Attendance at cancer follow-up clinic: does it increase anxiety or provide reassurance for men successfully treated for testicular cancer?

The Burden of Cystoscopic Bladder Cancer Surveillance: Anxiety, Discomfort, and Patient Preferences for Decision Making

OBJECTIVE

To examine discomfort, anxiety, and preferences for decision making in patients undergoing surveillance cystoscopy for non-muscle-invasive bladder cancer (NMIBC).

METHODS

Veterans with a prior diagnosis of NMIBC completed validated survey instruments assessing procedural discomfort, worry, and satisfaction, and were invited to participate in semistructured focus groups about their experience and desire to be involved in surveillance decision making. Focus group transcripts were analyzed qualitatively, using (1) systematic iterative coding, (2) triangulation involving multiple perspectives from urologists and an implementation scientist, and (3) searching and accounting for disconfirming evidence.

RESULTS

Twelve patients participated in 3 focus groups. Median number of lifetime cystoscopy procedures was 6.5 (interquartile range 4-10). Based on survey responses, two-thirds of participants (64%) experienced some degree of procedural discomfort or worry, and all participants reported improvement in at least 2 dimensions of overall well-being following cystoscopy. Qualitative analysis of the focus groups indicated that participants experience preprocedural anxiety and worry about their disease. Although many participants did not perceive themselves as having a defined role in decision making surrounding their surveillance care, their preferences to be involved in decision making varied widely, ranging from acceptance of the physician's recommendation, to uncertainty, to dissatisfaction with not being involved more in determining the intensity of surveillance care.

CONCLUSION

Many patients with NMIBC experience discomfort, anxiety, and worry related to disease progression and not only cystoscopy. Although some patients are content to defer surveillance decisions to their physicians, others prefer to be more involved. Future work should focus on defining patient-centered approaches to surveillance decision making.

The meaning and significance of routine follow-up in lung cancer - a qualitative study of patients' experiences and interpretations

PURPOSE

Questions have been raised about the benefits of routine follow-up for patients with lung cancer and a number of studies have now explored alternative models of care for this patient group. This study explores the experiences of lung cancer patients attending routine follow-up and illustrates factors which might influence patients' interpretations of the meaning and significance of follow-up.

METHOD

This qualitative study was undertaken to gain insight into patients' experiences of attending routine follow-up clinics after treatment completion. A purposive sample of ten patients was interviewed, including patients of both genders, different lung cancer types, treatment intent, treatment received, performance status and experience of follow-up.

RESULTS

Analysis of the transcripts revealed patients' confidence and faith in their consultants and the importance of having a connection with the oncology department. The meaning and significance of follow-up is constructed by what they bring to the consultation (anxiety, vulnerability, uncertainty, symptoms) as well as what happens within that consultation (reassurance, relief, encouragement). Although some participants were anxious about attending, all express expectation and desire for follow-up to continue. Many were, however, prepared to consider nurse-led follow-up.

CONCLUSION

Although small, this study highlights the significance that patients with lung cancer attach to attending follow-up clinics and the need to consider patients' experiences in the design of future follow-up care and also consideration should be given to complementary and innovative approaches to follow-up.

The Quality of Life and Hormonal Disturbances in Testicular Cancer Survivors in Cisplatin Era

OBJECTIVES

To assess the degree of hormonal abnormalities in testicular cancer survivors and the effect of these changes on patients' quality of life.

METHODS

Men with complete remission of testicular cancer for over 2 yr were eligible. Patients completed the State-Trait Anxiety Inventory (STAI), the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), the International Index of Erectile Function (IIEF), and the Sexual Functioning Questionnaire (SFQ), and rated their physical and psychological well-being, quality of life, and relationship with their partner. Levels of the hormones testosterone, estradiol, thyreotropin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin were determined. Relationships between hormone levels and questionnaire results were assessed.

RESULTS

A total of 326 men were tested, of whom 269 were treated with platinum-based chemotherapy. The most common endocrine abnormalities were above-normal gonadotropin levels (LH, 55%, and FSH, 49% of cases) and lowered testosterone (15%). Twenty-seven percent (STAI) and 28% (HADS) of the patients had abnormal anxiety levels, while the depression rate was 15% (BDI) and 18% (HADS); 40% of patients had erectile dysfunction. Linear regression analysis excluding the influence of age showed higher depression levels in the BDI among patients with elevated LH (p=0.010) or FSH (p=0.017). Patients with above-normal LH showed increased sexual problems in the SFQ (p=0.030). Elevated gonadotropins correlated with deteriorated physical well-being (p=0.028). Men with abnormal estradiol were more prone to erectile dysfunction (p=0.009).

CONCLUSIONS

Hormonal abnormalities have a negative impact on the quality of life of testicular cancer survivors.

Involving users in service planning: A focus group approach

This paper outlines the way in which a focus group approach was used to involve service users in the possible reconfiguration of follow-up services for breast cancer patients at a North London hospital. The focus group was used to identify the priority issues for users and the development of an objective questionnaire, to survey all current service users. Within the National Health Service (NHS) the concept of user involvement has been embodied in contemporary health policy, and has become an important constituent of current policy direction. This study was the first stage of a larger stakeholder project that aimed to involve service users and clinicians in developing a new model of breast cancer follow-up service. From the focus group emerged five key themes around breast cancer follow up. They were: The need for reassurance after the diagnosis of cancer. Continuity of care. Privacy and dignity and other elements of the examination technique. Information and the detection of new symptoms. The opportunity to discuss feelings and worries. In this paper, the nature of breast cancer follow-up services is outlined, and the difficulties associated with such services are discussed. The background to user involvement within the United Kingdom is explored, and the strategies that have previously been used are considered. The practical issues involved in using the focus group approach are examined, and the experience of using such an approach is outlined in this study. The involvement of service users as a key stakeholder in the process of planning change, through a participatory research strategy, ensured that their voices were heard alongside those of both hospital and primary care staff.

Follow-up for people with cancer: nurse-led services and telephone interventions

BACKGROUND

Questions about the suitability of traditional outpatient follow-up clinics as a way of providing on-going monitoring for patients following serious illness have led to the development of a range of nurse-led services. However, there has been little attempt to draw some of this knowledge together formally and consider the weight of evidence on the necessity and value of nurse-led follow-up.

AIM

To provide a review of literature evaluating the impact of nurse led follow-up in cancer care, with particular focus on the use and value of telephone interventions.

METHOD

A literature search was conducted of nursing, medical and social science databases and the following keywords: cancer follow-up, nurse-led follow-up, telephone follow-up, telephone-based interventions and telephone survey. The search yielded over 150 papers, of which 37 were relevant to this review.

FINDINGS

The literature suggests that nurse-led follow-up for people with cancer meets their needs for psychological support and information. The telephone is identified as a suitable means of providing this kind of service.

CONCLUSION

This review demonstrates that nurse-led follow-up services are acceptable, appropriate and effective. Combined with use of the telephone, such services can be an efficient means of maintaining contact with a large client group, providing vital support to vulnerable patients during their move into aftercare and beyond.

Health care implications and space allocation of research published in nursing journals

PURPOSE

To examine how research is disseminated through nursing journals and to examine characteristics of published research.

DESIGN

A cross-sectional descriptive survey was conducted with manuscripts from 78 nursing journals that publish research.

METHOD

The final issue for 1999 was examined. Pairs of independent raters content-analyzed all research manuscripts.

DISCUSSION

Research studies comprised 241 (42.9%) of the manuscripts and 51.4% of the journal space. Many empirical studies omitted validity and reliability. Few manuscripts reported the date for completion of data collection, and fewer than one third contained the length of time from acceptance to publication.

CONCLUSIONS

Enhanced instrumentation reporting, shorter time from data collection to publication, and an increase in journal space devoted to research might enable nurses to make more cutting-edge clinical decisions.

A qualitative study of patient satisfaction with follow-up cancer care: the case of Hong Kong

This paper reports the results of a qualitative study that examined the experiences of cancer patients with the intention of incorporating consumer perspectives into the development of quality cancer care in Hong Kong. Altogether, eight focus group interviews were conducted with a total of 41 cancer patients. The results indicate that patients lack clear guidance and support regarding the management of sequelae and surveillance against recurrence. Patients also raised concerns about the lack of access to information, and the lack of health care provider accountability. Any understanding of the scope and goals of follow-up cancer care is obscured when the healthcare environment is not conducive to good doctor-patient communication. Patients are calling for more explicit goals and clinical practice guidelines to serve as frames of reference for both patients and doctors.