Living in a state of suspension – a phenomenological approach to the spouse’s experience of oral cancer

Caregiving consequences in cancer family caregivers: a narrative review of qualitative studies

Background

Cancer is a significant public health issue, causing various challenges for individuals affected by it. As cancer progresses, patients often become dependent on others for support. Family caregivers and members play a crucial role in the recovery and rehabilitation of these patients. However, caregivers themselves face numerous challenges throughout the course of their family member's illness. Exploring the experiences of family caregivers can inform long-term planning and supportive interventions to address their caregiving difficulties. This study reviews previous literature on caregiving outcomes.

Method

This study presents a narrative review of qualitative studies, analyzing a total of 23 articles. The results were extracted and organized into subcategories. After revision by the research team, main categories were identified. These categories encompass both positive and negative outcomes of caregiving.

Results

The findings of this review demonstrate that caring for a family member with cancer has significant implications for caregivers. These implications include: (A) Positive outcomes of caregiving (such as achieving self-management and balance, promoting kinship intimacy, finding meaning and purpose, and experiencing spiritual growth) and (B) Negative outcomes of caregiving (including care-related physical exhaustion, disruption of personal life plans, psycho-emotional consequences, and socio-economic burden).

Conclusion

The results of this study highlight the challenges faced by family caregivers and emphasize the importance of addressing their needs within the healthcare system. By providing support and attention to their well-being, caregivers can enhance their resilience and adaptability in managing caregiving difficulties.

Prevalence of Anxiety, Depression, and Perceived Stress Among Family Caregivers of Patients Diagnosed With Oral Cancer in a Tertiary Care Hospital in Central India: A Cross-Sectional Study

Background and objectives Oral cancer is a significant health issue in India, with one of the highest incidence rates globally. Family caregivers play a crucial role in the care of oral cancer patients, but their mental health often faces challenges. This study aimed to assess the prevalence of anxiety, depression, and perceived stress among family caregivers of oral cancer patients in a tertiary care hospital in central India and explore the associated psychosocial factors. Population and method The study was carried out between March 2023 and August 2023 in a tertiary care hospital in Wardha, Maharashtra. Family caregivers (N=82, mean age = 36.1 (SD 10.5) years) of patients with clinically diagnosed oral cancer were subjected first to structured psychiatric clinical interviews to screen for psychiatric diagnoses and then were given self-reporting questionnaires for socio-demographic data, Beck Depression Inventory (BDI-II) for measuring the emotional, cognitive, and motivational symptoms of depression, Manifest Anxiety Scale (MAS) to assess the degree of anxiety and Perceived Stress Scale-10 (PSS-10) to assess stress level. Data was analysed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Chi-square test and logistic regression analyses were conducted wherever appropriate in order to explore predictive factors of depressive, anxious, or stress symptoms. Result In the studied population, the majority experienced symptoms of depression (65.1%), anxiety (69.5%), and perceived stress (74.7%). Caregivers of patients with advanced oral cancer were found to have a higher likelihood of experiencing depression (χ2 (1) = 16.76, p < .001) and anxiety related to unemployment (χ2 (1) = 10.12, p = .001) or insufficient earnings (χ2 (1) = 28.63, p < .001). Additionally, participants with no or little formal education (χ2 (1) = 4.63, p = 0.031) and lower income (χ2 (1) = 28.63, p < .0001) were significantly more likely to experience distress compared to those with higher levels of education. Conclusion This study highlights the need for comprehensive support systems for family caregivers of oral cancer patients. Educational programs, financial assistance, and mental health services should be tailored to caregivers' specific needs. Early identification and intervention strategies can help mitigate the psychological impact of caregiving. Further research is essential to develop targeted interventions that enhance the well-being of caregivers and improve the quality of life for both patients and caregivers.

Ambiguous loss in family caregivers of loved ones with cancer, a synthesis of qualitative studies

PURPOSE

The purpose of this synthesis of qualitative studies is to explore manifestations of ambiguous loss within the lived experiences of family caregivers (FCG) of loved ones with cancer. Grief and loss are familiar companions to the family caregivers of loved ones with cancer. Anticipatory loss, pre-loss grief, complicated grief, and bereavement loss have been studied in this caregiver population. It is unknown if family caregivers also experience ambiguous loss while caring for their loved ones along the uncertain landscape of the cancer illness and survivorship trajectory.

METHODS

We conducted a four-step qualitative meta-synthesis of primary qualitative literature published in three databases between 2008 and 2021. Fourteen manuscripts were analyzed using a qualitative appraisal tool and interpreted through thematic synthesis and reciprocal translation.

RESULTS

Five themes were derived, revealing FCGs appreciate change in their primary relationship with their loved ones with cancer, uncertainty reconciling losses, an existence that is static in time, living with paradox, and disenfranchised grief. The results of this synthesis of qualitative studies complement the descriptors of ambiguous loss presented in previous research.

CONCLUSIONS

The results of this synthesis of qualitative studies complement the descriptors of ambiguous loss presented in previous theoretical and clinical research. By understanding ambiguous loss as a complex and normal human experience of cancer FCGs, oncology and palliative care healthcare providers can introduce interventions and therapeutics to facilitate caring-healing and resiliency.

IMPLICATIONS FOR CANCER SURVIVORS

Untreated ambiguous loss can result in a decrease in wellbeing, loss of hope, and loss of meaning in life. It is imperative that cancer FCGs experiencing ambiguous loss are recognized and supported so that they may live well in the family disease of cancer.

Family Caregivers' Experiences of Caring for Patients With Head and Neck Cancer: A Systematic Review and Metasynthesis of Qualitative Studies

BACKGROUND

Family caregivers of head and neck cancer (HNC) patients undertook heavy care tasks and role responsibilities. They were facing multiple challenges during the patients' cancer trajectory.

OBJECTIVE

The aim of this study was to synthesize existing qualitative evidence regarding family caregivers' experiences of caring for HNC patients.

METHODS

A meta-aggregation approach was used. Articles were collected from MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO, and Cochrane Library. Supplementary resources were collected by scrutinizing reference lists and performing citation tracking.

RESULTS

A total of 20 studies were included and synthesized. Three meta-themes covering "accepting the diagnosis and treatment on patients: a distressing process," "facing changes of life and adapting to new roles," and "appreciating the external supports" were identified with 10 subthemes. There was high confidence in the evidence for "facing changes of life and adapting to new roles" and moderate confidence in the evidence for the other 2 meta-themes.

CONCLUSIONS

Taking care of HNC patients is a distressing process. Caregivers took on role responsibilities and developed strategies to make adjustments to life changes, so as to provide better care for patients. External supports regarding caregiving and self-care were desired.

IMPLICATIONS FOR PRACTICE

Psychological distress was common among caregivers and calls for routine clinical screening. Providing caregivers with practical strategies to deal with daily caregiving tasks was crucial. Healthcare workers can play a critical role in providing tailored support in different caregiving stages. The findings informed the interventions and future research to improve HNC caregivers' experiences.

Oral Psychosomatic Disorders in Family Caregivers of Oral Squamous Cell Carcinoma Patients

Objective:

To investigate the oral psychosomatic disorders (PSDs) in family caregivers (FCs) of oral cancer (OC) patients and to evaluate the correlation between these oral PSDs to severity of depression anxiety and stress.

Methods:

A total of 50 participants were included each in first degree relative (FDR), second degree relative (SDR) and control group. All the participants completed DASS-21 questionnaire and were subjected to thorough clinical history and oral examination.

Results:

All the FCs reported statistically significant higher mean levels of depression, anxiety and stress compared to controls (p˂0.001). A significantly greater number of FCs (40.00%) reported oral PSDs than control group (12.00%). Most prevalent oral PSD in FCs was aphthous stomatitis followed by oral lichen planus, bruxism, burning mouth syndrome and myofascial pain dysfunction syndrome. Moreover, there was a preponderance of these diseases in FDR (60.86%) compared to SDR (26.08%). FCs with moderate to very severe depression, anxiety and stress showed higher prevalence of these oral PSDs compared to the ones with mild depression, anxiety and stress.

Conclusion:

The observations of higher prevalence of oral PSDs in FCs with psychological alterations can enhance healthcare professionals’ awareness to better understand FCs’ oral healthcare needs.

How cancer of oral cavity affects the family caregivers? - A cross-sectional study in Wardha, India, using the Caregiver Quality of Life Index - Cancer questionnaire

Introduction:

Oral cancer is now a major public health problem in India. It does not only affect the patient, but also has a deep psychosocial impact on the family caregivers who are deeply involved with the cancer patient for nursing, timely medication, and consulting the doctor. Studies have found that the caregivers often suffer from depression, anxiety, and fear of losing their near and dear ones. This study aims to capture the psychosocial impact of oral cancer on the family caregivers.

Materials and Methods:

This was a cross-sectional study carried out in a tertiary care hospital with the primary caregivers of those oral cancer patients who completed their treatment and came for follow-up after 2–3 months of treatment completion. The study participants were recruited till a sample size of 100 was reached. This was adequate to report proportions with an error of 10%. We have used “The Caregiver Quality of Life Index – Cancer” scale to capture the psychosocial impact of oral cancer on primary caregiver of the patient. The study was initiated after obtaining approval from the Institutional Ethics Committee. Informed written consents were obtained from all the study participants before beginning the interviews.

Results:

Caregivers played an important role in the recovery of the patients. However, the strain of caregiving resulted in increased emotional stress among them. We found 56% of the family caregivers were female and 41% were male. Majority of the caregivers who accompanied the patients to hospital were the spouses. For the caregivers, the mean score for burden of the disease was found to be 60.0 (±20.2), that for disruption was 50.4 (±21.7), and for positive adaptation was 61.4 (±20.7).

Conclusion:

Caregivers, who are usually invisible to the health-care team, should be recognized and their mental and physical well-being should also be given attention.

Patient and carer experience of nutrition care throughout treatment for head and neck cancer: a systematic qualitative review and thematic synthesis

Nutrition care plays a critical role in the provision of best practice care to head and neck cancer (HNC) patients, with carers playing an important role in supporting patients to maintain nutrition intake. This qualitative systematic review investigated patient and carer experience of nutrition care throughout and beyond HNC treatment. Five databases were systematically searched for qualitative studies reporting on patient and carer experience of nutrition care throughout HNC. Twenty-five studies including 435 patients and 46 carers were identified, revealing three themes: information and support in the healthcare setting, enteral feeding challenges and management, and life outside hospital. Findings highlight the importance of providing individualised person-centred nutrition care to patients with HNC and their carers. Further qualitative research is needed to inform healthcare professionals about the needs of patients and carers to provide appropriate support throughout the treatment trajectory across and between different treatment modalities.

Living with Dysphagia in the Community: Caregivers "do whatever it takes."

The psychological and psychosocial impacts of dysphagia on patients are well documented, however, caregiver perspectives have received limited attention and findings have been predominantly in the head and neck cancer population. The aim of this study was to understand the experience of supporting a person with dysphagia of varying aetiologies in the community from the caregiver perspective. Using a qualitative descriptive approach grounded in phenomenology, caregivers of a person with dysphagia living at home were interviewed (n = 15). Thematic analysis revealed an overarching theme of "You do whatever it takes," describing the caregiver experience of supporting a family member/friend with dysphagia at home. This theme was underpinned by three subthemes where caregivers described (1) being a caregiver; (2) support networks; and (3) practicalities of living with dysphagia. Caregivers voiced a range of pertinent issues experienced when caring for a family member/friend with dysphagia including how personal attributes and life experience impact the caregiver role. Demonstrated through the practical and emotional supports caregivers provided, it was apparent they are instrumental in supporting a family member/friend with dysphagia to live at home and in the community successfully. Through understanding the caregiver experience, health professionals will be in a better position to involve and support caregivers who play a vital role in those living with dysphagia in the community. Incorporating caregivers as direct recipients of dysphagia services will ensure the practical and psychosocial needs of caregivers are addressed, enabling optimal care for people with dysphagia living at home.

Well-Being of Caregivers of Patients with Laryngeal Cancer Treated by Radiotherapy

Introduction  Laryngeal cancer is the second most common head and neck cancer, but no study to date reports exclusively on the well-being of the caregivers of patients with laryngeal cancer treated by radiotherapy.

Objective  The present prospective pilot study aims to describe the impact of the work on the well-being of the caregivers of patients with laryngeal cancer.

Methods  The caregivers of patients undergoing radiotherapy with curative intent for laryngeal cancer were included in the present study, and they were asked to fill out a specific questionnaire, while the patients filled out the Hospital Anxiety and Depression Scale (HADS) following diagnosis but prior to treatment.

Results  A total of 50 caregivers were included, 20% of which were male, and 80%, female. In total, 62% ( n  = 31) of the caregivers were spouses, while the remaining were daughters/sons ( n  = 11; 22%), siblings ( n  = 6; 12%), or they were classified as “other” ( n  = 2; 4%). The female caregivers scored lower (worse) on the depression/worry domain, and this was statistically significant ( p  = 0.047); they also reported a statistically significant higher negative impact on employment ( p  = 0.011) compared with the male caregivers. In general, the caregivers of patients with late-stage tumors tended to report lower (worse) scores on all domains (except hospital contact) compared with the caregivers of patients with early-stage tumors. No other differences were observed regarding the patients' age, gender, tumor site or their HADS score.

Conclusion  The diagnosis and treatment of laryngeal cancer impacts the caregiver's psychological well-being, particularly that of female caregivers. This should be taken into consideration when the patients begin the hospital treatment pathway. However, larger studies are needed to target resources more appropriately.

Quality of Life in Patients with Reconstructions After Resections for Oral Cavity Cancers

To determine effects of reconstruction in advanced oral cavity cancers in achieving a quality of life (QOL), which can help patients to cope with their routine day to day activity. A Cross sectional analysis involving 32 patients of stage III and IV oral cavity cancers already operated in the department of otolaryngology and head and neck surgery was carried out. All these patients had resection of their tumors along with reconstruction. Patients who consented for QOL assessment and follow up through personal visit and telephonic interviews were included in the study. Voice related quality of life; Swallowing related QOL; overall Quality of life (WHO QOL BREF II) and disability assessment scale (WHO DAS II) were used for assessing the various QOL parameters during post-operative period. Patients with stage T3 tumors had better QOL compared to patients with T4 stage tumors. Patients who had reconstruction with free flaps had better QOL compared to those with Pectoralis Major myocutaneous (PMMC) flaps or those reconstructed with combinations of flaps involving delto-pectoral flaps or local flaps along with a free flap or PMMC. Patients with lower stage tumors have better QOL even after reconstruction. If available, free flaps should be preferred over local flaps. Delto-pectoral flaps should be a less preferred option in terms of QOL. Every patient should be counseled accordingly while any reconstruction plan is included in the management of cancers of oral cavity.

A core competency framework for prostate cancer peer navigation

PURPOSE

Trained peer navigators can offer valuable peer support and mentorship to cancer patients and caregivers due to their highly relevant and unique perspective about the disease experience. In order to define the role of prostate cancer (PC) peer navigators within the cancer care system, it is important to establish the essential competencies of a PC peer navigator. We systematically identified and verified a set of core competencies for PC peer navigators and present a competency framework for PC peer navigators.

METHODS

In phase 1, we conducted formative research consisting of a literature review and environmental scan as well as a secondary analysis of qualitative interviews. In phase 2, we drafted and mapped competencies. Finally in phase 3, expert stakeholders completed an anonymous survey to indicate whether they endorsed the competencies and to rank the importance of each competency to the peer navigator role. Open-ended feedback was also provided for each competency.

RESULTS

Six core competency domains emerged: (1) self as navigator, (2) communication, (3) knowledge/information, (4) facilitate patient-centred care, (5) eHealth/technology, and (6) caregiver needs. Forty-seven core competency statements were mapped to these domains. Expert stakeholders (n = 27) included cancer survivors, caregivers, and healthcare providers. Most (89%) of core competency statements were endorsed by stakeholders and received high priority ratings, whereas only five of the competencies were less uniformly endorsed.

CONCLUSIONS

This is the first attempt to list core competencies for PC peer navigators and may offer guidance for standardizing the PC peer navigator role and training.

Providing care to a family member affected by head and neck cancer: a phenomenological study

BACKGROUND

Cancer is recognized as a family illness as many head and neck cancer (HNC) patients after treatment require assistance from a family caregiver throughout the rest of their life. The purpose of this study was to explore the lived experience of primary family caregivers of HNC patients dealing with laryngectomy regarding their complex supportive role.

METHODS

Phenomenological study based on individual interviews of twelve primary caregivers of HNC patients, recruited by purposeful sampling. Interview contents were analyzed in depth, in accordance with Colaizzi's descriptive analysis framework, to explore and identify significant themes and subthemes.

RESULTS

Analysis evidenced three main topics and subthemes embracing various aspects of the caregiver's lived experiences: (1) experiencing disease and the pathway of care, (2) handling changes to everyday life, and (3) support received by others.

CONCLUSION

Given the essential role the caregiver has in the patient's post-treatment recovery, future planning of HNC patient care must consider the caregivers' needs. In order to guarantee an appropriate and effective health professional care, it is important to consider caregivers' issues and needs as part of HNC patient care planning from the diagnosis to the follow-up.

Caring for patients with oral cancer in Taiwan: The challenges faced by family caregivers

Family caregivers face multiple challenges when caring for patients with oral cancer at home. Understanding the difficulties they face may assist health professionals to better organise and provide support for family caregivers of oral cancer patients. The aim of this study was to describe the caregivers' primary tasks and the difficulties they encounter when caring for a family member with oral cancer. This qualitative study included a purposeful sample of 22 primary family caregivers ranging in age from 25 to 71 years old. The researchers used face-to-face, semi-structured and tape-recorded interviews to collect data and employed qualitative content analysis to elicit caregiving-related themes. Six task-related themes and associated challenges were identified. These included managing the patient's nutritional issues, investigating and making decisions about patient care, managing sudden and unpredictable changes in the patient's condition, managing emotional distress, adjusting their attitudes towards patient care, and seeking resources. Family caregivers handle such essential tasks when they care for patients in home settings and they face specific challenges related to them. This study identified several challenges related to each task. From the outset, healthcare providers should actively offer caregiving information and strategies. Health professionals can incorporate strategies for supporting caregivers' ability to carry out these tasks into their treatment model and can help caregivers manage difficulties that can impede them from doing so.

A comparison of psychological well-being and quality of life between spouse and non-spouse caregivers in patients with head and neck cancer: a 6-month follow-up study

OBJECTIVE

The caregivers of patients with head and neck cancer (HNC) may suffer from impaired psychological well-being and a decreased quality of life (QOL) related to the chronic burden of caring for patients' physical conditions and their mood changes. In this study, we aimed to compare the psychological well-being and QOL between spouse caregivers and non-spouse caregivers of patients with HNC over a 6-month follow-up period.

PATIENTS AND METHODS

This study was conducted using a prospective design with consecutive sampling. We recruited study subjects from the outpatient combined treatment clinic of HNC at a medical center in Southern Taiwan. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition was carried out by a trained senior psychiatrist to diagnose caregivers. Furthermore, one research assistant collected the caregivers' demographic characteristics, clinical data, and clinical rating scales, including the Short Form 36 (SF-36) Health Survey, Hospital Anxiety and Depression Scale (HADS), and Family Appearance, Pulse, Grimace, Activity, and Respiration index at the patients' pretreatment, as well as their 3- and 6-month follow-up appointments.

RESULTS

Of the 143 subjects that successfully completed the study, two-thirds of caregivers were spouses. During the 6-month follow-up period, spouse caregivers demonstrated significantly higher rates of depression diagnosis (p=0.032), higher scores in the depression subscale of HADS (HADS-D) (p=0.010), and lower SF-36 mental component summary (MCS) scores (p=0.007) than non-spouse caregivers. Furthermore, during those 6 months, HADS-D (p=0.007) and the anxiety subscale of HADS scores (p<0.001) significantly decreased, while SF-36 MCS scores significantly increased (p=0.015).

CONCLUSION

The mental health of spouse caregivers of HNC patients was more severely affected than that of non-spouse caregivers during the observed 6-month follow-up period. Therefore, clinicians need to pay more attention to caregivers' psychological distress during patient care, especially for spouse caregivers.

Depression, anxiety, quality of life, and predictors of depressive disorders in caregivers of patients with head and neck cancer: A six-month follow-up study

OBJECTIVE

Caregivers of patients with cancer experience a variety of psychological distress. This study aimed to investigate the mental health status and depressive disorder predictors in caregivers of patients with head and neck cancer (HNC) over a six-month follow-up.

METHODS

We recruited the participants for this study from a HNC outpatient clinic in a medical center from February 2012 to January 2013. Caregivers of HNC patients were evaluated with the Structured Clinical Interview for the DSM-IV, Clinician Version, the Hospital Anxiety and Depression Scale, the Short Form 36 Health Survey (SF-36), and the Family APGAR index. Baseline evaluations were performed, and additional evaluations were performed again 3months and 6months later.

RESULTS

We assessed a total of 132 caregivers in this study. Over the 6-month follow-up period, the severity of the caregivers' depression and anxiety significantly decreased, while their quality of life improved significantly. At the 6-month assessment, the most prevalent psychiatric disorders were depressive disorders (12.9%), followed by alcohol abuse (1.5%) and primary insomnia (1.5%). Older age, hypnotics use, pre-existing depressive disorders at baseline, and a lower mental component of SF-36 score at baseline were found to significantly predict depressive disorders after 6months.

CONCLUSION

Our findings show that the mental health of caregivers of HNC patients improves during the 6-month follow-up, as well as that depressive disorders were the most prevalent psychiatric diagnosis. Clinicians need to be alert to and manage any emerging mental health problems in caregivers during patient care, especially depressive disorders.

Quality of life impairment in patients with head and neck cancer and their caregivers: a comparative study

Introduction

Head and neck cancer represents 3% of all the types of malignant neoplasms and squamous cell carcinoma (SCC) is responsible for 90% of these cases. There have been some studies evaluating the quality of life of these patients, but little is known about the physical and emotional effects on their caregivers.

Objective

To evaluate the quality of life of patients with head and neck cancer and their caregivers by applying validated questionnaires.

Methods

Thirty patients with advanced tumors (SCC stage III or IV) and their 30 caregivers were included. Specific questionnaires (Coop/Wonca, EORTC QLQ–C30, EORTC H&N35, Coop/Wonca, and Caregiver Strain Index – CSI) were applied during routine medical consultations.

Results

Of the 30 patients, 28 were males and 25 had stage IV tumors, with mean age of 56.6 years. 36.7% had the primary tumor in the oropharynx and 70% reported pain. The functional cognitive, physical, and emotional scales were the most affected. Pain, fatigue, and sleep disorders were the most prevalent symptoms. Of the 30 caregivers, 23 were females and 70% were the primary caregivers. 36.7% of the caregivers had high levels of stress, mainly related to the feeling of incapacity. The comparison between patients and caregivers demonstrated that the two groups had similar quality of life impairment: physical fitness (p = 0.487), mental health (p = 0.615), daily activities (p = 0.793), social activities (p = 0.301), changes in health (p = 0.649), and overall health (p = 0.168).

Conclusion

Quality of life impairment is similar between patients and their caregivers. This result demonstrates that not only the patients show quality of life impairment, but their caregivers also have it and at similar proportions.

The Experience of Caregivers Living with Cancer Patients: A Systematic Review and Meta-Synthesis

The objectives of this meta-synthesis were to: (1) explore the experience of caregivers who were caring for cancer patients, including their perceptions and responses to the situation; and (2) describe the context and the phenomena relevant to the experience. Five databases were used: CINAHL, MEDLINE, Academic Search, Science Direct, and a Thai database known as the Thai Library Integrated System (ThaiLIS). Three sets of the context of the experience and the phenomena relevant to the experience were described. The contexts were (1) having a hard time dealing with emotional devastation; (2) knowing that the caregiving job was laborious; and (3) knowing that I was not alone. The phenomenon showed the progress of the caregivers’ thoughts and actions. A general phenomenon of the experience—balancing my emotion—applied to most of the caregivers; whereas, more specific phenomenon—keeping life as normal as possible and lifting life above the illness—were experienced by a lesser number of the caregivers. This review added a more thorough explanation of the issues involved in caregiving for cancer patients. A more comprehensive description of the experience of caregiving was described. The findings of this review can be used to guide clinical practice and policy formation in cancer patient care.

A Phenomenologic Study of Family Caregivers of Patients With Head and Neck Cancers

PURPOSE/OBJECTIVES

To describe and understand the lived experience of family caregivers of patients with head and neck cancers (HNCs).

RESEARCH APPROACH

Phenomenology using van Manen's human science approach
.

SETTING

Two hospital systems providing regional cancer care in upstate New York. 
.

PARTICIPANTS

Nine family caregivers of patients with HNCs who had completed treatment
.

METHODOLOGIC APPROACH

Qualitative analysis of semi-structured, conversational interviews about the lived experience of family caregivers.

FINDINGS

Five major themes emerged related to the lived experiences of this sample of caregivers.

CONCLUSIONS

Family caregivers of patients with HNCs play a fundamental role in the post-treatment phase of care, including meeting specific physical and psychosocial needs. Further investigation should explore the relationship between information needs and the experience of vigilance and fear.

INTERPRETATION

Nurses must include caregivers in physical and psychosocial plans of care. Balancing and meeting information needs of caregivers to avoid undue emotional stress and recognizing their support needs are valuable components of care.

Changes Experienced in Quality of Life for Skull Base Surgical Patients: A Qualitative Case Study

Objective Skull base tumors are associated with quality of life (QOL) changes. A qualitative case-study approach may help better understand patients' experiences. Methods A total of 34 skull base surgery patients were selected into focus groups using a criterion-based maximum variation sampling strategy from a sampling frame of 138 patients. Eight groups were organized based on a factorial design of surgical approach (endoscopic/pen) and tumor location (anterior/central). Data were analyzed using a conceptual framework. Qualitative analysis was performed on focus group transcripts to identify major themes and determine if surgical approach or tumor location had differential effects on QOL. Concepts were quantitatively tallied from written workbooks. Results The 34 participants (19 men, 15 women; mean age: 48 years, standard deviation: 14 years) had mixed reactions to their diagnosis ranging from relief to fear. Participants reported physical and nonphysical changes in QOL with some variation in physical complaints by tumor location. Several major themes emerged from the analysis. Skull base tumors are associated with fear and frustration, loss of physical senses and self-identity, social isolation, and coping mechanisms. Conclusions Skull base surgery may impact patients' lives. Qualitative study of patient experiences can provide rich information to better understand this disease.

Speaking legibly: Qualitative perceptions of altered voice among oral tongue cancer survivors

OBJECTIVE

Treatment for oral tongue cancer poses unique challenges to restoring and maintaining personally acceptable, intelligible speech.

METHODS

We report how oral tongue cancer survivors describe their speech after treatment in a qualitative descriptive approach using constant comparative technique to complete a focal analysis of interview data from a larger grounded theory study of oral tongue cancer survivorship. Interviews were completed with 16 tongue cancer survivors 3 months to 12 years postdiagnosis with stage I-IV disease and treated with surgery alone, surgery and radiotherapy, or chemo-radiation. All interview data from the main study were analyzed for themes describing perceptions of speech as oral tongue cancer survivors.

RESULTS

Actual speech impairments varied among survivors. None experienced severe impairments that inhibited their daily lives. However, all expressed some level of concern about speech. Concerns about altered speech began when survivors heard their treatment plans and continued through to survivorship without being fully resolved. The overarching theme, maintaining a pattern and character of speech acceptable to the survivor, was termed "speaking legibly" using one survivor's vivid in vivo statement. Speaking legibly integrate the sub-themes of "fears of sounding unusual", "learning to talk again", "problems and adjustments", and "social impact".

CONCLUSIONS

Clinical and scientific efforts to further understand and address concerns about speech, personal presentation, and identity among those diagnosed with oral tongue are important to improving care processes and patient-centered experience.

Living close to a person with cancer: a review of the international literature and implications for social work practice

To help family caregivers (FCs), social workers need to understand the complexity of FC's experiences and challenges. For this systematic review, several relevant, multidisciplinary electronic databases were searched. Of 1,643 titles identified, 108 articles met the inclusion criteria and are included in this review. Various experiences, symptoms, and burden related to caregiving responsibilities are described and discussed. The understanding evolving from this study about the FC's own health risk, caregiver burden, and experiences over time can enhance a social worker's awareness of an FC's challenging situation and the potential impact this has on the FC's ability to provide care to the patient.

How relatives of patients with head and neck cancer experience pain, disease progression and treatment: a qualitative interview study

PURPOSE

This study of relatives to patients with head and neck cancer (HNC) treated with radiotherapy describes how the relatives experienced the patient's situation, especially with respect to pain, and how the relatives themselves experienced the situation.

METHODS

Semi-structured interviews of 21 relatives to HNC patients who suffered from pain were conducted, and a qualitative content analysis was performed.

RESULTS

The relatives experienced that the patients suffered from physical, psychological, and social pain. A dark picture consisting of lack of participation and knowledge, psychological distress, and lack of support were reported. Thus, a main category: relatives struggle with loved one's pains related to head and neck cancer treatment and with their own demanding situation - was based on the following four categories: inability to relieve and comprehend the physical suffering of the patients; overwhelming emotions were experienced that affect the patients and the relatives themselves; in need of support from the health care service; and altered daily activities and family roles due to illness and treatment.

CONCLUSION

In patients physical, psychological, and social pain were prominent and in relatives psychological distress, lack of knowledge and support were experienced. Thus, to reduce pain and anxiety in patients and relatives, the health care professionals should provide relevant knowledge about pain management. The health care professionals should also provide educational interventions that address the psychological and social factors that impact pain for HNC patients and their relatives. Well-thought supporting care and easily accessible information about practical concerns should be offered to HNC patients and their relatives.

In the middle and on the sideline: the experience of spouses of men with prostate cancer

BACKGROUND

Spouses play an important role in how well patients with prostate cancer manage their illness. Whereas earlier studies mostly included both patients and spouses, this study focuses on the spouses' experiences during the course of the illness.

OBJECTIVE

The objective of this study was to explore how the daily life of female spouses is affected by their husband's prostate cancer.

METHODS

Qualitative interviews were conducted with 9 spouses of men receiving potential curative treatment for prostate cancer.

RESULTS

Prostate cancer in men had significant impact on spouses' everyday life. The results showed that spouses strived to achieve a balance between focusing on their own needs and meeting their husbands' needs along the course of the illness. Four themes emerged: strong and optimistic versus vulnerable and overstrained, maintaining the partner's sense of manhood, being on the sideline, and the need for relationships outside the immediate family.

CONCLUSION

Being a spouse to a man with prostate cancer is emotionally and practically demanding. There is a danger of the spouses suppressing their own needs in the process of supporting their husbands. Those spouses living in the situation over a period of years expressed fatigue and a shift in focus from their husbands' needs to their own needs for support.

IMPLICATIONS FOR PRACTICE

Healthcare providers should provide support for spouses during the course of the illness, encourage spouses to participate in seminars for couples living with prostate cancer, and be aware of the potential for situational fatigue in spouses many years after the diagnosis.

Measuring health-related quality of life outcomes in head and neck reconstruction

A qualitative study was undertaken to understand the impact of omitted health concepts in existing patient-reported outcome (PRO) instruments for health-related quality of life (HR-QOL) evaluation following head and neck (H&N) cancer reconstruction. Twenty-six patients were interviewed. Patients described a broad range of symptoms. Oral competence, rhinorrhea, facial sensation, smile, vision and eye discharge are missing from existing PRO instruments. Altered appearance was a major stressor; both function and appearance changes had a negative psychosocial impact leading to social isolation and embarrassment. This framework is the foundation for development of a more complete PRO instrument, the FACE-Q Oncology.

A preliminary study on the relationships between global health/quality of life and specific head and neck cancer quality of life domains in Puerto Rico

PURPOSE

Health-related quality of life (HRQOL) is an important treatment outcome for head and neck cancer (HNC) patients. By ascertaining the most important HNC HRQOL issues, research and practice can be directed toward enhancing patient QOL.

MATERIALS AND METHODS

A cross-sectional study of 46 ENT clinic HNC patients in Puerto Rico (PR) was completed. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 (general QOL), and the QLQ-H&N35 (HNC QOL) instruments were administered. Correlations and multivariable regressions were separately conducted for QLQ-H&N35 variables on the three QLQ-C30 outcome variables: overall health, overall QOL, and the global health/QOL domain.

RESULTS

Correlation findings included statistically significant negative correlations between the three QLQ-C30 outcome variables and the QLQ-H&N35 variables pain, swallowing, social eating, social contact, and sexuality. Multivariable linear regression identified statistically significant inverse indicators of the outcomes: (1) "lessening of sexuality" with "overall health" (p= 0.02), (2) "problem with social eating" (p= 0.023), "taking pain killers" (p= 0.025), and "problem with social contact" (p= 0.035) with "overall QOL," and (3) "problems with social eating" (p < 0.009) and "taking pain killers" (p= 0.016) with the "global health/QOL" domain.

CONCLUSIONS

We conclude that problems with pain, social eating, social interactions, and loss of sexuality are critical indicators of degraded HRQOL in HNC patients living in Puerto Rico. Our results add to the overall knowledge base regarding QOL among HNC patients. The promise of improved QOL for the HNC patient is attainable through additional research in conjunction with advances in clinical treatments and patient management protocols.

To live close to a person with cancer--experiences of family caregivers

The purpose of this study was to obtain a deeper understanding of the experiences of Family Caregivers (FC) living close to a patient with cancer. This article reports on the findings from individual interviews with 15 FCs of patients with cancer. The interview transcripts were analyzed using qualitative hermeneutic analysis. This study revealed that living close to a cancer patient over the course of his or her illness affected many aspects of FCs lives in significant ways. Their experiences can be summarized with two major themes: (1) living in an ever changing life world and (2) balancing between conflicting interests and dilemmas. This study contributed to deeper insights into FC's experiences than previously reported in the literature.

Psychological functioning of caregivers for head and neck cancer patients

Patients with head and neck squamous cell carcinoma (HNSCC) often require assistance from family caregivers during the treatment and post-treatment period. This review article sought to summarize current findings regarding the psychological health of HNSCC caregivers, including factors that may be associated with poorer psychological health. Online databases (PUBMED, MEDLINE and PSYCINFO) were searched for papers published in English through September 2010 reporting on the psychological health of caregivers of HNSCC patients. Eleven papers were identified. Caregivers experience poorer psychological health, including higher levels of anxious symptoms, compared to patients and to the general population. Fear of patient cancer recurrence is evident among caregivers and is associated with poorer psychological health outcomes. The 6-month interval following diagnosis is a significant time of stress for caregivers. Greater perceived social support may yield positive benefits for the psychological health of caregivers. To date, there have been relatively few reports on the psychological health of caregivers of HNSCC patients. Well designed, prospective, longitudinal studies are needed to enhance our understanding of how caregiver psychological health may vary over the cancer trajectory and to identify strategies for improving caregiver outcomes.

Views of Iranian patients on life with cancer: a phenomenological study

Cancer is one of the major causes of death worldwide. The diagnosis of this disease can cause significant stress, which destroys the patient's hopes, dreams and expectations. The aim of this qualitative phenomenological study was to explore the perceptions of 23 Iranian patients about life with cancer using in-depth and semi-structured interviews as the method of data collection. The data were analyzed using Benner's interpretive thematic analysis method. Four main themes were clarified by studying the patients' experiences of life with cancer: (i) cancer as a kind of divine test; (ii) a very bitter and debilitating experience; (iii) chemotherapy as the most difficult experience of cancer; and (iv) a continuous struggle. Life with cancer is full of suffering, stress and bitterness. Fear and hope are intertwined; this phase can be successfully endured by patience, tolerance and stability. It is also helpful if close relatives can raise the patient's morale. Certainly, in this process, religious beliefs, faith and culture-oriented interventions can significantly help patients deal with cancer.

Graphical modeling can be used to illustrate associations between variables describing functioning in head and neck cancer patients

OBJECTIVE

To examine the associations between variables of functioning measured by the International Classification of Functioning, Disability and Health (ICF) in head and neck cancer (HNC) patients by means of graphical modeling.

STUDY DESIGN AND SETTING

Graphical modeling was used on a data set of a cross-sectional multicentric study of 145 patients with HNC. Functioning was qualified using the extended ICF checklist. Multiple imputation was used to handle missing data. The least absolute shrinkage and selection operator for generalized linear models was used to identify conditional associations between the ICF categories. Bootstrap aggregating was used to enhance the accuracy and validity of model selection.

RESULTS

The resulting graph shows largely meaningful associations between the ICF categories. One central point could be visualized consisting of a circular path of d330 Speaking, d350 Conversation, b510 Ingestion functions, s320 Structure of mouth, and b310 Voice functions. Another important structure in the graph were the bow-shaped associations beginning with d335 Producing nonverbal messages to b130 Energy and drive functions.

CONCLUSION

Graphical modeling can be used to describe associations between different areas of functioning in HNC patients. They found associations can be the basis for improved rehabilitation and gives a deeper understanding of functioning in HNC patients.