analyzed for this study. Caregivers completed the Caregiver Quality of Life Index-Cancer (CQOLC) Scale. Both patients and caregivers completed the Linear Analogue Self-Assessment (LASA) to measure QOL, and Profile of Mood States (POMS) to measure mood states.

RESULTS

Overall, 131 patient-caregiver pairs participated in the study. At baseline, caregivers of older adults (≥65years) had higher mental (P=0.01), emotional (P=0.003), spiritual (P<0.01), and social support (P=0.03) LASA QOL scores. Caregivers of older adults also had higher baseline QOL (CQOLC, P=0.003) and mood (POMS, P=0.04) than caregivers of younger adults. Caregivers of patients with higher LASA QOL scores had higher overall (P=0.02), mental (P=0.006), physical (P=0.02), emotional (P=0.002), and spiritual LASA QOL scores (P=0.047).

CONCLUSIONS

Caregivers of older adults with advanced cancer demonstrated better QOL and fewer mood disturbances compared to caregivers of younger patients. When patients have good QOL, caregivers also had good QOL.

Characteristics of elderly cancer patients' concerns and their quality of life in Japan: a Web-based survey

OBJECTIVE

Cancer incidence and the number of cancer patients are increasing in today's aging society. The purpose of this study was to investigate the characteristics of elderly cancer patients' concerns and examine the association between their concerns and quality of life.

METHODS

This was a cross-sectional web-based survey completed by ambulatory cancer patients aged 20 years or older. The questionnaire on cancer patients' concerns, comprehensive concerns assessment tool and the European Organization for Research and Treatment of Cancer QLQ-C30 were distributed to the subjects. Multiple regression analysis was conducted to determine which patients' concerns significantly contributed to their quality of life.

RESULTS

The final study population consisted of 807 cancer patients, among whom 243 (30%) were elderly (65 years or older). Elderly cancer patients had particular difficulty with self-management, psychological symptoms and medical information, and the prevalence of their concerns was generally lower than that of younger patients, with the exception of physical symptoms. Multiple types of elderly patients' concerns were independently associated with quality of life.

CONCLUSIONS

We found that elderly cancer patients suffered from various concerns, thus multidisciplinary intervention is important for providing them with optimal care. The results of this study suggest that elderly cancer patients' quality of life will improve if their concerns are properly handled.

Impact of a structured multidisciplinary intervention on quality of life of older adults with advanced cancer

BACKGROUND

Patients experience reductions in quality of life (QOL) while receiving cancer treatment and several approaches have been proposed to address QOL issues. In this project, the QOL differences between older adult (age 65+) and younger adult (age 18-64) advanced cancer patients in response to a multidisciplinary intervention designed to improve QOL were examined.

METHODS

This study was registered on ClinicalTrials.gov, NCT01360814. Newly diagnosed advanced cancer patients undergoing radiation therapy were randomized to active QOL intervention or control groups. Those in the intervention group received six multidisciplinary 90-minute sessions designed to address the five major domains of QOL. Outcomes measured at baseline and weeks 4, 27, and 52 included QOL (Linear Analogue Self-Assessment (LASA), Functional Assessment of Cancer Therapy-General (FACT-G)) and mood (Profile of Mood States (POMS)). Kruskall-Wallis methodology was used to compare scores between older and younger adult patients randomized to the intervention.

RESULTS

Of 131 patients in the larger randomized controlled study, we report data on 54 evaluable patients (16 older adults and 38 younger adults) randomized to the intervention. Older adult patients reported better overall QOL (LASA 74.4 vs. 62.9, p = 0.040), higher social well-being (FACT-G 91.1 vs. 83.3, p = 0.045), and fewer problems with anger (POMS anger-hostility 95.0 vs. 86.4, p = 0.028). Long-term benefits for older patients were seen in the anger-hostility scale at week 27 (92.2 vs. 84.2, p = 0.027) and week 52 (96.3 vs. 85.9, p = 0.005).

CONCLUSIONS

Older adult patients who received a multidisciplinary intervention to improve QOL while undergoing advanced cancer treatments benefited differently in some QOL domains, compared to younger adult patients. Future studies can provide further insight on how to tailor QOL interventions for these age groups.

The impact of clinical conditions and social factors on the psychological distress of cancer patients: an explorative study at a consultation and liaison service in a rural general hospital

BACKGROUND

In recent decades, increasing attention has been paid to the subjective dimension of cancer, especially to psychosocial screening procedures, major psychiatric disorders but also psychological and psychosocial distress, and finally to met needs of oncologic patients. This study aims first to describe cancer patients in a rural hospital attended by a psycho-oncological consultation-liaison team, second to assess predictors for psychological distress in cancer patients, and finally to identify predictors for recommendation of further psychosocial support.

METHODS

The sample (n = 290) comprises a full survey of patients at breast and bowel cancer services (n=209) and patients referred by other medical and surgical services because of psychosocial impairment (n = 81). All patients were assessed by means of the PO-Bado (Psycho-Oncological Basic Documentation) expert rating scale. Assessment of predictors for psychological distress was conducted by multivariate regression models and assessment for predictors for need for outpatient psychosocial support by a logistic regression analysis. All analyses were conducted using STATA 12.

RESULTS

Most members of the assessed sample (average age 65, 82% women) were not severely impaired from a functional and psychological point of view. A total of 14% had received psychiatric treatment before. Mood swings, anxiety, grief, and fatigue were the most important distress symptoms. Selectively referred patients vs. full survey patients of cancer centres, as well as bowel vs. breast cancer patients show a higher level of psychological and physical distress. Fatigue, assessed metastases, and functional limitations were the best predictors for psychological burden. Referral mode, gender, age, family problems, fatigue, and previous psychiatric treatment were associated with further need of psychosocial support.

CONCLUSIONS

Psycho-oncological consultation and liaison services may offer support to patients in an early stage of cancer, especially in cancer centres. Because of selectively referred patients show a higher burden, the use of basic screening instruments could be meaningful. Fatigue, metastases status, and functional limitations may better predict psychological distress than pain, duration of illness, psychosocial conditions or previous psychiatric treatment. More attention has to be paid to outpatient follow-up with older cancer patients, those with family problems, and those suffering from significant fatigue.