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Halpin SN, Alain G, Seaman A, Stevens EE, Zhao H, Fowler ME, Zhang Q, Cadet T, Ye M, Krok-Schoen JL. Comorbid Dementia and Cancer Therapy Decision-Making: A Scoping Review. J Appl Gerontol 2024; 43:1132-1143. [PMID: 38347680 DOI: 10.1177/07334648241233375] [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: 08/09/2024] Open
Abstract
Comorbid dementia complicates cancer therapy decision-making in older adults. We aimed to synthesize the recent literature (<5 years) on the challenges associated with cancer therapy decision-making among older people living with dementia (PLWD) and their caregivers. Of the 20,763 references, 8767 had their title and abstract screened, and eight met the inclusion criteria. Six studies were qualitative, one study employed mixed methods, and one study was quasi-experimental. Most studies were conducted in the UK (89%) and reported homogeneity in race and geography. Breast (56%) and prostate (45%) were the most frequent reported cancers. Five studies (56%) reported multiple types of dementia, with two (22%) indicating stages. The studies indicated that communication between patients, caregivers, and clinical teams might alleviate stress caused by worsening health prospects and potential ethical concerns. Information from this review can lead to better-informed, patient-centered treatment decision processes among older PLWD and cancer, their caregivers, and clinicians.
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Affiliation(s)
- Sean N Halpin
- GenOmics and Translational Research Center RTI International, Research Triangle Park, NC, USA
| | - Gabriel Alain
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Aaron Seaman
- Department of General Internal Medicine, The University of Iowa, Iowa City, IA, USA
| | - Erin E Stevens
- Division of Palliative Care, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Hui Zhao
- School of Nursing, James Madison University, Harrisonburg, VA, USA
| | - Mackenzie E Fowler
- School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Qiuyang Zhang
- Department of Structural & Cellular Biology, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Tamara Cadet
- School of Social Policy & Practice, University of Pennsylvania, Boston, MA, USA
| | - Minzhi Ye
- School of Lifespan Development and Educational Science, Kent State University, Kent, OH, USA
| | - Jessica L Krok-Schoen
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
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Wurz A, Duchek D, Ellis K, Bansal M, Carrier ME, Tao L, Dyas L, Kwakkenbos L, Levis B, El-Baalbaki G, Rice DB, Wu Y, Henry RS, Bustamante L, Harb S, Hebblethwaite S, Patten SB, Bartlett SJ, Varga J, Mouthon L, Markham S, Thombs BD, Culos-Reed SN. A qualitative interview study exploring the psychological health impacts of the SPIN-CHAT program among people with systemic sclerosis at the onset of COVID-19: perceptions of trial participants and research team members. Disabil Rehabil 2024; 46:533-545. [PMID: 36708187 DOI: 10.1080/09638288.2023.2169775] [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: 08/03/2022] [Accepted: 01/13/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE Explore trial participants' and research team members' perceptions of the impact of the videoconference-based, supportive care program (SPIN-CHAT Program) during early COVID-19 for individuals with systemic sclerosis (SSc). METHODS Data were collected cross-sectionally. A social constructivist paradigm was adopted, and one-on-one videoconference-based, semi-structured interviews were conducted with SPIN-CHAT Trial participants and research team members. A hybrid inductive-deductive approach and reflexive thematic analysis were used. RESULTS Of the 40 SPIN-CHAT Trial participants and 28 research team members approached, 30 trial participants (Mean age = 54.9; SD = 13.0 years) and 22 research team members agreed to participate. Those who took part in interviews had similar characteristics to those who declined. Five themes were identified: (1) The SPIN-CHAT Program conferred a range of positive psychological health outcomes, (2) People who don't have SSc don't get it: The importance of SSc-specific programming, (3) The group-based format of the SPIN-CHAT Program created a safe space to connect and meet similar others, (4) The structure and schedule of the SPIN-CHAT Program reduced feelings of boredom and contributed to enhanced psychological health, (5) The necessity of knowledge, skills, and tools to self-manage SSc and navigate COVID-19. CONCLUSION Participants' and research team members' perspectives elucidated SPIN-CHAT Program benefits and how these benefits may have been realized. Results underscore the importance of social support from similar others, structure, and self-management to enhance psychological health during COVID-19. TRIAL REGISTRATION clinicaltrials.gov (NCT04335279)IMPLICATIONS FOR REHABILITATIONThe videoconference-based, supportive care SPIN-CHAT Program enhanced psychological health amongst individuals affected by systemic sclerosis.SPIN-CHAT Program participants and research team members shared that being around similar others, program structure, and self-management support were important and may have contributed to enhanced psychological health.Further efforts are required to explore experiences within supportive care programs to better understand if and how psychological health is impacted.
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Affiliation(s)
- Amanda Wurz
- School of Kinesiology, University of the Fraser Valley, Chilliwack, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Delaney Duchek
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Kelsey Ellis
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Mannat Bansal
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Lydia Tao
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Laura Dyas
- National Scleroderma Foundation, Michigan Chapter, Southfield, MI, USA
| | - Linda Kwakkenbos
- Clinical Psychology, Radboud University, Nijmegen, The Netherlands
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Center for Mindfulness, Department of Psychiatry, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | | | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
| | - Yin Wu
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Richard S Henry
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
| | - Laura Bustamante
- Department of Applied Human Sciences, Concordia University, Montreal, Canada
| | - Sami Harb
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | | | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, Canada
- Research Institute, McGill University Health Centre, Montreal, Canada
| | - John Varga
- University of Michigan, Ann Arbor, MI, USA
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
- APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France
| | - Sarah Markham
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Canada
- Biomedical Ethics Unit, McGill University, Montreal, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Cancer Care, Alberta Health Services, Calgary, Canada
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Bellass S, Scharf T, Errington L, Bowden Davies K, Robinson S, Runacres A, Ventre J, Witham MD, Sayer AA, Cooper R. Experiences of hospital care for people with multiple long-term conditions: a scoping review of qualitative research. BMC Med 2024; 22:25. [PMID: 38229088 PMCID: PMC10792930 DOI: 10.1186/s12916-023-03220-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/07/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Multiple long-term conditions-the co-existence of two or more chronic health conditions in an individual-present an increasing challenge to populations and healthcare systems worldwide. This challenge is keenly felt in hospital settings where care is oriented around specialist provision for single conditions. The aim of this scoping review was to identify and summarise published qualitative research on the experiences of hospital care for people living with multiple long-term conditions, their informal caregivers and healthcare professionals. METHODS We undertook a scoping review, following established guidelines, of primary qualitative research on experiences of hospital care for people living with multiple long-term conditions published in peer-reviewed journals between Jan 2010 and June 2022. We conducted systematic electronic searches of MEDLINE, CINAHL, PsycInfo, Proquest Social Science Premium, Web of Science, Scopus and Embase, supplemented by citation tracking. Studies were selected for inclusion by two reviewers using an independent screening process. Data extraction included study populations, study design, findings and author conclusions. We took a narrative approach to reporting the findings. RESULTS Of 8002 titles and abstracts screened, 54 papers reporting findings from 41 studies conducted in 14 countries were identified as eligible for inclusion. The perspectives of people living with multiple long-term conditions (21 studies), informal caregivers (n = 13) and healthcare professionals (n = 27) were represented, with 15 studies reporting experiences of more than one group. Findings included poor service integration and lack of person-centred care, limited confidence of healthcare professionals to treat conditions outside of their specialty, and time pressures leading to hurried care transitions. Few studies explored inequities in experiences of hospital care. CONCLUSIONS Qualitative research evidence on the experiences of hospital care for multiple long-term conditions illuminates a tension between the desire to provide and receive person-centred care and time pressures inherent within a target-driven system focussed on increasing specialisation, reduced inpatient provision and accelerated journeys through the care system. A move towards more integrated models of care may enable the needs of people living with multiple long-term conditions to be better met. Future research should address how social circumstances shape experiences of care.
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Affiliation(s)
- Sue Bellass
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK.
| | - Thomas Scharf
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Linda Errington
- School of Biomedical Nutritional and Sport Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Kelly Bowden Davies
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Sian Robinson
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle Upon Tyne NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Adam Runacres
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Jodi Ventre
- NIHR ARC Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Miles D Witham
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle Upon Tyne NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Avan A Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle Upon Tyne NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Rachel Cooper
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle Upon Tyne NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
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Castelo-Loureiro A, Perez-de-Acha A, Torres-Perez AC, Cunha V, García-Valdés P, Cárdenas-Reyes P, Soto-Perez-de-Celis E. Delivering Palliative and Supportive Care for Older Adults with Cancer: Interactions between Palliative Medicine and Geriatrics. Cancers (Basel) 2023; 15:3858. [PMID: 37568674 PMCID: PMC10417379 DOI: 10.3390/cancers15153858] [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: 07/03/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The world's population is aging rapidly, with projections indicating that by 2050 one in six people will be aged ≥65 years. As a result, the number of cancer cases in older people is expected to increase significantly. Palliative care is an essential component of cancer care with a direct impact on quality of life. However, older adults with cancer often suffer from multiple comorbidities, cognitive impairment, and frailty, posing unique challenges in the delivery of palliative care. The complex healthcare needs of older patients with cancer therefore require a comprehensive assessment, including a geriatric evaluation. Collaboration between geriatrics and palliative care can offer a solution to the challenges faced by older people with cancer, since this is a population with overlapping concerns for both disciplines. This review highlights the importance of palliative care for older adults with cancer and the benefits of a multidisciplinary approach. It also addresses the coordination of palliative care and geriatrics for specific symptom management and decision making.
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Affiliation(s)
| | - Andrea Perez-de-Acha
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Ana Cristina Torres-Perez
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Vanessa Cunha
- School of Medicine, University of Toronto, Toronto, ON M5S 3G5, Canada
| | - Paola García-Valdés
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
- Department of Palliative Care, Hospital Gea González, Mexico City 14080, Mexico
| | - Paula Cárdenas-Reyes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
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Tielemans LML, van Heugten KD, Hamaker ME, van Walree IC. Preferred and actual involvement of caregivers in oncologic treatment decision-making: A systematic review. J Geriatr Oncol 2023; 14:101525. [PMID: 37198027 DOI: 10.1016/j.jgo.2023.101525] [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: 12/21/2022] [Revised: 04/04/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Treatment decision-making in cancer is complex and many patients bring their caregiver to appointments to help them make those decisions. Multiple studies show the importance of involving caregivers in the treatment decision-making process. We aimed to explore the preferred and actual involvement of caregivers in the decision-making process of patients with cancer and to see if there are age or cultural background related differences in caregiver involvement. MATERIALS AND METHODS A systematic review of Pubmed and Embase was performed on January 2, 2022. Studies containing numerical data regarding caregiver involvement were included, as were studies describing the agreement between patients and caregivers regarding treatment decisions. Studies assessing solely patients aged younger than 18 years old or terminally ill patients, and studies without extractable data were excluded. Risk of bias was assessed by two independent reviewers using an adapted version of the Newcastle-Ottawa scale. Results were analysed in two separate age groups, one <62 years and one ≥62 years. RESULTS Twenty-two studies with a total of 11,986 patients and 6,260 caregivers were included in this review. A median of 75% of patients preferred caregivers to be involved in decision-making and a median of 85% of caregivers preferred to be involved. With regards to age groups, the preferred involvement of caregivers was more frequent in the younger study populations. With regards to geographical differences, studies performed in Western countries showed a lower preference for caregiver's involvement compared to studies from Asian countries. A median of 72% of the patients reported the caregiver was actually involved in the treatment decision-making and a median of 78% of the caregivers reported they were actually involved. The most important role of caregivers was to listen and provide emotional support. DISCUSSION Patients and caregivers both want caregivers to be involved in the treatment decision-making process and most caregivers are actually involved. An ongoing dialogue between clinicians, patients and caregivers about decision-making is important to meet the individual patient's and caregiver's needs when involved in the decision-making process. Important limitations were a lack of studies in older patients and significant differences in outcome measures among studies.
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Affiliation(s)
- Laura M L Tielemans
- Department of Geriatric Medicine, Elisabeth-Twee Steden Ziekenhuis, Tilburg, the Netherlands.
| | - Kirsten D van Heugten
- Department of Geriatric Medicine, Elisabeth-Twee Steden Ziekenhuis, Tilburg, the Netherlands
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, the Netherlands
| | - Inez C van Walree
- Department of Geriatric Medicine, University Medical Centrum Utrecht, Utrecht, the Netherlands
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Neal D, Morgan JL, Ormerod T, Reed MWR. Intervention to reduce age bias in medical students' decision making for the treatment of older women with breast cancer: A novel approach to bias training. J Psychosoc Oncol 2023; 42:48-63. [PMID: 37233450 DOI: 10.1080/07347332.2023.2214548] [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: 05/27/2023]
Abstract
Objectives: Despite NICE guidelines to 'treat people with invasive breast cancer, irrespective of age, with surgery and appropriate systemic therapy, rather than endocrine therapy alone', older patients receive differential treatment and experience worse outcomes. Research has evidenced the prevalence of ageism and identified the role of implicit bias in reflecting and potentially perpetuating disparities across society, including in healthcare. Yet age bias has rarely been considered as an explanatory factor in poorer outcomes for older breast cancer patients nor, consequentially, has removing age bias been considered as an approach to improving outcomes. Many organizations carry out bias training with the aim of reducing negative impacts from biased decision making, yet the few evaluations of these interventions have mostly seen small or negative effects. This study explores whether a novel intervention to address age bias leads to better quality decision making for the treatment of older women with breast cancer.Methods: An online study compared medical students' treatment recommendations for older breast cancer patients and the reasoning for their decision making before and after a novel bias training intervention. Thirty-one medical students participated in the study.Results: The results show that the bias training intervention led medical students to make better quality decisions for older breast cancer patients. The quality of decision making was measured by decreases in age-based decision making and increased efforts to include patients in decision making. These results suggest there is value in exploring whether if anti-bias training interventions could usefully be applied in other areas of practice where older patients experience poorer outcomes.Conclusions: This study evidences that bias training improves the quality of decision making by medical students in respect of older breast cancer patients. The study findings show promise that this novel approach to bias training might usefully be applied to all medical practitioners making treatment recommendations for older patients.
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Affiliation(s)
- Daisy Neal
- Brighton and Sussex Medical school, Brighton, UK
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The Role of Nurse on the Treatment Decision Support for Older People with Cancer: A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11040546. [PMID: 36833079 PMCID: PMC9956907 DOI: 10.3390/healthcare11040546] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Background: The number of older adults with cancer is increasing worldwide. The role of nurses in supporting patients' decision-making is expanding, as this process is fraught with complexity and uncertainty due to comorbidities, frailty, cognitive decline, etc., in older adults with cancer. The aim of this review was to examine the contemporary roles of oncology nurses in the treatment decision-making process in older adults with cancer. Methods: A systematic review of PubMed, CINAHL, and PsycINFO databases was conducted in accordance with PRISMA guidelines. Results: Of the 3029 articles screened, 56 full texts were assessed for eligibility, and 13 were included in the review. We identified three themes regarding nurses' roles in the decision-making process for older adults with cancer: accurate geriatric assessments, provision of available information, and advocacy. Nurses conduct geriatric assessments to identify geriatric syndromes, provide appropriate information, elicit patient preferences, and communicate efficiently with patients and caregivers, promoting physicians. Time constraints were cited as a barrier to fulfilling nurses' roles. Conclusions: The role of nurses is to elicit patients' broader health and social care needs to facilitate patient-centered decision-making, respecting their preferences and values. Further research focusing on the role of nurses that considers diverse cancer types and healthcare systems is needed.
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Morishima T, Kuwabara Y, Saito MK, Odani S, Kudo H, Kato M, Nakata K, Miyashiro I. Patterns of staging, treatment, and mortality in gastric, colorectal, and lung cancer among older adults with and without preexisting dementia: a Japanese multicentre cohort study. BMC Cancer 2023; 23:67. [PMID: 36658524 PMCID: PMC9854163 DOI: 10.1186/s12885-022-10411-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 12/05/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Little is known about dementia's impact on patterns of diagnosis, treatment, and outcomes in cancer patients. This study aimed to elucidate the differences in cancer staging, treatment, and mortality in older cancer patients with and without preexisting dementia. METHODS Using cancer registry data and administrative data from 30 hospitals in Japan, this multicentre retrospective cohort study examined patients aged 65-99 years who were newly diagnosed with gastric, colorectal, or lung cancer in 2014-2015. Dementia status (none, mild, and moderate-to-severe) at the time of cancer diagnosis was extracted from clinical summaries in administrative data, and set as the exposure of interest. We constructed multivariable logistic regression models to analyse cancer staging and treatment, and multivariable Cox regression models to analyse three-year survival. RESULTS Among gastric (n = 6016), colorectal (n = 7257), and lung (n = 4502) cancer patients, 5.1%, 5.8%, and 6.4% had dementia, respectively. Patients with dementia were more likely to receive unstaged and advanced-stage cancer diagnoses; less likely to undergo tumour resection for stage I, II, and III gastric cancer and for stage I and II lung cancer; less likely to receive pharmacotherapy for stage III and IV lung cancer; more likely to undergo tumour resection for all-stage colorectal cancer; and more likely to die within three years of cancer diagnosis. The effects of moderate-to-severe dementia were greater than those of mild dementia, with the exception of tumour resection for colorectal cancer. CONCLUSION Older cancer patients with preexisting dementia are less likely to receive standard cancer treatment and more likely to experience poorer outcomes. Clinicians should be aware of these risks, and would benefit from standardised guidelines to aid their decision-making in diagnosing and treating these patients.
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Affiliation(s)
- Toshitaka Morishima
- Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567, Osaka, Japan.
| | - Yoshihiro Kuwabara
- grid.489169.b0000 0004 8511 4444Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567 Osaka, Japan
| | - Mari Kajiwara Saito
- grid.489169.b0000 0004 8511 4444Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567 Osaka, Japan
| | - Satomi Odani
- grid.489169.b0000 0004 8511 4444Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567 Osaka, Japan
| | - Haruka Kudo
- grid.489169.b0000 0004 8511 4444Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567 Osaka, Japan
| | - Mizuki Kato
- grid.489169.b0000 0004 8511 4444Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567 Osaka, Japan
| | - Kayo Nakata
- grid.489169.b0000 0004 8511 4444Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567 Osaka, Japan
| | - Isao Miyashiro
- grid.489169.b0000 0004 8511 4444Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567 Osaka, Japan
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Kuryba AJ, Boyle JM, van der Meulen J, Aggarwal A, Walker K, Fearnhead NS, Braun MS. Severity of Dementia and Survival in Patients Diagnosed with Colorectal Cancer: A National Cohort Study in England and Wales. Clin Oncol (R Coll Radiol) 2023; 35:e67-e76. [PMID: 36216698 DOI: 10.1016/j.clon.2022.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/08/2022] [Accepted: 08/25/2022] [Indexed: 01/04/2023]
Abstract
AIMS There is little evidence about the survival of patients with colorectal cancer (CRC) also diagnosed with dementia. We quantified dementia severity and estimated how it is associated with 2-year overall survival. MATERIALS AND METHODS Records of patients aged 65 years or older diagnosed with CRC in England and Wales were identified. A novel proxy for dementia severity combined dementia diagnosis in administrative hospital data with Eastern Cooperative Oncology Group performance status. Cox regression was used to estimate hazard ratios with and without risk adjustment. RESULTS In total, 4033 of 105 250 CRC patients (3.8%) had dementia recorded. Two-year survival decreased with increasing dementia severity from 65.4% without dementia, 53.5% with mild dementia, 33.0% with moderate dementia to 16.5% with severe dementia (hazard ratio comparing severe with no dementia: 2.97; 95% confidence interval 2.79, 3.16). Risk adjustment for comorbidity and cancer stage reduced this association slightly (hazard ratio 2.52; 95% confidence interval 2.37, 2.68) and additional adjustment for treatment factors reduced it further (hazard ratio 1.60; 95% confidence interval 1.50, 1.70). CONCLUSIONS Survival of CRC patients varied strongly according to dementia severity, suggesting that a 'one-size-fits-all' policy for the care of CRC patients with dementia is not appropriate. Comprehensive assessment of cancer patients with dementia that considers dementia severity is essential in a shared decision-making process that ensures patients receive the most appropriate treatment for their individual needs and preferences.
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Affiliation(s)
- A J Kuryba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - J M Boyle
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - J van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Department of Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - K Walker
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - N S Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M S Braun
- Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK; School of Medical Sciences, University of Manchester, Manchester, UK
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Price ML, Surr CA, Gough B, Ashley L. Understanding the experiences and psychosocial support needs of caregivers of people with comorbid dementia and cancer. Psychol Health 2022:1-23. [PMID: 36536600 DOI: 10.1080/08870446.2022.2157030] [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: 05/25/2022] [Revised: 10/28/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Family carers of people living with comorbid dementia and cancer (CDC) play a vital supportive role, but this may be particularly burdensome and adversely impact their own health and wellbeing. OBJECTIVE To examine the experiences and psychosocial support needs of caregivers of people with CDC. METHODS A flyer advertising the study was distributed to relevant UK voluntary sector organisations and shared across social media. 13 carers of people with CDC were recruited. In-depth semi-structured interviews were conducted and transcripts were analysed using reflexive thematic analysis, underpinned by an inductive phenomenological approach. RESULTS Complex interactions of dementia and cancer resulted in heightened responsibility for carers, who played a crucial role in recognition/management of symptoms, performing difficult cancer-related care, and treatment decision-making that posed difficult ethical challenges. Care-recipients had reduced insight into their cancer diagnosis and prognosis, so carers often carried the emotional burden alone. Responsibilities faced by carers were compounded by a lack of targeted, accessible information/support for CDC. Carers expressed a desire to talk to and learn from others who understand the unique challenges of navigating cancer-related decision-making, treatment and care for people who are also living with dementia. CONCLUSIONS Cancer alongside dementia presents complex challenges for carers, who desire more cancer-related information and support which is tailored to people living with dementia and their family caregivers.
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Affiliation(s)
- Mollie L Price
- School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Claire A Surr
- School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Brendan Gough
- School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Laura Ashley
- School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
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Hargreaves S, Sbaffi L, Ford N. Information seeking amongst informal caregivers of people with dementia: a qualitative study. JOURNAL OF DOCUMENTATION 2022. [DOI: 10.1108/jd-03-2022-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis paper both supports previous findings relating to, and presents new insights into: the information needs and the information seeking processes of a sample of informal caregivers of people with dementia (in relation to their own needs and the interrelated needs of the people they are caring for); the extent to which such information needs are and are not being met; and the factors facilitating and hindering access to the right information.Design/methodology/approachThe study adopted a qualitative approach in the form of a thematic analysis of in-depth, semi-structured interviews with a sample of 20 informal caregivers from a range of different age groups, genders and caring roles.FindingsThematic analysis identified significant informational challenges, with a common perception that information seeking was onerous, requiring a proactive approach. Further challenges arose from a perceived lack of focus on carer needs coming up against the boundaries of professional knowledge and inconsistent information provision across the sample. Distance carers faced specific issues. A second theme of negative impacts described burdens arising from: difficulties in accessing information from a complex array of support services closure or change in services and unfulfilled information needs. Participants employed strategies to enable access to information, for example, being open about their caring role; and building formal or informal support networks. It is important to address emotional as well as cognitive dimensions of information needs.Practical implicationsThis research highlights a need for health and social care, practice and policy to acknowledge and address information needs of this diverse population and build resilience. Above all, information seeking and sharing must be understood within the context of the emotional impact of caring, and recognition of these twin needs is crucial.Originality/valueWhilst previous research has focussed on identifying specific needs and knowledge acquisition at cross-sections, a more holistic understanding of experiences is underexplored. This approach is needed to take into account broader contexts, diversity of experiences and different caring roles, e.g. primary and secondary carers, and in situ and distance carers.
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Miu DKY, Lam KY, Chan CO. Do Cognitively Impaired Elderly Patients with Cancer Respond Differently on Self-reported Symptom Scores? A 5-Year Retrospective Analysis. Indian J Palliat Care 2022; 28:167-173. [PMID: 35673685 PMCID: PMC9168287 DOI: 10.25259/ijpc_18_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: An increasing number of elderly subjects with cancer were admitted to the palliative care unit and they have suffered both distressing symptoms and cognitive impairment. We aim to identify the prevalence of cognitive impairment among elderly cancer patients receiving in-patient palliative care and to examine any difference between patients with cognitive impairment on self-reported symptoms. Materials and Methods: Subjects’ age ≥65 admitted to a palliative care unit from 01 September 2015 to 31 August 2020 was included in the study. Exclusion criteria were those with an impaired conscious state, severe cognitive impairment, or language problems that were non-communicable. Variables collected included baseline demographics, cancer diagnosis, cancer stage, mobility state using the modified Barthel index (mBI), and performance status as measured by the palliative performance scale. Cognitive impairment was defined by abbreviated mental test ≤6. Self-reported symptoms scales were measured by the Chinese version of MD Anderson Symptom Inventory and EORTC QLQ C-30 (European Organisation for Research and Treatment of Cancer, Quality of Life Core Questionnaire 30). Results: Nine hundred and ninety-one subjects with 1174 admissions were retrieved. Eight hundred and seventy-three admission episodes were included in this study. Three hundred and eight (35%) have cognitive impairment. Cognitively impaired subjects were older, showed worse physical function and performance status, and more often residing in old age homes. Independent predictors of cognitive impairment were age (OR 1.09), mBI (OR 0.96), chair/bed bound state (OR 1.79), and presence of brain metastasis (OR 2.63). They reported lower scores in pain (P < 0.001), distress (P < 0.001), sleep disturbance (P < 0.001) and nausea and vomiting (P = 0.012) in the self-reported symptoms scale. Conclusion: Elderly cancer patients with cognitive impairment were older with poorer performance status. They have reported a lower level of pain, distress, and sleep disturbance. Clinicians should be alerted to this phenomenon to tackle the unmet concomitant symptoms.
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Affiliation(s)
- Doris Ka Ying Miu
- Department of Rehabilitation and Extended Care, Wong Tai Sin Hospital, Hong Kong,
| | - Kai Yin Lam
- Department of Rehabilitation and Extended Care, Wong Tai Sin Hospital, Hong Kong,
| | - Chung On Chan
- Department of Rehabilitation and Extended Care, Wong Tai Sin Hospital, Hong Kong,
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Hodges V, Hynes C, Lassa S, Mitchell C. Support needs of carers making proxy healthcare decisions for people with dementia: a systematic review based on the Noblit and Hare meta-ethnographic synthesis of qualitative studies. BMJ Open 2021; 11:e052608. [PMID: 34930737 PMCID: PMC8689175 DOI: 10.1136/bmjopen-2021-052608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There are 50 million dementia sufferers worldwide. Decisions about healthcare often need to be made when the person with dementia lacks capacity to do so.Understanding the support needs of carers acting as proxy healthcare decision-makers will be vital in improving the decision-making process for people with dementia and addressing the holistic needs of carers. OBJECTIVE The objective of this study was to review the existing literature on the support needs of carers acting as proxy healthcare decision-makers for people with dementia. DESIGN A qualitative systematic review protocol was published on PROSPERO. The Critical Appraisal Skills Programme checklist was used to appraise study quality. A meta-ethnographic synthesis was performed to develop third-order constructs. DATA SOURCES A search was conducted using three online databases (MEDLINE, CINAHL and PsycINFO). ELIGIBILITY CRITERIA Fifteen studies met the inclusion criteria: primary qualitative research involving carers of people with dementia who had been involved in making proxy healthcare decisions. DATA EXTRACTION AND SYNTHESIS Two independent researchers conducted validity assessments for each paper selected for inclusion, and discrepancies were resolved by discussions with a third reviewer. Nvivo software was used and conceptual findings from study papers lead to interpretations of findings by the team. RESULTS From the 15 papers included in the study, three main domains arose from the meta-ethnography; informational, practical and emotional. Informational support needs included information about dementia itself and the anticipated disease trajectory. Practical needs included continuity of care, person-centred care and the use of legal frameworks.Emotional support included recognising the guilt that healthcare decisions can provoke and the importance of providing guidance in an empathic manner. CONCLUSIONS This meta-ethnography highlights opportunities for healthcare professionals and policymakers to improve experiences of carers making proxy healthcare decisions for people with dementia. PROSPERO REGISTRATION NUMBER CRD42020124485.
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Affiliation(s)
- Victoria Hodges
- Academic Unit of Primary Medical Care, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Catherine Hynes
- Academic Unit of Primary Medical Care, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Samuel Lassa
- Academic Unit of Primary Medical Care, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Caroline Mitchell
- Academic Unit of Primary Medical Care, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
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Cancer Management among Older Adults Living with Dementia: A Call to Action from Asian Perspectives. Asia Pac J Oncol Nurs 2021; 9:3-4. [PMID: 35528801 PMCID: PMC9072177 DOI: 10.1016/j.apjon.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022] Open
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Factors affecting the decision to investigate older adults with potential cancer symptoms: a systematic review. Br J Gen Pract 2021; 72:e1-e10. [PMID: 34782315 PMCID: PMC8597772 DOI: 10.3399/bjgp.2021.0257] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Older age and frailty increase the risk of morbidity and mortality from cancer surgery and intolerance of chemotherapy and radiotherapy. The effect of old age on diagnostic intervals is unknown; however, older adults need a balanced approach to the diagnosis and management of cancer symptoms, considering the benefits of early diagnosis, patient preferences, and the likely prognosis of a cancer. AIM To examine the association between older age and diagnostic processes for cancer, and the specific factors that affect diagnosis. DESIGN AND SETTING A systematic literature review. METHOD Electronic databases were searched for studies of patients aged >65 years presenting with cancer symptoms to primary care considering diagnostic decisions. Studies were analysed using thematic synthesis and according to the Synthesis Without Meta-analysis guidelines. RESULTS Data from 54 studies with 230 729 participants were included. The majority of studies suggested an association between increasing age and prolonged diagnostic interval or deferral of a decision to investigate cancer symptoms. Thematic synthesis highlighted three important factors that resulted in uncertainty in decisions involving older adults: presence of frailty, comorbidities, and cognitive impairment. Data suggested patients wished to be involved in decision making, but the presence of cognitive impairment and the need for additional time within a consultation were significant barriers. CONCLUSION This systematic review has highlighted uncertainty in the management of older adults with cancer symptoms. Patients and their family wished to be involved in these decisions. Given the uncertainty regarding optimum management of this group of patients, a shared decision-making approach is important.
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Hsu WH, Hsieh JG, Wang YW, Hsieh CJ, Lin HR, Wu SY. Insufficient pain control for patients with cancer and dementia during terminal cancer stages. Am J Transl Res 2021; 13:13034-13042. [PMID: 34956521 PMCID: PMC8661160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/07/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE To estimate differences in pain control between patients with cancer and with or without dementia during terminal cancer stages 3 months or 1 month before cancer death. PATIENTS AND METHODS We conducted frequency matching cohort for age, sex, and year of death for both groups at a 1:4 ratio. The prescription prevalence, total cumulative dose, and average daily dose of opioids during the terminal cancer stages 3 months and 1 month before cancer death were estimated. RESULTS Patients with cancer and dementia were prescribed lower amounts of opioids 3 months before death (57.5% vs. 73.9%, respectively; adjusted odds ratio [OR] 0.46; 95% confidence interval [CI] 0.44-0.49) and 1 month before death (54.4% vs. 70.3%, respectively; adjusted OR 0.50; 95% CI 0.47-0.53). The total cumulative dose of opioids (mg) was lower in patients with cancer and dementia 3 and 1 month(s) before death (3 months: 1,578 mg vs. 2,666 mg, respectively; β=-1,125.9, P<0.001; 1 month: 921 mg vs. 1,533 mg, respectively; β=-622.1, P<0.001). The average daily opioid dose (mg/day), patients with cancer and dementia received a lower dose 3 months before death (31 mg vs. 48 mg; β=-22.6, P<0.001) and 1 month before death (38 mg vs. 60 mg; β=-17.1, P<0.001). CONCLUSION The prevalence of opioid prescription was significantly lower in patients with both cancer and dementia during their terminal cancer stages 3 months and 1 month before death.
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Affiliation(s)
- Wei-Hung Hsu
- Department of Family Medicine, Buddhist Tzu Chi General HospitalHualien 97002, Taiwan
| | - Jyh-Gang Hsieh
- Department of Family Medicine, Buddhist Tzu Chi General HospitalHualien 97002, Taiwan
| | - Ying-Wei Wang
- Department of Family Medicine, Buddhist Tzu Chi General HospitalHualien 97002, Taiwan
| | - Chia-Jung Hsieh
- Department of Public Health, Tzu Chi UniversityHualien 97004, Taiwan
| | - Huang-Ren Lin
- Department of Family Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan 265, Taiwan
| | - Szu-Yuan Wu
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia UniversityTaichung 41354, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan 265, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan 265, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia UniversityTaichung 41354, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan 265, Taiwan
- Graduate Institute of Business Administration, Fu Jen Catholic UniversityTaipei 242062, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical UniversityTaipei 110, Taiwan
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Johnston B, Stevens E. Exploring the Dilemma of Ethical Issues Using the Lens of Seedhouse Can Help Oncology Nurses to Gain a Different Perspective on Caring for Older Adults with Cancer. Semin Oncol Nurs 2021; 37:151231. [PMID: 34753643 DOI: 10.1016/j.soncn.2021.151231] [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: 10/19/2022]
Abstract
OBJECTIVE To explore ethical issues associated with older adults with cancer and the people who matter to them. DATA SOURCES A scoping review of the literature was conducted to inform the article using CINAHL, Medline, and Google Scholar databases using broad terms, older adults, geriatrics, cancer, and ethics. CONCLUSION Older adults with cancer experience ageism, which stems from a range of uncertainties on best practice in care and treatment. By employing an ethical lens, decision-making by oncology nurses can be aided by creating and promoting autonomy through impeccable communication. Best interests for individual older adults with cancer can also be served by oncology nurses working in a way that serves needs first and acts in the best interests of the person and their family. IMPLICATIONS FOR NURSING PRACTICE The article is of relevance to practicing oncology globally nurses because the framework can be easily used in clinical practice.
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Affiliation(s)
- Bridget Johnston
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK; NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK.
| | - Elaine Stevens
- University of the West of Scotland, Paisley, Scotland, UK
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Managing a Dual Diagnosis of Cancer and Dementia in an Acute Setting: Considerations, Implications, and Future Recommendations. Semin Oncol Nurs 2021; 37:151233. [PMID: 34753641 DOI: 10.1016/j.soncn.2021.151233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To present an overview of the issues related to the well-being of people affected by cancer and dementia. To highlight the evidence from dementia care that can help improve the care experiences of people with dementia and cancer. DATA SOURCES Electronic databases such as PubMed and CINAHL were used to retrieve relevant literature published between 2010 and 2020. CONCLUSION Having a dual diagnosis of dementia and cancer poses several challenges across the cancer care pathway. Communication, treatment decision-making, environment ,and time-related issues were all identified. The literature suggests the need for evidence-based guidelines taking into consideration the person and the environment to support this population. IMPLICATIONS FOR NURSING PRACTICE To address these challenges and offer an optimal care experience for this group and their families, solutions need to focus both on the workforce and the environment. Offering dementia education for professionals working in acute cancer care, as well as adapting local environments that facilitate people navigate the space can be a starting point to offer person-centered, rights-based dementia sensitive care.
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Liu B, Ornstein KA, Alpert N, Schwartz RM, Dharmarajan KV, Kelley AS, Taioli E. Trends of hospitalizations among patients with both cancer and dementia diagnoses in New York 2007-2017. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2021; 9:100565. [PMID: 34252707 PMCID: PMC8453053 DOI: 10.1016/j.hjdsi.2021.100565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/25/2021] [Accepted: 07/05/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cancer and dementia have often been studied in isolation. We aimed to examine the spatiotemporal trend of inpatient admissions with both cancer and dementia diagnoses. METHODS Using state-wide inpatient claims data, we identified all hospital admissions for patients aged ≥50 years with both cancer and dementia diagnoses in New York State, 2007-2017. We examined the spatiotemporal trend of the admission using a novel Bayesian hierarchical model adjusting for socioeconomic factor, as measured by Yost index. RESULTS Admissions with the presence of both cancer and dementia diagnoses represented 8.5% of all admissions with a cancer diagnosis, and the proportion increased from 7.1% in 2007 to 9.7% in 2017. The median admission rate was 3.5 (interquartile range: 2.2-5.2) hospitalizations per 1000 population aged ≥50 years, which increased from 2.9 in 2007 to 3.7 in 2017. The admission rate peaked first in 2010 followed by a smaller peak in 2014, before stabilizing at a level higher than the pre-2010 period. Taking into account the spatiotemporal heterogeneity, we found that hospitalizations among those with both cancer and dementia diagnoses were associated with a higher socioeconomic status (the posterior median relative risk for Yost index = 1.046 (95% credible interval: 1.033-1.058)). CONCLUSIONS Hospitalizations of patients with both cancer and dementia increased over time. Cancer care providers and healthcare systems should be prepared to provide prevention and management strategies and engage in complex medical decision-making for this increasingly common patient population comprised of individuals with cancer and dementia.
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Affiliation(s)
- Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Katherine A Ornstein
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naomi Alpert
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rebecca M Schwartz
- Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Kavita V Dharmarajan
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amy S Kelley
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emanuela Taioli
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Filteau C, Simeone A, Ravot C, Dayde D, Falandry C. Cultural and Ethical Barriers to Cancer Treatment in Nursing Homes and Educational Strategies: A Scoping Review. Cancers (Basel) 2021; 13:3514. [PMID: 34298728 PMCID: PMC8305927 DOI: 10.3390/cancers13143514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 01/15/2023] Open
Abstract
(1) Background: The aging of the population, the increase in the incidence of cancer with age, and effective chronic oncological treatments all lead to an increased prevalence of cancer in nursing homes. The aim of the present study was to map the cultural and ethical barriers associated with the treatment of cancer and educational strategies in this setting. (2) Methods: A systematic scoping review was conducted until April 2021 in MEDLINE, Embase, and CINAHL. All articles assessing continuum of care, paramedical education, and continuing education in the context of older cancer patients in nursing homes were reviewed. (3) Results: A total of 666 articles were analyzed, of which 65 studies were included. Many factors interfering with the decision to investigate and treat, leading to late- or unstaged disease, palliative-oriented care instead of curative, and a higher risk of unjustified transfers to acute care settings, were identified. The educational strategies explored in this context were generally based on training programs. (4) Conclusions: These results will allow the co-construction of educational tools intended to develop knowledge and skills to improve diagnostic and therapeutic decision-making, the consistency of care, and, ultimately, the quality of life of older cancer patients in nursing homes.
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Affiliation(s)
- Cynthia Filteau
- Service de Gériatrie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (C.R.); (C.F.)
- Département de Gériatrie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC H1T 2M4, Canada
| | - Arnaud Simeone
- Université Lumière-Groupe de Recherche en Psychologie Sociale (UR GRePS) Institut de Psychologie, 69676 Bron, France;
| | - Christine Ravot
- Service de Gériatrie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (C.R.); (C.F.)
| | - David Dayde
- Plateforme de Recherche de l’Institut de Cancérologie des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France;
| | - Claire Falandry
- Service de Gériatrie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (C.R.); (C.F.)
- Laboratoire CarMeN, INSERM, INRAE, Université Claude Bernard Lyon-1, 69600 Oullins, France
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21
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Caba Y, Dharmarajan K, Gillezeau C, Ornstein KA, Mazumdar M, Alpert N, Schwartz RM, Taioli E, Liu B. The Impact of Dementia on Cancer Treatment Decision-Making, Cancer Treatment, and Mortality: A Mixed Studies Review. JNCI Cancer Spectr 2021; 5:pkab002. [PMID: 34056540 PMCID: PMC8152697 DOI: 10.1093/jncics/pkab002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/21/2020] [Accepted: 11/16/2020] [Indexed: 11/12/2022] Open
Abstract
Dementia and cancer occur commonly in older adults. Yet, little is known about the effect of dementia on cancer treatment and outcomes in patients diagnosed with cancer, and no guidelines exist. We performed a mixed studies review to assess the current knowledge and gaps on the impact of dementia on cancer treatment decision-making, cancer treatment, and mortality. A search in PubMed, Medline, and PsycINFO identified 55 studies on older adults with a dementia diagnosis before a cancer diagnosis and/or comorbid cancer and dementia published in English from January 2004 to February 2020. We described variability using range in quantitative estimates, ie, odds ratios (ORs), hazard ratios (HRs), and risk ratios (RR) when appropriate and performed narrative review of qualitative data. Patients with dementia were more likely to receive no curative treatment (including hospice or palliative care) (OR, HR, and RR range = 0.40-4.4, n = 8), while less likely to receive chemotherapy (OR and HR range = 0.11-0.68, n = 8), radiation (OR range = 0.24-0.56, n = 2), and surgery (OR range = 0.30-1.3, n = 4). Older adults with cancer and dementia had higher mortality than those with cancer alone (HR and OR range = 0.92-5.8, n = 33). Summarized findings from qualitative studies consistently revealed that clinicians, caregivers, and patients tended to prefer less aggressive care and gave higher priority to quality of life over life expectancy for those with dementia. Current practices in treatment-decision making for patients with both cancer and dementia are inconsistent. There is an urgent need for treatment guidelines for this growing patient population that considers patient and caregiver perspectives.
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Affiliation(s)
- Yaelin Caba
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kavita Dharmarajan
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christina Gillezeau
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Healthcare Delivery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naomi Alpert
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rebecca M Schwartz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Emanuela Taioli
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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22
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Ashley L, Kelley R, Griffiths A, Cowdell F, Henry A, Inman H, Hennell J, Ogden M, Walsh M, Jones L, Mason E, Collinson M, Farrin A, Surr C. Understanding and identifying ways to improve hospital-based cancer care and treatment for people with dementia: an ethnographic study. Age Ageing 2021; 50:233-241. [PMID: 33156901 PMCID: PMC7793597 DOI: 10.1093/ageing/afaa210] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 12/17/2022] Open
Abstract
Background Providing cancer care and treatment for ageing populations with complicating comorbidities like dementia is a growing global challenge. This study aimed to examine the hospital-based cancer care and treatment challenges and support needs of people with dementia, and identify potential ways to address these. Methods A two-site ethnographic study in England involving semi-structured interviews, observations and accompanying conversations, and medical record review. Participants (N = 58) were people with dementia and comorbid cancer (n = 17), informal caregivers (n = 22) and hospital staff (n = 19). Ethnographically informed thematic analysis was conducted. Results There was an accumulated complexity of living with both illnesses simultaneously. People with dementia and families could feel confused and uninformed due to difficulties understanding, retaining and using cancer information, which impacted their informed treatment decision-making. Dementia increased the complexity and burden of travelling to and navigating unfamiliar hospital environments, frequent lengthy periods of waiting in hospital, and self-managing symptoms and side-effects at home. Oncology staff were often working without the full picture, due to variable documenting of dementia in medical records, dementia training was limited, and time and resource pressures impeded the highly individualised, flexible cancer care required by people with dementia. Supportive family carers were crucial in enabling people with dementia to access, navigate and undergo cancer treatment and care. Conclusions Dementia complicates cancer care in a range of ways accumulating across the cancer pathway. Our findings suggest there are several strategies and interventions, which we list here, with potential to improve cancer care and treatment for people with dementia and their families.
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Affiliation(s)
- Laura Ashley
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Rachael Kelley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Alys Griffiths
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Ann Henry
- Clinical Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Hayley Inman
- Oncology Services, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | | | | | | | - Ellen Mason
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Claire Surr
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
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Abstract
PURPOSE OF REVIEW Cognitive impairment is increasing in an ageing population and as people live longer, they are more likely to develop cancer therefore cognitive impairment and cancer are frequently co-occurring. We reviewed articles published since 2018 on cognitive impairment and cancer. RECENT FINDINGS The current review has focused on diagnosis, treatment and palliative and end of life care. A comprehensive systematic review reported joint cancer and cognitive impairment prevalence from 0.2 to 45.6%. The review reported there was reduced likelihood of patients with co-occurring cognitive and cancer receiving information regarding cancer stage, reduced cancer treatment with curative intent and limited pain and symptom management. Further studies emphasized the role of family carers in supporting patients with cognitive impairment through cancer treatment. SUMMARY Disappointingly in an area where the numbers of patients with cognitive impairment and cancer are increasing, there appears to be little recently published research in this area. We conclude that further research is required to determine how best to support patients with cognitive impairment and cancer and families during diagnosis of cancer, treatment and continuing care and most importantly the findings of all studies are implemented within clinical practice.
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Cunningham N. Understanding the training and education needs of homecare workers supporting people with dementia and cancer: A systematic review of reviews. DEMENTIA 2020; 19:2780-2803. [PMID: 31271044 PMCID: PMC7925442 DOI: 10.1177/1471301219859781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Many people with dementia, supported by family carers, prefer to live at home and may rely on homecare support services. People with dementia are also often living with multimorbidities, including cancer. The main risk factor for both cancer and dementia is age and the number of people living with dementia and cancer likely to rise. Upskilling the social care workforce to facilitate more complex care is central to national workforce strategies and challenges. Training and education development must also respond to the key requirements of a homecare workforce experiencing financial, recruitment and retention difficulties. This systematic review of reviews provides an overview of dementia and cancer training and education accessible to the homecare workforce. Findings reveal there is a diverse range of training and education available, with mixed evidence of effectiveness. Key barriers and facilitators to effective training and education are identified in order to inform future training, education and learning development for the homecare workforce supporting people with dementia and cancer.
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Hopkinson J, King A, Courtier N, Milton R, Elias J. Potential for identification of memory problems in the cancer clinic to enable improved treatment experience and outcomes: Mixed methods case study research. Eur J Oncol Nurs 2020; 48:101777. [PMID: 32805611 DOI: 10.1016/j.ejon.2020.101777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To inform improvement in cancer treatment experience and outcomes for people with dementia or milder cognitive impairment. People with dementia, compared to those without, experience more side effects from cancer treatment and have poorer outcomes including poorer survival. METHODS The research was a mixed methods exploratory case study. Each case was a cancer treatment in a person with memory loss, a common symptom of dementia. Observations were conducted in 30 clinic sessions at one cancer centre between September 2014 and February 2015. Thirty-three encounters between people with a memory problem and a staff member were observed and ten consultations recorded. Interviews were conducted with five staff members and six people receiving cancer treatment, five accompanied by their carer. Analysis, informed by hermeneutic phenomenology, enabled the treatment pathway to be mapped and modelled to reveal sites for intervention. FINDINGS Five potential sites of intervention were identified in the treatment pathway. Five actions at the sites of intervention that may improve patient experience and outcomes include, raising awareness of common problems for people with cognitive impairment receiving cancer treatment, encouraging disclosure of memory problems, staff training to identify memory problems and to know what to do, offering tools and techniques to aid self-management of memory problems, and addressing carer support needs. CONCLUSION Embedding biomedical treatment of cancer within a dementia-friendly psychosocial system may enable safe cancer treatment for a greater number of people with dementia or milder cognitive impairment.
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Affiliation(s)
- Jane Hopkinson
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Wales, UK.
| | - Amanda King
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Wales, UK
| | - Nicholas Courtier
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Wales, UK
| | - Rebecca Milton
- Centre for Trials Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Wales, UK
| | - Jayne Elias
- Velindre University NHS Trust, Cardiff, Wales, UK
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Navigating cancer treatment and care when living with comorbid dementia: an ethnographic study. Support Care Cancer 2020; 29:2571-2579. [PMID: 32955656 PMCID: PMC7981315 DOI: 10.1007/s00520-020-05735-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/01/2020] [Indexed: 11/08/2022]
Abstract
Objectives The risks of developing cancer and dementia increase as we age; however, this comorbidity remains relatively under-researched. This study reports on the challenges that people affected by comorbid cancer and dementia face when navigating engagement with cancer treatment within secondary care. Materials and methods An ethnographic study recruiting 17 people with cancer and dementia, 22 relatives and 19 oncology staff in two UK National Health Service Trusts. Observations (46 h) and informal conversations were conducted during oncology appointments involving people with dementia. Semi-structured interviews (n = 37) with people living with cancer and dementia, their relatives and staff working in various roles across oncology services were also carried out. Data were analysed using ethnographically informed thematic analysis. Results People with cancer and dementia experienced challenges across three areas of navigating cancer treatment and care: navigating through multiple services, appointments and layers of often complex information; repeatedly navigating transport to and from hospital; and navigating non-dementia-friendly hospital outpatient environments alongside the cognitive problems associated with dementia. Conclusions Dementia impacts patients’ abilities to navigate the many practical aspects of attending hospital for cancer treatment and care. This study indicates the importance of addressing ways to improve the experience of travelling to and from the hospital, alongside extending the ongoing efforts to develop ‘dementia-friendly’ hospital in-patient areas and practices, to outpatient departments. Such steps will serve to improve hospital-based cancer treatment and care and more broadly outpatient appointment experiences for people with dementia and their families.
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McWilliams L. An Overview of Treating People with Comorbid Dementia: Implications for Cancer Care. Clin Oncol (R Coll Radiol) 2020; 32:562-568. [PMID: 32718761 DOI: 10.1016/j.clon.2020.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/02/2020] [Accepted: 06/18/2020] [Indexed: 01/26/2023]
Abstract
With increasing prevalence of both cancer and dementia in the UK, due to an ageing population, oncology healthcare professionals will experience higher numbers of people with both conditions. As dementia is highly heterogeneous and symptoms vary from individual to individual, it presents specific challenges for healthcare professionals, people with dementia and caregivers alike. This overview will describe current theories that explain the association between cancer and dementia, report prevalence rates and highlight the evidence on the impact of having a diagnosis of dementia on outcomes along the cancer pathway from cancer symptom detection to cancer treatment outcomes. It suggests that although prevalence rates of cancer and dementia are typically lower than other comorbidities, people with cancer and dementia have poorer cancer-related outcomes. This includes later stage cancer diagnoses, fewer cancer treatment options and an increased risk of death compared with people who have cancer alone or other comorbid conditions. Considerations for cancer treatment decision making and management are proposed to improve patient experience for this group.
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Affiliation(s)
- L McWilliams
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.
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28
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Corbett T, Cummings A, Calman L, Farrington N, Fenerty V, Foster C, Richardson A, Wiseman T, Bridges J. Self‐management in older people living with cancer and multi‐morbidity: A systematic review and synthesis of qualitative studies. Psychooncology 2020; 29:1452-1463. [DOI: 10.1002/pon.5453] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Teresa Corbett
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- NIHR ARC Wessex University of Southampton UK
| | - Amanda Cummings
- Macmillan Survivorship Research Group University of Southampton Southampton UK
| | - Lynn Calman
- Macmillan Survivorship Research Group University of Southampton Southampton UK
| | - Naomi Farrington
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- University Hospital Southampton NHS Foundation Trusts Southampton UK
| | - Vicky Fenerty
- University of Southampton Library University of Southampton Southampton UK
| | - Claire Foster
- Macmillan Survivorship Research Group University of Southampton Southampton UK
| | - Alison Richardson
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- NIHR ARC Wessex University of Southampton UK
- University Hospital Southampton NHS Foundation Trusts Southampton UK
| | - Theresa Wiseman
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- The Royal Marsden NHS Foundation Trust London UK
| | - Jackie Bridges
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- NIHR ARC Wessex University of Southampton UK
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29
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Griffiths AW, Ashley L, Kelley R, Cowdell F, Collinson M, Mason E, Farrin A, Henry A, Inman H, Surr C. Decision-making in cancer care for people living with dementia. Psychooncology 2020; 29:1347-1354. [PMID: 32567082 DOI: 10.1002/pon.5448] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/20/2020] [Accepted: 06/17/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Increasing numbers of people are expected to live with comorbid cancer and dementia. Cancer treatment decision-making for these individuals is complex, particularly for those lacking capacity, requiring support across the cancer care pathway. There is little research to inform practice in this area. This ethnographic study reports on the cancer decision-making experiences of people with cancer and dementia, their families, and healthcare staff. METHODS Participant observations, informal conversations, semi-structured interviews, and medical note review, in two NHS trusts. Seventeen people with dementia and cancer, 22 relatives and 19 staff members participated. RESULTS Decision-making raised complex ethical dilemmas and challenges and raised concerns for families and staff around whether correct decisions had been made. Whose decision it was and to what extent a person with dementia and cancer was able to make decisions was complex, requiring careful and ongoing consultation and close involvement of relatives. The potential impact dementia might have on treatment understanding and toleration required additional consideration by clinicians when evaluating treatment options. CONCLUSIONS Cancer treatment decision-making for people with dementia is challenging, should be an ongoing process and has emotional impacts for the individual, relatives, and staff. Longer, flexible, and additional appointments may be required to support decision-making by people with cancer and dementia. Evidence-based decision-making guidance on how dementia impacts cancer prognosis, treatment adherence and efficacy is required.
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Affiliation(s)
- Alys Wyn Griffiths
- Centre for Dementia Research, School of Health & Community Studies, Leeds Beckett University, Leeds, UK
| | - Laura Ashley
- School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Rachael Kelley
- Centre for Dementia Research, School of Health & Community Studies, Leeds Beckett University, Leeds, UK
| | - Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Ellen Mason
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Ann Henry
- Clinical Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,School of Medicine, University of Leeds, Leeds, UK
| | - Hayley Inman
- Oncology Services, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Claire Surr
- Centre for Dementia Research, School of Health & Community Studies, Leeds Beckett University, Leeds, UK
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30
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Surr CA, Kelley R, Griffiths AW, Ashley L, Cowdell F, Henry A, Collinson M, Mason E, Farrin AJ. Enabling people with dementia to access and receive cancer treatment and care: The crucial role of supportive networks. J Geriatr Oncol 2020; 11:1125-1131. [PMID: 32253158 PMCID: PMC7544010 DOI: 10.1016/j.jgo.2020.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/27/2020] [Accepted: 03/26/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Despite cancer and dementia being conditions in which prevalence increases with age, there remains limited research on the cancer treatment and care needs of this population. Our study aimed to address this gap and this paper reports on the role of supportive networks in enabling people with dementia to access cancer treatment and care. MATERIALS AND METHODS An ethnographic study involving seventeen people with cancer and dementia, 22 relatives and nineteen oncology staff. It comprised observations (46 h) of and informal conversations during oncology appointments attended by people with dementia and their relatives and semi-structured interviews (n = 37) with people living with cancer and dementia, their relatives and staff working in various roles across oncology services. Data were analysed using thematic analysis. RESULTS Patients and oncology staff relied on and expected relatives to provide practical and emotional support around cancer treatment and care. Families varied in their ability to provide required support due to extent of the family network, practical issues, knowledge of the patient and their wishes, family conflict and the patient's willingness to accept help. Where no family network was available, support provision was complex and this could compromise access to cancer treatment. CONCLUSIONS People with comorbid cancer and dementia rely heavily on a supportive family network to access treatment and care. Oncology services need to assess the supportive networks available to individual patients in developing cancer treatment plans. Urgent consideration needs to be given to how those with no family networks can be appropriately supported.
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Affiliation(s)
- Claire A Surr
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK.
| | - Rachael Kelley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK.
| | - Alys W Griffiths
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK.
| | - Laura Ashley
- School of Social Sciences, Leeds Beckett University, Leeds, UK.
| | - Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK.
| | - Ann Henry
- Clinical Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; School of Medicine, University of Leeds, Leeds, UK.
| | - Michelle Collinson
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - Ellen Mason
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - Amanda J Farrin
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
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31
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Hirooka K, Nakanishi M, Fukahori H, Nishida A. Impact of dementia on quality of death among cancer patients: An observational study of home palliative care users. Geriatr Gerontol Int 2020; 20:354-359. [DOI: 10.1111/ggi.13860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 11/19/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Kayo Hirooka
- Graduate School of Health ManagementKeio University Kanagawa Japan
| | - Miharu Nakanishi
- Mental Health and Nursing Research TeamTokyo Metropolitan Institute of Medical Science Tokyo Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical CareKeio University Kanagawa Japan
| | - Atsushi Nishida
- Mental Health Promotion ProjectTokyo Metropolitan Institute of Medical Science Tokyo Japan
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Ornstein KA, Liu B, Schwartz RM, Smith CB, Alpert N, Taioli E. Cancer in the context of aging: Health characteristics, function and caregiving needs prior to a new cancer diagnosis in a national sample of older adults. J Geriatr Oncol 2020; 11:75-81. [PMID: 30952516 PMCID: PMC6774923 DOI: 10.1016/j.jgo.2019.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/25/2019] [Accepted: 03/25/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION As cancer trajectories change due to screening, earlier diagnoses, living longer with illnesses, and new successful treatments, cancer is increasingly a disease of older adults. While cancer diagnoses themselves are very stressful for patients and families, little is known about the health status, functional limitations, and social resources of older patients before they face a new cancer diagnosis. MATERIALS AND METHODS Using the National Health and Aging Trends Study (NHATS), a national survey of older Medicare beneficiaries linked to Medicare claims data, we examined the health characteristics, functional limitations and social and financial resources of older adults before a new diagnosis of lung, breast, prostate or colorectal cancer and how these factors vary by race/ethnicity. RESULTS We identified 274 community-dwelling older adults with incident cancer diagnoses: lung (30.6%), breast (20.3%), prostate (30.8%), and colorectal (18.3%) representing 1,202,920 older Medicare beneficiaries. The sample was 81% Non-Hispanic White, 10% Non-Hispanic Black, and 9% Hispanic/Other. Before diagnosis, patients had an average of three comorbidities and 29% of patients reported poor/fair health. Almost one-third were living alone, 13% received help with at least one activity of daily living (ADL), 11% had probable dementia and nearly one in ten already received financial help from family members. DISCUSSION Before an older adult has ever been diagnosed with a major cancer, many face significant health and financial challenges and are dependent on others for care. These needs vary based on cancer type and race/ethnicity and must be considered as clinicians develop individualized care plans for patients alongside caregivers.
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Affiliation(s)
- Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Bian Liu
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Rebecca M Schwartz
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, United States of America
| | - Cardinale B Smith
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, United States of America
| | - Naomi Alpert
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Emanuela Taioli
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Martin C, Shrestha A, Burton M, Collins K, Wyld L. How are caregivers involved in treatment decision making for older people with dementia and a new diagnosis of cancer? Psychooncology 2019; 28:1197-1206. [PMID: 30908755 PMCID: PMC6563536 DOI: 10.1002/pon.5070] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To explore how caregivers are involved in making treatment decisions for older people living with dementia and a new diagnosis of cancer. METHOD A systematic review of PubMed, CINAHL, PsycINFO, Web of Science, and Scopus databases was conducted. Studies recruiting formal or informal caregivers for older people with dementia and a diagnosis of cancer were considered for inclusion. RESULTS Of 1761 articles screened, 36 full texts were assessed for eligibility, and six were included in the review. This review has identified that health care professionals (HCPs) are often unaware of the coexistence or severity of dementia in cancer patients, and therefore fail to properly address care needs as a result. While caregivers are relied on to help make decisions, they have unmet information needs and feel excluded from decision-making. CONCLUSION Treatment decision making in the context of older adults with dementia and a new diagnosis of cancer needs further research. This will help HCPs to understand their needs and improve the experience of decision making for both caregivers and the people that they care for.
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Affiliation(s)
- Charlene Martin
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield
| | - Anne Shrestha
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield
| | - Maria Burton
- Department of Health and Social Care Research, Sheffield Hallam University, Sheffield
| | - Karen Collins
- Department of Health and Social Care Research, Sheffield Hallam University, Sheffield
| | - Lynda Wyld
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield
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Bridging the divide: the adjustment and decision-making experiences of people with dementia living with a recent diagnosis of cancer and its impact on family carers. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18001411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractThe risk of living with dementia and, separately, cancer, increases exponentially with age. However, to date, there is a paucity of research investigating the experiences of people living with both these conditions. This study used semi-structured interviews to explore the decision-making and treatment options for people who live with both dementia and cancer. In total, ten people living with both dementia and cancer (aged 39–93 years) and nine family carers were interviewed. Braun and Clarke's approach to thematic analysis was used together with framework matrices to organise the data. In this article four sequential and descriptive themes are presented. ‘Reaching a diagnosis of cancer’ describes the vital role that family carers play in encouraging the person with dementia to seek an explanation for their presenting (undiagnosed cancer) symptoms to their general practitioner. ‘Adjusting to the cancer diagnosis when living with dementia’ outlines a variety of emotional and practical responses to receiving news of the diagnosis. ‘Weighing up the cancer treatment options’ highlights the different decisions and circumstances that family carers and people living with both dementia and cancer are faced with post-diagnosis. ‘Undergoing cancer treatment’ shares the finding that cancer treatment decision-making was not straightforward and that people living with both dementia and cancer would often forget about their cancer and what procedures they had been through.
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