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Becevic M, Anbari AB, McElroy JA. It's Not Always Easy: Cancer Survivorship Care in Primary Care Settings. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1592-1599. [PMID: 37133797 DOI: 10.1007/s13187-023-02304-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
By 2040, an anticipated 26.1 million people with a history of cancer will be part of the healthcare system. The purpose of this study was to explore Missouri-based non-oncology clinicians' perspectives on caring for patients with a history of cancer to identify needs of rural-based clinicians to optimize their patients' survivorship care. Using an interpretive qualitative descriptive approach, we conducted semi-structured interviews with 17 non-oncology clinicians. We encouraged clinicians to discuss their approach to caring for patients with a history of cancer and invited them to talk about what might help them increase their knowledge of survivorship care best practices. Through interpretive qualitative descriptive analysis methods including first level coding and constant comparison, we found there is consensus that cancer survivorship care is important; however, training that now guides our clinicians occurred mostly during residency, if at all. Clinicians relied on previous patient encounters and oncology notes combined with their patients' personal account of treatment history to inform the best next steps. Clinicians expressed strong interest in having a simple protocol of their patient's treatment with prompts of known long-term cancer treatment-related effects and a patient-centric follow-up monitoring schedule (mandatory vs recommended vs optional). Clinicians expressed interest in educational opportunities about cancer care and ability for curbside consults with oncologists. They consistently noted the limited resources available in rural areas and that rural patients may have different preferences and approaches to cancer survivorship. There is a clear opportunity to improve non-oncology clinicians' knowledge of the needs of people with a history of cancer as well as their own knowledge base and self-efficacy, especially in rural settings.
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Affiliation(s)
- Mirna Becevic
- Department of Dermatology, School of Medicine, University of Missouri, 1 Hospital Drive, MA111, Columbia, MO, 65212, USA.
- Missouri Telehealth Network, University of Missouri, 4215 Phillips Farm Road, Suite 121, MO, 65212, Columbia, USA.
- Institute for Data Science and Informatics, University of Missouri, 241 Naka Hall, Columbia, MO, 65211, USA.
| | - Allison B Anbari
- Sinclair School of Nursing, University of Missouri, 915 Hitt St., Columbia, MO, 65212, USA
| | - Jane A McElroy
- Family and Community Medicine, University of Missouri, Medical Sciences Building, 1 Hospital Drive, MA306, Columbia, MO, 65212, USA
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Tao J, Zheng Y, Huang Q, Pu F, Shen Q, Hu Y. Patient-Reported Outcomes Measurement Information System in patients with gastrointestinal cancer: a scoping review. Support Care Cancer 2023; 31:567. [PMID: 37682320 DOI: 10.1007/s00520-023-08010-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE The purpose of this study was to identify and evaluate the use of the Patient-Reported Outcomes Measurement Information System in patients with gastrointestinal cancer, as well as provide references for analyzing treatment outcomes, gauging prognostic risk, and assessing clinical symptoms and function in gastrointestinal cancer patients. METHODS PubMed, Web of Science, ProQuest, Embase, and CINAHL were systematically searched using keywords and controlled vocabulary through January 2023. RESULTS The scoping review collected 30 studies published from 2012 to 2022, including observational studies (n = 21), interventional studies (n = 4), and mixed studies (n = 5). Outcome indicators included mood, pain, fatigue, sleep, the ability to perform activities of daily living, social functioning, and other health problems. CONCLUSION Being a self-report questionnaire, the Patient-Reported Outcomes Measurement Information System offers a full assessment of patient's symptoms and quality of life, and accurately captures their actual thoughts, feelings, and experiences. Individuals with gastrointestinal cancer made frequent use of the Patient-Reported Outcomes Measurement Information System to provide an accurate measure of their health status.
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Affiliation(s)
- Jiaping Tao
- Zhejiang Chinese Medical University, Hangzhou, China
- The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yeping Zheng
- The Second Affiliated Hospital of Jiaxing University, Jiaxing, China.
| | | | - Fengyan Pu
- The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Qianqian Shen
- The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yuanmin Hu
- The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
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Olson JL, Robertson M, Chen M, Conroy DE, Schmitz KH, Mama SK. Healthier Energy Balance Behaviors Most Important for Health-Related Quality of Life in Rural Cancer Survivors in Central Pennsylvania. J Phys Act Health 2023:1-8. [PMID: 37210076 DOI: 10.1123/jpah.2022-0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/01/2023] [Accepted: 04/04/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Rural cancer survivors face a greater number of health disparities, including poorer health-related quality of life (HRQoL), than urban cancer survivors. Engagement in healthy lifestyle behaviors also varies between rural and urban cancer survivors. Lifestyle behaviors can improve HRQoL; however, the combination of behaviors most important for HRQoL in rural survivors is unclear. This study examined clusters of lifestyle behaviors in rural cancer survivors, and differences in HRQoL between behavioral clusters. METHODS Rural cancer survivors in the United States (N = 219) completed a cross-sectional survey. Lifestyle behaviors were classified into unhealthy/healthy binary categories (inactive/active, longer/shorter sedentary time, excessive/acceptable fat intake, very low/higher fruit and vegetable intake, some/no alcohol consumption, and poor/good sleep quality). Behavioral clusters were identified by latent class analysis. HRQoL differences between behavioral clusters were assessed by ordinary least squares regression. RESULTS The 2-class model demonstrated the best fit and interpretability. The "mostly unhealthy behaviors" class (38.5% of sample) had higher probabilities of all unhealthy behaviors, except alcohol consumption. The "healthier energy balance" class (61.5% of sample) had higher probabilities of active, shorter sedentary, higher fruit and vegetable consumption, excessive fat intake, some alcohol consumption, and poor sleep categories, and reported better HRQoL. CONCLUSIONS Healthier energy balance behaviors were particularly relevant for HRQoL in rural cancer survivors. Multiple behavior change interventions to improve HRQoL in rural cancer survivors should focus on supporting energy balance behaviors. Many rural cancer survivors may lead very unhealthy lifestyles, placing them at high risk of adverse outcomes. This subpopulation should be prioritized to help alleviate cancer health disparities.
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Affiliation(s)
- Jenny L Olson
- Department of Kinesiology, The Pennsylvania State University, University Park, PA,USA
- College of Medicine, The Pennsylvania State University, Hershey, PA,USA
| | - Michael Robertson
- Department of Nutrition, Metabolism & Rehabilitation Sciences, The University of Texas Medical Branch at Galveston, Galveston, TX,USA
| | - Minxing Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX,USA
| | - David E Conroy
- Department of Kinesiology, The Pennsylvania State University, University Park, PA,USA
| | - Kathryn H Schmitz
- College of Medicine, The Pennsylvania State University, Hershey, PA,USA
| | - Scherezade K Mama
- Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX,USA
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Robbins R, Cole R, Ejikeme C, Orstad SL, Porten S, Salter CA, Sanchez Nolasco T, Vieira D, Loeb S. Systematic review of sleep and sleep disorders among prostate cancer patients and caregivers: a call to action for using validated sleep assessments during prostate cancer care. Sleep Med 2022; 94:38-53. [PMID: 35489117 PMCID: PMC9277625 DOI: 10.1016/j.sleep.2022.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/20/2022] [Accepted: 03/24/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE/BACKGROUND To examine the impact of prostate cancer (PCa) on sleep health for patients and caregivers. We hypothesized that sleep disturbances and poor sleep quality would be prevalent among patients with PCa and their caregivers. PATIENTS/METHODS A systematic literature search was conducted according to the Preferred Reporting Items for a Systematic Review and Meta-analysis guidelines. To be eligible for this systematic review, studies had to include: (1) patients diagnosed with PCa and/or their caregivers; and (2) objective or subjective data on sleep. 2431 articles were identified from the search. After duplicates were removed, 1577 abstracts were screened for eligibility, and 315 underwent full-text review. RESULTS AND CONCLUSIONS Overall, 83 articles met inclusion criteria and were included in the qualitative synthesis. The majority of papers included patients with PCa (98%), who varied widely in their treatment stage. Only 3 studies reported on sleep among caregivers of patients with PCa. Most studies were designed to address a different issue and examined sleep as a secondary endpoint. Commonly used instruments included the Insomnia Severity Index and European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaires (EORTC-QLQ). Overall, patients with PCa reported a variety of sleep issues, including insomnia and general sleep difficulties. Both physical and psychological barriers to sleep are reported in this population. There was common use of hypnotic medications, yet few studies of behavioral interventions to improve sleep for patients with PCa or their caregivers. Many different sleep issues are reported by patients with PCa and caregivers with diverse sleep measurement methods and surveys. Future research may develop consensus on validated sleep assessment tools for use in PCa clinical care and research to promote facilitate comparison of sleep across PCa treatment stages. Also, future research is needed on behavioral interventions to improve sleep among this population.
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Affiliation(s)
- Rebecca Robbins
- Harvard Medical School, Boston, MA, USA; Brigham & Women's Hospital, Boston, MA, USA.
| | - Renee Cole
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Stephanie L Orstad
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Sima Porten
- Department of Urology, University of California, San Francisco, USA
| | | | | | - Dorice Vieira
- NYU Grossman School of Medicine, New York, NY, USA; Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - Stacy Loeb
- Departments of Urology and Population Health, NYU School of Medicine and Manhattan Veterans Affairs, New York, NY, USA
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Klemp JR, Knight CJ, Lowry B, Long T, Bush C, Alsman K, Krebill H, Peereboom D, Overholser L, Greiner KA. Informing the delivery of cancer survivorship care in rural primary care practice. J Cancer Surviv 2022; 16:4-12. [PMID: 35107796 PMCID: PMC8881424 DOI: 10.1007/s11764-021-01134-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/06/2021] [Indexed: 11/26/2022]
Abstract
Purpose The cancer survivor population is projected to increase to 22.2 million by 2030, requiring improved collaboration between oncology and primary care practices (PCP). PCPs may feel ill-equipped to provide cancer survivorship care to patients without input from cancer specialists. Compared with nonrural cancer survivors, rural cancer survivors report experiencing worse treatment-related symptoms. The goal of this study was to gain a better understanding of the perspectives of PCP teams towards survivorship care and to develop and test an interdisciplinary training program to improve cancer survivorship care in rural practice. Methods This study was conducted in two phases. First, focus groups were conducted with rural PCP teams to gather information regarding beliefs, practices, and barriers related to cancer survivorship care delivery. A thematic analysis was completed using an iterative process of reviewing transcripts. Results from phase 1 were used to inform the development of a pilot intervention tested within seven rural PCPs (phase 2). Pre- and post-intervention knowledge changes were compared, and post-session interviews assessed planned or sustained practice changes. Results Seven PCPs participated in focus groups (phase 1). Cross-cutting themes identified included (1) organizational barriers affecting the delivery of cancer survivorship care, (2) challenges of role delineation with specialists and patients, (3) difficulty accessing survivorship care and resources, and (4) providers’ lack of knowledge of cancer survivorship care. For phase 2, seven practices participated in four case-based educational sessions. Within and between practice changes were identified. Conclusion This project explored cancer survivorship perspectives among PCP teams. Lack of familiarity with evidence-based guidelines and the inability to identify cancer survivors was apparent during discussions and led to the implementation of the phase 2 intervention, iSurvive. As a result, PCPs either changed or planned changes to improve the identification and evidence-based care of cancer survivors. Implications for Cancer Survivors Address barriers to access cancer survivorship care in rural primary care practices.
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Affiliation(s)
- J R Klemp
- University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, KS, USA.
| | - C J Knight
- University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - B Lowry
- Department of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - T Long
- Masonic Cancer Alliance, The University of Kansas Cancer Center, Kansas City, KS, USA
| | - C Bush
- Ascension, Wichita, KS, USA
| | - K Alsman
- Masonic Cancer Alliance, The University of Kansas Cancer Center, Kansas City, KS, USA
| | - H Krebill
- Masonic Cancer Alliance, The University of Kansas Cancer Center, Kansas City, KS, USA
| | - D Peereboom
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L Overholser
- University of Colorado School of Medicine, Aurora, CO, USA
| | - K A Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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van der Kruk SR, Butow P, Mesters I, Boyle T, Olver I, White K, Sabesan S, Zielinski R, Chan BA, Spronk K, Grimison P, Underhill C, Kirsten L, Gunn KM. Psychosocial well-being and supportive care needs of cancer patients and survivors living in rural or regional areas: a systematic review from 2010 to 2021. Support Care Cancer 2021; 30:1021-1064. [PMID: 34392413 PMCID: PMC8364415 DOI: 10.1007/s00520-021-06440-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/13/2021] [Indexed: 01/16/2023]
Abstract
Purpose To summarise what is currently known about the psychosocial morbidity, experiences, and needs of people with cancer and their informal caregivers, who live in rural or regional areas of developed countries. Methods Eligible studies dating from August 2010 until May 2021 were identified through several online databases, including MEDLINE, EMBASE, PsychINFO, and RURAL (Rural and Remote Health Database). Results were reported according to the PRISMA guidelines and the protocol was registered on PROSPERO (CRD42020171764). Results Sixty-five studies were included in this review, including 20 qualitative studies, 41 quantitative studies, and 4 mixed methods studies. Qualitative research demonstrated that many unique psychosocial needs of rural people remain unmet, particularly relating to finances, travel, and accessing care. However, most (9/19) quantitative studies that compared rural and urban groups reported no significant differences in psychosocial needs, morbidity, or quality of life (QOL). Five quantitative studies reported poorer psychosocial outcomes (social and emotional functioning) in urban cancer survivors, while three highlighted poorer outcomes (physical functioning, role functioning, and self-reported mental health outcomes) in the rural group. Conclusion Recent research shows that rural people affected by cancer have unique unmet psychosocial needs relating to rurality. However, there was little evidence that rural cancer survivors report greater unmet needs than their urban counterparts. This contrasts to the findings from a 2011 systematic review that found rural survivors consistently reported worse psychosocial outcomes. More population-based research is needed to establish whether uniquely rural unmet needs are due to general or cancer-specific factors.
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Affiliation(s)
- Shannen R. van der Kruk
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
- Cancer Research Institute, University of South Australia, Adelaide, SA Australia
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, NSW Australia
| | - Ilse Mesters
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Terry Boyle
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA Australia
| | - Ian Olver
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA Australia
| | - Kate White
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Sabe Sabesan
- College of Medicine and Dentistry (CMD), James Cook University, QLD, Townsville, Australia
| | - Rob Zielinski
- Central West Cancer Care Centre, Orange Base Hospital, Orange, NSW Australia
- Western Sydney University, Sydney, NSW Australia
| | - Bryan A. Chan
- School of Medicine, Griffith University, Brisbane, QLD Australia
| | - Kristiaan Spronk
- Cancer Research Institute, University of South Australia, Adelaide, SA Australia
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA Australia
| | - Peter Grimison
- Department of Medical Oncology, Chris O’Brien Lifehouse, Sydney, NSW Australia
| | | | | | - Kate M. Gunn
- Cancer Research Institute, University of South Australia, Adelaide, SA Australia
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA Australia
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The mediating role of unmet needs in the relationship between displacement and psychological adjustment: A study of cancer survivors from a Portuguese island region. Eur J Oncol Nurs 2021; 52:101928. [PMID: 33756420 DOI: 10.1016/j.ejon.2021.101928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The present study aims to explore whether the association between previous displacement to mainland Portugal to perform cancer therapy and current psychological adaptation is mediated by cancer survivors' unmet needs in terms of their emotional experience, financial concerns, access and continuity of care, and relations with others. METHOD This cross-sectional study included a sample of 173 cancer survivors from the Azores archipelago (Portugal) recruited from a local oncological health unit. Participants completed a sociodemographic and clinical questionnaire and self-report measures assessing their unmet needs and psychological adaptation. Two parallel multiple mediation models were tested. RESULTS Azorean cancer survivors live with unmet needs, especially emotional needs (M = 16.68, SD = 10.78). Displacement was indirectly associated with both anxious (indirect effect = 0.58, SE = 0.27, 95% Bias Corrected and accelerated Confidence Interval = [0.05, 1.15]) and depressive symptomatology (indirect effect = 0.36, SE = 0.17, 95% Bias Corrected and accelerated Confidence Interval = [0.03, 0.84]) through unmet emotional needs. CONCLUSION Previous displacements seem to play an important role in the way cancer survivors adapt to survivorship by contributing to higher levels of unmet emotional needs. These findings can provide a scientific and clinical contribution to other isolated or island regions in the world where survivors face similar constraints.
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Johnson LA, Schreier AM, Swanson M, Ridner S. Dimensions of Distress in Lung Cancer. Oncol Nurs Forum 2020; 47:732-738. [PMID: 33063781 DOI: 10.1188/20.onf.732-738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To (a) compare the domains of distress between patients who were distressed and patients who were not distressed and (b) examine the relationship between the National Comprehensive Cancer Network Distress Thermometer and Problem List for Patients (DT-PL) and the Hospital Anxiety and Depression Scale (HADS) in individuals with advanced lung cancer. SAMPLE & SETTING Individuals with advanced lung cancer receiving chemotherapy were recruited from a comprehensive cancer center in the southeastern United States. METHODS & VARIABLES A cross-sectional, descriptive, exploratory design was used. Individuals with lung cancer completed the DT-PL and the HADS. Data were analyzed using descriptive statistics, t tests, and chi-square analysis. RESULTS Significant differences were found between the nondistressed group and the clinically distressed group in three domains of distress. IMPLICATIONS FOR NURSING Distress in individuals with advanced lung cancer goes beyond psychological stressors and includes family problems and physical problems.
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Tran TXM, Park J, Lee J, Jung YS, Chang Y, Cho H. Utility of the Patient-Reported Outcomes Measurement Information System (PROMIS) to measure primary health outcomes in cancer patients: a systematic review. Support Care Cancer 2020; 29:1723-1739. [PMID: 33058000 DOI: 10.1007/s00520-020-05801-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To systematically review the literature on how the Patient-Reported Outcomes Measurement Information System (PROMIS) measure system is used to assess patient-reported outcomes (PROs) in cancer patients. METHODS We conducted a systematic review following the PRISMA guidelines. Articles were identified through searches of PubMed, EMBASE, and additional manual review of the publications listed on the PROMIS website. We included studies measuring outcomes, including physical function, fatigue, pain, anxiety, and depression in cancer patients. Eligible articles included interventional and observational studies published in English between 2009 and 2019. RESULTS A total of 1789 records were identified and screened by three reviewers, 118 articles were reviewed in full text, and 42 articles met the inclusion criteria. The majority of studies used the PROMIS measure system to prospectively assess longitudinal changes in PROs; the number of measurements ranges from 2 to 4 with the time points of follow-up set at 3, 6, and 12 months after the baseline assessment. Depression and fatigue were the most frequently measured outcomes. Fixed-length short forms with four items were the most common measure types. A transition toward utilizing a web- or smartphone-based electronic tool was observed to limit the burden of the conventional paper-based survey to collect and store PROs. CONCLUSION The PROMIS measure system is increasingly popular to measure PROs in cancer patients with acceptance of its various short forms and electronic-based systems to administer data electronically. Findings from this review highlight various aspects of PROMIS and may help health professionals in their choice of PRO tools for optimizing care and support for cancer patients.
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Affiliation(s)
- Thi Xuan Mai Tran
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Jungeun Park
- Division of Healthcare Technology Assessment Research, National Evidence-based healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Joonki Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yuh-Seog Jung
- Cancer Knowledge and Information Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
- Division of Tumor Immunology, Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Yoonjung Chang
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
- National Cancer Survivorship Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Hyunsoon Cho
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
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Strayhorn SM, Carnahan LR, Zimmermann K, Hastert TA, Watson KS, Ferrans CE, Molina Y. Comorbidities, treatment-related consequences, and health-related quality of life among rural cancer survivors. Support Care Cancer 2020; 28:1839-1848. [PMID: 31342166 PMCID: PMC6980904 DOI: 10.1007/s00520-019-05005-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/17/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE We explored how lifetime comorbidities and treatment-related cancer symptoms were associated with quality of life (QOL) in rural cancer survivors. METHODS Survivors (n = 125) who were rural Illinois residents aged 18+ years old were recruited from January 2017 to September 2018. We conducted 4 multivariable regressions with QOL domains as outcomes (social well-being, functional well-being, mental health-MHQOL, physical health-PHQOL); the number of physical and psychological comorbidities (e.g., arthritis, high blood pressure, stroke) and treatment-related cancer symptoms (e.g., worrying, feeling sad, lack of appetite, lack of energy) as predictors; and, cancer-related and demographic factors related to these variables as covariates. RESULTS The number of comorbidities and number of treatment-related symptoms were inversely associated with functional well-being (Std β = - 0.36, p < 0.0001 and - 0.18, p = 0.03), and MHQOL (Std β = - 0.30, p = 0.001 and Std β = - 0.25, p = 0.004). Comorbidities were associated inversely with social well-being (Std β = - 0.27, p = .003). Comorbidities and treatment-related symptoms were not associated with PHQOL (p = 0.20-0.24). Sensitivity analyses suggested that psychological comorbidities, treatment-related psychological symptoms, and physical comorbidities were associated with social well-being, functional well-being, and MHQOL. CONCLUSIONS Our study highlights the utility of risk-based survivorship care plans to address the negative, additive impact of comorbidities and the treatment-related symptoms to improve the health-related QOL among rural survivors. Future research should assess how contextual factors (e.g., geographic distance to oncologists and other providers) should be incorporated in survivorship care planning and implementation for rural survivors.
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Affiliation(s)
- Shaila M Strayhorn
- University of Illinois at Chicago Institute for Health Research and Policy, 1747 W. Roosevelt Rd., Chicago, IL, 60608, USA
| | - Leslie R Carnahan
- University of Illinois at Chicago Center for Research on Women and Gender, 1640 W. Roosevelt Rd., Chicago, IL, 60608, USA
| | - Kristine Zimmermann
- University of Illinois at Chicago Center for Research on Women and Gender, 1640 W. Roosevelt Rd., Chicago, IL, 60608, USA
| | - Theresa A Hastert
- Karmanos Cancer Institute of Wayne State University, 4100 John R St, Detroit, MI, 48201, USA
| | - Karriem S Watson
- University of Illinois Cancer Center, 914 S. Wood St., Chicago, IL, 60612, USA
| | - Carol Estwing Ferrans
- University of Illinois at Chicago College of Nursing, 845 S. Damen Ave., Chicago, IL, 60612, USA
| | - Yamilé Molina
- University of Illinois at Chicago Center for Research on Women and Gender, 1640 W. Roosevelt Rd., Chicago, IL, 60608, USA.
- Karmanos Cancer Institute of Wayne State University, 4100 John R St, Detroit, MI, 48201, USA.
- Division of Community Health Sciences, School of Public Health, 1603 W. Taylor St., MC 923, Chicago, USA.
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Pain management index (PMI)-does it reflect cancer patients' wish for focus on pain? Support Care Cancer 2019; 28:1675-1684. [PMID: 31290020 DOI: 10.1007/s00520-019-04981-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The pain management index (PMI) was developed to combine information about the prescribed analgesics and the self-reported pain intensity in order to assess physicians' response to patients' pain. However, PMI has been used to explore undertreatment of cancer pain. The present study explores prevalence of negative PMI and its associations to clinical variables, including the patient-perceived wish for more attention to pain. METHODS A single-center, cross-sectional, observational study of cancer patients was conducted. Data on demographics and clinical variables, as well as patient-perceived wish for more attention to pain, were registered. PMI was calculated. Negative PMI indicates that the analgesics prescribed might not be appropriate to the pain intensity reported by the patient, and associations to negative PMI were explored by logistic regression models. RESULTS One hundred eighty-seven patients were included, 53% had a negative PMI score. Negative PMI scores were more frequent among patients with breast cancer (OR 4.2, 95% CI 1.3, 13.5), in a follow-up setting (OR 12.1, 95% CI 1.4, 101.4), and were inversely associated to low performance status (OR 0.14, 95% CI 0.03, 0.65). Twenty-two percent of patients with negative PMI scores reported that they wanted more focus on pain management, versus 13% among patients with a non-negative PMI score; the difference was not statistically significant. CONCLUSION A high prevalence of negative PMI was observed, but only 1/5 of patients with a negative PMI wanted more attention to pain by their physician. Our findings challenge the use of PMI as a measure of undertreatment of cancer pain.
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