Participation in patient support groups among cancer survivors: do psychosocial and medical factors have an impact?

A Better Me? An Interpretative Phenomenological Analysis of the Experiences of Female Cancer Survivors' Heightened Preoccupation With 'Healthy Eating'

The end of treatment is known to be a particularly challenging time for many cancer survivors as they transition to coping with their condition independently. They may engage in health behaviours, such as implementing drastic dietary changes to manage the side effects of treatment they have undergone or as a way to assuage their anxiety. Understanding cancer survivors' heightened preoccupation with healthy eating is therefore fundamental to our understanding of the psychological phenomenology of cancer. This study explored how people who have developed a heightened preoccupation with healthy eating after a cancer diagnosis make sense of this change. Eight participants were recruited through social media. They each engaged in a semi-structured interview over Zoom concerning their changed relationship with food following cancer. Their accounts were then analysed using interpretative phenomenological analysis (IPA). The article focuses on four group experiential themes arising from the analysis: Open and Enlightened About Food, Becoming a Better Me?, Developing a New Passion for Nutrition, and Becoming Consumed by Food. The themes that arose from the analysis speak to the experience of becoming a 'better' person from having lived through cancer and developed a new relationship with food. Instead of seeing illness as a loss, several of the participants reported a positive shift linked to having developed an interest in healthy eating, something which became central to their identity. However, others experienced their new engagement with healthy eating as a preoccupation that engulfed them. These findings are discussed in light of existing theory and research, and their clinical implications are outlined. Areas for future research are also suggested.

Decision regret of cancer patients after radiotherapy: results from a cross-sectional observational study at a large tertiary cancer center in Germany

PURPOSE

The decision-making process regarding cancer treatment is emotionally challenging for patients and families, harboring the risk of decision regret. We aimed to explore prevalence and determinants of decision regret following radiotherapy.

METHODS

This cross-sectional observational study was conducted at a tertiary cancer center to assess decision regret following radiotherapy. The study employed the German version of the Ottawa Decision Regret Scale (DRS) which was validated in the study population. Decision regret was categorized as absent (0 points), mild (1-25 points), and strong (> 25 points). Various psychosocial outcome measures were collected using validated questionnaires to identify factors that may be associated with decision regret.

RESULTS

Out of 320 eligible patients, 212 participated, with 207 completing the DRS. Median age at start of radiotherapy was 64 years [interquartile range (IQR), 56-72], genders were balanced (105 female, 102 male), and the most common cancer types were breast (n = 84; 41%), prostate (n = 57; 28%), and head-and-neck cancer (n = 19; 9%). Radiotherapy was applied with curative intention in 188 patients (91%). Median time between last radiotherapy fraction and questionnaire completion was 23 months (IQR, 1-38). DRS comprehensibility was rated as good or very good by 98% (196 of 201) of patients. Decision regret was reported by 43% (n = 90) as absent, 38% (n = 78) as mild, and 18% (n = 38) as strong. In the multiple regression analysis, poor Eastern Cooperative Oncology Group performance status, low social support, and dissatisfaction with care were independent risk factors for higher decision regret after radiotherapy.

CONCLUSIONS

The German version of the DRS could be used to assess decision regret in a diverse cohort of cancer patients undergoing radiotherapy. Decision regret was prevalent in a considerable proportion of patients. Further studies are necessary to validate these findings and obtain causal factors associated with decision regret after radiotherapy.

Prospective analysis of the attendance behaviour of the participants of a facilitated support group for patients after allogeneic hematopoietic cell transplantation

PURPOSE

Support groups might help survivors of allogeneic hematopoietic cell transplantations (HCT) to cope with medical, psychological, and social challenges. The aim of this project was (1) to establish a facilitated post-HCT support group and (2) to assess the participation behaviour.

METHODS

From 11/2013 until 7/2017, all adult patients who had received a HCT at our centre were invited to participate in a professionally facilitated support group. The format of the group was unstructured without any rules regarding regular attendance. The attendance was prospectively minuted by the facilitator. Reasons for non-attendance were assessed by a survey.

RESULTS

During the observation period, 53 group meetings were scheduled. Nine meetings were cancelled because of low attendance. Altogether 23 different patients (F: n=10; M: n=13) and 10 spouses (F: n=9; M: n=1) participated. Median participation was 5 [range 2-11]. With respect to all HCT patients who had the theoretical opportunity to attend, the mean participation rate was 7%. Thirteen patients and four spouses attended more than one meeting. The median count of participations among those participants was 8 [2-32]. The median interval from the first until the last participation was 16 months. The main reason reported for non-participation was the effort to get to the venue of the support group.

CONCLUSIONS

To our knowledge, this is the first analysis on the attendance behaviour of the participants of a support group for HCT survivors. The results provide guidance for the organization of future support groups and indicate what participation rates can be expected and how they might be increased.

Empowerment in cancer patients: Does peer support make a difference? A systematic review

OBJECTIVE

Empowerment is critical for cancer patients to make informed choices, to manage medication, and to navigate through the oncological care system. Cancer peer support provides patients with information, emotional relief and may promote empowerment. This paper provides a systematic review of the literature examining the impact of cancer peer support interventions on psychological empowerment.

METHODS

PubMed, Web of Science, CINAHL, Cochrane Library, PsycINFO and PSYNDEX databases were systematically searched from inception until December 2020. We included quantitative studies, published in English or German, which examined peer-led cancer support interventions and their impact on the three components of psychological empowerment (intrapersonal, interactional and behavioural) among participating cancer patients.

RESULTS

Database searches and screening of relevant reference lists identified 2336 potentially relevant articles. A total of 29 studies were included in the review. Active coping, self-efficacy and knowledge were the most prominent dimensions of empowerment in these studies. The majority of studies revealed that peer support led to a small to medium, significant increase in psychological empowerment, and was associated with further patient-reported benefits.

CONCLUSIONS

The existing evidence suggests a weak to moderate, positive association between cancer peer support and the three components of psychological empowerment among cancer patients. Peer support groups should be seen as an important element in cancer care and clinical practice and, thus, be more systematically involved in cancer care.

A Phenotypic Comparison of Loudness and Pain Hyperacusis: Symptoms, Comorbidity, and Associated Features in a Multinational Patient Registry

Purpose Hyperacusis is a complex and poorly understood auditory disorder characterized by decreased tolerance to sound at levels that would not trouble most individuals. Recently, it has been suggested that individuals who experience otalgia in response to everyday sounds (termed pain hyperacusis) may differ clinically from those whose primary symptom is the perception of everyday sounds as excessively loud (termed loudness hyperacusis). Despite this theoretical distinction, there have been no empirical studies directly comparing these two populations of hyperacusis patients. Method Using data from a multinational patient registry (the Coordination of Rare Diseases at Sanford Registry), we examined self-reported demographics, symptoms, comorbidity, and response to treatment in a sample of 243 adults with hyperacusis, 152 of whom were classified as having pain hyperacusis based on reported symptoms. Bayesian statistical tests were used to investigate both the presence and absence of group differences between patients with loudness and pain hyperacusis. Results Individuals with pain hyperacusis presented with a more severe clinical phenotype, reporting a higher frequency of temporary symptom exacerbations (i.e., "setbacks"), less perceived symptom improvement over time, more severe comorbid headache disorders, and reduced benefit from sound therapy. However, the two hypothesized hyperacusis subtypes exhibited more similarities than differences, with the majority of symptoms and comorbidities being equally prevalent across groups. Multiple comorbidities were commonly observed, including tinnitus, primary headache disorders, psychiatric disorders, and functional somatic syndromes. Intolerance of sensory stimuli in other modalities was also frequently reported. Conclusion Although this study provides little evidence that loudness and pain hyperacusis are pathophysiologically distinct conditions, our findings indicate that a pain-predominant phenotype may be a meaningful prognostic marker in patients with hyperacusis.

Assessment of Self-Efficacy as a Way to Help Identify Cancer Patients Who Might Benefit from Self-Help Group Attendance?

Participating in patient self-help groups is highly recommended to patients in cancer care. Yet, engagement is relatively rare. A total of 253 patients participated in our study conducted as a paper-and-pencil questionnaire. A binominal logistic regression, with interest in participation in self-help groups being the dependent variable, was run. General interest in self-help was high among the respondents. Female gender, higher age, higher education and low self-efficacy were found to significantly predict interest in self-help. Patients reported a lack of information provided by medical professionals. Self-efficacy as a predictor might contribute to characterizing patients who might benefit from self-help group participation.

Using the Healthy Days Measure to Assess Factors Associated with Poor Health-Related Quality of Life for Patients with Metastatic Breast, Lung, or Colorectal Cancer Enrolled in a Medicare Advantage Health Plan

This study investigated factors associated with patient-reported health-related quality of life (HRQoL) using the Centers for Disease Control and Prevention's Healthy Days tool for patients with Medicare Advantage undergoing treatment for metastatic breast, lung, and colorectal cancer. In 2015, a total of 6390 patients were mailed surveys regarding factors that may influence their HRQoL, including cancer-related symptoms. HRQoL was measured as the number of physically and mentally unhealthy days experienced in the past 30 days and summed for the total number of unhealthy days. Frequent unhealthy days was defined as ≥14 total unhealthy days in the prior month. Of 1567 respondents, the mean number of total unhealthy days (standard deviation) was 14.0 (11.9) with 46.2% experiencing frequent unhealthy days. On average, patients reported 10.5 (10.5) physically and 6.7 (9.4) mentally unhealthy days. Cancer-related symptoms, particularly pain and fatigue, were significantly associated with increased unhealthy days. In adjusted models, patients with pain had 83% more unhealthy days than patients without pain; patients with fatigue had 104% more unhealthy days than patients without fatigue. Diarrhea/constipation and shortness of breath also were associated with more unhealthy days. Cancer-related symptoms, most notably pain and fatigue, were associated with worse HRQoL for patients with metastatic cancer. Interventions aimed at ameliorating symptoms may improve quality of life for patients undergoing cancer treatment.

The Effectiveness of Psychoeducational Support Groups for Women With Breast Cancer and Their Caregivers: A Mixed Methods Study

Background: Previous studies on the effectiveness of psychological interventions in oncology mainly used quantitative measures and no study was conducted with regard to both caregivers and patients.

Aim: This study evaluates the effectiveness of psychoeducational support groups, both for women with breast cancer, and for their informal caregivers through the use of quantitative and qualitative measures.

Methods: A longitudinal design was used comparing two psychoeducational support groups with other two groups in a standard care control condition. Participants were 28 women with a diagnosis of breast cancer in the care of a hospital in Northern Italy, and 21 family caregivers. The quantitative data were collected by Cognitive Behavioral Assessment for Outcome Evaluation (CBA-OE) and the qualitative data through the use of semi-structured interviews.

Results: The statistical analysis showed a significant change attributable to the psychological intervention that proves the effectiveness of such an intervention in the patients’ and caregivers’ group. The qualitative analysis allowed us to interpret the behavioral and psychological profile emerging from CBA-OE, by considering the subjective experience of the treatment groups. The group experience offered affective, relational and informative support, and allowed participants to create a network and to feel understood and reassured.

Conclusion: The results suggest the usefulness of psychoeducational support groups for women with breast cancer and for their caregivers. The value of this kind of intervention is not only at an individual level but also at a systems level, and family involvement ensures the best positive outcomes.

How does the process of group singing impact on people affected by cancer? A grounded theory study

OBJECTIVE

This study aimed to build an understanding of how the process of singing impacts on those who are affected by cancer, including patients, staff, carers and those who have been bereaved.

DESIGN

A qualitative study, informed by a grounded theory approach.

SETTING AND PARTICIPANTS

Patients with cancer, staff, carers and bereaved who had participated for a minimum of 6 weeks in one of two choirs for people affected by cancer.

METHODS

31 participants took part in Focus Group Interviews lasting between 45 min and an hour, and 1 participant had a face-to-face interview.

FINDINGS

Four overarching themes emerged from the iterative analysis procedure. The overarching themes were: building resilience, social support, psychological dimensions and process issues. Following further analyses, a theoretical model was created to depict how building resilience underpins the findings.

CONCLUSION

Group singing may be a suitable intervention for building resilience in those affected by cancer via an interaction between the experience and impact of the choir.

Retracted: Using the Healthy Days Measure to Assess Factors Associated with Poor Health-Related Quality of Life for Patients with Metastatic Breast, Lung, or Colorectal Cancer Enrolled in a Medicare Advantage Health Plan

The article entitled, "Using the Healthy Days Measure to Assess Factors Associated with Poor Health-Related Quality of Life for Patients with Metastatic Breast, Lung, or Colorectal Cancer Enrolled in a Medicare Advantage Health Plan," by Casebeer AW et al, which published online ahead of print in Population Health Management [doi: 10.1089/pop.2018.0024], is being retracted by the authors so that they can remove references to the 8-item Morisky Medication Adherence Scale (MMAS-8) and republish the article without such references. Dr. Casebeer's team obtained a license to use the MMAS-8 scale from Dr. Morisky prior to conducting the study. Nevertheless, after publication of a separate article in the Journal of Patient-Reported Outcomes that also cited the MMAS-8, as the lead author, Dr. Casebeer was contacted by Dr. Morisky who requested that a number of changes be made to the article. Dr. Casebeer and her team have no desire to engage in a dispute with Dr. Morisky and therefore proactively contacted the Editor of Population Health Management and requested that the scale be removed from her published paper. After assessing all of the provided information, the Editor agreed to the authors' request. It is important to note that the retraction of Dr. Casebeer's article is not the result of any misconduct on her part or that of her team. The retraction serves to remove the published version of the article that contains the MMAS-8 scale and a revised version that does not contain the tool or any references to it will be published. The elimination of the scale does not alter the results or conclusions of the study. Population Health Management is committed to upholding the highest standards of peer review and the community it serves.

A prospective and population-based inquiry on the use and acceptability of peer support for women newly diagnosed with breast cancer

The degree to which peer support is used and accepted as a supportive care approach by women with breast cancer is unclear. We examine peer support use across three major modalities (i.e. support groups, online platforms, one-on-one) and identify enablers and barriers to peer support using the beliefs framework of the theory of planned behaviour. A population-based sample of women newly diagnosed with breast cancer (n = 3105) who were on average 54.08 weeks since diagnosis completed mailed surveys at baseline measuring beliefs about peer support and intention. Peer support use was measured via telephone interview at baseline and prospectively at 12-month follow-up (n = 2780). In all, 37% of women had used at least one peer support service since diagnosis (support group = 20%, online = 18%, one-on-one = 10%). A path analysis examined what beliefs enabled or acted as barriers to peer support use at follow-up adjusting for past behaviour (i.e. baseline use), sociodemographic characteristics, and treatment. In order of relative strength, enablers included beliefs that peer support is an outlet for honest expression of feelings (β = .35), a source of empathy (β = .30), approved by doctors (β = .07), and approved by family/partner (β = .04). Barriers were beliefs that it encourages dwelling about breast cancer (β = - .06) and involves exposure to negative stories about this disease (β = - .04). Strategies which communicate the potential emotional support benefits of a shared illness experience and social approval by others, particularly the medical profession, may help to promote acceptance of peer support and encourage service uptake in breast cancer.

Preferences for models of peer support in the digital era: A cross-sectional survey of people with cancer

OBJECTIVE

Many people with cancer report an unmet need for peer support, yet participation rates are low. This study examined cancer patients' preferences for participating in peer support, and the characteristics associated with having or wanting to participate in peer support.

METHODS

Adult cancer patients were recruited from outpatient oncology clinics at 5 hospitals in Australia. Participants were invited to self-complete 2 questionnaires: one at recruitment assessing their demographic and cancer characteristics, and another 4 weeks later assessing their preferences for participating in cancer-related peer support.

RESULTS

The peer support questionnaire was completed by 177/273 (65%) of participants. Most (59%, n = 104) had or wanted to participate in peer support. More than half reported that it was important the people they connected with had the same cancer treatment (56%, n = 99) or type of cancer (53%, n = 94) as themselves. Half had or wanted to participate in 1-to-1 peer support (52%, n = 92). Half had or wanted to connect with peers face-to-face (53%, n = 93). Only 13% (n = 23) were receptive to connecting with peers over the internet. Being aged ≤65 years was significantly associated (OR = 2.3; 95% CI: 1.1-5.1) with reporting a preference for participating in peer support.

CONCLUSIONS

Cancer patients are interested in participating in peer support, particularly those who are younger. Despite the digital era, traditional forms of peer support continue to be important in supporting people with cancer. Greater understanding of the barriers to cancer patients' involvement in potentially low cost and high reach web-based models of peer support is required.

Japanese Cancer Survivors' Awareness of and Participation in Support Groups

Cancer survivors face many challenges, and cancer support groups provide a range of support. Several reports have shown the benefits of support groups. However, it is not clear how Japanese cancer survivors use them. This study aimed to examine cancer survivors' awareness of and reasons for participation or non-participation in cancer support groups. We conducted a cross-sectional questionnaire survey with ambulatory patients with cancer across eight designated cancer hospitals. The questionnaire covered patients' demographics, disease characteristics, participation/non-participation in cancer support groups, and reasons for participation/non-participation. In total, 569 questionnaires were distributed, and responses were received from 275 patients with cancer. Of these, 135 patients were aware of support groups and 23 had participated in a group. Patients who were aware of support groups were more likely to be young, female patients. Many patients learned about support groups from hospital notices. Most support group participants expected to receive information about the disease and treatment (91%). They also wanted to hear about other patients' experiences (73%). The most common reasons for non-participation were "no particular reason" (38%) and "family or friends support me" (27%). About half of participating patients were unaware of support groups. Even among patients who were aware, many did not attend a support group. Developing a better understanding of support group use in cancer survivors may enhance provision of adequate care based on individual needs.

From self-care for healthy people to self-management for cancer patients with cancer portals

Self-care to prevent cancer and self-management to cope with the disease are two discrete effective mechanisms for improving of control and management of neoplasia. Both them have certain strategies and practices. Often the two are used interchangeably despite their different approaches. Strategies of self-care usually refer to prevention at different levels include primary, secondary and tertiary. In contrast, strategies of self-management are related to management and alleviation of unpleasant cancer-related symptoms and treatment-related side effects for improving the quality of life of cancer survivors. Successful promoting of self-care and self-management strategies need people and survivor empowerment. Within this context, innovative approaches open a new window. In this paper after a brief review of related strategies and practices, we provide an explanation of how cancer portals may play an important role in the empowerment process and what are key potentials for implementing of self- care and self-management strategies for cancer.

Patients' Knowledge and Attitudes towards Cancer Peer Support Programs

The objective of this study was to gain a better understanding of cancer patients' preexisting knowledge, expectations and concerns towards peer support programs. Data were collected and analyzed in 51 patients using a standardized short interview and content analysis. Only 37% of the patients claimed to know peer support programs, and half of these regularly attended a support group. Forty-seven percent of the patients who did not know these programs showed a general interest. Reasons for attending a support group were primarily the exchange with other patients (18% of all statements), obtaining information about disease and treatment (10%) and receiving emotional support (9%). The main argument against participation was the fear of suffering when confronted with problems of others (21%). Utilization may be increased if volunteers and health care practitioners give patients more detailed information about the various offers of peer support.