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Ivert LU, Winther AH, Jonsson P, Brauner H. Exploring the educational needs of patients with cutaneous lymphoma using an educational needs assessment tool. Front Oncol 2024; 14:1433821. [PMID: 39169940 PMCID: PMC11335495 DOI: 10.3389/fonc.2024.1433821] [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: 05/16/2024] [Accepted: 07/23/2024] [Indexed: 08/23/2024] Open
Abstract
Background Cutaneous T-cell lymphomas (CTCL) are a group of rare non-Hodgkin lymphomas characterized by initial localization of malignant T-lymphocytes in the skin. Support and information from nurses and patient support groups have proven useful for patients with CTCL, but little is known about the educational needs of these patients. Objectives To investigate the self-reported educational needs among CTCL patients using an educational needs assessment tool and to explore differences related to sex, age, disease duration, clinical stage, and education. Methods This observational single center study analyzed 70 patients with CTCL in routine dermatological outpatient care. The patients were asked to complete a questionnaire to capture their educational needs in regard to CTCL. The questionnaire was inspired by the educational needs assessment tool, designed and validated for patients with rheumatoid disease. The questionnaire included a general question, "In general, how much information do you want to receive about your lymphoma disease?", and five domains covering information relating to disease process (6 items), treatment (4 items), feelings (2 items), self-management of itch, sleep, and rest (2 items), and support systems (3 items). The domain scores ranged from 0 to 18 and the total score from 0 to 51, with a higher score indicating a greater need for education. Results When asked "In general, how much information do you need?", females wanted to know more compared with males (2.6 vs. 2.1, p=0.006), and patients with higher education wanted to know more than patients with lower education (2.5 vs. 2.0, p=0.025). The domains concerning treatment (80%) and disease process (75%) revealed the greatest needs for education. Patients with a disease duration <2 years reported a greater educational need for the domain support system, compared with patients with longer disease duration. Patients with lower education reported a greater educational need about feelings compared with patients with higher education. Conclusions We found that 65% of the CTCL patients in the cohort, particularly females, expressed a need for education, especially regarding disease process and treatment. A deeper understanding of the educational needs would enable healthcare providers to give personalized information.
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Affiliation(s)
- Lina U. Ivert
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna H. Winther
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Jonsson
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Brauner
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
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Ottevanger R, van Beugen S, Kersten JM, Evers AWM, Vermeer MH, Willemze R, Quint KD. Evaluation of Quality of Life and Treatment Satisfaction in Newly Diagnosed Cutaneous T-Cell Lymphoma Patients. Cancers (Basel) 2024; 16:937. [PMID: 38473299 DOI: 10.3390/cancers16050937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Little is known about the impact of MF on quality of life (QoL) in newly diagnosed patients. OBJECTIVES To describe the impact of the MF diagnosis on QoL, patient expectations, and treatment satisfaction over the first 6 months after diagnosis. METHODS Outcomes of this prospective cohort study of newly diagnosed MF patients conducted between 2020 and 2022 at the Leiden University Medical Center included the Skindex-29, RAND-12 Health Survey, degree of itch, pain, and fatigue (Visual Analogue Scale (VAS)), patient expectations, and Client Satisfaction Questionnaire-8 (CSQ-8), measured at baseline and after six months. RESULTS A total of 28 patients with MF were included. At baseline, 66% (n = 18) "strongly-totally" expected positive effects of the treatment. At the time of diagnosis, 28% of the patients (n = 8) were moderately to severely affected. There was no statistical change in the Skindex-29 score sum score (20 [10-34] vs. 20 [9-36]; p = 0.81) or in the other three subdomains, the RAND-12 scores, and the VAS itch, pain, and fatigue over time. Treatment satisfaction was high overall. CONCLUSION Despite that the newly diagnosed MF patients anticipate a positive treatment effect, few improvements in QoL and symptom reduction were found. These data can be used for adequate expectation management and provide a rationale for further evaluation of treatment regimens in these patients.
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Affiliation(s)
- Rosanne Ottevanger
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Sylvia van Beugen
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, 2311 EZ Leiden, The Netherlands
| | - Juliette M Kersten
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, 2311 EZ Leiden, The Netherlands
| | - Maarten H Vermeer
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Henderson Berg MH, Popradi G, Roberge D, Petrogiannis-Haliotis T, Pehr K. Psychological Distress and Treatment Outcome in Patients With Early-Stage Mycosis Fungoides. J Cutan Med Surg 2024; 28:29-32. [PMID: 38229268 PMCID: PMC10908191 DOI: 10.1177/12034754231220913] [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] [Indexed: 01/18/2024]
Abstract
BACKGROUND Skin diseases have been shown to worsen psychological distress, which, in turn, may be detrimental to treatment outcomes. Both the impact of psychological distress on response to treatment in mycosis fungoides (MF) and the effect of treatments on psychological well-being are unclear. OBJECTIVES To evaluate (1) the association between pretreatment psychological morbidity and treatment outcome in early-stage MF and (2) the impact of response to treatment on psychological well-being. METHODS This was a prospective cohort study of patients with early-stage MF who started a new stage-directed treatment for their disease. The response was determined using the modified severity-weighted assessment tool, and psychological distress was assessed using the 12-item General Health Questionnaire (GHQ-12) and Penn State Worry Questionnaire (PSWQ). Participants were followed for 1 year. RESULTS In all, 24 consecutive patients were recruited. Objective response rate was 71% (17/24), consistent with existing literature. Prior to treatment, 9 patients (38%) had clinically significant psychological distress on the GHQ-12, while 8 (33%) demonstrated high-level worry on the PSWQ. Of these patients, 6 had pathologic scores on both instruments. Patients with significantly less baseline anxiety/depression on the GHQ-12 responded better to treatment than patients with higher levels (P = .004). In addition, responders' mean GHQ-12 scores decreased by 39% and their PSWQ scores by 17%, whereas nonresponders' GHQ-12 scores increased by 93% (P = .042) and their PSWQ scores by 11% (P = .019). CONCLUSIONS These findings suggest that (1) baseline psychological distress is associated with worse outcomes in patients with early-stage MF and that (2) effective treatment improves psychological morbidity.
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Affiliation(s)
- Meagan-Helen Henderson Berg
- Division of Dermatology, McGill University, Montréal, QC, Canada
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
- McGill Multidisciplinary Cutaneous Lymphoma Clinic, Montréal, QC, Canada
| | - Gizelle Popradi
- McGill Multidisciplinary Cutaneous Lymphoma Clinic, Montréal, QC, Canada
- Division of Hematology, McGill University, Montréal, QC, Canada
| | - David Roberge
- McGill Multidisciplinary Cutaneous Lymphoma Clinic, Montréal, QC, Canada
- Division of Radiation Oncology, Centre Hospitalier de l’Universite de Montreal, Montréal, QC, Canada
| | - Tina Petrogiannis-Haliotis
- McGill Multidisciplinary Cutaneous Lymphoma Clinic, Montréal, QC, Canada
- Department of Pathology, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Division of Hematology, Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, Montréal, QC, Canada
| | - Kevin Pehr
- Division of Dermatology, McGill University, Montréal, QC, Canada
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
- McGill Multidisciplinary Cutaneous Lymphoma Clinic, Montréal, QC, Canada
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Segal O, Goldzweig G, Shapiro Bratt I, Baum S, Lyakhovitsky A, Barzilai A. Illness Perception Regarding Early-stage Mycosis Fungoides among Dermatologists: A Multi-centre Cross-sectional Study. Acta Derm Venereol 2022; 102:adv00784. [DOI: 10.2340/actadv.v102.2046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Early-stage mycosis fungoides is a rare cutaneous T-cell lymphoma with a good prognosis. Data regarding patients’ illness perception of mycosis fungoides are accumulating. However, investigating the dermatologists’ viewpoint is also essential, as it shapes the therapeutic relationship and doctor–patient communication. The aim of this study was to investigate the aspects of dermatologists’ illness perception towards early-stage mycosis fungoides and the way they present it to patients. Twenty-five dermatology residents and 55 attending physicians from all Israeli dermatology departments and the community completed the study questionnaires online. Dermatologists viewed mycosis fungoides as a chronic disease, causing a moderate emotional burden. In contrast to previously published data regarding patients’ illness perception, dermatologists demonstrated dominancy in the notion that patients were able to control their disease. Most dermatologists thought that patients perceived mycosis fungoides as an indolent lymphoma that causes anxiety. Dermatologists used a high diversity of themes when presenting mycosis fungoides to patients. The differences between the residents’ and attending physicians’ perceptions were minimal. Dermatologists have a kaleidoscope of views regarding the way they perceive mycosis fungoides, the way they think patients perceive it, and the way they communicate with patients. Maintaining patient-centred communication enables dermatologists to identify these gaps and view mycosis fungoides from their patients’ perspective.
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Abstract
PURPOSE OF REVIEW With an increasing number of long-term lymphoma survivors, there has been emphasis on optimizing quality of life and identifying survivorship challenges. This review summarizes the latest advancements pertaining to health-related quality of life and survivorship in lymphoma. RECENT FINDINGS Quality of life can vary from diagnosis through survivorship though some physical, social, and emotional effects may be persistent. Incorporation of patient reported outcomes enables recognition of factors that significantly impact quality of life. A greater understanding of quality of life and survivorship issues has generated momentum for practice change, improving education, and designing behavior related interventions. Patients with lymphoma face many challenges as they navigate their cancer experience. There is a tremendous opportunity to build upon this work through well-designed prospective longitudinal studies aimed at identifying vulnerable patient groups and impactful points of intervention during survivorship.
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Ottevanger R, van Beugen S, Evers AWM, Willemze R, Vermeer MH, Quint KD. Quality of life in patients with Mycosis Fungoides and Sézary Syndrome: a systematic review of the literature. J Eur Acad Dermatol Venereol 2021; 35:2377-2387. [PMID: 34331819 PMCID: PMC9291074 DOI: 10.1111/jdv.17570] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/20/2021] [Accepted: 07/16/2021] [Indexed: 12/29/2022]
Abstract
Cutaneous T‐cell Lymphoma’s (CTCL) are a rare, heterogeneous group of T‐cell lymphomas that primarily manifest in the skin. Mycosis fungoides (MF) and Sézary syndrome (SS) are considered the classic types of CTCL. The diverse manifestation of CTCL results in a wide range of symptoms with a possible mild to severe impact on Quality of Life (QoL) depending on the disease stage. Previous studies on QoL in CTCL patients report diverse patient populations and use many different QoL instruments. In the current literature, a clear overview on the influence of the different stages of disease (early MF, late‐stage MF/SS or total group) on the QoL is lacking. Therefore, a systematic search of the literature was conducted using the PubMed, Embase, PsycINFO and Web of Science databases. Studies were included if they described QoL in patients with MF and SS retrieved by standardized instruments or qualitative interviews. In total, 24 studies were included using 18 different questionnaires to report on dermatology‐specific, cancer‐specific and generic QoL. The effect on QoL was found to be greater in patients with late‐stage disease as compared to early stage disease, with significant impairments on functional, emotional and physical domains. Nonetheless, even in patients with limited disease, QoL was mildly to moderately affected. Overall, pruritus was the most frequent reported and most bothersome symptom. Significant influence of the disease on daily life activities were found, not only in patients but also on caregivers and family. This broad, structured overview on QoL in MF and SS patients underlines the influence of disease stage on QoL, and therefore, recommends future studies to distinguish between disease stages when reporting results. Furthermore, this overview can inform clinicians in clinical practice by creating awareness of QoL deficits according to disease stage.
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Affiliation(s)
- R Ottevanger
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - S van Beugen
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - A W M Evers
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - R Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - M H Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - K D Quint
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
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