The Self-regulation Model of Illness applied to smoking behavior in lung cancer

Tobacco Cessation Interventions in Non-Respiratory Cancers: A Systematic Review With Meta-analysis of Randomized Controlled Trials

BACKGROUND

Considering the high rates of persistent tobacco use, effective cessation interventions are needed for cancer patients and caregivers. Despite the need, there is a significant lack of research on tobacco cessation, especially for non-respiratory cancers (breast, prostate, colorectal, cervical, and bladder cancer).

PURPOSE

The objective was to evaluate tobacco use and tobacco cessation interventions among patients and caregivers for non-respiratory cancers.

METHODS

Randomized controlled trials assessing tobacco cessation interventions were identified. Five electronic databases were searched in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines through July 2023. Studies exclusive to lung, oral, thoracic, and head and neck cancers were excluded. Effect sizes were estimated; risk of bias was assessed.

RESULTS

Of 3,304 studies, 17 were included. Interventions included behavioral (n = 6), pharmacotherapy (n = 2), and a combination (n = 9) treatment. Eight studies included a health behavior model; mean behavioral change techniques were 5.57. Pooled magnitude of the odds of cessation was positive and significant (odds ratio = 1.24, 95% confidence interval [Lower Limit 1.02, Upper Limit 1.51]) relative to usual care/placebo. Cumulative meta-analysis examined the accumulation of results over-time and demonstrated that studies have been significant since 2020. Two studies included caregivers' who were involved in the provision of social support.

CONCLUSIONS

Current interventions have the potential to reduce tobacco use in non-respiratory cancers. Results may be beneficial for promoting tobacco cessation among non-respiratory cancers. There is a considerable lack of dyadic interventions for cancer survivors and caregivers; researchers are encouraged to explore dyadic approaches.

Study protocol for a hybrid type 1 effectiveness-implementation trial testing virtual tobacco treatment in oncology practices [Smokefree Support Study 2.0]

BACKGROUND

Persistent smoking among patients diagnosed with cancer is associated with adverse clinical outcomes, yet an evidence-based tobacco use intervention has not been well-integrated into cancer care in community oncology settings. This paper describes the protocol of a nation-wide clinical trial conducted by the ECOG-ACRIN National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base to assess the effectiveness of a virtual tobacco treatment intervention and the process of implementing tobacco treatment in NCORP community oncology settings.

METHODS/DESIGN

This two-arm, multisite (n: 49 NCORP sites) hybrid type 1 effectiveness-implementation randomized controlled trial compares the effectiveness of a Virtual Intervention Treatment (VIT) versus an Enhanced Usual Control (EUC) among English and Spanish speaking patients recently diagnosed with cancer, reporting current smoking and receiving care at a participating NCORP Community or Minority/Underserved Site. The VIT includes up to 11 virtual counseling sessions with a tobacco treatment specialist and up to 12 weeks of nicotine replacement therapy (NRT). The EUC arm receives a referral to the NCI Quitline. The primary study outcome is biochemically confirmed 7-day point prevalence smoking abstinence. Moderators of treatment effect will be assessed. The study evaluates implementation processes from participating NCORP site staff via survey, administrative, and focus group data, including reach, acceptability, appropriateness, fidelity, feasibility, adoption, cost and sustainability outcomes.

DISCUSSION

This trial will generate findings about the effectiveness of an evidence-based virtual tobacco treatment intervention targeting patients diagnosed with cancer and illuminate barriers and facilitators that influence implementing tobacco treatment into community oncology settings nationally. In the era of COVID-19, virtual care solutions are vital for maximizing access and utilization of tobacco treatment delivery.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT03808818) on January 18th, 2019; Last update posted: May 21st, 2020.

Illness perception about hepatitis C virus infection: a cross-sectional study from Khyber Pakhtunkhwa Pakistan

Background

Hepatitis C virus (HCV) infection is a debilitating chronic health problem and can be fatal if left untreated. Illness perceptions are self-manifested beliefs that influence the ability of individuals to cope with their disease and perceive it as manageable or threatening condition. Limited evidence is available from low resource settings regarding patient perception about HCV. In this study, we aimed to assess the perception of individuals with HCV, the impact of their sociodemographic and clinical characteristics on their HCV perception, and its link to patient-oriented treatment outcomes.

Methods

A cross-sectional survey was undertaken enrolling individuals with HCV who attended Hepatitis C clinics at two hospitals of Khyber Pakhtunkhwa, Pakistan. Illness perception was measured using Brief Illness Perception Questionnaire (BIPQ). Descriptive statistics, Kruskal Wallis tests and Mann Whitney U tests were performed to study patient sociodemographic and clinical characteristics and to analyze the questionnaire results. Multivariable linear regression was used to assess determinants associated with perception scores.

Results

Participants represented poor HCV perception and their overall mean BIPQ score was 43.35, SD = 13.15. Participants had a low degree of understanding about their illness (mean coherence score = 2.92, SD = 1.85). Individuals with more than four years, compared to less than one year, of estimated HCV infection were more likely to view that their illness would continue (mean timeline score = 6.27, SD = 2.50 versus 5.36, SD = 2.53; respectively, p < 0.01). Similarly, individuals with hepatic cirrhosis, compared to without, were more likely to attribute symptoms to their disease (mean identity score = 5.48, SD = 2.14 versus 4.89, SD = 2.38; respectively, p = 0.04). Female participants reported higher degrees at which the illness affected them emotionally (i.e., emotional representation) and lower coherence about HCV than males (p = 0.04 and 0.006, respectively). Individuals who did not achieve sustained virological response 24 weeks after treatment with interferon-based therapy, compared to treatment naïve individuals, reported lower trust in being successfully treated with newer anti-HCV agents (i.e., direct acting antivirals) (p = 0.029). However, multivariable linear regression revealed that no sociodemographic or clinical determinants were associated with a higher BIPQ score (i.e., more threatening, or negative perceptions).

Conclusion

Individuals with HCV in Pakistan generally report threatening or negative views about HCV infection. Lack of trust in treatment efficacy was also apparent, especially in those who experienced failed anti-HCV treatments in the past. Healthcare professionals should consider these perceptions when treating individuals with HCV to optimize their compliance by aligning their perception with the high effectiveness of current anti-HCV therapies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07055-5.

Les représentations de la maladie : choix des outils de mesure et applications dans le champ du cancer

Objectif : Dresser un bilan des outils quantitatifs disponibles pour mesurer les représentations de la maladie et analyser leur utilisation empirique auprès de patients atteints de cancer.

Matériel et méthodes : Revue de la littérature.

Résultats : Sept outils de mesure des représentations de la maladie existent dont un spécifique au cancer. L’Illness Perception Questionnaire est utilisé dans 29 des 33 études retenues.

Conclusion : Associer ces échelles avec des méthodes reposant sur des approches davantage centrées sur le contexte socioculturel semble à privilégier.

Integrating tobacco treatment into lung cancer screening practices: Study protocol for the Screen ASSIST randomized clinical trial

BACKGROUND

Integrating tobacco treatment services into lung cancer screening (LCS) has the potential to leverage a 'teachable moment' to promote cessation among long-term smokers and reduce disparities in tobacco treatment access. This protocol paper describes the Screen ASSIST (Aiding Screening Support In Stopping Tobacco) trial, which will identify how to best deliver evidence-driven tobacco treatment in the context of LCS.

METHODS

Screen ASSIST is a randomized clinical trial with a 3-factor, fully crossed factorial design that enrolls current smokers (any cigarette use in the past 30 days) scheduled to attend LCS at multiple sites in the Mass General Brigham healthcare system. To maximize reach, recruitment is conducted at 3 time points: 1) at the time of LCS scheduling, 2) at the LCS visit, and 3) after the participant has received their LCS results. Participants are stratified by LCS study site and recruitment point and randomly assigned into 8 groups that test intervention components varying on telehealth counseling duration (4 weeks vs. 8 weeks), nicotine replacement therapy duration (2 weeks vs. 8 weeks), and systematic screening and referral for social determinants of health via a service named 'AuntBertha' (referral vs. no referral). The primary study outcome is self-reported past 7-day tobacco abstinence at 6-month follow-up. This trial will also assess systems integration and evaluate implementation of the intervention.

DISCUSSION

Screen ASSIST will identify the most effective combination of tobacco cessation treatments within the LCS context, in order to improve the cost-effectiveness of LCS and quality of life among long-term heavy smokers.

Patients' knowledge of diabetes foot complications and self-management practices in Ghana: A phenomenological study

Background

The prevalence of diabetes is increasing in low and middle-income countries (LMICs) and over two-thirds of these are not diagnosed. Consequently, diabetes complications usually exist at the time of diagnosis. Foot ulcers is a leading cause of disability and mortality among diabetes patients.

Purpose

To assess the knowledge and experiences of adult patients with Diabetes on diabetes complications and self-management practices with emphasis on foot care.

Methodology

This applied phenomenological study design. Twenty patients attending Diabetes clinics were purposively sampled from two hospitals in Ghana. Face-to-face semi-structured interviews were conducted to evaluate patient’s understanding of diabetes and self-management practices. The interviews were audio-taped, transcribed, and analysed to generate themes using the constant comparison method.

Results

Three-quarters of the participants in the study correctly defined diabetes as high blood glucose levels, but few knew the risk factors and complications of diabetes. Stroke and Hypertension were the most popular complications known, whiles diabetes foot complications were the least known. Almost all participants showed awareness of dietary self-management practices, but few had limited knowledge in foot care practices.

Conclusion

Diabetes education in LMICs should promote self-management practices, especially foot care and clear dietary guidelines. There is also opportunity to invest in specialist diabetes training for healthcare providers and increase community-based care for people living with diabetes in Ghana.

The psychometric properties of the Revised Illness Perception Questionnaire (IPQ-R) regarding Internet gaming disorder in a general population of Chinese adults

BACKGROUND AND AIMS

Internet gaming disorder (IGD) has been recognized as a mental illness. Cognitive and emotional illness representations affect coping and health outcomes. Very little is known about such perceptions related to IGD, in both general and diseased populations. This study examined the psychometric properties of the Revised Illness Perception Questionnaire (IPQ-R) for IGD in a general population that included mostly non-cases while a small proportion of the sample was IGD cases.

METHODS

An anonymous cross-sectional telephone survey was conducted in a random sample of 1,501 Chinese community-dwelling adults (41.3% male; mean age = 40.42, SD = 16.85) in Macao, China.

RESULTS

The confirmatory factor analysis identified a modified 6-factor model (i.e., timeline cyclical, consequences, personal control, treatment control, illness coherence, and emotional representations) of 26 items that showed satisfactory model fit and internal consistency. Criterion-related validity was supported by the constructs' significant correlations with stigma (positive correlations: timeline cyclical, consequence, emotional representations; negative correlations: illness coherence). Ever-gamers, compared to never-gamers, reported higher mean scores in the subscales of personal control and illness coherence, and lower mean scores in time cyclical, consequence, and emotional representations. Among the sampled gamers, probable IGD cases were more likely than non-IGD cases to perceive IGD as cyclical and involved more negative emotions.

CONCLUSIONS

This study shows that the revised 26-item version of IPQ-R is a valid instrument for assessing illness representation regarding IGD in a general population of Chinese adults. It can be used in future research that examines factors of incidence and prevention related to IGD.

Relationships Between Smoking Status and Psychological Distress, Optimism, and Health Environment Perceptions at Time of Diagnosis of Actual or Suspected Lung Cancer

BACKGROUND

While much research and practice resources have addressed smoking cessation among cancer patients, less emphasis has been placed on personal psychological and environment factors associated with smoking at the time of diagnosis.

OBJECTIVE

The aim of this study was to examine differences in psychological distress, optimism, and perceptions of the health environment/illness experience based on smoking status in patients with current, former, and no smoking history with newly diagnosed suspected or actual lung cancer.

METHODS

Data were derived from a descriptive study of 52 patients (34 men and 18 women aged 37-83 years) undergoing diagnostic evaluation for actual or suspected lung cancer. Descriptive statistics were used to characterize data. Analysis of variance, χ, and Spearman correlation tests were used to determine relationships among main study variables (smoking status, anxiety, worry, perceived cognitive functioning, optimistic outlook, health environment/illness experience perceptions).

RESULTS

Current smoking status was associated with higher psychological distress (anxiety and worry) among patients facing a new suspected or actual cancer diagnosis.

CONCLUSIONS

The study was able to provide important information relative to smoking status and psychological distress at the time of diagnosis of suspected or actual lung cancer. Findings demonstrate needs for assessment and targeted interventions to reduce psychological distress and to promote long-term adaptation in patients smoking at time of diagnosis.

IMPLICATIONS FOR PRACTICE

Nurses are positioned to provide support and resources for cancer patients. It is critical that smoking cessation interventions also address nicotine craving, emotion regulation, and adaptive coping skills.

Perceived Illness and Treatment Adherence to Hypertension Among Patients Attending a Tertiary Hospital in Kathmandu, Nepal

INTRODUCTION

Hypertension (HTN) is a silent killer, accountable for life-threatening complications. An individual's illness perception may affect adherence to treatment which is crucial to prevent complications of HTN. The objective of this study was to identify illness perception and treatment adherence among patients with HTN in a tertiary hospital in Kathmandu, Nepal.

METHODS

Descriptive correlational study was conducted in the out-patient department of Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu Nepal. Non-probability purposive sampling was used. A face-to-face interview was conducted from September to December 2018, using a structured questionnaire that included socio-demographic variables, illness perception questionnaire (revised) and Hill bone compliance to high blood pressure therapy scale. Data analysis was done by using descriptive and inferential statistics (chi-square test, Spearman rank correlation).

RESULTS

Among 204 participants, 51% were male, 77% were literate, mean ± S.D. age was 60±12. About 72% experienced headache and 88% said that headache is related to HTN. Behavioural factors and psychological factors were regarded as the leading cause of HTN. Almost 63% participants believed HTN as highly threatening illness. Higher scores in timeline (acute/chronic), personal control, and treatment control revealed that patients believed HTN as a chronic disease with a higher rate of personal and treatment control. Regarding treatment adherence, the mean score was 16.58 (SD = 2.08), and only 14.7% had perfect adherence. Participants were more adherent to medication and appointment keeping rather than reduce salt intake. Duration of HTN diagnosis (p=0.027) and duration under HTN medication (p= 0.021) were found to be significantly associated with treatment adherence. There was a significant positive correlation between illness perception and treatment adherence (ρ = 0.282, p<0.01).

CONCLUSION

Illness perception and treatment adherence are correlated. Hence, it is beneficial to improve illness perception to achieve perfect treatment adherence. Reinforcement is essential to maintain adherence to both medications and behaviour therapy.

Illness Cognitions Among Adolescents and Young Adults Who Have a Parent with Cancer: a Qualitative Exploration Using the Common-Sense Model of Self-regulation as a Framework

BACKGROUND

Individuals construct beliefs about an illness based on their own perceptions, interpretation, and understanding of the illness and its treatment. These beliefs (collectively referred to as "illness cognitions" or "representations") can have implications for psychological outcomes in family members and carers of an individual with an illness. The aim of this study was to explore young people's perceptions of their parent's cancer using the Common-Sense Model of Self-Regulation as a theoretical framework.

METHODS

Semi-structured, one-on-one interviews were conducted with young people who had a parent diagnosed with cancer. Interview transcripts were analysed using deductive thematic analysis techniques.

RESULTS

Eleven young people aged 15-24 years participated in the study. Major themes aligned with the dimensions of the Common-Sense Model of Self-Regulation. Young people described their experiences with parental cancer with reference to cognitive representations (beliefs about the illness identity, their understanding or coherence of the illness, and consequences, curability or controllability, timeline, and cause of the illness) and emotional representations (emotional beliefs and subjective feelings about the illness).

CONCLUSIONS

Findings indicate that young people's perceptions of their parent's cancer can be usefully described within the framework of the Common-Sense Model of Self-Regulation. Future research should investigate the relationships between young people's illness cognitions, coping strategies, and psychological adjustment following their parent's cancer diagnosis. This will provide valuable insights for the development of interventions that target specific types of illness cognitions associated with maladaptive coping strategies and poor adjustment.

An observational mixed-methods approach to investigate the fear of cancer recurrence cognitive and emotional model by Lee-Jones et al with women with breast cancer during radiotherapy treatment

There is minimal qualitative research on fear of cancer recurrence (FCR) in patients who are still undergoing treatment. This study explored how breast cancer patients' illness beliefs changed during radiotherapy treatment, so as to provide their longitudinal perspective across sessions. These beliefs were mapped to Lee-Jones et al FCR model to assess its applicability to patients during this key treatment phase. A framework qualitative analysis was employed for verbatim interactions between patients (n = 8) and their radiographer (n = 2) over a minimum of three weekly review sessions (26 review consultations in total). Results proved suggested evolution and repetition of themes within and across sessions. Most themes were consistent with the early stages of the Lee-Jones et al model (antecedents and FCR) such as internal and external cues, cognitions and emotions. The crucial observation was that somatic stimuli were interpreted as side effects of radiotherapy treatment rather than cancer symptoms. Patients were still undergoing their last phase of major treatment, whereas the Lee-Jones et al model has been constructed to explain patients' past treatment experience. New themes emerged, including current exercise, concurrent illnesses/problems, cancer treatment as a constant reminder (of diagnosis) and associated sleeping difficulties. Decatastrophising of symptoms and experiences relating to cancer and its treatment was also a prominent theme indicating a possible coping mechanism to reduce worries about treatment side effects and associated experiences. Finally, some evidence was found from failure of emotional/fear processing in patients due to early surface reassurance by health professionals - a possible explanation of how FCR might arise. Early detection of FCR and promoting support while patients are still undergoing treatment might prevent patients from developing FCR after treatment.

Patient and family-initiated escalation of care: a qualitative systematic review protocol

BACKGROUND

Despite the introduction of rapid response systems and early warning scores, clinical deterioration that is not recognised or responded to early enough prevails in acute care areas. One intervention that aims to address this issue and that is gaining increased attention is patient- and family-initiated escalation of care schemes. Existing systematic review evidence to date has tended to focus on identifying the impact or effectiveness of these schemes in practice. However, they have not tended to focus on qualitative evidence to consider the experience of deterioration and the factors that may promote or hinder engagement with these schemes in the practice setting. This systematic review will address this gap. The aim of this review is to explore patients', relatives' and healthcare professionals' experiences of deterioration and their perceptions of the barriers or facilitators to patient and family-initiated escalation of care in acute adult hospital wards.

METHODS

We will search Medline, CINAHL, Embase and PsycINFO databases using free-text and MESH terms relating to deterioration, family-initiated rapid response, families, patients, healthcare staff, hospital and experiences. We will search grey literature and reference lists of included studies for further published and unpublished literature. All studies with a qualitative design or method will be included. Two reviewers will independently assess studies for eligibility, extract data and appraise the quality of included studies. Data will be synthesised using a thematic synthesis approach, and findings will be presented narratively.

DISCUSSION

Patient- and family-initiated escalation of care schemes have been developed and implemented in several countries including the United States, the United Kingdom and Australia, but there is limited evidence regarding patients' or families' perceptions of deterioration or the barriers and facilitators to using these schemes in practice, particularly in acute adult areas. This systematic review will provide evidence for the development of a patient and family escalation of care scheme that can be tested in a feasibility study.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018106952.

Health-Seeking Behaviour and Delayed Presentation of Oral Cancer Patients in a Developing Country: A Qualitative Study based on the Self-Regulatory Model

Background: The aim of this study was to explore reasons for delayed health-seeking for late stage oral cancer patients. Methods: Semi-structured in-depth interviews were conducted with 35 oral cancer patients with TNM stage III to IV disease, who were treated at six tertiary regional centres managing oral cancer throughout Malaysia. Interviews were audio-recorded, transcribed verbatim, coded using NVivo (version 10.0) qualitative software and analysed using framework analysis. Results: Participants interpreted their early symptoms as a minor condition and did not consider it as requiring immediate attention. Four types of coping strategies causing delayed help-seeking emerged: 1) self-remedy 2) self-medication 3) seeking traditional healers and 4) consulting general medical practitioners (GPs) instead of dentists. Socio-economic factors, cultural beliefs and religious practices have some influence on diagnostic delay. Conclusion: Low levels of public knowledge and awareness regarding early signs and symptoms of oral cancer as well as GPs’ misdiagnosis of early lesions results in delayed diagnosis.

Helping cancer patients quit smoking using brief advice based on risk communication: A randomized controlled trial

This randomized controlled trial aimed to examine the effectiveness of a smoking cessation intervention using a risk communication approach. A total of 528 smoking cancer patients were randomly allocated either into an intervention group (n = 268) to receive brief advice based on risk communication by a nurse counselor or a control group (n = 260) to receive standard care. Subjects in both groups received a smoking cessation booklet. Patient follow-ups were at 1 week and at 1, 3, 6, 9 and 12 months. No significant differences were found in self-reported point-prevalence 7-day abstinence between the intervention and control groups at 6 months (15.7% vs 16.5%; OR 0.94, 95% CI 0.59-1.50). The rate of at least 50% self-reported reduction of smoking at 6 months, was higher in the intervention group than in the control group (16.8% vs 12.3%; OR 1.43, 95% CI 0.88-2.35). The biochemically validated quit rate at the 6-month follow-up was higher in the intervention group than in the control group (5.2% vs 3.8%; OR 1.38, 95% CI 0.60-3.16). These data suggest that advice based on risk communication was not effective for quitting but improved the rate of smoking reduction among smoking cancer patients.

The Self-Regulation Model of Illness: Comparison between Zika and Dengue and Its Application to Predict Mosquito Prevention Behaviours in Malaysia, a Dengue-Endemic Country

Perceptions about illnesses may influence self-care and preventive health behaviours. Illness perceptions of the Zika virus (ZIKV) infection were investigated under the framework of the Self-Regulation Model of Illness. Illness perception differences between ZIKV and dengue fever were also examined. Lastly, associations between illness perceptions of ZIKV with mosquito prevention practices were studied. Samples were drawn from landline telephone numbers using computer-assisted telephone interviewing in Malaysia. A total of 567 respondents completed the survey between February 2015 and May 2016. The median and interquartile range (IQR) for the total six dimensions of illness perceptions score was higher for dengue (23.0 (IQR 17.0-28.0)) than ZIKV (20.0 (IRQ 11.0-28.0)), p < 0.001. Respondents who planned to have children (OR 1.670, 95% CI 1.035-2.694 vs. no intention to have children) and had friends or acquaintances who died of dengue (OR 2.372, 95% CI 1.300-4.327 vs. no friends who died of dengue) were more likely to have a higher total score for six illness perceptions for ZIKV compared to dengue. Multivariate analysis indicated that the best predictors for mosquito control practices after the ZIKV outbreak was declared a Public Health Emergency of International Concern, in descending order, were causes, control, timeline, and consequences dimensions of illness perception. Understanding the context in which a person perceives ZIKV may contribute to developing interventions that influence prevention behaviours.

Explaining poor health-seeking among HIV-infected released prisoners

PURPOSE

- Little is understood about the self-described barriers that recently released HIV-infected prisoners face when accessing healthcare and adhering to medications. The purpose of this paper is to elucidate these barriers from the perspective of released prisoners themselves.

DESIGN/METHODOLOGY/APPROACH

- A qualitative assessment using 30 semi-structured interviews explored individuals' self-reported acute stressors and barriers to health-seeking during community re-integration for recidivist prisoners. Leventhal's Self-Regulation Model of Illness (SRMI) is applied to examine both structural and psychological barriers.

FINDINGS

- The SRMI explains that individuals have both cognitive and emotional processing elements to their illness representations, which mediate coping strategies. Cognitive representations of HIV that mediated treatment discontinuation included beliefs that HIV was stigmatizing, a death sentence, or had no physiological consequences. Negative emotional states of hopelessness and anger were either acute or chronic responses that impaired individuals' motivation to seek care post-release. Individuals expressed feelings of mistrust, fatalism and denial as coping strategies in response to their illness, which reduced likelihood to seek HIV care.

ORIGINALITY/VALUE

- Interventions for HIV-infected individuals transitioning to the community must incorporate structural and psychological components. Structural support includes housing assistance, employment and health insurance, and linkage to mental health, substance abuse and HIV care. Psychological support includes training to enhance agency with medication self-administration and HIV education to correct false beliefs and reduce distress. Additionally, healthcare workers should be specifically trained to establish trust with these vulnerable populations.

Systematic Review of Tobacco Use after Lung or Head/Neck Cancer Diagnosis: Results and Recommendations for Future Research

Tobacco use after cancer diagnosis is associated with adverse cancer outcomes, yet reliable prevalence estimates for this behavior are lacking. We conducted a systematic literature review of the prevalence of current tobacco use among individuals with a history of lung or head/neck cancer (CRD #42012002625). An extensive search of electronic databases (MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, and Web of Science) identified 7,777 potentially relevant articles published between 1980 and 2014 and 131 of these yielded pertinent information. Aggregating results across heterogeneous study designs and diverse patient samples, the overall mean prevalence rate of current tobacco use (mostly cigarette smoking) was 33.0% (median, 31.0%). Among current tobacco users at cancer diagnosis, the mean prevalence rate of current tobacco use (mostly cigarette smoking) was 53.8% (median, 50.3%). In many cases, an operational definition of "current" tobacco use was absent, and biochemical verification of self-reported smoking status was infrequent. These and other observed methodologic limitations in the assessment and reporting of cancer patients' tobacco use underscore the necessity of uniform tobacco use assessment in future clinical research and cancer care.

Posttraumatic Stress Disorder and Illness Perception in Young Survivors of Childhood Cancer

Objetivo

Este estudo teve como objetivo avaliar a presença de Transtorno de Estresse Pós-Traumático (TEPT) e a sua relação com a perceção da doença numa amostra de 65 jovens sobreviventes de cancro infantil, com uma média de idades de 19 anos (DP= 2,70) e que tinham terminado o tratamento, em média, há sete anos.

Método

Foram aplicados instrumentos para obtenção de dados sociodemográficos e clínicos, de sintomas de TEPT – “Posttraumatic Stress Disorder Checklist – Civilian” (PCL-C) e de perceção da doença – “Revised Illness Perception Questionnaire for Healthy People” (IPQ-RH).

Resultados

A presença de sintomas de TEPT variade 9,2% a 18,5% na amostra, e a perceção da doença esteve correlacionada com os sintomas deste transtorno. As subescalas Representação Emocional e Coerência da Doença (IPQ-RH), foram preditoras dos sintomas de Reexperiência (β = 0,0370; p < 0,01; β = 0,261; p<0,05, respetivamente). A subescala Representação Emocional (IPQ-RH) também foi preditora de sintomas de Esquiva (β = 0,330; p < 0,001).

Conclusão

Concluiu-se que a perceção da doença deve ser investigada para prevenir os sintomas de TEPT em sobreviventes de câncer infantil.

Helping cancer patients quit smoking by increasing their risk perception: a study protocol of a cluster randomized controlled trial

Background

Despite smoking cessation can largely improve cancer prognosis and quality of life, many patients continued smoking after the diagnosis of cancer. This study aims to test the effectiveness of a smoking cessation intervention using risk communication approach to help cancer patients quit smoking, and to improve their health related quality of life.

Methods

A cluster randomized controlled trial will be employed. Cancer patients who continued smoking after the diagnosis of cancer and have medical follow-up at the out-patient clinics of the five acute hospitals in Hong Kong will be invited to participate. Subjects in the experimental group will receive (1) health warnings of smoking based on a special designed leaflet; and (2) a patient-centred counseling from nurse counselors with emphasis on risk perceptions of smoking to cancer prognosis. Additionally, they will receive two more telephone counseling at 1-week and 1-month. Control group receive standard care and a generic self-help smoking cessation booklet. Outcomes measure include (a) self-reported and the biochemically validated quit rate, (b) patient’s smoking reduction by at least 50 % compared to baseline, (c) quit attempt(s), (d) change in the intention to quit, (e) change in risk perceptions of smoking, and (f) change in health related quality of life.

Discussion

This study will make an important contribution to evidence-based practice by testing the effectiveness of a tailored smoking cessation intervention for cancer patients. The results will support the development of clinical practice guidelines to promote smoking cessation in cancer patients to improve their prognosis and quality of life.

Trial registration

ClinicalTrials.gov NCT01685723. Registered 9 November 2012.

Second-Hand Smoke As a Predictor of Smoking Cessation Among Lung Cancer Survivors

Purpose

Second-hand smoke (SHS; ie, exposure to smoking of friends and spouses in the household) reduces the likelihood of smoking cessation in noncancer populations. We assessed whether SHS is associated with cessation rates in lung cancer survivors.

Patients and Methods

Patients with lung cancer were recruited from Princess Margaret Cancer Centre, Toronto, ON, Canada. Multivariable logistic regression and Cox proportional hazard models evaluated the association of sociodemographics, clinicopathologic variables, and SHS with either smoking cessation or time to quitting.

Results

In all, 721 patients completed baseline and follow-up questionnaires with a mean follow-up time of 54 months. Of the 242 current smokers at diagnosis, 136 (56%) had quit 1 year after diagnosis. Exposure to smoking at home (adjusted odds ratio [aOR], 6.18; 95% CI, 2.83 to 13.5; P < .001), spousal smoking (aOR, 6.01; 95% CI, 2.63 to 13.8; P < .001), and peer smoking (aOR, 2.49; 95% CI, 1.33 to 4.66; P = .0043) were each associated with decreased rates of cessation. Individuals exposed to smoking in all three settings had the lowest chances of quitting (aOR, 9.57; 95% CI, 2.50 to 36.64; P < .001). Results were similar in time-to-quitting analysis, in which 68% of patients who eventually quit did so within 6 months after cancer diagnosis. Subgroup analysis revealed similar associations across early- and late-stage patients and between sexes.

Conclusion

SHS is an important factor associated with smoking cessation in lung cancer survivors of all stages and should be a key consideration when developing smoking cessation programs for patients with lung cancer.

Illness perceptions predict exercise capacity and psychological well-being after pulmonary rehabilitation in COPD patients

OBJECTIVE

Patients' beliefs about their disease have been associated with emotional adjustment and outcomes in several severe illnesses. The aim of the present study was to investigate whether illness perceptions before pulmonary rehabilitation influence exercise capacity and quality of life after rehabilitation in patients suffering from chronic obstructive pulmonary disease (COPD).

METHODS

Ninety-six patients with COPD (GOLD III/IV) were approached on admission to rehabilitation and reassessed before discharge. Assessment included medical measures of FEV% predicted, and exercise capacity (6 min walk test). Additionally, depressive symptoms (Hospital Anxiety and Depression scale), anxiety (COPD specific anxiety questionnaire) and quality of life (Short Form 36 health survey (SF-36)) were assessed. Illness beliefs were measured by the Revised Illness Perception Questionnaire (IPQ-R).

RESULTS

Exercise capacity and psychological well-being (SF-36) of patients improved after rehabilitation programme, while physical functioning (SF-36) did not change. Additionally, patients showed significantly lower levels of depressive symptoms, COPD specific anxiety and negative perceptions of their illness after pulmonary rehabilitation compared to baseline. In the hierarchical multiple regression analyses, after controlling for socio-demographic data, psychological variables, illness severity and baseline scores of the corresponding variables, it was shown that illness perceptions before rehabilitation predicted exercise capacity and psychological well-being, both assessed at the end of treatment.

CONCLUSION

COPD patients' perceptions about their illness before rehabilitation influence exercise capacity and quality of life (psychological well-being) after treatment. Therefore it might be relevant to identify and change maladaptive illness perceptions in order to improve medical and psychological outcome in COPD.

A six-month study of pulmonary cancer in Albanian women

Lung cancer is a potentially lethal disease, whose prevalence in Albania is constantly increasing, especially in women. Early diagnosis is extremely important with regard to life expectancy and quality. The authors conducted a survey on the behaviour in a sample group of Albanian women diagnosed with primary and secondary lung cancers. A discussion upon diagnostic methods, smoking habits, histological type, Karnofsky performance status (KPS), and treatment modalities is made. The data collected by the authors suggest that nonsmokers formed the main group of lung cancer female patients. The most frequent histological type was adenocarcinoma. Mesothelioma was the most frequent of the secondary pulmonary lung cancers, followed from metastasizing breast cancer. Despite a generally good performance of the cases, the diagnosis of pulmonary cancer is delayed. The data collected could not find a convincing etiological role of tobacco smoking, but caution is needed, regarding the short time length of the study and the sustained number of participants.

Impact of patient smoking behavior on empathic helping by family caregivers in lung cancer

PURPOSE/OBJECTIVES

To test the impact of patient smoking behavior on family caregiver judgments of responsibility, emotions, empathic responses, and helping behavior.

DESIGN

Structural equation modeling.

SETTING

Five oncology outpatient settings in Canada.

SAMPLE

304 dyads consisting of patients with lung cancer and their primary caregivers.

METHODS

Self-report questionnaires, abstracted medical record data, confirmatory factor analysis, and structural equation modeling.

MAIN RESEARCH VARIABLES

Smoking history, judgments of responsibility for controlling the disease, anger, pride, empathic responses, and helping behaviors.

FINDINGS

The impact of patient smoking behavior on caregiver help was mediated by caregiver judgments of responsibility, affective reactions of anger and pride, and empathic responses by caregivers.

CONCLUSIONS

When patients continued to engage in smoking behavior, despite a diagnosis of lung cancer, caregivers tended to ascribe more responsibility and feel more anger and less pride in the patients' efforts to manage the disease, therefore placing caregivers at risk for less empathy and helping behavior.

IMPLICATIONS FOR NURSING

Caregiver blame and anger must be assessed, particularly when the patient with lung cancer continues to smoke. If caregiver judgments of blame and anger are evident, then an attribution approach is indicated involving a dialogue between the caregiver and the patient, with the aim of enhancing the caregiver's understanding of how negative attributions and linked emotions impact his or her ability to engage in empathic helping behaviors.

Feasibility test of a UK-scalable electronic system for regular collection of patient-reported outcome measures and linkage with clinical cancer registry data: the electronic Patient-reported Outcomes from Cancer Survivors (ePOCS) system

Background

Cancer survivors can face significant physical and psychosocial challenges; there is a need to identify and predict which survivors experience what sorts of difficulties. As highlighted in the UK National Cancer Survivorship Initiative, routine post-diagnostic collection of patient reported outcome measures (PROMs) is required; to be most informative, PROMs must be linked and analysed with patients' diagnostic and treatment information. We have designed and built a potentially cost-efficient UK-scalable electronic system for collecting PROMs via the internet, at regular post-diagnostic time-points, for linking these data with patients' clinical data in cancer registries, and for electronically managing the associated patient monitoring and communications; the electronic Patient-reported Outcomes from Cancer Survivors (ePOCS) system. This study aims to test the feasibility of the ePOCS system, by running it for 2 years in two Yorkshire NHS Trusts, and using the Northern and Yorkshire Cancer Registry and Information Service.

Methods/Design

Non-metastatic breast, colorectal and prostate cancer patients (largest survivor groups), within 6 months post-diagnosis, will be recruited from hospitals in the Yorkshire Cancer Network. Participants will be asked to complete PROMS, assessing a range of health-related quality-of-life outcomes, at three time-points up to 15 months post-diagnosis, and subsequently to provide opinion on the ePOCS system via a feedback questionnaire. Feasibility will be examined primarily in terms of patient recruitment and retention rates, the representativeness of participating patients, the quantity and quality of collected PROMs data, patients' feedback, the success and reliability of the underpinning informatics, and the system running costs. If sufficient data are generated during system testing, these will be analysed to assess the health-related quality-of-life outcomes reported by patients, and to explore if and how they relate to disease, treatment and/or individual differences characteristics.

Discussion

There is currently no system in the UK for collecting PROMs online and linking these with patients' clinical data in cancer registries. If feasible, ePOCS has potential to provide an affordable UK-scalable technical platform to facilitate and support longitudinal cohort research, and improve understanding of cancer survivors' experiences. Comprehensive understanding of survivorship difficulties is vital to inform the development and provision of supportive services and interventions.