The Relationship Between Meaning of Illness, Social Support, Coping Strategies, and Quality of Life for Lung Cancer Patients and Their Family Members

Psychological outcomes in patients with rare cancers: a systematic review and meta-analysis

Background

Rare cancers are those that exhibit an incidence of less than six per 100,000 in a year. On average, the five-year relative survival for patients with rare cancers is worse than those with common cancers. The traumatic experience of cancer can be further intensified in patients with rare cancers due to the limited clinical evidence and the lack of empirical evidence for informed decision-making. With rare cancers cumulatively accounting for up to 25% of all cancers, coupled with the rising burden of rare cancers on societies globally, it is necessary to determine the psychological outcomes of patients with rare cancers.

Methods

This PRISMA-adherent systematic review (PROSPERO: CRD42023475748) involved a systematic search of PubMed, Embase, Cochrane and PsycINFO for all peer-reviewed English language studies published since 2000 to 30th January 2024 that evaluated the prevalence, incidence and risk of depression, anxiety, suicide, and post-traumatic stress disorder (PTSD) in patients with rare cancers. Two independent reviewers appraised and extracted the summary data from published studies. Random effects meta-analyses and meta-regression were used for primary analysis.

Findings

We included 32 studies with 57,470 patients with rare cancers. Meta-analyses indicated a statistically significant increased risk-ratio (RR) of depression (RR = 2.61, 95% CI: 1.43-4.77, I2 = 97%) and anxiety (RR = 2.66, 95% CI: 1.27-5.55, I2 = 92%) in patients with rare cancers compared to healthy controls. We identified a high suicide incidence (315 per 100,000 person-years, 95% CI: 162-609, I2 = 95%), prevalence of depression (17%, 95% CI: 14-22, I2 = 88%), anxiety (20%, 95% CI: 15-25, I2 = 96%) and PTSD (18%, 95% CI: 9-32, I2 = 25%). When compared to patients with common cancer types, suicide incidence, and PTSD prevalence were significantly higher in patients with rare cancers. Systematic review found that having advanced disease, chemotherapy treatment, lower income, and social status were risk factors for negative psychological outcomes.

Interpretation

We highlight the need for early identification of psychological maladjustment in patients with rare cancers. Additionally, studies to identify effective interventions are imperative.

Funding

This study was supported by the National Medical Research Council Transition Award, SingHealth Duke-NUS Oncology Academic Clinical Programme, the Khoo Pilot Collaborative Award, the National Medical Research Council Clinician Scientist-Individual Research Grant-New Investigator Grant, the Terry Fox Grant and the Khoo Bridge Funding Award.

Illness Perception and Quality of Life in Patients with Breast Cancer

Simple Summary

The declining average age of cancer patients may become a serious problem for health care systems and societies in general in the near future. For this reason, there is a need to fully understand the factors determining health-related quality of life in breast cancer patients, beyond clinical characteristics and sociodemographic factors. In our study, we aimed to demonstrate the relationship between illness perception and quality of life in breast cancer patients. The results of our study confirm the beneficial effect of positive illness perception on the intensity of symptoms related to cancer and treatment, as well as functional domains of EORTC QLQ-C30.

Abstract

Introduction. In 2020, breast cancer was the most frequently diagnosed malignancy worldwide. The QoL level plays a role in assessing the effectiveness of the diagnosis and therapy and is a significant prognostic factor. The subject that is relatively less often addressed in the literature is the impact of psycho-social factors and health-related beliefs on QoL in breast cancer patients. The aim of the study was to assess the association of illness perception, the sense of coherence, and illness acceptance with QoL in breast cancer patients. Methods. The study included 202 women (mean age 53.0 ± 10.3) treated surgically for breast cancer at the Lower Silesian Oncology Centre. The following standardized questionnaires were used: Acceptance of Illness Scale (AIS), Mental Adjustment to Cancer (Mini-MAC), Quality of Life Questionnaires (EORTC QLQ-C30 and QLQ-BR23), The Multidimensional Essence of Disease and Illness Scale (MEDIS), and Life Orientation Test (LOT-R). Results. There is a statistically significant association between illness acceptance and QoL. There is a statistically significant association between the sense of coherence (life optimism—LOT-R) and QoL among breast cancer patients. There is a statistically significant association between illness perception and QoL. There was a statistically significant correlation between the increasing importance of illness as a dysfunction, decreasing QoL, and increasing intensity of symptoms and complaints. Conclusions. Patients with a high level of illness acceptance, with an optimistic disposition, and with a positive illness perception have better QoL within all the functional domains and experience lower intensity of cancer- and treatment-related symptoms as compared to those with low level of illness acceptance, with moderate optimism or a pessimistic disposition, and with neutral or negative illness perception.

Exceptional Survival Among Kentucky Stage IV Non-small Cell Lung Cancer Patients: Appalachian Versus Non-Appalachian Populations

PURPOSE

To determine differences in exceptional survival (ES)-survival of 5 years or more past diagnosis-between stage IV non-small cell lung cancer (NSCLC) patients residing in the Appalachian versus non-Appalachian regions of Kentucky.

METHODS

This was a population-based, retrospective case-control study of Kentucky patients, diagnosed with stage IV NSCLC between January 1, 2000, and December 31, 2011. The data were drawn from the Kentucky Cancer Registry.

FINDINGS

Findings from the multivariable logistic regression revealed no significant differences in the odds of ES between patients who resided in Appalachian versus non-Appalachian Kentucky. Being female and undergoing surgery only as the first course of treatment were associated with higher odds of ES. Increasing age, unspecified histology, having poorly differentiated or undifferentiated carcinomas, and receiving radiation therapy only as the first course of treatment were associated with decreased odds of ES.

CONCLUSION

Differences in the odds of ES among stage IV NSCLC patients were not related to residence in Appalachian versus non-Appalachian Kentucky. ES was associated with other nongenetic and treatment factors that warrant further investigations.

Identification of the correlation between illness perception and anxiety level in cancer patients

PURPOSE

To investıgate the relationship between the perception of the disease and level of anxiety in patients with cancer.

DESIGN AND METHODS

A correlation and descriptive study from a convenience sample of 318 oncological patients aged 18 years and older was done. Subjects were measured with a Patient's Information Form, the Revised Illness Perception Questionnare, and the Strait-Trait Anxiety Inventory.

FINDINGS

When evaluated together with most of its subscales, illness perception was found to affect anxiety.

PRACTICE IMPLICATIONS

Nurses should evaluate the anxiety levels of the cancer patients in every stage and should educate the patients and their relatives on coping with anxiety. Appropriate treatment and care depending on the illness perception of the cancer patients should be planned by nurses.

Reflection of illness and strategies for handling advanced lung cancer - a qualitative analysis in patients and their relatives

Background

Lung cancer patients are often diagnosed in an advanced stage of disease. In a situation of palliative treatment, both patients and their relatives experience existential burden. Evidence suggests that multi-professional teams should deal with them as dyads. However, little is known about differences in their individual situation. The purpose of this study is to explore and compare reflections that arise out of the context of diagnosis and to compare how patients and their relatives try to handle advanced lung cancer.

Methods

Data was collected by qualitative interviews. A total of 18 participants, 9 patients diagnosed with advanced lung cancer (ICD- 10 C-34, stage IV) starting or receiving palliative treatment and 9 relatives were interviewed. Data was interpreted using qualitative content analysis.

Results

Reflection aspects were “thoughts about the cause”, “meaning of belief” and “experience of inequity”. Patients often experienced the diagnosis as inequity and were more receptive for believing in treatment success. The main strategies found were “repression”, “positive attitude”, “strong focus on the present” and “adjustment of life terms”. Patient and relative dyads used the same strategies, but with different emphasis. That life time is limited was more frequently realized by relatives than by patients.

Conclusion

While strategies used by relatives are similar to those of patients’, they are less reflective and more pragmatic in terms of handling daily life and organizing care. The interviewed patients were mostly not able to takeover these tasks. To strong was their belief in treatment success, their repression of the future and the focus on the present. This implicates, that in terms of end-of-life care, relatives are important to reach patients who are often not receptive to this topic.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-2110-x) contains supplementary material, which is available to authorized users.

Diagnosis as the First Critical Point in the Treatment Trajectory: An Exploration of Operable Lung Cancer Patients' Lived Experiences

BACKGROUND

Significant advances have been made in the surgical treatment of lung cancer while patient experiences with diagnosis, treatment, and rehabilitation remain only sparsely researched.

OBJECTIVE

The objective of this study was to investigate how the diagnosis affects the daily lives of patients with operable lung cancer in order to identify their needs for care interventions from the point of diagnosis to hospitalization.

METHODS

We investigated patients' lived experiences from a longitudinal perspective at 4 critical time points during the treatment trajectory; we present here the findings from the first time point, diagnosis. Data were collected through interviews conducted 7 to 10 days following diagnosis of lung cancer. Data from 19 patients are included, and the analysis is based on Ricoeur's interpretation theory. The study framework is inspired by Schutz's phenomenological sociology.

RESULTS

The findings are presented as themes that summarize and express the ways in which a diagnosis affects patients' daily lives: the cancer diagnosis comes as a shock, it changes everyday awareness; it presents the patient with an unfamiliar body, disturbs social relationships, forces the patient to face a new life situation, and demands one-on-one supportive care.

CONCLUSIONS

Diagnosis is the first critical point for patients with operable lung cancer and disrupts their daily life. Patients need psychosocial support during the period from diagnosis to surgical intervention and patient-tailored one-on-one information.

IMPLICATIONS FOR PRACTICE

This article contributes to the knowledge base of support needs of lung cancer patients. Interventions aimed at supportive care during the period between diagnosis and surgical intervention should be researched.

Factor Structure and Psychometric Properties of the Brief Illness Perception Questionnaire in Turkish Cancer Patients

OBJECTIVE

The main aim of this study was to investigate the factor structure and psychometric properties of the Brief Illness Perception Questionnaire (BIPQ) in Turkish cancer patients.

METHODS

This methodological study involved 135 cancer patients. Statistical methods included confirmatory or exploratory factor analysis and Cronbach alpha coefficients for internal consistency.

RESULTS

The values of fit indices are within the acceptable range. The alpha coefficients for emotional illness representations, cognitive illness representations, and total scale are 0.83, 0.80, and 0.85, respectively.

CONCLUSIONS

The results confirm the two-factor structure of the Turkish BIPQ and demonstrate its reliability and validity.

A Review of Instruments on Cognitive Appraisal of Stress

PURPOSE

The purpose of this paper is to present a review of theoretically based measures of cognitive appraisal, and discuss psychometric strengths and limitations.

BACKGROUND

Understanding how an individual appraises stressful events becomes important when faced with alterations in mental health. Cognitive appraisals influence how an individual copes with stressful events and life crises that leads to changes in mental health. Measures on how an individual appraises a stressful event lack conceptual soundness and are limited by weak psychometric properties.

DATA SOURCES

Health and Psychosocial Instruments (HAPI) electronic database was searched using combinations of the key words cognitive appraisal, primary appraisal, secondary appraisal, appraisal of illness, appraisal of health, and stress appraisal. The quality of these instrument sources was assessed by published psychometric data in the primary source.

RESULTS

Five instruments were found that measure cognitive appraisal as theoretically described: the Meaning of Illness Questionnaire, the Stress Appraisal Measure, the Appraisal of Illness Scale, the Cognitive Appraisal of Health Scale, and the Primary Appraisal/Secondary Appraisal scale. A description of each tool, including purpose, scoring, and psychometric support, is provided.

CONCLUSION

There are a limited number of instruments that measure cognitive appraisal as theoretically described. Theoretically sound instruments with established psychometric support are needed to make accurate inferences about the role of cognitive appraisal in the mental and physical health of individuals experiencing stress.

Financial Burden of Pediatric Cancer for Patients and Their Families

PURPOSE

Cancer treatment may cause financial stress for pediatric oncology patients and their families. We evaluated pediatric cancer caregivers' perceived financial burden related to socioeconomic factors (eg, parental employment) and health care use factors (eg, unexpected hospitalizations).

METHODS

A single-site, cross-sectional survey of primary caretakers of patients with childhood cancer was performed from July 2010 to July 2012. Eligible patients were treated at a pediatric cancer hospital, diagnosed at age ≤ 21 years and were ≤ 5 years from diagnosis (N = 254). Financial burden was rated on a visual analog scale of 0 to 100. Multivariable linear regression models were used to calculate coefficients and 95% CIs of financial burden by time since diagnosis.

RESULTS

Mean age at diagnosis was 6.8 years (SD = 5.5 years), and average time since diagnosis was 1.6 years (SD = 1.4 years). The most common diagnosis was leukemia (41.9%). When adjusted for sex, age at diagnosis, insurance status, and rural residence, caregivers whose child was 1 to 5 years from diagnosis with ≥ 5 unexpected hospitalizations experienced 24.9 (95% CI, 9.1 to 40.7; P < .01) points higher financial burden than those with no unexpected hospitalizations. In addition, when compared with families without employment disruptions, families of children 1 to 5 years from diagnosis in which a caregiver had quit or changed jobs reported 13.4 (95% CI, 3.2 to 23.6; P = .01) points higher financial burden.

CONCLUSIONS

Efforts to reduce unexpected hospitalizations and employment disruptions by providing more comprehensive supportive care for pediatric patients with cancer could help ease families' financial burden.

Coping styles and social support among depressed Chinese family caregivers of patients with esophageal cancer

OBJECTIVES

To determine the coping styles of family caregivers of patients with esophageal cancer and examine the relationships between depression, coping styles and social support.

METHODS

A descriptive and correlational survey was conducted in three university-affiliated oncology and thoraco-cardiac surgery departments in Shiyan, China. A convenience sample of 301 Chinese family caregivers of hospitalized patients with esophageal cancer were asked to respond to a set of four questionnaires including: Socio-demographic questionnaire, Center for Epidemiological Studies Depression, Brief COPE Inventory, and Multidimensional Scale of Perceived Social Support.

RESULTS

For the positive coping style, male caregivers used more problem-coping than female caregivers. However, for negative coping, both male and female caregivers used maladaptive coping styles. There were significant correlations between emotion-focused coping styles with adaptive coping, maladaptive coping, depression and social support.

CONCLUSIONS

Family caregivers play a major role in caring for cancer patients and suffer from various psycho-social problems. What is lacking in the literature was to address the cultural differences in cancer caregiving burden, roles, and appropriate interventions to help them face the multiple demands of caregiving. Therefore, a need to develop and evaluate interventions using randomized clinical trials and sensitive instruments to measure the effectiveness of the intervention on patients' and caregivers' outcomes.

A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach

CONTEXT

Pancreatic cancer presents a wide spectrum of significant symptomatology. The high symptom burden, coupled with a rapidly fatal diagnosis, limits preparation or time for adjustment for both patients and their family caregivers. From the initial diagnosis and throughout the illness experience, the physical and emotional demands of caregiving can predispose caregivers themselves to illness and a greater risk of mortality. Understanding the negative and positive aspects of caregiving for patients with advanced pancreatic cancer will inform interventions that promote positive caregiver outcomes and support caregivers in their role.

OBJECTIVES

To provide feasibility data for a larger, mixed methods, longitudinal study focused on the experience of family caregivers of patients with advanced pancreatic cancer and preliminary qualitative data to substantiate the significance of studying this caregiver population.

METHODS

This was a mixed methods study guided by the Stress Process Model. Eight family caregivers of patients with advanced pancreatic cancer from oncology practices of a university-affiliated medical center were surveyed.

RESULTS

The pilot results supported the ability to recruit and retain participants and informed recruitment and data collection procedures. The qualitative results provided preliminary insights into caregiver experiences during the diagnosis and treatment phases. Key findings that substantiated the significance of studying these caregivers included the caregiving context of the history of sentinel symptoms, the crisis of diagnosis, the violation of assumptions about life and health, recognition of the circle of association, and contextual factors, as well as primary and secondary stressors, coping strategies, resources, discoveries, gains and growth, associated changes/transitions, and unmet caregiver needs.

CONCLUSION

Findings indicated caregivers' willingness to participate in research, highlighted the negative and positive aspects of the caregiver experience, and reinforced the significance of the future study and the need to develop interventions to support family caregivers in their roles.

Coping with stress of family caregivers of cancer patients in Turkey

Objective:

Cancer is a disease that not only affects the individual's mental and physical integrity but also affects the functionality of the family system. Caregivers experience stress when patients cannot cope with the symptoms they are experiencing. The stress experienced by caregivers gives rise to psychological and physical symptoms. The purpose of this study is to determine the attitude of coping with stress of family caregivers of cancer patients.

Methods:

This study was conducted as a descriptive research at the Medical Oncology Clinic. The study sample group comprised of 127 family caregivers. In the collection of the data, the Personel Information Form and Attitude of Coping with Stress Inventory were used.

Results:

The coping attitude used most frequently by family caregivers was active planning, and the least used coping attitude was avoidance isolation (biochemical). There was no significant statistical difference between the coping attitude depending on the descriptive characteristics of the family caregivers (P > 0.05).

Conclusion:

Results show that family caregivers of cancer patients tend to choose effective coping methods. However, there were still caregivers that displayed ineffective coping attitudes. Therefore, it is important to support the effective coping attitudes of caregivers and intervene in order to change the ineffective coping attitudes.

Quality of life among adult patients with neurofibromatosis 1, neurofibromatosis 2 and schwannomatosis: a systematic review of the literature

The aim of this study was to review the literature on quality of life among adult patients with neurofibromatosis 1, neurofibromatosis 2 and schwannomatosis, and to identify the specific aspects of quality of life that were studied and reported in this population. We also set out to report predictors of quality of life. Published research reports were included if they described quality of life in this population and met methodological quality according to a list of predefined criteria. Eight studies (7 in NF1, 1 in NF2, 0 in schwannomatosis), conducted between 2001 and 2013, met inclusion criteria. The methodological quality of the eight studies was mostly high according to ratings by predefined criteria. Most studies reported that patients with NF experience decreased quality of life when compared to the general population. Visibility and disease severity were strong predictors of skin-specific quality of life in NF1 patients. However, the majority of findings regarding predictors of quality of life were weak or inconclusive. Given the decreased quality of life in NF patients, it is important to examine more comprehensively the psychosocial factors in this population, especially in patients with NF2 and schwannomatosis. Mind body interventions that address these domains may provide comprehensive and efficacious long term treatment.

Social support and quality of life among lung cancer patients: a systematic review

OBJECTIVE

This systematic review analyzed the relationships between social support and quality of life (QOL) indicators among lung cancer patients. In particular, the patterns of relationships between different social support facets and sources (received and perceived support from healthcare professionals, family, and friends) and QOL aspects (emotional, physical symptoms, functional, and social) as well as the global QOL index were investigated.

METHODS

The review yielded 14 original studies (57% applying cross-sectional designs) analyzing data from a total of 2759 patients.

RESULTS

Regarding healthcare professionals as support source, corroborating evidence was found for associations between received support (as well as need for and satisfaction with received support) and all aspects of QOL, except for social ones. Overall, significant relations between support from healthcare personnel and QOL were observed more frequently (67% of analyzed associations), compared with support from families and friends (53% of analyzed associations). Corroborating evidence was found for the associations between perceived and received support from family and friends and emotional aspects of QOL. Research investigating perceived social support from unspecified sources indicated few significant relationships (25% of analyzed associations) and only for the global QOL index.

CONCLUSIONS

Quantitative and qualitative differences in the associations between social support and QOL are observed, depending on the source and type of support. Psychosocial interventions may aim at enabling provision of social support from healthcare personnel in order to promote emotional, functional, and physical QOL among lung cancer patients.

Coping with and factors impacting upon the experience of lung cancer in patients and primary carers

There is a paucity of research exploring patients' and their informal carers' experience of coping with and factors impacting on the lung cancer experience. This study aims to explore how patients and their informal carers cope with a diagnosis of lung cancer and describe the key factors that mediate distress in this population in order that they may be better supported in the future. This was a qualitative study employing semi-structured interviews and framework analysis to elicit the experience of 37 patients with lung cancer and 23 primary carers regarding their coping with and factors influencing patient/carer distress. The findings illustrate that participants used both emotional- and problem-focused coping strategies, including accepting the reality of lung cancer, adopting a positive attitude/fighting spirit, denial, avoidance and distraction and information seeking. Maintaining normality was also important. Key factors that mediate the lung cancer experience were also identified including hope, social network, prior experience of cancer and other chronic illnesses, the competing coping strategies of patients and their primary carers, the unpredictable nature of patients' behaviour, changing symptomatology, the perceived attitudes of health professionals and the impact of perceived delays in diagnosis. This study provides important insights into how patients with lung cancer and their primary carers might be better supported.

The relationship between social support and the level of anxiety, depression, and quality of life of Turkish women with gynecologic cancer

BACKGROUND

Anxiety and depression are among the most common psychosocial problems with gynecologic cancer patients. In this respect, "social support" has become a key tool in the patients' coping with the aforementioned risk factors as an important contributor to their well-being.

OBJECTIVE

The purpose of this study was to assess the relationship between social support and the level of anxiety, depression, and quality of life of Turkish women with gynecologic cancer.

METHODS

In a hospital in Turkey, 187 women with a diagnosis of gynecologic cancer comprised a convenience sample and completed 4 study instruments in a cross-sectional design.

RESULTS

Statistically significant correlations among type of perceived social support, quality of life, anxiety, and depression (P < .001) were found. While high social support was associated with increased quality of life, it was also associated with reduced anxiety and depression rates.

CONCLUSION

Our study showed that the type of perceived social support by the patients with cancer had significant effect on depression, anxiety, and quality of life.

IMPLICATIONS FOR PRACTICE

Social support is a powerful tool that can mediate the effects of difficult life stressors and decrease the incidence of mood disorders, and, therefore, greater importance should be attached to it in the realm of cancer treatment. Supported by the collaborative efforts of family members and healthcare professionals, cancer patients will more easily cope with the drawbacks of their state.

Lung cancer patients' beliefs about complementary and alternative medicine in the promotion of their wellness

PURPOSE

Cancer patients are increasingly turning to complementary and alternative medicine (CAM) because they believe that conventional treatments are not optimizing their overall wellness. However, the relationship between CAM use, wellness, and patient beliefs has received little attention in the nursing literature. This study aimed to understand lung cancer patients' beliefs about CAM use in promoting their own wellness.

METHOD

An interpretive qualitative design guided the study. Semi-structured interviews were conducted with 12 adult lung cancer outpatients who used CAM. An inductive approach to analysis was taken; this included immersion in the data, open coding, categorization of similar codes, and identification of emerging patterns and themes.

RESULTS

The patients' beliefs about CAM use in promoting their own wellness were the result of an ongoing adaptive process of belief modification and reformation/transformation that began with their cancer diagnosis. This evolution of patient beliefs comprised four main themes: processing the initial upheaval of beliefs into a life change; developing beliefs that motivated CAM use; validating their new beliefs; and synthesizing these experiences and belief changes into a personal philosophy/meaning of "wellness with cancer."

CONCLUSIONS

CAM, as a strategy to promote wellness, played an integral role in the experience of wellness with cancer. Patients' experiences with CAM were governed by their underlying beliefs; thus, clinicians should consider their patient's beliefs when discussing CAM strategies. Given the importance of recommendations health professionals should also offer guidance and open discussion of CAM with patients and tailor CAM to their needs.

Perceived social support and coping strategies in advanced cancer patients

Background:

Cancer patients who perceived themselves as having adequate social support resources fare better and make adaptation easier than patients who perceive their support as inadequate. Besides, the levels of social support can have an important impact on patient's ways of coping when confronting the challenge of advanced cancer.

Objective:

To analyze the relationships among demographic and medical variables, perceived social support, and coping strategies in patients with advanced cancer.

Methods:

A descriptive correlational study was performed in 132 advanced cancer patients under chemotherapy treatment. The participants were asked to provide their demographic data and complete the questionnaires of Personal Resource Questionnaire-85 that measure perceived social support and Ways of Coping Inventory – Cancer version that measure coping strategies. Besides, medical data was obtained from participants’ hospital records. The data was analyzed using SPSS statistical package.

Results:

This study has contributed to a better understanding of the theoretical linkages among perceived social support and coping mechanisms in advanced cancer patients. The results showed that there was a significant moderate positive relationship between perceived social support and seeking and using social support, and focusing on the positive. Also, there was a significant positive relationship between perceived social support, income, and health perception.

Discussion:

The findings indicate that in advanced cancer there is a need to monitorize patients with low levels of perceived social support and enhance their social support resources, particularly in men.

The meaning of cancer: implications for family finances and consequent impact on lifestyle, activities, roles and relationships

OBJECTIVE

This study explores the impact that cancer-related financial hardship/worries can have on family life.

METHODS

Forty patients (19 male and 21 female) and 17 carers participated in a qualitative study, which drew on certain elements of grounded theory methods. Participants were 18 years or older and were accessed through a regional cancer centre, an acute National Health Service trust, a support group and the Macmillan Benefits Helpline. Interviews were transcribed verbatim and analysed thematically with the aid of nvivo 7 (QSR International, Cambridge, MA, USA).

RESULTS

Many participants said that prior to experiencing cancer, they had never thought about its effects on finances. The early part of the cancer journey was characterised by a need to be positive about the future, limited discussion about money within families and a lack of action in relation to finances. Many participants, especially those of working age, described cancer-related financial worries and difficulties that had impacted on family lifestyle, roles and relationships. Consequences included house repossession, bankruptcy, loss of independence and relationship breakdown.

CONCLUSIONS

Health and social care professionals have a role in prompting people affected by cancer to take stock of their finances early in the cancer trajectory, in order to avert knock-on effects. An approach that combines hope with proactivity is needed. More work into the long-term effects of financial difficulties/worries and specific financial issues that affect people from Black and minority ethnic backgrounds is needed.

Palliative care in lung cancer

Advancements in the surgical and medical treatment of lung cancer have resulted in more favorable short-term survival outcomes. After initial treatment, lung cancer requires continued surveillance and follow-up for long-term side effects and possible recurrence. The integration of quality palliative care into routine clinical care of patients with lung cancer after surgical intervention is essential in preserving function and optimizing quality of life through survivorship. An interdisciplinary palliative care model can effectively link patients to the appropriate supportive care services in a timely fashion. This article describes the role of palliative care for patients with lung cancer.

Balancing a changed life situation: the lived experience from next of kin to persons with inoperable lung cancer

The purpose of this study was to identify and describe the experiences of quality of life/life situation among those who were next of kin to persons with inoperable lung cancer. Data were collected in qualitative interviews, where 11 next of kin articulated their lived experiences, and were interpreted through interpretive phenomenology. Four themes were identified: changed life situation, experiences of uncertainty due to awareness of the ill person's changed health status, interpersonal relationships, and false hopes due to health care professionals' treatment. These four themes gave a structure presenting the essence: balancing a changed life situation. The findings of the study point out the importance of promoting support for the next of kin, because they are significantly affected by the changed life situation. There is a need to identify their needs and to support them.

A biopsychosocial perspective on the experience of lung cancer

This article examines the effects of an individual's smoking status (current, former, or never-smoker) on the biological, social, and psychological aspects of lung cancer. Current and never-smokers differ in their biological risk factors, responses to treatment, and survival rate. In partial contrast, smoking status does not affect the major social aspect of the disease. The social stigma, which stems from the public perception that lung cancer is a preventable disease, affects social interactions for all patients irrespective of smoking status. The psychological aspects of the disease, including feelings of guilt, vary with smoking status. These observations point to the heterogeneity of lung cancer and underscore the complex links between the disease and smoking behavior.

Development of the Ways Of Helping Questionnaire: a measure of preferred coping strategies for older African American cancer survivors

Although researchers have identified beneficial coping strategies for cancer patients, existing coping measures do not capture the preferred coping strategies of older African American cancer survivors. A new measure, the Ways of Helping Questionnaire (WHQ), was evaluated with 385 African American cancer survivors. Validity evidence from factor analysis resulted in 10 WHQ subscales (Others There for Me, Physical and Treatment Care Needs, Help from God, Church Family Support, Helping Others, Being Strong for Others, Encouraging My Healthy Behaviors, Others Distract Me, Learning about Cancer, and Distracting Myself). Reliability evidence was generally strong. Evidence regarding hypothesized relationships with measures of well-being and another coping measure was mixed. The WHQ's content coverage makes it especially relevant for older African American cancer survivors.

The significance of social support and social networks among newly diagnosed lung cancer patients in Sweden

The purposes of this study were to identify and describe the impact that social support and a social network has for adult people recently diagnosed with lung cancer in Sweden. Ten lung cancer patients participated. The data were collected using qualitative interviews based on an interview guide and were analyzed using constant comparative analysis. This led to a core category, "receiving confirmation as a person", which was grounded via four categories: "good relationships within a social network", "conversation enables support", "confidence in the situation", and "to manage by oneself". These categories were all related to each other. How these categories might have a positive influence on a person and give them the strength to move on were also clarified. The social network identified comprised of a few people who were close to the patient. The knowledge gained from this study can be used when developing care guidelines at different levels for use by health-care professionals.

Quality of life, health satisfaction and family impact on caregivers of children with developmental delays

OBJECTIVE

To study the quality of life, health satisfaction and family impact on caregivers of children with developmental delays in Taiwan.

DESIGN

Cross-sectional study.

SUBJECTS

The caregivers of children with diagnoses of developmental delays recruited from a teaching hospital in northern Taiwan.

METHODS

The main caregivers of 48 male and 22 female children with developmental delays were recruited. WHOQOL-BREF for health-related quality of life (HRQOL), PedsQL-Health Satisfaction for health satisfaction, PedsQL-Family Impact Module and Impact on Family Scale for family impact were evaluated. The correlation of caregivers' HRQOL, health satisfaction and family impact were also studied.

RESULTS

Caregivers in nuclear families had higher health satisfaction scores (78.2 for nuclear families vs. 66.9 for extended families, P < 0.05) when assessed by the PedQL-Health Satisfaction questionnaire. Children's age was negatively correlated with family impact, including parent (-0.272, P = 0.023), family (-0.262, P = 0.029) and total scores (-0.281, P = 0.018) as assessed using the PedsQL-Family Impact Module.

CONCLUSION

A negative relation between impact of burden and child's age suggests that family members gradually adapt to the delayed developmental status in their children as they grow. Caregivers in nuclear families having higher health satisfaction than those in extended families may be due to Chinese cultural effects.

Evaluating quality of life and pulmonary function of long-term survivors of non-small cell lung cancer treated with radical or postoperative radiotherapy

BACKGROUND

Our aim in the present study was to describe the quality of life (QOL), evaluate pulmonary function, and compare demographic and clinical characteristics with QOL in long-term survivors of non-small cell lung cancer treated with radical or postoperative radiotherapy.

METHODS

Twenty-eight patients were recruited in the study. QOL was evaluated using The European Organization for Research and Treatment of Cancer, Quality of Life Core Questionnaire (EORTC QLQ-C30, v.3). Statistical analysis was performed by SPSS 14.

RESULTS

Patients' files were reviewed in October 2006. Median duration of follow-up was 46 months (range: 25-125 months). Seven of 9 scales were found to meet the minimal reliability limit (Cronbach's alpha >0.70). The lowest and highest reliability coefficients were 0.56 and 0.93 for social and role functioning, respectively. All interscale correlations were statistically significant (P < 0.01). The strongest positive correlation was found between physical functioning and, role and cognitive functioning (r = 0.59, r = 0.37 or P = 0.01, P = 0.05, respectively). The highest correlation of EORTC QLQ-C30 and the Karnofsky performance scale (KPS) during the questionnaire was found to be with physical functioning and constipation (r = 0.41, r = 0.44 or P = 0.02, P = 0.01, respectively). When the effect of various demographic and clinical parameters on QOL was evaluated; initial KPS, age, educational level, health insurance status, stage, chemotherapy, comorbid disease, and passive smoking were determined as significant factors influencing QOL. Physical, role, cognitive, and emotional functions were found to be significantly lower in the presence of dyspnea (r = 0.42, r = 0.58, r = 0.50, r = 0.63 or P = 0.02, P < 0.01, P < 0.01, P < 0.05, respectively). Regarding the symptom scales, dyspnea was found to be correlated with increasing of fatigue, pain, insomnia, and appetite loss (r = 0.52, r = 0.40, r = 0.64, r = 0.38 or P < 0.01, P = 0.03, P < 0.05, P = 0.04, respectively). The parameters of pulmonary function tests (FEV1, FVC, and FEV1/FVC) did not show any significant relation with any scale of QOL.

CONCLUSION

Overall, we found that QOL of our patients who survived at least 2 years after radiotherapy, was good. The Turkish version of the EORTC QLQ-C30, v.3 is a valid and reliable instrument for Turkish lung cancer patients and can be used in clinical studies. We believe further studies are needed to have a better understanding of patients' pretreatment and posttreatment QOLs.