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Spoor JKH, Donders-Kamphuis M, Veenstra WS, van Dijk SA, Dirven CMF, Sillevis Smitt PAE, van den Bent MJ, Leenstra S, Satoer DD. Cognition and health-related quality of life in long-term survivors of high-grade glioma: an interactive perspective from patient and caregiver. Acta Neurochir (Wien) 2024; 166:166. [PMID: 38565800 PMCID: PMC10987343 DOI: 10.1007/s00701-024-06037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The health-related quality of life (HRQoL) and cognition are important indicators for the quality of survival in patients with high-grade glioma (HGG). However, data on long-term survivors and their caregivers are scarce. We aim to investigate the interaction between cognition and HRQoL in long-term survivors, their caregivers' evaluations, and the effect on caregiver strain and burden. METHODS 21 long-term HGG (8 WHO grade III and 13 WHO grade IV) survivors (survival ≥ 5 years) and 15 caregivers were included. Cognition (verbal memory, attention, executive functioning, and language), HRQoL, anxiety and depression, caregiver strain, and caregiver burden were assessed with standardized measures. Questionnaires were completed by patients and/or their caregivers. RESULTS Mean survival was 12 years (grade III) and 8 years (grade IV). Cognition was significantly impaired with a large individual variety. Patients' general HRQoL was not impaired but all functioning scales were deviant. Patient-proxy agreement was found in most HRQoL subscales. Three patients (14%) showed indications of anxiety or depression. One-third of the caregivers reported a high caregiver strain or a high burden. Test scores for attention, executive functioning, language, and/or verbal memory were correlated with perceived global health status, cognitive functioning, and/or communication deficits. Caregiver burden was not related to cognitive deficits. CONCLUSIONS In long-term HGG survivors maintained HRQoL seems possible even when cognition is impaired in a large variety at the individual level. A tailored approach is therefore recommended to investigate the cognitive impairments and HRQoL in patients and the need for patient and caregiver support.
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Affiliation(s)
- Jochem K H Spoor
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Marike Donders-Kamphuis
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- HMC, Department of Neurosurgery, The Hague, The Netherlands
| | - Wencke S Veenstra
- Department of Rehabilitation Medicine, Center for Rehabilitation - University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sarah A van Dijk
- Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Peter A E Sillevis Smitt
- Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martin J van den Bent
- Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sieger Leenstra
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Djaina D Satoer
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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2
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Sannes TS, Yusufov M, Amonoo HL, Broden EG, Burgers DE, Bain P, Pozo-Kaderman C, Miran DM, Smith TS, Braun IM, Pirl WF. Proxy ratings of psychological well-being in patients with primary brain tumors: A systematic review. Psychooncology 2023; 32:203-213. [PMID: 36371618 PMCID: PMC10373343 DOI: 10.1002/pon.6063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/14/2022] [Accepted: 10/31/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This systematic review examined the agreement of proxy ratings of depression and anxiety in neuro-oncology patients. METHODS Searches were conducted across 4 databases (MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science) to identify studies that compared proxy ratings (non-health care providers) of anxiety and depression in patients with brain cancer. Methodological quality and potential risk of bias were evaluated using the Joanna Briggs Institute Critical Appraisal Checklist. RESULTS Out of the 936 studies that were screened for inclusion, 6 were included for review. The findings were mixed in terms of whether patient and proxy ratings were accurate (e.g., deemed equivalent), with many of the selected studies suggesting moderate level of agreement for several of the selected studies and, when both depression and anxiety were included, depression ratings from proxy raters were more accurate than for anxiety. We identified important limitations across the selected articles, such as low sample size, clarity on defining proxy raters and the different instructions that proxy raters are given when asked to assess patients' mood symptoms. CONCLUSIONS Our findings suggest that proxy ratings of depression and anxiety should be interpreted with caution. While there is some agreement in proxy and patients with brain cancer ratings of depression and anxiety (greater agreement for depression), future work should recruit larger samples, while also remaining mindful of defining proxy raters and the instructions given in collecting these ratings.
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Affiliation(s)
- Timothy S Sannes
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Miryam Yusufov
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Hermioni L Amonoo
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Mass General Brigham, Boston, Massachusetts, USA
| | - Elizabeth G Broden
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Darcy E Burgers
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Bain
- Countway Library, Harvard Medical School, Boston, Massachusetts, USA
| | - Cristina Pozo-Kaderman
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Damien M Miran
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy S Smith
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ilana M Braun
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - William F Pirl
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Yang X, Yoo HK, Amin S, Cheng WY, Sundaresan S, Zhang L, Duh MS. Burden Among Caregivers of Pediatric Patients with Neurofibromatosis Type 1 (NF1) and Plexiform Neurofibroma (PN) in the United States: A Cross-Sectional Study. Neurol Ther 2022; 11:1221-1233. [PMID: 35679001 PMCID: PMC9178532 DOI: 10.1007/s40120-022-00365-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 05/11/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction Patients with neurofibromatosis type 1 (NF1) may develop plexiform neurofibromas (PNs) that can cause disfigurement, pain, and dysfunction, and may even be life-threatening. Studies have indicated NF1-PN can substantially impact the quality of life (QoL) of pediatric patients. However, research on caregiver burden is scarce. Methods Caregivers of pediatric patients ages 2–18 years with NF1-PN in the USA were recruited through the Children’s Tumor Foundation to participate in an online cross-sectional survey (December 2020–January 2021). Caregiver burden was measured using the Zarit Burden Interview (ZBI), and productivity loss from patientcare was measured using the Work Productivity and Activity Impairment questionnaire, adapted for caregiving (WPAI:CG). Results Ninety-five caregivers were recruited with a median age of 44.0 years. Most were female (88.4%), white/Caucasian (85.3%), and did not have NF1 or PN (86.3% and 89.5%, respectively). Commonly reported health conditions among caregivers include anxiety (48.4%) and depression (34.7%). On the ZBI (range 0–88; higher = greater burden), mean (SD) scores were 23.0 (13.8) and 12.7% of caregivers reported moderate–severe (scores 41–60) or severe burden (scores 61–88). Fifty-six caregivers were employed and working in the 7 days prior to completing the WPAI:CG. They reported missing an average of 6.9% of their working hours and an average reduction of 17.3% of on-the-job effectiveness, contributing to 22.3% loss in work productivity. Among all 95 caregivers, an average of 17.2% of regular daily activities were impaired. Conclusions The burden among caregivers of pediatric patients with NF1-PN is considerable and underscores an unmet need for better disease management.
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Affiliation(s)
| | | | | | | | | | | | - Mei S Duh
- Analysis Group, Inc., Boston, MA, USA
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4
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Hemodynamic Imaging in Cerebral Diffuse Glioma-Part A: Concept, Differential Diagnosis and Tumor Grading. Cancers (Basel) 2022; 14:cancers14061432. [PMID: 35326580 PMCID: PMC8946242 DOI: 10.3390/cancers14061432] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
Diffuse gliomas are the most common primary malignant intracranial neoplasms. Aside from the challenges pertaining to their treatment-glioblastomas, in particular, have a dismal prognosis and are currently incurable-their pre-operative assessment using standard neuroimaging has several drawbacks, including broad differentials diagnosis, imprecise characterization of tumor subtype and definition of its infiltration in the surrounding brain parenchyma for accurate resection planning. As the pathophysiological alterations of tumor tissue are tightly linked to an aberrant vascularization, advanced hemodynamic imaging, in addition to other innovative approaches, has attracted considerable interest as a means to improve diffuse glioma characterization. In the present part A of our two-review series, the fundamental concepts, techniques and parameters of hemodynamic imaging are discussed in conjunction with their potential role in the differential diagnosis and grading of diffuse gliomas. In particular, recent evidence on dynamic susceptibility contrast, dynamic contrast-enhanced and arterial spin labeling magnetic resonance imaging are reviewed together with perfusion-computed tomography. While these techniques have provided encouraging results in terms of their sensitivity and specificity, the limitations deriving from a lack of standardized acquisition and processing have prevented their widespread clinical adoption, with current efforts aimed at overcoming the existing barriers.
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Byrne A, Torrens-Burton A, Sivell S, Moraes FY, Bulbeck H, Bernstein M, Nelson A, Fielding H. Early palliative interventions for improving outcomes in people with a primary malignant brain tumour and their carers. Cochrane Database Syst Rev 2022; 1:CD013440. [PMID: 34988973 PMCID: PMC8733789 DOI: 10.1002/14651858.cd013440.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Primary malignant brain tumours can have an unpredictable course, but high-grade gliomas typically have a relentlessly progressive disease trajectory. They can cause profound symptom burden, affecting physical, neurocognitive, and social functioning from an early stage in the illness. This can significantly impact on role function and on the experiences and needs of informal caregivers. Access to specialist palliative and supportive care early in the disease trajectory, for those with high-grade tumours in particular, has the potential to improve patients' and caregivers' quality of life. However, provision of palliative and supportive care for people with primary brain tumours - and their informal caregivers - is historically ill-defined and ad hoc, and the benefits of early palliative interventions have not been confirmed. It is therefore important to define the role and effectiveness of early referral to specialist palliative care services and/or the effectiveness of other interventions focused on palliating disease impact on people and their informal caregivers. This would help guide improvement to service provision, by defining those interventions which are effective across a range of domains, and developing an evidence-based model of integrated supportive and palliative care for this population. OBJECTIVES To assess the evidence base for early palliative care interventions, including referral to specialist palliative care services compared to usual care, for improving outcomes in adults diagnosed with a primary brain tumour and their carers. SEARCH METHODS We conducted searches of electronic databases, CENTRAL, MEDLINE, CINAHL, Web of Science, and PsycINFO (last searched 16 November 2021). We conducted searches to incorporate both qualitative and quantitative search terms. In addition to this, we searched for any currently recruiting trials in ClinicalTrials.gov and in the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal, and undertook citation tracking via Scopus. We also handsearched reference lists of potentially eligible systematic review articles to identify any other relevant studies, contacted experts in the field and searched key authors via Web of Science and searched SIGLE (System of Information on Grey Literature in Europe). SELECTION CRITERIA We included studies looking at early referral to specialist palliative care services - or early targeted palliative interventions by other healthcare professionals - for improving quality of life, symptom control, psychological outcomes, or overall survival as a primary or secondary outcome measure. Studies included randomised controlled trials (RCTs), non-randomised studies (NRS), as well as qualitative and mixed-methods studies where both qualitative and quantitative data were included. Participants were adults with a confirmed radiological and/or histological diagnosis of a primary malignant brain tumour, and/or informal adult carers (either at individual or family level) of people with a primary malignant brain tumour. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodological procedures for data extraction, management, and analysis. We used GRADE to assess the certainty of the evidence for symptom control, i.e. cognitive function. MAIN RESULTS We identified 9748 references from the searches, with 8337 remaining after duplicates were removed. After full-text review, we included one trial. There were no studies of early specialist palliative care interventions or of early, co-ordinated generalist palliative care approaches. The included randomised trial addressed a single symptom area, focusing on early cognitive rehabilitation, administered within two weeks of surgery in a mixed brain tumour population, of whom approximately half had a high-grade glioma. The intervention was administered individually as therapist-led computerised exercises over 16 one-hour sessions, four times/week for four weeks. Sessions addressed several cognitive domains including time orientation, spatial orientation, visual attention, logical reasoning, memory, and executive function. There were no between-group differences in outcome for tests of logical-executive function, but differences were observed in the domains of visual attention and verbal memory. Risk of bias was assessed and stated as high for performance bias and attrition bias but for selective reporting it was unclear whether all outcomes were reported. We considered the certainty of the evidence, as assessed by GRADE, to be very low. AUTHORS' CONCLUSIONS Currently there is a lack of research focusing on the introduction of early palliative interventions specifically for people with primary brain tumours, either as co-ordinated specialist palliative care approaches or interventions focusing on a specific aspect of palliation. Future research should address the methodological shortcomings described in early palliative intervention studies in other cancers and chronic conditions. In particular, the specific population under investigation, the timing and the setting of the intervention should be clearly described and the standardised palliative care-specific components of the intervention should be defined in detail.
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Affiliation(s)
- Anthony Byrne
- Cardiff and Vale University Health Board, Llandough Hospital, Penarth, UK
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Anna Torrens-Burton
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Stephanie Sivell
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Fabio Ynoe Moraes
- Department of Oncology, Division of Radiation Oncology, Kingston Health Sciences Centre, Kingston, Canada
| | | | - Mark Bernstein
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Helen Fielding
- Palliative Medicine, Abertawe Bro Morgannwg University Health Board, Swansea, UK
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6
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Au TH, Willis C, Reblin M, Peters KB, Nghiemphu PL, Taylor JW, Colman H, Cohen AL, Ormond DR, Chakravarti A, Willmarth N, Menon J, Ma J, Bauer H, Watanabe AH, Ulrich CM, Singh P, Marshall A, Korytowsky B, Stenehjem D, Brixner D. Caregiver burden by treatment and clinical characteristics of patients with glioblastoma. Support Care Cancer 2021; 30:1365-1375. [PMID: 34510238 PMCID: PMC8727395 DOI: 10.1007/s00520-021-06514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/20/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Glioblastoma is an incurable disease with a poor prognosis. For caregivers of people with glioblastoma, the burden of care can be high. Patients often present with different clinical characteristics, which may impact caregiver burden in different ways. This study aimed to evaluate associations between patient clinical characteristics and caregiver burden/quality of life (QoL). METHODS Caregiver-patient dyads were enrolled at 7 academic cancer centers in the United States. Eligible caregiver participants were self-reported as the primary caregiver of an adult living with glioblastoma and completed a caregiver burden survey. Eligible patients were age ≥ 18 years at glioblastoma diagnosis and alive when their respective caregiver entered the study, with the presence of cognitive dysfunction confirmed by the caregiver. Data were analyzed with descriptive statistics and multivariable analyses. RESULTS The final cohort included 167 dyads. Poor patient performance status resulted in patient difficulty with mental tasks, more caregiving tasks, and increased caregiving time. Language problems were reported in patients with left-sided lesions. Patient confusion was negatively associated with all caregiver domains: emotional health, social health, general health, ability to work, confidence in finances, and overall QoL. Better caregiver QoL was observed in patients with frontal lobe lesions versus non-frontal lobe lesions. CONCLUSION This study reinforced that patient performance status is a critical clinical factor that significantly affects caregiver burden, caregiving tasks, and caregiver time. Additionally, patient confusion affects multiple facets of caregiver burden/QoL. These results could be used to support guided intervention for caregiver support, customized to the patient experience.
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Affiliation(s)
- Trang H Au
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Connor Willis
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Katherine B Peters
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | | | - Jennie W Taylor
- Departments of Neurology and Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Howard Colman
- Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Adam L Cohen
- Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - D Ryan Ormond
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Arnab Chakravarti
- Department of Radiation Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Jyothi Menon
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Junjie Ma
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Hillevi Bauer
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Alexandre H Watanabe
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Cornelia M Ulrich
- Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - David Stenehjem
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.,Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, USA
| | - Diana Brixner
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
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7
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Gutiérrez-Sánchez D, Gómez-García R, López-Medina IM, Cuesta-Vargas AI. Psychometric Testing of the Spanish Modified Version of the Mini-Suffering State Examination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157821. [PMID: 34360115 PMCID: PMC8345708 DOI: 10.3390/ijerph18157821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 01/04/2023]
Abstract
Background: The mini-suffering state examination is a valid and reliable measure that have been used to assess suffering in patients with advanced cancer. The aim of this study was to carry out a psychometric analysis of the Spanish version of the mini-suffering state examination. Method: A validation study was conducted. Seventy-two informal caregivers of deceased patients in palliative care were included in this study. A psychometric testing of content validity, internal consistency, and convergent validity with the Spanish version of the quality of dying and death questionnaire was performed. Results: The original instrument was modified to be used by informal caregivers. The content validity was acceptable (0.96), and the internal consistency was moderate (α = 0.67). Convergent validity was demonstrated (r = −0.64). Conclusion: The Spanish modified version of the MSSE showed satisfactory measurement properties. The Spanish modified version of MSSE can be useful to facilitate screening, monitor progress, and guide treatment decisions in end-of-life cancer patients.
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Affiliation(s)
- Daniel Gutiérrez-Sánchez
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain
- Biomedical Research Institute of Málaga (IBIMA), 29071 Málaga, Spain; (R.G.-G.); (A.I.C.-V.)
- Correspondence:
| | - Rafael Gómez-García
- Biomedical Research Institute of Málaga (IBIMA), 29071 Málaga, Spain; (R.G.-G.); (A.I.C.-V.)
- Fundación Cudeca, 29631 Málaga, Spain
| | - Isabel María López-Medina
- Research Group Nursing and Innovation in Healthcare (CuiDsalud), Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain;
| | - Antonio I. Cuesta-Vargas
- Biomedical Research Institute of Málaga (IBIMA), 29071 Málaga, Spain; (R.G.-G.); (A.I.C.-V.)
- Department of Physiotherapy, University of Málaga, 29071 Málaga, Spain
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4059, Australia
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8
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Chen D, Zhu J, Xu Q, Wang F, Ji C, Di H, Yuan P, Bai X, Chen L. The role of informal caregivers for patients with glioma: a systematic review and meta-synthesis of qualitative studies. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1020. [PMID: 34277820 PMCID: PMC8267327 DOI: 10.21037/atm-21-2761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/17/2021] [Indexed: 12/21/2022]
Abstract
Background This study aimed to systematically review, appraise, and synthesize the current evidence on the experiences and needs encountered by informal caregiver of patients with glioma throughout the disease trajectory and to provide a set of practical implications for health professionals. Methods Seven English databases and four Chinese databases were searched in this systematic review and meta-analysis. Additional manual searches were completed to identify primary studies, with the language limited by English and Chinese. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research was used to appraise the methodological quality of each study. Results The systematic review included 16 papers that yielded 71 findings and 6 categories. Finally, 2 synthesized findings were extracted: (I) role transition of caregivers for glioma patients throughout the disease trajectory; (II) support and information need by caregivers of glioma patients. Accordingly, there is a need to recognize the importance of permanent and tailored support for caregivers by providing accurate, practical, and evidence-based information. Discussion This is the first attempt to systematically evaluate the breadth and quality of the literature concerning the experiences of caregivers with glioma patients. The results generated from the review may shed some light on problems encountered by glioma patients and their families. A limitation of this review is that in most selected studies, the reflexivity of interviewees is not addressed, which may influence the interpretation of the findings. Moreover, the selected studies were reported in English or Chinese, therefore, caution is needed in interpreting the results.
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Affiliation(s)
- Dan Chen
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jinfeng Zhu
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.,Medical School of Nanjing University, Nanjing, China
| | - Qiuning Xu
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Fang Wang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Cuiling Ji
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Hengdan Di
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ping Yuan
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaoyan Bai
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Lu Chen
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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9
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Chikada A, Takenouchi S, Arakawa Y, Nin K. A descriptive analysis of end-of-life discussions for high-grade glioma patients. Neurooncol Pract 2021; 8:345-354. [PMID: 34061125 DOI: 10.1093/nop/npab010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background End-of-life discussions (EOLDs) in patients with high-grade glioma (HGG) have not been well described. Therefore, this study examined the appropriateness of timing and the extent of patient involvement in EOLDs and their impact on HGG patients. Methods A cross-sectional survey was conducted among 105 bereaved families of HGG patients at a university hospital in Japan between July and August 2019. Fisher's exact test and the Wilcoxon rank-sum test were used to assess the association between patient participation in EOLDs and their outcomes. Results In total, 77 questionnaires were returned (response rate 73%), of which 20 respondents replied with refusal documents. Overall, 31/57 (54%) participated in EOLDs at least once in acute hospital settings, and a significant difference was observed between participating and nonparticipating groups in communicating the patient's wishes for EOL care to the family (48% vs 8%, P = .001). Moreover, >80% of respondents indicated that the initiation of EOLDs during the early diagnosis period with patients and families was appropriate. Most EOLDs were provided by neurosurgeons (96%), and other health care providers rarely participated. Additionally, patient goals and priorities were discussed in only 28% of the EOLDs. Patient participation in EOLDs was not associated with the quality of EOL care and a good death. Conclusions Although participation in EOLDs is relatively challenging for HGG patients, this study showed that participation in EOLDs may enable patients to express their wishes regarding EOL care. It is important to initiate EOLDs early on through an interdisciplinary team approach while respecting patient goals and priorities.
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Affiliation(s)
- Ai Chikada
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sayaka Takenouchi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuko Nin
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Cantisano N, Menei P, Roualdes V, Seizeur R, Allain P, Le Gall D, Roy A, Dinomais M, Besnard J. Patient-reported functional executive challenges and caregiver confirmation in adult brain tumor survivors. J Cancer Surviv 2020; 15:696-705. [PMID: 33106993 DOI: 10.1007/s11764-020-00961-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/18/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The main objective of this study was to provide further information concerning the validity of patient-reported executive function (EF) in survivors of primary brain tumor (PBT) compared with a report provided by each patient's caregiver. METHODS Forty survivors of PBT, 40 non-cancer controls and their proxies completed an assessment of functional executive disorders (e.g., planning, inhibition, shifting, action initiation). Comparisons of self and informant EF reports were examined, for both patients and non-cancer controls. The extent of the concordance between patients' reports and their caregivers' reports was also determined. RESULTS PBT survivors and their caregivers reported more problems related to EF in contrast with the non-cancer comparison group (significant differences). There was a high level of agreement between patients' and caregivers' ratings within the patient group. CONCLUSIONS This study provides evidence suggesting that at an average of 3.67 (SD = 2.31) years following treatment for a PBT, EF difficulties are reported by patients and their caregivers. This study establishes a consistency between what is reported by survivors and what is reported by those who frequently interact with them. Further research investigating the link between these ratings and quality of life as well as other functions is encouraged. IMPLICATIONS FOR CANCER SURVIVORS This study's results demonstrate the importance of listening to PBT survivors' perception of EF difficulties. While not confirmed by neuropsychological evaluations, the functional executive challenges reported by these survivors' close relatives reflect what PBT survivors themselves report. Specialists should pay close attention to these difficulties to guarantee optimal post-cancer care.
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Affiliation(s)
- Nicole Cantisano
- Centre d'Etudes en Psychopathologie et Psychologie de la Santé (EA 7411), University of Toulouse Jean Jaurès, Toulouse, France
| | - Philippe Menei
- Department of Neurosurgery, Angers University Hospital, Angers, France
| | - Vincent Roualdes
- Department of Neurosurgery, Nantes University Hospital, Nantes, France
| | - Romuald Seizeur
- Department of Neurosurgery, Brest Regional University Hospital, Brest, France
| | - Philippe Allain
- Department of Neurology, Angers University Hospital, Angers, France
- Laboratoire de Psychologie des Pays de la Loire (EA 4638), University of Angers, Angers, France
| | - Didier Le Gall
- Department of Neurology, Angers University Hospital, Angers, France
- Laboratoire de Psychologie des Pays de la Loire (EA 4638), University of Angers, Angers, France
| | - Arnaud Roy
- Laboratoire de Psychologie des Pays de la Loire (EA 4638), University of Angers, Angers, France
- Centre Référent des Troubles d'Apprentissage et Centre de Compétence Nantais de Neurofibromatose, Nantes University Hospital, Nantes, France
| | - Mickaël Dinomais
- Department of Pediatric Physical Medicine and Rehabilitation, Angers University Hospital, Angers, France
| | - Jérémy Besnard
- Laboratoire de Psychologie des Pays de la Loire (EA 4638), University of Angers, Angers, France.
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Abstract
OPINION STATEMENT As cancer care has evolved so has the awareness of the issues cancer patients, their caregivers and families face during and after treatment, giving rise to the cancer survivorship care initiative. The body of research pertaining to quality of life, health-related quality of life, and multidimensional symptom burden of neuro-oncology patients and their caregivers has grown significantly, yielding a wealth of data and information indicating interventions and actions targeting symptoms and needs are both warranted and desired. The provision of survivorship care aiming to deliver care in a patient-centered, whole-person model offers a means by which these interventions and actions can be actualized. The research specific to survivorship care models and survivorship care plans and their delivery remains a large opportunity, one worth the careful consideration and participation of neuro-oncology healthcare providers for the benefit of their highly deserving patients and their caregivers and families.
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Byrne A, Sivell S, Moraes FY, Bulbeck H, Torrens-Burton A, Bernstein M, Nelson A, Fielding H. Early palliative interventions for improving outcomes in people with a primary malignant brain tumour and their carers. Hippokratia 2019. [DOI: 10.1002/14651858.cd013440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anthony Byrne
- Llandough Hospital; Cardiff and Vale University Health Board; Penlan Road Penarth Vale of Glamorgan UK CF64 2XX
- School of Medicine, Cardiff University; Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine; Cardiff UK
| | - Stephanie Sivell
- School of Medicine, Cardiff University; Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine; Cardiff UK
| | - Fabio Ynoe Moraes
- Kingston Health Sciences Centre; Department of Oncology, Division of Radiation Oncology; Queen's University 25 King St W Kingston ON Canada K7L 5P9
| | - Helen Bulbeck
- brainstrust; Director of Services; 4 Yvery Court Castle Road Cowes Isle of Wight UK PO31 7QG
| | - Anna Torrens-Burton
- School of Medicine, Cardiff University; Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine; Cardiff UK
| | - Mark Bernstein
- University of Toronto; Faculty of Medicine; Toronto Ontario Canada
| | - Annmarie Nelson
- School of Medicine, Cardiff University; Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine; Cardiff UK
| | - Helen Fielding
- Abertawe Bro Morgannwg University Health Board; Palliative Medicine; Singleton Hospital Sketty Lane Swansea UK SA2 8QA
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Rosenlund L, Degsell E, Jakola AS. Moving from clinician-defined to patient-reported outcome measures for survivors of high-grade glioma. Patient Relat Outcome Meas 2019; 10:267-276. [PMID: 31692481 PMCID: PMC6711557 DOI: 10.2147/prom.s179313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/23/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Persons with high-grade glioma face both neurological and cancer-related symptoms from the tumor itself and its treatment affecting their daily lives. Survival alone is not an adequate outcome, the quality of the survivorship experience needs to be regarded with equal importance. Patient-reported outcome (PRO) measures can be used to evaluate treatment effects and symptom management interventions. PURPOSE The aim of this review was to identify the use, challenges, and potential of PRO measures in survivors of high-grade glioma. METHODS A narrative expert opinion review was performed on the subject. In addition to our own experiences we searched PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and PsycINFO for brain tumor-specific PRO measures used in the population of adult patients with high-grade glioma, both original articles and reviews were included. RESULTS There are several PRO measures that have been validated for patients with primary brain tumors including high-grade glioma. PRO measures are used both in clinical trials to evaluate the effect of treatment on health-related quality of life, and in daily clinical practice for holistic needs assessment and symptom management. Common PRO measures used for patients with high-grade glioma are European Organization for Research and Treatment of Cancer general instrument for patients with cancer together with brain tumor module, Functional Assessment of Cancer Therapy-Brain, and MD Anderson Symptom Inventory for Brain Tumor. Neurologic and cognitive disorders often occur in patients with high-grade glioma, which affects patients' ability to self-report over time, making it more challenging in this population. PRO as a primary outcome seems underutilized. CONCLUSION For clinical research, PRO measures need to be used together with other clinical outcome measures rather than replacing traditional outcome measures. Moving to more use of PRO measures in survivorship care has potential to improve patient-caregiver-healthcare team communication, symptom management, and quality of care. Implementing PROs in survivorship care should also involve caregivers and a response based on the results.
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Affiliation(s)
- Lena Rosenlund
- Regional Cancer Centre Stockholm, Stockholm, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - Eskil Degsell
- Regional Cancer Centre Stockholm, Stockholm, Sweden
- Malignant Brain Tumor Pathway, Quality and Patient Safety Department, Karolinska University Hospital, Stockholm, Sweden
- The Swedish Brain Tumor Association, Stockholm, Sweden
| | - Asgeir Store Jakola
- Department of Clinical Neurosciences, Institute of Physiology and Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
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14
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Li C, Feng S, Chen L. MicroRNA-142-3p inhibits proliferation and induces apoptosis by targeting the high-mobility group box 1 via the Wnt/β-catenin signaling pathway in glioma. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:4493-4502. [PMID: 31949846 PMCID: PMC6962963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/30/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND Glioma is one of the most common brain tumors. Copious microRNAs have been identified as critical regulators in the development of glioma. MicroRNA-142-3p (miR-142-3p) has been reported as a tumor suppressor in some malignancies. However, the roles and molecular mechanisms of miR-142-3p in the development of glioma are poorly defined. METHODS An RT-qPCR assay was carried out to detect expressions of miR-142-3p and high-mobility group box 1 (HMGB1) mRNA. A bioinformatic analysis and a luciferase reporter assay were used to explore the interaction between miR-142-3p and HMGB1 3'UTR. A Western blot assay was performed to examine protein expression of HMGB1, c-myc, cleaved caspase-3, and β-catenin. Cell proliferative ability was assessed by an MTS assay. The cell apoptotic rate was measured using flow cytometry via the double-staining of Annexin V-FITC and propidium iodide (PI). RESULTS MiR-142-3p expression was remarkably reduced in glioma tissues. Mechanical analyses showed that HMGB1 was a target of miR-142-3p. Functional investigations revealed that miR-142-3p suppressed proliferation and induced apoptosis by targeting HMGB1 in glioma cells. Moreover, miR-142-3p inactivated Wnt/β-catenin signaling and activated caspase-3 signaling by targeting HMGB1 in glioma cells. CONCLUSION MiR-142-3p inhibits proliferation and induces apoptosis by targeting HMGB1 via the Wnt/β-catenin signaling pathway in glioma cells, providing a deep exploration into the roles and molecular basis of miR-142-3p in the proliferation and apoptosis of glioma cells and highlighting the therapeutical values of miR-142-3p and HMGB1 for glioma.
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Affiliation(s)
- Chong Li
- Department of Neurosurgery, Chinese PLA General Hospital Beijing, China
| | - Shiyu Feng
- Department of Neurosurgery, Chinese PLA General Hospital Beijing, China
| | - Ling Chen
- Department of Neurosurgery, Chinese PLA General Hospital Beijing, China
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Stieb S, Fischbeck S, Wagner W, Appels J, Wiewrodt D. High psychosocial burden in relatives of malignant brain tumor patients. Clin Neurol Neurosurg 2018; 170:1-6. [PMID: 29709767 DOI: 10.1016/j.clineuro.2018.04.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/10/2018] [Accepted: 04/22/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Not only tumor patients suffer enormously from their disease, also the caregivers are massively affected by the disease of their relatives. In this study, we investigate the psychological burden in caregivers of outpatient malignant brain tumor patients. PATIENTS AND METHODS Fifty caregivers of patients with primary malignant brain tumors were included in our study. Study participants filled in a form with demographic details, a self-established questionnaire concerning general well-being and three established psychological questionnaires to assess anxiety, depression, stress and social support: The "Hospital Anxiety and Depression Scale" (HADS), the "Perceived Stress Scale" (PSS-10) and the "Social Support Questionnaire" (F-SozU). RESULTS Caregivers of patients with primary malignant brain tumors showed in the HADS clinically relevant anxiety in 49% and depression in 20% of the cases. The stress level of the caregivers was increased (mean: 18 points) compared to the general population mean: 13 points), although they felt well supported by their social environment (mean: 4.25 points; general population 3.99 points). There was a significant positive correlation between anxiety and depression (p < 0.001). Female caregivers suffered significantly more from anxiety (p = 0.017) and stress (p = 0.012) than their male counterparts. No correlation was found between tumor grade, age of relatives and patients or the state of living together with the patient and anxiety or depression. CONCLUSIONS Although the caregivers felt well supported by their social environment, stress, anxiety and depression are common phenomena in caregivers of patients with malignant brain tumors. Especially female ones have an increased risk for developing these comorbidities.
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Affiliation(s)
- Sonja Stieb
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Switzerland.
| | - Sabine Fischbeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Psychology and Medical Sociology, Johannes Gutenberg University Mainz, Germany.
| | - Wolfgang Wagner
- Department of Neurosurgery, University Hospital Mainz, Germany.
| | - Julia Appels
- Department of Neurosurgery, University Hospital Muenster, Germany.
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Do carer’s levels of unmet needs change over time when caring for patients diagnosed with high-grade glioma and how are these needs correlated with distress? Support Care Cancer 2017; 26:275-286. [DOI: 10.1007/s00520-017-3846-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/24/2017] [Indexed: 12/27/2022]
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17
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Hsu T, Loscalzo M, Ramani R, Forman S, Popplewell L, Clark K, Katheria V, Strowbridge R, Rinehart R, Smith D, Matthews K, Dillehunt J, Feng T, Smith D, Sun C, Hurria A. Are Disagreements in Caregiver and Patient Assessment of Patient Health Associated with Increased Caregiver Burden in Caregivers of Older Adults with Cancer? Oncologist 2017; 22:1383-1391. [PMID: 28808093 PMCID: PMC5679832 DOI: 10.1634/theoncologist.2017-0085] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/08/2017] [Indexed: 12/27/2022] Open
Abstract
Cancer‐related therapy is increasingly administered in the outpatient setting, resulting in increased dependence on caregivers suggest to provide physical and emotional support to patients. This article describes differences in patient versus caregiver assessments of patient health, considering caregiver perceptions of the patient's health and abilities compared to that reported by the patient. Background. As patients age, caregivers increasingly provide essential support and patient information. We sought to determine if patient‐caregiver assessments of patient health differ and if differences contribute to burden in caregivers of older adults with cancer. Materials and Methods. One hundred patients, aged ≥65, and their caregivers independently assessed patient function, comorbidity, nutrition, social activity, social support, and mental health. Caregivers completed the Caregiver Strain Index (CSI). Patient‐caregiver assessments were compared using the Wilcoxon signed rank test and paired t test. Association between caregiver burden and differences between patient‐caregiver assessments was examined using generalized linear regression. Results. Median patient age was 70 (range 65–91) and 70% had advanced disease. Sixty percent of patients reported requiring help with instrumental activities of daily living (IADLs); most had good social support (median Medical Outcomes Study [MOS]‐Social Support Survey score 92) and mental health (median Mental Health Inventory score 85). Caregivers were a median age of 66 (range 28–85), 73% female, 68% spousal caregivers, and 79% lived with the patient. Caregivers rated patients as having poorer physical function (more IADLs dependency [p = .008], lower Karnofsky Performance Status [p = .02], lower MOS‐Physical Function [p < .0001]), poorer mental health (p = .0002), and having more social support (p = .03) than patients themselves. Three‐quarters of caregivers experienced some caregiver burden (mean CSI score 3.1). Only differences in patient‐caregiver assessment of the patient's need for help with IADLs were associated with increased caregiver burden (p = .03). Conclusion. Patient‐caregiver assessments of patient function, mental health, and social support differ. However, only differences in assessment of IADLs dependency were associated with increased caregiver burden. Implications for Practice. As patients age, there is a higher incidence of frailty and cognitive impairments. As a result, caregivers play an increasingly vital role in providing information about patient health to healthcare providers, which is used to help healthcare providers tailor treatments and optimize patient health. These findings highlight that caregiver reporting in older adults with cancer may not replace patient reporting in those older adults who are otherwise able to self‐report. Furthermore, clinicians should check for caregiver burden in caregivers who report providing more help with instrumental activities of daily living than patients themselves report and provide appropriate support as needed.
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Affiliation(s)
- Tina Hsu
- City of Hope National Medical Center, Duarte, California, USA
| | | | - Rupal Ramani
- City of Hope National Medical Center, Duarte, California, USA
| | - Stephen Forman
- City of Hope National Medical Center, Duarte, California, USA
| | | | - Karen Clark
- City of Hope National Medical Center, Duarte, California, USA
| | - Vani Katheria
- City of Hope National Medical Center, Duarte, California, USA
| | - Rex Strowbridge
- City of Hope National Medical Center, Duarte, California, USA
| | | | - Dan Smith
- City of Hope National Medical Center, Duarte, California, USA
| | - Keith Matthews
- City of Hope National Medical Center, Duarte, California, USA
| | - Jeff Dillehunt
- City of Hope National Medical Center, Duarte, California, USA
| | - Tao Feng
- City of Hope National Medical Center, Duarte, California, USA
| | - David Smith
- City of Hope National Medical Center, Duarte, California, USA
| | - Canlan Sun
- City of Hope National Medical Center, Duarte, California, USA
| | - Arti Hurria
- City of Hope National Medical Center, Duarte, California, USA
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Halkett GKB, Lobb EA, Shaw T, Sinclair MM, Miller L, Hovey E, Nowak AK. Distress and psychological morbidity do not reduce over time in carers of patients with high-grade glioma. Support Care Cancer 2016; 25:887-893. [DOI: 10.1007/s00520-016-3478-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022]
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Quality of life discordance between terminal cancer patients and family caregivers: a multicenter study. Support Care Cancer 2016; 24:2853-60. [PMID: 26838021 DOI: 10.1007/s00520-016-3108-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/26/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Research studies on quality of life (QOL) discordance between cancer patients and family caregivers are limited, and the results are inconsistent. The objective of this study was to examine QOL discordance between patients and family caregivers in a hospice setting and to identify factors associated with the discordance. METHODS We enrolled 178 patient-family caregiver pairs from six tertiary hospital hospice palliative care units in South Korea in this cross-sectional study. To establish groupings based on patient and family caregiver QOL levels, we measured the QOL of patient and family caregiver pairs using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 for Palliative Care and the Caregiver QOL Index-Cancer, respectively. Pairs were categorized into the following three groups: both good QOL pairs, only poor patient QOL, and only poor family caregiver QOL. Factors associated with only poor patient or only poor family caregiver QOL were compared to both good QOL pairs. A stepwise multivariate regression model was used to identify relevant factors. RESULTS The QOL of family caregivers did not correlate significantly (P = 0.227) with QOL in terminally ill cancer patients. As well, poor emotional function in patients was the only significant factor associated with the only poor patient QOL group [adjusted odds ratio (aOR), 4.1; 95 % confidence interval (CI), 1.5-11.5]. However, emotionally distressed family caregivers (aOR, 10.2; 95 % CI, 2.8-37.5), family caregivers who professed a religion (aOR, 4.1; 95 % CI, 1.5-11.3), and family caregivers with low social support (aOR, 3.9; 95 % CI, 1.5-10.6) were independent predictors for the only poor family caregiver QOL group. CONCLUSIONS Assessing the respective emotional status of both the patient and family caregiver is needed in hospice care to reduce the gap in QOL between the two groups. Further, more attention should be paid to the lack of social support for family caregivers.
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Primary brain tumor patients’ supportive care needs and multidisciplinary rehabilitation, community and psychosocial support services: awareness, referral and utilization. J Neurooncol 2015; 127:91-102. [DOI: 10.1007/s11060-015-2013-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/22/2015] [Indexed: 11/29/2022]
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Long A, Halkett GKB, Lobb EA, Shaw T, Hovey E, Nowak AK. Carers of patients with high-grade glioma report high levels of distress, unmet needs, and psychological morbidity during patient chemoradiotherapy. Neurooncol Pract 2015; 3:105-112. [PMID: 31386072 DOI: 10.1093/nop/npv039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Indexed: 11/14/2022] Open
Abstract
Background Few studies have explored the unmet needs of carers of people with high-grade glioma. We aimed to determine carers' levels of distress during treatment, understand their support needs and explore predictors of distress. Methods Carers of people with high-grade glioma undergoing chemoradiotherapy were recruited to this prospective, longitudinal cohort study. Carers completed the validated Supportive Care Needs Survey, Brain Tumour Specific Supportive Care Needs Scale, Distress Thermometer (DT), and General Health Questionnaire (GHQ-12). Questionnaires were administered during patients' chemoradiotherapy and 3 and 6 months later. Results We recruited 118 carers who were mainly female (72%) and caring for spouse (82%). The mean age was 53 years (SD = 13.6; range, 21-89). Thirty-one percent of carers reported moderate distress (DT score 5-6/10) and 31% reported extreme distress (score 7-10/10) during combined chemoradiotherapy. Carer distress was associated with adverse GHQ scores (r = 0.61, P < .001). Seventy-two percent reported a negative financial impact of caring and 51% of those previously working full-time had taken leave or reduced working hours. The top 5 moderate/high unmet needs were: accessing prognostic information; accessing financial support and government benefits; accessible hospital parking; impact of caring on usual life; reducing stress in the patients' life. Conclusion Carers reported substantial distress, and high distress levels were correlated with greater psychological impact and increased self-reporting of unmet needs. Future research should focus on interventions that aid in reducing carer distress.
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Affiliation(s)
- Anne Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
| | - Georgia K B Halkett
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
| | - Elizabeth A Lobb
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
| | - Thérèse Shaw
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
| | - Elizabeth Hovey
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
| | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
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