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Wang JZ, Landry AP, Raleigh DR, Sahm F, Walsh KM, Goldbrunner R, Yefet LS, Tonn JC, Gui C, Ostrom QT, Barnholtz-Sloan J, Perry A, Ellenbogen Y, Hanemann CO, Jungwirth G, Jenkinson MD, Tabatabai G, Mathiesen TI, McDermott MW, Tatagiba M, la Fougère C, Maas SLN, Galldiks N, Albert NL, Brastianos PK, Ehret F, Minniti G, Lamszus K, Ricklefs FL, Schittenhelm J, Drummond KJ, Dunn IF, Pathmanaban ON, Cohen-Gadol AA, Sulman EP, Tabouret E, Le Rhun E, Mawrin C, Moliterno J, Weller M, Bi W(L, Gao A, Yip S, Niyazi M, Aldape K, Wen PY, Short S, Preusser M, Nassiri F, Zadeh G. Meningioma: International Consortium on Meningiomas consensus review on scientific advances and treatment paradigms for clinicians, researchers, and patients. Neuro Oncol 2024; 26:1742-1780. [PMID: 38695575 PMCID: PMC11449035 DOI: 10.1093/neuonc/noae082] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024] Open
Abstract
Meningiomas are the most common primary intracranial tumors in adults and are increasing in incidence due to the aging population and increased access to neuroimaging. While most exhibit nonmalignant behavior, a subset of meningiomas are biologically aggressive and are associated with treatment resistance, resulting in significant neurologic morbidity and even mortality. In recent years, meaningful advances in our understanding of the biology of these tumors have led to the incorporation of molecular biomarkers into their grading and prognostication. However, unlike other central nervous system (CNS) tumors, a unified molecular taxonomy for meningiomas has not yet been established and remains an overarching goal of the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy-Not Official World Health Organization (cIMPACT-NOW) working group. Additionally, clinical equipoise still remains on how specific meningioma cases and patient populations should be optimally managed. To address these existing gaps, members of the International Consortium on Meningiomas including field-leading experts, have prepared this comprehensive consensus narrative review directed toward clinicians, researchers, and patients. Included in this manuscript are detailed overviews of proposed molecular classifications, novel biomarkers, contemporary treatment strategies, trials on systemic therapies, health-related quality-of-life studies, and management strategies for unique meningioma patient populations. In each section, we discuss the current state of knowledge as well as ongoing clinical and research challenges to road map future directions for further investigation.
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Affiliation(s)
- Justin Z Wang
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Alexander P Landry
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - David R Raleigh
- Department of Radiation Oncology, Neurological Surgery, and Pathology, University of California San Francisco, San Francisco, California, USA
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg and German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kyle M Walsh
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA
| | - Roland Goldbrunner
- Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - Leeor S Yefet
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jörg C Tonn
- Department of Neurosurgery, University Hospital Munich LMU, Munich, Germany
| | - Chloe Gui
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Quinn T Ostrom
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA
| | - Jill Barnholtz-Sloan
- Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, Maryland, USA
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Arie Perry
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Yosef Ellenbogen
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - C Oliver Hanemann
- Peninsula Schools of Medicine, University of Plymouth University, Plymouth, UK
| | - Gerhard Jungwirth
- Division of Experimental Neurosurgery, Department of Neurosurgery, Heidelberg University, Heidelberg, Germany
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Translational Medicine, University of Liverpool, UK
| | - Ghazaleh Tabatabai
- Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany
- Cluster of Excellence (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies,” Eberhard Karls University Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | - Tiit I Mathiesen
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael W McDermott
- Division of Neuroscience, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
- Miami Neuroscience Institute, Baptist Health of South Florida, Miami, Florida, USA
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | - Christian la Fougère
- Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tübingen, Germany
- Cluster of Excellence (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies,” Eberhard Karls University Tübingen, Tübingen, Germany
| | - Sybren L N Maas
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (IMN-3), Research Center Juelich, Juelich, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany
| | - Priscilla K Brastianos
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Felix Ehret
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Giuseppe Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Rome, Italy
| | - Katrin Lamszus
- Laboratory for Brain Tumor Biology, University Hospital Eppendorf, Hamburg, Germany
| | - Franz L Ricklefs
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | - Katharine J Drummond
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Omar N Pathmanaban
- Division of Neuroscience and Experimental Psychology, Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester, UK
| | - Aaron A Cohen-Gadol
- Department of Neurological Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Erik P Sulman
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, New York, USA
| | - Emeline Tabouret
- CNRS, INP, Inst Neurophysiopathol, Aix-Marseille University, Marseille, France
| | - Emelie Le Rhun
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Christian Mawrin
- Department of Neuropathology, University Hospital Magdeburg, Magdeburg, Germany
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Wenya (Linda) Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Gao
- Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto, Ontario, Canada
| | - Stephen Yip
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiation Oncology, University Hospital, Munich, Germany
- German Cancer Consortium (DKTK), Munich, Germany
| | - Maximilian Niyazi
- Bavarian Cancer Research Center (BZKF), Munich, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | | | - Kenneth Aldape
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Patrick Y Wen
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Short
- Leeds Institute of Medical Research, St James’s University Hospital, Leeds, UK
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Farshad Nassiri
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Winebrenner SE, Hall L, Hermann C, Martin RCG. Scanxiety in survivors of pancreatic cancer. J Psychosoc Oncol 2024:1-18. [PMID: 39357071 DOI: 10.1080/07347332.2024.2408552] [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: 10/04/2024]
Abstract
PURPOSE To understand the scanxiety experience in pancreatic cancer (PC) survivors following curative surgical resection. DESIGN A qualitative study with a hermeneutic phenomenological approach was used. METHODS Eighteen PC survivors participated. Data from in-depth, semi-structured interviews were analyzed and themes emerged from systematic line-by-line coding of the interview transcripts. FINDINGS Two key themes emerged: 'the recurring cycle of scanxiety' and 'hope for lifelong remission'. Participants experienced similar patterns of scanxiety that impacted everyday life. Hope was an essential stabilizing component of the cancer-scan experience, and enabled participants to conceptualize a cure, despite the high likelihood of recurrent, incurable disease. A conceptual framework was developed to provide further insight. IMPLICATIONS Everyday life is significantly affected during times of PC surveillance scans. This study enhances our understanding of the cancer-scan experience and provides a framework to guide care.
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Affiliation(s)
- Susan Ellis Winebrenner
- School of Nursing, University of Louisville, Louisville, KY, USA
- Norton Cancer Institute, Louisville, KY, USA
| | - Lynne Hall
- School of Nursing, University of Louisville, Louisville, KY, USA
| | - Carla Hermann
- School of Nursing, Indiana University Southeast, New Albany, IN, USA
| | - Robert C G Martin
- Department of Surgery, University of Louisville, Louisville, KY, USA
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Khatri R, Quinn PL, Wells-Di Gregorio S, Pawlik TM, Cloyd JM. Surveillance-Associated Anxiety After Curative-Intent Cancer Surgery: A Systematic Review. Ann Surg Oncol 2024:10.1245/s10434-024-16287-5. [PMID: 39343818 DOI: 10.1245/s10434-024-16287-5] [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: 05/13/2024] [Accepted: 09/17/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Regular surveillance imaging is commonly used after curative-intent resection of most solid-organ cancers to enable prompt diagnosis and management of recurrent disease. Given the fear of cancer recurrence, surveillance may lead to distress and anxiety ("scanxiety") but its frequency, severity, and management among cancer survivors are poorly understood. METHODS A systematic review of the PubMed, Embase, CINAHL, and PsycINFO databases was conducted to evaluate existing literature on anxiety and emotional experiences associated with surveillance after curative-intent cancer surgery as well as interventions aimed at reducing scanxiety. RESULTS Across the 22 included studies encompassing 8693 patients, reported rates of scanxiety varied significantly, but tended to decrease as time elapsed after surgery. Qualitative studies showed that scanxiety arises from various factors innate to the surveillance experience and is most prevalent in the scan-to-results waiting period. Common risk factors for scanxiety included sociodemographic and cancer-related characteristics, low coping self-efficacy, pre-existing anxiety, and low patient well-being. Conversely, reassurance was a positive aspect of surveillance reported in several studies. Trials evaluating the impact of interventions all focused on modifying the surveillance regimen compared with usual care, but none led to reduced rates of scanxiety. CONCLUSIONS Although scanxiety is nearly universal across multiple cancer types and patient populations, it is transient and generally limited in severity. Because existing trials evaluating interventions to reduce scanxiety have not identified effective strategies to date, future research is needed to identify interventions aimed at reducing their impact on high-risk individuals.
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Affiliation(s)
- Rakhsha Khatri
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Patrick L Quinn
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sharla Wells-Di Gregorio
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Kamphuis MJ, van der Kamp LT, van Eijk RPA, Rinkel GJE, Visser-Meily JMA, van der Schaaf IC, Vergouwen MDI. Scanxiety and quality of life around follow-up imaging in patients with unruptured intracranial aneurysms: a prospective cohort study. Eur Radiol 2024; 34:6018-6025. [PMID: 38311702 PMCID: PMC11364567 DOI: 10.1007/s00330-024-10602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVES Patients with an unruptured intracranial aneurysm (UIA) may experience scanxiety around follow-up imaging. We studied the prevalence and temporal pattern of scanxiety, and compared quality of life (QoL) outcomes in patients with and without scanxiety. METHODS We performed a prospective cohort study in a tertiary referral center in the Netherlands between October 2021 and November 2022. We sent questionnaires to patients ≥ 18 years old undergoing UIA follow-up imaging 4 weeks before (T1), immediately after (T2), and 6 weeks after the scan (T3) to assess health-related QoL (HRQoL) and emotional functioning. At T3, we also assessed scanxiety with a purpose-designed questionnaire. We compared differences in QoL outcomes between respondents with and without scanxiety using mixed models. RESULTS Of 158 eligible patients, 106 (67%) participated (mean age 61 years ± 11 [standard deviation], 84 women). Sixty of the 91 respondents (66%) who completed the purpose-designed questionnaire experienced scanxiety. Of the 49 respondents who experienced scanxiety after the scan, it resolved in 22 (45%) within a day after receiving the radiology report. HRQoL did not differ between respondents with or without scanxiety. Emotional functioning was worse for respondents with scanxiety (mean Hospital Anxiety and Depression Scale sum score difference at T1, 3.6 [95% CI, 0.9-6.3]; T2, 4.1 [95% CI, 1.5-6.8]; and T3, 4.0 [95% CI, 1.5-6.5]). CONCLUSIONS Two-thirds of the respondents experienced scanxiety around follow-up imaging, which often resolved within a day after receiving results. Patients with scanxiety had similar HRQoL but worse emotional functioning compared to patients without scanxiety. The time between the scan and receiving the results should be minimized to decrease the duration of scanxiety. CLINICAL RELEVANCE STATEMENT We showed that scanxiety is common in UIA patients, and negatively associated with emotional functioning. Since scanxiety often disappears immediately after receiving the radiology report, it should be communicated to the patient as early as possible to alleviate patients' distress. KEY POINTS • Many patients with an unruptured intracranial aneurysm experience emotional distress around follow-up imaging, termed "scanxiety." • Patients with scanxiety had worse emotional functioning compared to patients without scanxiety. • Scanxiety often resolved within a day after receiving the radiology report.
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Affiliation(s)
- Maarten J Kamphuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Laura T van der Kamp
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ruben P A van Eijk
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Irene C van der Schaaf
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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García Santos JM, Plasencia Martínez JM. Scanxiety: potential lessons for personalized radiology. Eur Radiol 2024; 34:6016-6017. [PMID: 38627291 DOI: 10.1007/s00330-024-10726-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/01/2024] [Accepted: 03/09/2024] [Indexed: 04/20/2024]
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Haggstrom DA, Braafladt SM, Han PKJ. Active Surveillance for Low-Risk Cancer-The Waiting Is the Hardest Part. JAMA Oncol 2024:2822320. [PMID: 39145971 DOI: 10.1001/jamaoncol.2024.2667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
This Viewpoint describes the benefits and challenges of active surveillance as a clinical approach to monitor low-risk cancers with favorable prognoses.
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Affiliation(s)
- David A Haggstrom
- VA Health Systems Research Center for Health Information and Communication, Indianapolis VA Medical Center, Indianapolis, Indiana
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Signe M Braafladt
- Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana
- Department of Surgery, Indiana University School of Medicine, Indianapolis
| | - Paul K J Han
- Behavioral Research Program, National Cancer Institute, Bethesda, Maryland
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Blake A, Perrino MR, Morin CE, Taylor L, McGee RB, Lewis S, Hines-Dowell S, Pandey A, Turner P, Kubal M, Su Y, Tang L, Howell L, Harrison LW, Abramson Z, Schechter A, Sabin ND, Nichols KE. Performance of Tumor Surveillance for Children With Cancer Predisposition. JAMA Oncol 2024; 10:1060-1067. [PMID: 38900420 PMCID: PMC11190829 DOI: 10.1001/jamaoncol.2024.1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/14/2024] [Indexed: 06/21/2024]
Abstract
Importance Pediatric oncology patients are increasingly recognized as having an underlying cancer predisposition syndrome (CPS). Surveillance is often recommended to detect new tumors at their earliest and most curable stages. Data on the effectiveness and outcomes of surveillance for children with CPS are limited. Objective To evaluate the performance of surveillance across a wide spectrum of CPSs. Design, Setting, and Participants This cohort study reviewed surveillance outcomes for children and young adults from birth to age 23 years with a clinical and/or molecular CPS diagnosis from January 1, 2009, through September 31, 2021. Patients were monitored using standard surveillance regimens for their corresponding CPS at a specialty pediatric oncology center. Patients with hereditary retinoblastoma and bone marrow failure syndromes were excluded. Data were analyzed between August 1, 2021, and December 6, 2023. Exposure Cancer predisposition syndrome. Main Outcomes and Measures Outcomes of surveillance were reviewed to evaluate the incidence, spectrum, and clinical course of newly detected tumors. Surveillance modalities were classified for accuracy and assessed for common strengths and weaknesses. Results A total of 274 children and young adults (mean age, 8 years [range, birth to 23 years]; 144 female [52.6%]) with 35 different CPSs were included, with a median follow-up of 3 years (range, 1 month to 12 years). During the study period, 35 asymptomatic tumors were detected in 27 patients through surveillance (9.9% of the cohort), while 5 symptomatic tumors were detected in 5 patients (1.8% of the cohort) outside of surveillance, 2 of whom also had tumors detected through surveillance. Ten of the 35 tumors (28.6%) were identified on first surveillance imaging. Malignant solid and brain tumors identified through surveillance were more often localized (20 of 24 [83.3%]) than similar tumors detected before CPS diagnosis (71 of 125 [56.8%]; P < .001). Of the 24 tumors identified through surveillance and surgically resected, 17 (70.8%) had completely negative margins. When analyzed across all imaging modalities, the sensitivity (96.4%), specificity (99.6%), positive predictive value (94.3%), and negative predictive value (99.6%) of surveillance were high, with few false-positive (6 [0.4%]) or false-negative (5 [0.3%]) findings. Conclusions and Relevance These findings suggest that standardized surveillance enables early detection of new tumors across a wide spectrum of CPSs, allowing for complete surgical resection and successful treatment in the majority of patients.
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Affiliation(s)
- Alise Blake
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Melissa R. Perrino
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Cara E. Morin
- Department of Diagnostic Imaging, St Jude Children’s Research Hospital, Memphis, Tennessee
- Now with Department of Radiology, Cincinnati Children’s Hospital Medical Center, Ohio
| | - Leslie Taylor
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Rose B. McGee
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Sara Lewis
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Stacy Hines-Dowell
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Arti Pandey
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Paige Turner
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Manish Kubal
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Yin Su
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Li Tang
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Laura Howell
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Lynn W. Harrison
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Zachary Abramson
- Department of Diagnostic Imaging, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Ann Schechter
- Department of Diagnostic Imaging, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Noah D. Sabin
- Department of Diagnostic Imaging, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kim E. Nichols
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
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Panteliodi E, Hudson D. A sense of space in the core of the bore: Enhancing the MRI experience through use of spatial audio. Radiography (Lond) 2024; 30:1451-1454. [PMID: 39138028 DOI: 10.1016/j.radi.2024.07.019] [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: 05/03/2024] [Revised: 07/06/2024] [Accepted: 07/23/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Magnetic Resonance Imaging (MRI) continues to be an imaging technique that causes anxiety and concern for many patients. One longstanding approach that helps many patients is listening to music as a distraction technique during a scan. However, despite improvements in scanner technology itself, the means of providing music in this way has hardly changed, and so there may be opportunity to utilise emerging approaches in audio technology to further enhance the positive effect beyond simple distraction alone. OBJECTIVES The aim of this technical note is to introduce spatial audio and its potential application in the MRI setting to create a sense of space within the confined environment of a scanner. FINDINGS Initial feedback from a few patients indicate that spatial audio music may indeed enhance the perception of space within the MRI scanner, potentially mitigating or lowering feelings of claustrophobia and anxiety. CONCLUSION Spatial audio could enhance the sense of space felt within an MRI scanner, but research is needed to evidence whether this would indeed have an improved effect compared to rot conventional audio. IMPLICATIONS FOR PRACTICE This technical note sets the stage for further exploration of spatial audio technology within the setting of MRI to help adjust cognitive appraisal and concern over its confined nature. Providing music through this means could be another approach to help patients manage a scan and improve their experience of it.
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Affiliation(s)
- E Panteliodi
- InHealth Group, Beechwood Hall, Kingsmead Road, High Wycombe, Bucks, HP11 1JL, UK
| | - D Hudson
- InHealth Group, Beechwood Hall, Kingsmead Road, High Wycombe, Bucks, HP11 1JL, UK; Department of Psychology, University of Exeter, Streatham Campus, UK.
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Recht MP, Donoso-Bach L, Brkljačić B, Chandarana H, Jankharia B, Mahoney MC. Patient-centered radiology: a roadmap for outpatient imaging. Eur Radiol 2024; 34:4331-4340. [PMID: 38047974 DOI: 10.1007/s00330-023-10370-3] [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: 04/17/2023] [Revised: 08/16/2023] [Accepted: 08/31/2023] [Indexed: 12/05/2023]
Abstract
Creating a patient-centered experience is becoming increasingly important for radiology departments around the world. The goal of patient-centered radiology is to ensure that radiology services are sensitive to patients' needs and desires. This article provides a framework for addressing the patient's experience by dividing their imaging journey into three distinct time periods: pre-exam, day of exam, and post-exam. Each time period has aspects that can contribute to patient anxiety. Although there are components of the patient journey that are common in all regions of the world, there are also unique features that vary by location. This paper highlights innovative solutions from different parts of the world that have been introduced in each of these time periods to create a more patient-centered experience. CLINICAL RELEVANCE STATEMENT: Adopting innovative solutions that help patients understand their imaging journey and decrease their anxiety about undergoing an imaging examination are important steps in creating a patient centered imaging experience. KEY POINTS: • Patients often experience anxiety during their imaging journey and decreasing this anxiety is an important component of patient centered imaging. • The patient imaging journey can be divided into three distinct time periods: pre-exam, day of exam, and post-exam. • Although components of the imaging journey are common, there are local differences in different regions of the world that need to be considered when constructing a patient centered experience.
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Affiliation(s)
- Michael P Recht
- Department of Radiology, NYU Langone Health, New York, NY, USA.
| | - Lluís Donoso-Bach
- Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Boris Brkljačić
- Department of Radiology, University Hospital Dubrava Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | | | - Mary C Mahoney
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, USA
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10
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Zwanenburg LC, Suijkerbuijk KPM, van Dongen SI, Koldenhof JJ, van Roozendaal AS, van der Lee ML, Schellekens MPJ. Living in the twilight zone: a qualitative study on the experiences of patients with advanced cancer obtaining long-term response to immunotherapy or targeted therapy. J Cancer Surviv 2024; 18:750-760. [PMID: 36495465 PMCID: PMC11082039 DOI: 10.1007/s11764-022-01306-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The introduction of immunotherapy and targeted therapy has drastically improved the life expectancy of patients with advanced cancer. Despite improved survival, obtaining long-term response can be highly distressing and comes with uncertainties that affect several life domains. The aim of this study is to gain a deeper understanding of long-term responders' lived experiences with obtaining long-term response to immunotherapy or targeted therapy. METHODS We conducted an exploratory qualitative study using thematic data analysis. Semi-structured in-depth interviews were conducted with 17 patients with advanced melanoma or lung cancer who had a confirmed response to or long-term stable disease while on immunotherapy or targeted therapy. RESULTS Long-term responders are living in a twilight zone, where they neither feel like a patient, nor feel healthy. This impacts their self-image, interactions with their social environment, and feelings of uncertainty. Due to their uncertain life perspective, long-term responders are going back and forth between hope and despair, while they are longing for their 'old' life, several barriers, such as protective behavior of the social environment, force them to adjust to a life with cancer. CONCLUSION Long-term responders are facing many challenges, such as searching for a renewed identity, dealing with ongoing uncertainty, and having to adapt to a new normal. This emphasizes the importance of providing this new patient group with tailored information and support. IMPLICATIONS FOR CANCER SURVIVORS Healthcare professionals can support patients by normalizing their feelings and providing space for varying emotions. Using patient-tailored scan frequencies could help temper fear of progression.
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Affiliation(s)
- Laura C Zwanenburg
- Department of Scientific Research, Helen Dowling Institute: Centre for Psycho-Oncology, Bilthoven, The Netherlands.
- Department of Medical and Clinical Psychology, Tilburg University School of Social and Behavioral Sciences, Tilburg, The Netherlands.
| | - Karijn P M Suijkerbuijk
- Department of Medical Oncology, University Medical Centre in Utrecht, Utrecht, The Netherlands
| | - Sophie I van Dongen
- Department of Scientific Research, Helen Dowling Institute: Centre for Psycho-Oncology, Bilthoven, The Netherlands
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - José J Koldenhof
- Department of Medical Oncology, University Medical Centre in Utrecht, Utrecht, The Netherlands
| | - Anne S van Roozendaal
- Department of Scientific Research, Helen Dowling Institute: Centre for Psycho-Oncology, Bilthoven, The Netherlands
| | - Marije L van der Lee
- Department of Scientific Research, Helen Dowling Institute: Centre for Psycho-Oncology, Bilthoven, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University School of Social and Behavioral Sciences, Tilburg, The Netherlands
| | - Melanie P J Schellekens
- Department of Scientific Research, Helen Dowling Institute: Centre for Psycho-Oncology, Bilthoven, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University School of Social and Behavioral Sciences, Tilburg, The Netherlands
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11
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Rick TJ, Sagaram S, Jewett PI, Lee HY, Sadak KT, Turcotte LM, Vogel RI, Blaes A. A pilot randomized controlled trial of an online intervention for Hodgkin lymphoma survivors to increase knowledge about late effects and recommended screening. J Cancer Surviv 2024:10.1007/s11764-024-01587-2. [PMID: 38642203 DOI: 10.1007/s11764-024-01587-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/02/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Hodgkin lymphoma (HL) survivors who received chest radiotherapy are at risk for breast cancer and cardiovascular disease, but screening adherence is low. We assessed the acceptability/feasibility of a web-based educational intervention and its impact on knowledge of health risks and screening. METHODS HL survivors were randomized to either an interactive online educational intervention or handouts only. Surveys were completed at baseline and 3 months post-intervention. We described the acceptability/feasibility of the intervention and compared knowledge between groups. RESULTS Fifty-two HL survivors participated; 27 in the intervention group and 25 in the control group. Eighteen (66%) intervention participants completed the intervention and reported high acceptability (89-100%). At baseline, adherence to breast cancer screening was low across all participants. Post-intervention, those in the intervention group more often than controls correctly identified breast cancer and echocardiogram screening guidelines (35% vs. 28%, P = 0.02 and 82% vs. 52%, P = 0.04) and reported knowing how to address potential complications from cancer treatments (87% vs. 64%, P = 0.03). We detected no increase in screening behavior post-intervention. CONCLUSION Online education modules for high-risk HL survivors are an acceptable method to improve knowledge of health risks and screening guidelines. Future interventions should focus on improving screening uptake in this population. IMPLICATIONS FOR CANCER SURVIVORS Web-based learning can be useful in increasing cancer survivor knowledge of their unique risks and screening recommendations but does not necessarily change patient behavior. Involvement in a cancer survivorship program can help assess individual barriers and monitor uptake of screening.
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Affiliation(s)
- Tara J Rick
- Department of Medicine, Division of Hematology/Oncology, University of Minnesota, Minneapolis, USA.
- University of Minnesota Masonic Cancer Center, Minneapolis, USA.
| | | | - Patricia I Jewett
- Department of Medicine, Division of Hematology/Oncology, University of Minnesota, Minneapolis, USA
| | - Hee Yun Lee
- School of Social Work, University of Alabama, Tuscaloosa, USA
| | - Karim T Sadak
- University of Minnesota Masonic Cancer Center, Minneapolis, USA
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Minnesota, Minneapolis, USA
| | - Lucie M Turcotte
- University of Minnesota Masonic Cancer Center, Minneapolis, USA
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Minnesota, Minneapolis, USA
| | - Rachel I Vogel
- University of Minnesota Masonic Cancer Center, Minneapolis, USA
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, USA
| | - Anne Blaes
- Department of Medicine, Division of Hematology/Oncology, University of Minnesota, Minneapolis, USA
- University of Minnesota Masonic Cancer Center, Minneapolis, USA
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12
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Pfurtscheller G, Rassler B, Schwarz G, Klimesch W. Scan-associated anxiety (scanxiety): the enigma of emotional breathing oscillations at 0.32 Hz (19 bpm). Front Neurosci 2024; 18:1384993. [PMID: 38638691 PMCID: PMC11025454 DOI: 10.3389/fnins.2024.1384993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/21/2024] [Indexed: 04/20/2024] Open
Abstract
MRI-related anxiety in healthy participants is often characterized by a dominant breathing frequency at around 0.32 Hz (19 breaths per minute, bpm) at the beginning but in a few cases also at the end of scanning. Breathing waves at 19 bpm are also observed in patients with anxiety independently of the scanned body part. In patients with medically intractable epilepsy and intracranial electroencephalography (iEEG), spontaneous breathing through the nose varied between 0.24 and 0.37 Hz (~19 bpm). Remarkable is the similarity of the observed breathing rates at around 0.32 Hz during different types of anxiety states (e.g., epilepsy, cancer, claustrophobia) with the preferred breathing frequency of 0.32 Hz (19 bpm), which is predicted by the binary hierarchy model of Klimesch. This elevated breathing frequency most likely reflects an emotional processing state, in which energy demands are minimized due to a harmonic coupling ratio with other brain-body oscillations.
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Affiliation(s)
- Gert Pfurtscheller
- Institute of Neural Engineering, Graz University of Technology, Graz, Austria
| | - Beate Rassler
- Carl-Ludwig-Institute of Physiology, University of Leipzig, Leipzig, Germany
| | - Gerhard Schwarz
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Wolfgang Klimesch
- Centre of Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
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13
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Pearson SA, Taylor S, Krishan A, Marsden A, Howell S, Yorke J. A pragmatic qualitative study to explore women's and clinicians' experience of access to systemic anti-cancer therapies for the treatment of secondary breast cancer. Eur J Oncol Nurs 2024; 70:102515. [PMID: 38471325 DOI: 10.1016/j.ejon.2024.102515] [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: 03/30/2023] [Revised: 01/14/2024] [Accepted: 01/24/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE An estimated 57,000 women are currently living with secondary (metastatic) breast cancer across the UK. Equitable access to treatment has been associated with improved clinical outcomes, however geographical disparities have been reported which remain poorly understood. The purpose of our study was to explore women and clinicians' experience of geographic access to systemic anti-cancer therapies for the treatment of secondary breast cancer. METHOD The study setting was the integrated cancer system across the northwest region of Greater Manchester UK. A pragmatic qualitative study design was used. Women aged >18 years with a confirmed SBC diagnosis and clinicians responsible for the care and treatment of women with a secondary breast cancer diagnosis were interviewed using semi structured interviews to elicit their experience and perspectives on geographic access to treatment. Data were analysed using thematic analysis to identify emergent themes. RESULTS Eighteen interviews with women and 12 interviews with clinicians were completed. Four meta-themes were identified for geographic access, the influence of the health care system, person centred factors and the impact of Covid-19 on treatment access and receipt. CONCLUSION Our study was the first of its kind to explore women and clinicians experience of geographic access to systemic anti-cancer therapies for the treatment of secondary breast cancer. Findings provided a greater understanding of distance decay and the influence of the health care system on treatment access. This included the importance and availability of clinical trials as a potential treatment option. This provided important insights and contributed to ongoing debate.
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Affiliation(s)
- Sally Anne Pearson
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK; Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
| | - Sally Taylor
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK; Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Ashma Krishan
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Antonia Marsden
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Sacha Howell
- Division of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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14
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Jeong B, Lee YW, Lee SB, Kim J, Chung IY, Kim HJ, Ko BS, Lee JW, Son BH, Gwark S, Shin HJ, Yoo TK, Choi SH. Diagnostic yield of contrast-enhanced abdominal staging CT in patients with initially diagnosed breast cancer. Eur J Radiol 2024; 171:111295. [PMID: 38241854 DOI: 10.1016/j.ejrad.2024.111295] [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: 01/05/2024] [Accepted: 01/06/2024] [Indexed: 01/21/2024]
Abstract
PURPOSE To estimate the diagnostic yield (DY) of abdominal staging CT for detecting breast cancer liver metastasis (BCLM) in patients with initially diagnosed breast cancer and to determine the indications for abdominal staging CT. METHODS Patients with newly diagnosed breast cancer who underwent abdominal CT as an initial staging work-up between January 2019 and December 2020 were retrospectively analyzed. DY was calculated and analyzed according to patient age, type of treatments, histologic type, histologic grade, lymphovascular invasion, Ki-67 status, hormone receptor status, subtype, and the American Joint Committee on Cancer anatomical staging. RESULTS A total of 2056 patients (mean age, 51 ± 11 years) were included. The DY of abdominal staging CT for detecting BCLM was 1.1 % (22 of 2056). DY was significantly higher in stage III than in stage I or II cancers (3.9 % [18 of 467] vs. 0 % [0 of 412] or 0.4 % [4 of 1158], respectively, p < .001), and in human epidermal growth factor receptor-2 (HER2)-enriched cancers than in luminal or triple negative cancers (2.9 % [16 of 560] vs. 0.4 % [4 of 1090] or 0.5 % [2 of 406], respectively, p < .001). CONCLUSIONS The DY of abdominal staging CT for detecting BCLM was low among all patients with initially diagnosed breast cancer. However, although abdominal staging CT for detecting BCLM is probably unnecessary in all patients, it can be clinically useful in patients with stage III or human epidermal growth factor receptor-2-enriched breast cancers.
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Affiliation(s)
- Boryeong Jeong
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Young-Won Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Beom Seok Ko
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Sungchan Gwark
- Department of Surgery, Ewha Womens University Mokdong Hospital, Seoul, Republic of Korea
| | - Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Tae-Kyung Yoo
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea.
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea.
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Smits M, Rockall A, Constantinescu SN, Sardanelli F, Martí-Bonmatí L. Translating radiological research into practice-from discovery to clinical impact. Insights Imaging 2024; 15:13. [PMID: 38228934 DOI: 10.1186/s13244-023-01596-2] [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: 10/03/2023] [Accepted: 11/17/2023] [Indexed: 01/18/2024] Open
Abstract
At the European Society of Radiology (ESR), we strive to provide evidence for radiological practices that improve patient outcomes and have a societal impact. Successful translation of radiological research into clinical practice requires multiple factors including tailored methodology, a multidisciplinary approach aiming beyond technical validation, and a focus on unmet clinical needs. Low levels of evidence are a threat to radiology, resulting in low visibility and credibility. Here, we provide the background and rationale for the thematic series Translating radiological research into practice-from discovery to clinical impact, inviting authors to describe their processes of achieving clinically impactful radiological research. We describe the challenges unique to radiological research. Additionally, a survey was sent to non-radiological clinical societies. The majority of respondents (6/11) were in the field of gastrointestinal/abdominal medicine. The implementation of CT/MRI techniques for disease characterisation, detection and staging of cancer, and treatment planning and radiological interventions were mentioned as the most important radiological developments in the past years. The perception was that patients are substantially unaware of the impact of these developments. Unmet clinical needs were mostly early diagnosis and staging of cancer, microstructural/functional assessment of tissues and organs, and implant assessment. All but one respondent considered radiology important for research in their discipline, but five indicated that radiology is currently not involved in their research. Radiology research holds the potential for being transformative to medical practice. It is our responsibility to take the lead in studies including radiology and strive towards the highest levels of evidence.Critical relevance statement For radiological research to make a clinical and societal impact, radiologists should take the lead in radiological studies, go beyond the assessment of technical feasibility and diagnostic accuracy, and-in a multidisciplinary approach-address clinical unmet needs.Key points• Multiple factors are essential for radiological research to make a clinical and societal impact.• Radiological research needs to go beyond diagnostic accuracy and address unmet clinical needs.• Radiologists should take the lead in radiological studies with a multidisciplinary approach.
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Affiliation(s)
- Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands.
- Medical Delta, Delft, The Netherlands.
| | - Andrea Rockall
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Stefan N Constantinescu
- Ludwig Institute for Cancer Research, Brussels, Belgium
- de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
- WEL Research Institute, WELBIO Department, Wavre, Belgium
- Ludwig Institute for Cancer Research, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luis Martí-Bonmatí
- Department of Radiology and GIBI230 Research Group On Biomedical Imaging, Hospital Universitario y Politécnico La Fe and Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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16
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Ding S, Fontaine T, Serex M, Sá Dos Reis C. Strategies enhancing the patient experience in mammography: A scoping review. Radiography (Lond) 2024; 30:340-352. [PMID: 38141428 DOI: 10.1016/j.radi.2023.11.016] [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: 07/28/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION A positive experience in mammography is essential for increasing patient attendance and reattendance at these examinations, whether conducted for diagnostic or screening purposes. Mammograms indeed facilitate early disease detection, enhance the potential for cure, and consequently reduce breast cancer mortality. The main objective of this review was to identify and map the strategies aiming to improve the patient experience in diagnostic and screening mammography. METHODS This scoping review was performed following the JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Searches were performed through databases of MEDLINE, Embase.com, CINAHL, APA PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, ProQuest Dissertation and Theses, and three clinical trial registries. This review considered studies evaluating the effect of interventions, occurring within the mammography department, on the patient experience. RESULTS The literature search yielded 8113 citations of which 60, matching the inclusion criteria, were included. The strategies were classified into eight categories. The most represented one was breast compression and positioning, followed by relaxation techniques and analgesic care, communication and information, screening equipment, examination procedures, patient-related factors, physical environment, and finally staff characteristics. The studied outcomes related to patient experience were mainly pain, anxiety, comfort, and satisfaction. Other types of outcomes were also considered in the studies such as image quality, technical parameters, or radiation dose. Most studies were conducted by radiographers, on female patients, and none mentioned the inclusion of male or transgender patients. CONCLUSION This review outlined a diversity of strategies to improve patient experience, although technique-based interventions were predominant. Further research is warranted, notably on psychological strategies, and on men and transgender people. IMPLICATIONS FOR PRACTICE This scoping review provides guidance to healthcare providers and services for better patient/client-centered care.
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Affiliation(s)
- S Ding
- Department of Radiologic Medical Imaging Technology, School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western, Switzerland; BEST JBI Centre of Excellence, Switzerland.
| | - T Fontaine
- Department of Radiologic Medical Imaging Technology, School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western, Switzerland
| | - M Serex
- Library, School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western, Switzerland
| | - C Sá Dos Reis
- Department of Radiologic Medical Imaging Technology, School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western, Switzerland
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Maes D, McMullan C, Aiyegbusi OL, Ford S. Clinician survey of current global practice for sarcoma surveillance following resection of primary retroperitoneal, abdominal, and pelvic sarcoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107085. [PMID: 37748277 DOI: 10.1016/j.ejso.2023.107085] [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: 08/04/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION - Postoperative surveillance following resection of primary retroperitoneal, abdominal, and pelvic sarcoma (RPS) is standard of care in international sarcoma centres and has rapidly evolved without an evidence base to become highly intensive and prolonged. This clinician survey aims to capture a global, contemporary snapshot of international guidelines used to inform sarcoma surveillance following resection of primary RPS. MATERIALS AND METHODS - Between July 2022 and March 2023, an online, anonymous, clinician survey to assess the current duration, imaging intervals and imaging modalities used for postoperative surveillance following resection of primary RPS was distributed among clinicians working at centres which are members of the TransAtlantic Australasian Retroperitoneal Working Group (TARPSWG). RESULTS - Responses were received from 58 different TARPSWG centres. The majority of centres use institutional guidelines to guide surveillance intensity (n = 43, 74%) and the surveillance imaging modality (n = 39, 67%) used. For surveillance intensity and imaging modality, institutional guidelines are partially or entirely based on international guidelines in 81% (n = 47) and 78% (n = 45) of centres, respectively. Commonly used imaging modalities are contrast-enhanced CT abdomen-pelvis (n = 51, 88%) for abdominal surveillance and non-contrast enhanced CT (n = 25, 43%) for chest surveillance. Imaging intervals, timing of de-escalation of imaging frequency and total duration of surveillance for low-grade and high-grade RPS are reported. CONCLUSION - This global survey among TARPSWG members demonstrates the heterogeneity in sarcoma surveillance strategies worldwide and emphasises the need for a randomised controlled trial to provide an evidence base for the optimal surveillance schedule following primary resection of RPS.
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Affiliation(s)
- Danielle Maes
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
| | - Christel McMullan
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research (NIHR) SRMRC, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK; NIHR Birmingham Biomedical Research Centre (BRC), University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, UK.
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre (BRC), University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, UK; NIHR Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.
| | - Samuel Ford
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
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D’Ambrosio L, Fumagalli E, De Pas TM, Nannini M, Bertuzzi A, Carpano S, Boglione A, Buonadonna A, Comandini D, Gasperoni S, Vincenzi B, Brunello A, Badalamenti G, Maccaroni E, Baldi GG, Merlini A, Mogavero A, Ligorio F, Pennacchioli E, Conforti F, Manessi G, Aliberti S, Tolomeo F, Fiore M, Sbaraglia M, Dei Tos AP, Stacchiotti S, Pantaleo MA, Gronchi A, Grignani G. Guideline-Based Follow-Up Outcomes in Patients With Gastrointestinal Stromal Tumor With Low Risk of Recurrence: A Report From the Italian Sarcoma Group. JAMA Netw Open 2023; 6:e2341522. [PMID: 37930700 PMCID: PMC10628737 DOI: 10.1001/jamanetworkopen.2023.41522] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023] Open
Abstract
Importance Gastrointestinal stromal tumor (GIST) follow-up is recommended by international guidelines, but data on the role of follow-up in patients with low relapse risk are missing. For these patients, the potential benefit of anticipating recurrence detection should be weighed against psychological burden and radiologic examination loads in terms of costs and radiation exposure. Objective To evaluate the outcomes of guideline-based follow-up in low-risk GIST. Design, Setting, and Participants This multi-institutional retrospective cohort study involving Italian Sarcoma Group reference institutions evaluated patients with GIST who underwent surgery between January 2001 and June 2019. Median follow-up time was 69.2 months. Data analysis was performed from December 15, 2022, to March 20, 2023. Patients with GIST at low risk according to Armed Forces Institute of Pathology criteria were included provided adequate clinical information was available: primary site, size, mitotic index, surgical margins, and 2 or more years of follow-up. Exposures All patients underwent follow-up according to European Society for Medical Oncology (ESMO) guidelines. Main Outcomes and Measures The primary outcome was the number of tests needed to identify a relapse according to ESMO guidelines follow-up plan. Secondary outcomes included relapse rate, relapse timing, disease-free survival (DFS), overall survival (OS), GIST-specific survival (GIST-SS), postrelapse OS, secondary tumor rates, and theoretical ionizing radiation exposure. An exploratory end point, new follow-up schedule proposal for patients with low-risk GIST according to the observed results, was also assessed. Results A total of 737 patients (377 men [51.2%]; median age at diagnosis, 63 [range, 18-86] years) with low-risk GIST were included. Estimated 5-year survival rates were 95.5% for DFS, 99.8% for GIST-SS, and 96.1% for OS. Estimated 10-year survival rates were 93.4% for DFS, 98.1% for GIST-SS, and 91.0% for OS. Forty-two patients (5.7%) experienced disease relapse during follow-up (9 local, 31 distant, 2 both), of which 9 were detected after 10 or more years. This translated into approximately 1 relapse detected for every 170 computed tomography scans performed, with a median radiation exposure of 80 (IQR, 32-112) mSv per patient. Nongastric primary tumor (hazard ratio [HR], 2.09; 95% CI, 1.14-3.83; P = .02), and KIT mutation (HR, 2.77; 95% CI, 1.05-7.27; P = .04) were associated with a higher risk of relapse. Second tumors affected 187 of 737 patients (25%), of which 56 were detected during follow-up and represented the primary cause of death in these patients. Conclusions and Relevance In this cohort study on patients affected by low-risk GISTs, the risk of relapse was low despite a follow-up across 10 or more years. These data suggest the need to revise follow-up schedules to reduce the anxiety, costs, and radiation exposure of currently recommended follow-up strategy.
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Affiliation(s)
- Lorenzo D’Ambrosio
- Department of Medical Oncology, University of Turin, Turin, Italy
- San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Elena Fumagalli
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Tommaso Martino De Pas
- Medical Oncology Division, Cliniche Humanitas Gavazzeni, Bergamo, Italy
- Previously at Unit of Sarcomas and Thymomas, European Institute of Oncology, Milan, Italy
| | - Margherita Nannini
- Oncology Unit. Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Alexia Bertuzzi
- Medical Oncology, Humanitas Cancer Center, Rozzano (MI), Italy
| | - Silvia Carpano
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Angela Buonadonna
- Sarcoma and gastrointestinal tumors Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Danila Comandini
- Medical Oncology 1, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Silvia Gasperoni
- Clinical Oncology Unit, Oncology Department and Robotic Surgery, AOU Careggi, Florence, Italy
| | - Bruno Vincenzi
- Medical Oncology, Università Campus Bio-Medico, Rome, Italy
| | | | - Giuseppe Badalamenti
- Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Elena Maccaroni
- Department of Oncology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | | | - Alessandra Merlini
- Department of Medical Oncology, University of Turin, Turin, Italy
- Sarcoma Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Andrea Mogavero
- Department of Medical Oncology, University of Turin, Turin, Italy
- Sarcoma Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Francesca Ligorio
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Fabio Conforti
- Medical Oncology Division, Cliniche Humanitas Gavazzeni, Bergamo, Italy
- Previously at Unit of Sarcomas and Thymomas, European Institute of Oncology, Milan, Italy
| | - Giulia Manessi
- Department of Medical Oncology, University of Turin, Turin, Italy
- Sarcoma Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Sandra Aliberti
- Sarcoma Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Francesco Tolomeo
- Sarcoma Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Marco Fiore
- Sarcoma Service, Surgical Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Marta Sbaraglia
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | | | | | - Maria Abbondanza Pantaleo
- Oncology Unit. Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Surgical Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Giovanni Grignani
- Sarcoma Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
- Medical Oncology 2, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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19
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Hussain M, Chau S, Turner M, Paterson C. Scan-Associated Distress in People Affected by Cancer: A Qualitative Systematic Review. Semin Oncol Nurs 2023; 39:151502. [PMID: 37735038 DOI: 10.1016/j.soncn.2023.151502] [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: 05/18/2023] [Revised: 07/26/2023] [Accepted: 08/23/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE The term "scanxiety" has been coined to describe the anxiety commonly associated with individuals undergoing cancer-related imaging. Despite the prevalence and severity of scanxiety across various clinical and demographic populations, there remains a significant lack of qualitative insights from existing studies that effectively capture patients' experiences of scanxiety in their own words. Therefore, this review addresses the following research question: What are the experiences of scanxiety distress among people affected by cancer across the cancer care continuum? DATA SOURCES Following the PRISMA methodology, a meta-aggregation of qualitative studies was performed, encompassing patients of all age groups who had been diagnosed with cancer or were indicated for a cancer-related scan. Of the 556 articles screened, 15 were deemed eligible for inclusion in the analysis. CONCLUSION The three overarching themes of 1) experience of "scan-itis," 2) experience of "patient-clinician support," and 3) development of self-management strategies reveal the complex and interconnected factors that influence scanxiety in individuals undergoing cancer-related imaging. These findings emphasized distress experienced by patients during the waiting period for scan results, the act of viewing the results, and even the delivery of "bad" news. Consequently, patients expressed a strong desire for increased information, communication, and empathy from attending healthcare providers. Patients also report a myriad of self-coping strategies to manage their scanxiety well before, during, and after their scan appointment. IMPLICATIONS FOR NURSING PRACTICE The study highlights the need for targeted interventions for those undergoing cancer-related scans, including increased awareness and education for health professionals regarding scanxiety.
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Affiliation(s)
- M Hussain
- Faculty of Health, University of Canberra, Bruce ACT, Australia
| | - S Chau
- Caring Futures Institute, Flinders University, Australia
| | - M Turner
- Faculty of Health, University of Canberra, Bruce ACT, Australia
| | - C Paterson
- Faculty of Health, University of Canberra, Bruce ACT, Australia; Caring Futures Institute, Flinders University, Australia; Central Adelaide Local Health Network, Adelaide; Robert Gordon University, Aberdeen, Scotland, UK; Flinders Medical Centre, Adelaide, Australia.
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20
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Xu W, Liu Y. Association between acute adverse reactions to iodinated contrast media and anxiety in patients undergoing contrast-enhanced CT examination. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:1225-1233. [PMID: 37875363 PMCID: PMC10930856 DOI: 10.11817/j.issn.1672-7347.2023.220537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Indexed: 10/26/2023]
Abstract
OBJECTIVES As the use of iodinated contrast media has become more widely with advances in imaging, several guidelines have suggested that anxiety increases the risk of acute adverse reactions associated with iodinated contrast media. This study aims to evaluate the impact of anxiety on the occurrence of acute adverse reactions (AAR) to iodinated contrast media in patients undergoing contrast-enhanced CT examinations. METHODS Inpatients who underwent contrast-enhanced CT examinations at the Third Xiangya Hospital between February and October 2021 were prospectively recruited. Prior to the imaging examinations, all patients completed the Generalized Anxiety Disorder Scale-7 (GAD-7) assessment before the imaging examinations to determine the severity of anxiety, which was categorized as mild, moderate, or severe. Based on the occurrence of AAR, patients were classified into an AAR group and a non-AAR group. The difference in anxiety was compared between the 2 groups. Multivariate logistic regression analysis was used to identify independent risk factors associated with AAR. To ensure comparability between the 2 groups, propensity score matching (PSM) was utilized to align the clinical characteristics. Subsequently, the difference in anxiety within the matched groups was analyzed. RESULTS The study comprised 880 patients, with 80 patients in the AAR group and 800 patients in the non-AAR group. There was a significant difference in proportion of patients with mild-severe anxiety between the 2 groups (75% in the AAR group and 36% in the non-AAR group, P<0.001). Additionally, differences were also observed in occupation, income, underlying diseases, and allergy history (all P<0.001). The results of multivariate logistic regression analysis revealed that patients' income, allergy history, and anxiety were independent risk factors for AAR to iodinated contrast media (all P<0.05). Following PSM, each matched group included 66 cases, and no significant differences in clinical characteristics were observed between the 2 groups (all P>0.05). However, the proportion of patients with mild-severe anxiety remained significantly higher in the AAR group compared to the non-AAR group (75% in the AAR group and 31% in the non-AAR group, P<0.001). CONCLUSIONS Anxiety is associated with an increased risk of AAR to iodinated contrast media in patients undergoing contrast-enhanced CT examinations, suggesting the clinical importance of screening for anxiety before imaging examinations.
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Affiliation(s)
- Wei Xu
- Department of Radiology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
| | - Yan Liu
- Department of Radiology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
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21
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Hudson DM, Heales C. "I think this could be a big success" - A mixed methods study on practitioner perspectives on the acceptance of a virtual reality tool for preparation in MRI. Radiography (Lond) 2023; 29:851-861. [PMID: 37406474 DOI: 10.1016/j.radi.2023.06.005] [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: 02/05/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION A key part of a radiographer's role within MRI is providing the required emotional support to help patients succeed with a scan. Being informed is important; whilst information leaflets and videos are commonly used, these can be limited in their representation of the experience. Virtual reality tools are being shown to reasonably replicate a scan experience, having a positive impact on patient satisfaction and anxiety. The aim was to obtain the views of practitioners on the use and implementation of such a tool in practice. METHODS A mixed methods study was conducted looking at the use of a virtual scan experience for patients prior to MRI. Nine radiographers attended two focus group sessions to see the tool and undergo a virtual experience. Following this, a survey based on the technology acceptance model was completed along with a semi-structured discussion about its use. RESULTS Perceived usefulness, ease of use, attitude and intention to use were all positive towards the virtual scan tool. All practitioners saw value in such a tool and how it could be implemented within practice, highlighting areas for improvement and development. CONCLUSION The practitioner's perspective was that access to such a virtual scan experience could be of use to better prepare and support those patients needing extra support before a real scan. Acknowledgement of having time to discuss patient concerns was noted and this could provide a means of doing so away from busy scanning lists whilst not taking up additional time. IMPLICATIONS FOR PRACTICE Use of VR tools could be a conduit through which trust and rapport are built in advance away from busy scanning lists, thereby not impacting on operational throughput and hindering efficiency.
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Affiliation(s)
| | - C Heales
- Medical Imaging, Department of Health and Care Professions, Exeter University, Exeter, UK
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22
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Paalimäki-Paakki K, Virtanen M, Henner A, Vähänikkilä H, Nieminen MT, Schroderus-Salo T, Kääriäinen M. Effects of a 360° virtual counselling environment on patient anxiety and CCTA process time: A randomised controlled trial. Radiography (Lond) 2023; 29 Suppl 1:S13-S23. [PMID: 36280541 DOI: 10.1016/j.radi.2022.09.013] [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: 08/22/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION This study investigated whether a 360° virtual counselling environment (360°VCE) was more effective at decreasing patients' anxiety than routine standard of care counselling for patients undergoing coronary computed tomography angiography (CCTA), and if there was any difference in the process times for both of these groups. METHODS A total of 86 patients underwent CCTA in this randomised controlled trial. Patients were randomly assigned to intervention and control groups. The 360°VCE was developed using spherical panoramic images and non-immersive 360° technology. The primary outcome, anxiety, was measured using the State-Trait Anxiety Inventory (STAI). The secondary outcome, CCTA process time, was measured from the time of arrival in the department until end of examination. RESULTS Pre-scan anxiety was lower among patients in the 360°VCE group immediately before CCTA in comparison to patients in the control group (p = 0.015). Women demonstrated higher levels of anxiety than men in both groups. No between-group differences were discerned in CCTA process time. CONCLUSION Access to 360°VCE can reduce patients' pre-CCTA anxiety levels. IMPLICATIONS FOR PRACTICE The presented results can be used to improve patient counselling and care, reduce anxiety among patients undergoing CCTA, and optimise the CCTA examination procedure.
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Affiliation(s)
- Karoliina Paalimäki-Paakki
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland; Degree Programme of Radiography and Radiation Therapy, Oulu University of Applied Sciences, Oulu, Finland.
| | - Mari Virtanen
- School of Rehabilitation and Examination, Helsinki Metropolia University of Applied Sciences, Helsinki, Finland
| | - Anja Henner
- Degree Programme of Radiography and Radiation Therapy, Oulu University of Applied Sciences, Oulu, Finland
| | - Hannu Vähänikkilä
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Miika T Nieminen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Tanja Schroderus-Salo
- Degree Programme of Radiography and Radiation Therapy, Oulu University of Applied Sciences, Oulu, Finland
| | - Maria Kääriäinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Oulu University Hospital, Oulu, Finland
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23
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Bui KT, Li Z, Dhillon HM, Kiely BE, Blinman P. Scanxiety Conversations on Twitter: Observational Study. JMIR Cancer 2023; 9:e43609. [PMID: 37074770 PMCID: PMC10157462 DOI: 10.2196/43609] [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: 10/20/2022] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Scan-associated anxiety (or "scanxiety") is commonly experienced by people having cancer-related scans. Social media platforms such as Twitter provide a novel source of data for observational research. OBJECTIVE We aimed to identify posts on Twitter (or "tweets") related to scanxiety, describe the volume and content of these tweets, and describe the demographics of users posting about scanxiety. METHODS We manually searched for "scanxiety" and associated keywords in cancer-related, publicly available, English-language tweets posted between January 2018 and December 2020. We defined "conversations" as a primary tweet (the first tweet about scanxiety) and subsequent tweets (interactions stemming from the primary tweet). User demographics and the volume of primary tweets were assessed. Conversations underwent inductive thematic and content analysis. RESULTS A total of 2031 unique Twitter users initiated a conversation about scanxiety from cancer-related scans. Most were patients (n=1306, 64%), female (n=1343, 66%), from North America (n=1130, 56%), and had breast cancer (449/1306, 34%). There were 3623 Twitter conversations, with a mean of 101 per month (range 40-180). Five themes were identified. The first theme was experiences of scanxiety, identified in 60% (2184/3623) of primary tweets, which captured the personal account of scanxiety by patients or their support person. Scanxiety was often described with negative adjectives or similes, despite being experienced differently by users. Scanxiety had psychological, physical, and functional impacts. Contributing factors to scanxiety included the presence and duration of uncertainty, which was exacerbated during the COVID-19 pandemic. The second theme (643/3623, 18%) was the acknowledgment of scanxiety, where users summarized or labeled an experience as scanxiety without providing emotive clarification, and advocacy of scanxiety, where users raised awareness of scanxiety without describing personal experiences. The third theme was messages of support (427/3623, 12%), where users expressed well wishes and encouraged positivity for people experiencing scanxiety. The fourth theme was strategies to reduce scanxiety (319/3623, 9%), which included general and specific strategies for patients and strategies that required improvements in clinical practice by clinicians or health care systems. The final theme was research about scanxiety (50/3623, 1%), which included tweets about the epidemiology, impact, and contributing factors of scanxiety as well as novel strategies to reduce scanxiety. CONCLUSIONS Scanxiety was often a negative experience described by patients having cancer-related scans. Social media platforms like Twitter enable individuals to share their experiences and offer support while providing researchers with unique data to improve their understanding of a problem. Acknowledging scanxiety as a term and increasing awareness of scanxiety is an important first step in reducing scanxiety. Research is needed to guide evidence-based approaches to reduce scanxiety, though some low-cost, low-resource practical strategies identified in this study could be rapidly introduced into clinical care.
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Affiliation(s)
- Kim Tam Bui
- Medical Oncology, Concord Cancer Centre, Concord, Australia
- Sydney Medical School, University of Sydney, Camperdown, Australia
| | - Zoe Li
- Medical Oncology, Concord Cancer Centre, Concord, Australia
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group, School of Psychology, University of Sydney, Camperdown, Australia
- Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Camperdown, Australia
| | - Belinda E Kiely
- Medical Oncology, Concord Cancer Centre, Concord, Australia
- Sydney Medical School, University of Sydney, Camperdown, Australia
| | - Prunella Blinman
- Medical Oncology, Concord Cancer Centre, Concord, Australia
- Sydney Medical School, University of Sydney, Camperdown, Australia
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Seibel K, Sauer B, Wagner B, Becker G. "Scanxiety" and a sense of control: the perspective of lung cancer survivors and their caregivers on follow-up - a qualitative study. BMC Psychol 2023; 11:119. [PMID: 37069692 PMCID: PMC10111662 DOI: 10.1186/s40359-023-01151-0] [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: 12/07/2022] [Accepted: 03/29/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES Lung cancer survivors often suffer from physical, emotional and social long-term effects of disease and treatment. Caregivers are also affected by the cancer diagnosis throughout the course of the disease and are frequently burdened by high levels of psychosocial stress. However, little is known about how follow-up care after the completed treatment phase can help to improve long-term quality of life. In the context of patient-centred cancer care, considering the survivors' and caregivers' perspectives is an important step toward improving care structures. We therefore explored how lung cancer survivors and their caregivers experience follow-up examinations and their possible psychosocial effects on everyday life in order to shed light on what support is helpful for improving their quality of life. MATERIAL AND METHODS 25 survivors after curative lung cancer treatment and 17 caregivers underwent a face-to-face semi-structured, audio-recorded interview that was analysed using qualitative content analysis. RESULTS Especially burdened cancer survivors and caregivers described recurring anxiety before a follow-up appointment influencing their everyday life. At the same time, follow-up care also provided reassurance of still being healthy and helped regain a sense of security and control until the following scan. Despite possible long-term consequences in everyday life, the interviewees reported that the survivors´ psychosocial needs were not explicitly assessed or discussed. Nevertheless, the interviewees indicated that conversations with the physician were important for the success of "good" follow-up care. CONCLUSION Anxiety surrounding follow-up scans, also known as "scanxiety", is a common problem. In this study, we expanded on previous findings and found a positive aspect of scans, namely regaining a sense of security and control, which can strengthen the psychological well-being of the survivors and their families. To optimize follow-up care and improve the quality of life of lung cancer survivors and caregivers, strategies to integrate psychosocial care, like the introduction of survivorship care plans or increased use of patient-reported outcomes, should be explored in the future.
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Affiliation(s)
- Katharina Seibel
- Department of Palliative Medicine, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.
| | - Barbara Sauer
- Department of Palliative Medicine, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
| | - Bernd Wagner
- Department of Palliative Care, Marienhaus Hospital, An der Goldgrube 11, 55131, Mainz, Germany
| | - Gerhild Becker
- Department of Palliative Medicine, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
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Kelly BS, Kirwan A, Quinn MS, Kelly AM, Mathur P, Lawlor A, Killeen RP. The ethical matrix as a method for involving people living with disease and the wider public (PPI) in near-term artificial intelligence research. Radiography (Lond) 2023; 29 Suppl 1:S103-S111. [PMID: 37062673 DOI: 10.1016/j.radi.2023.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION The rapid pace of research in the field of Artificial Intelligence in medicine has associated risks for near-term AI. Ethical considerations of the use of AI in medicine remain a subject of much debate. Concurrently, the Involvement of People living with disease and the Public (PPI) in research is becoming mandatory in the EU and UK. The goal of this research was to elucidate the important values for our relevant stakeholders: People with MS, Radiologists, neurologists, Registered Healthcare Practitioners and Computer Scientists concerning AI in radiology and synthesize these in an ethical matrix. METHODS An ethical matrix workshop co-designed with a patient expert. The workshop yielded a survey which was disseminated to the professional societies of the relevant stakeholders. Quantitative data were analysed using the Pingouin 0.53 python package. Qualitative data were examined with word frequency analysis and analysed for themes with grounded theory with a patient expert. RESULTS 184 participants were recruited, (54, 60, 17, 12, 41 respectively). There were significant (p < 0.00001) differences in age, gender and ethnicity between groups. Key themes emerging from our results were the importance fast and accurate results, explanations over model performance and the significance of maintaining personal connections and choice. These themes were used to construct the ethical matrix. CONCLUSION The ethical matrix is a useful tool for PPI and stakeholder engagement with particular advantages for near-term AI in the pandemic era. IMPLICATIONS FOR PRACTICE We have produced an ethical matrix that allows for the inclusion of stakeholder opinion in medical AI research design.
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Affiliation(s)
- B S Kelly
- School of Medicine, UCD, Belfield, Dublin 4, Ireland; Department of Radiology, St Vincent's University Hospital, Dublin 4, Ireland; School of Computer Science and Insight Centre, UCD Belfield, Dublin 4, Ireland.
| | - A Kirwan
- Multiple Sclerosis Ireland National Office, 80 Northumberland Road, Dublin 4, Ireland
| | - M S Quinn
- School of Computer Science and Insight Centre, UCD Belfield, Dublin 4, Ireland
| | - A M Kelly
- School of Education, Trinity College Dublin, Dublin 2, Ireland
| | - P Mathur
- Department of Radiology, St Vincent's University Hospital, Dublin 4, Ireland
| | - A Lawlor
- Department of Radiology, St Vincent's University Hospital, Dublin 4, Ireland
| | - R P Killeen
- School of Medicine, UCD, Belfield, Dublin 4, Ireland
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de Vries ISA, van Ewijk R, Adriaansen LME, Bohte AE, Braat AJAT, Fajardo RD, Hiemcke-Jiwa LS, Hol MLF, Ter Horst SAJ, de Keizer B, Knops RRG, Meister MT, Schoot RA, Smeele LE, van Scheltinga ST, Vaarwerk B, Merks JHM, van Rijn RR. Imaging in rhabdomyosarcoma: a patient journey. Pediatr Radiol 2023; 53:788-812. [PMID: 36843091 PMCID: PMC10027795 DOI: 10.1007/s00247-023-05596-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 02/28/2023]
Abstract
Rhabdomyosarcoma, although rare, is the most frequent soft tissue sarcoma in children and adolescents. It can present as a mass at nearly any site in the body, with most common presentations in the head and neck, genitourinary tract and extremities. The optimal diagnostic approach and management of rhabdomyosarcoma require a multidisciplinary team with multimodal treatment, including chemotherapy and local therapy. Survival has improved over the last decades; however, further improvement in management is essential with current 5-year overall survival ranging from 35% to 100%, depending on disease and patient characteristics. In the full patient journey, from diagnosis, staging, management to follow-up after therapy, the paediatric radiologist and nuclear physician are essential members of the multidisciplinary team. Recently, guidelines of the European paediatric Soft tissue sarcoma Study Group, the Cooperative Weichteilsarkom Studiengruppe and the Oncology Task Force of the European Society of Paediatric Radiology (ESPR), in an ongoing collaboration with the International Soft-Tissue Sarcoma Database Consortium, provided guidance for high-quality imaging. In this educational paper, given as a lecture during the 2022 postgraduate ESPR course, the multi-disciplinary team of our national paediatric oncology centre presents the journey of two patients with rhabdomyosarcoma and discusses the impact on and considerations for the clinical (paediatric) radiologist and nuclear physician. The key learning points of the guidelines and their implementation in clinical practice are highlighted and up-to-date insights provided for all aspects from clinical suspicion of rhabdomyosarcoma and its differential diagnosis, to biopsy, staging, risk stratification, treatment response assessment and follow-up.
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Affiliation(s)
| | - Roelof van Ewijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Laura M E Adriaansen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anneloes E Bohte
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Arthur J A T Braat
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Raquel Dávila Fajardo
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiotherapy, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Laura S Hiemcke-Jiwa
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pathology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marinka L F Hol
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Otorhinolaryngology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Simone A J Ter Horst
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Bart de Keizer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Rutger R G Knops
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Michael T Meister
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
| | - Reineke A Schoot
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Ludi E Smeele
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute (NCI), Amsterdam, the Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Bas Vaarwerk
- Department of Paediatrics, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Suite C1-423.1, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands.
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Dunsmore VJ, Neupert SD. Coping With 'Scanxiety': Within-Person Processes in Lung Cancer. Psychol Rep 2023:332941231164336. [PMID: 36964680 PMCID: PMC10629386 DOI: 10.1177/00332941231164336] [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] [Indexed: 03/26/2023]
Abstract
Background: Patients with early-stage lung cancer undergo potentially curative therapy, and continue to undergo regularly scheduled CT scans to determine if cancer has reappeared, spread, or stayed the same. This process can be fraught with anxiety, coined 'Scanxiety'. The present study examined how coping and scan-related anxiety fluctuate within-person before one's scan. Method: Twenty five individuals with lung cancer who had received curative intent treatment (M age = 62.33, [SD = 8.10], 96% women, 80% white) participated in the study, which had two parts. First, participants provided information about proactive coping and scan-related anxiety every 30 days. Next, a daily diary study was implemented for 7 consecutive days before their CT scan, as well as the day of their CT scan, where participants reported on their daily anticipatory coping and scan-related anxiety. The 25 participants provided 59 monthly and 146 daily surveys for analysis. Results: Multilevel models revealed significant main effects of monthly proactive coping on monthly scan-related anxiety, as well as daily anticipatory coping on daily scan-related anxiety. On months when participants decreased their use of proactive coping, they also reported decreases in scan-related anxiety for that month. On days when participants reported decreases in outcome fantasy and stagnant deliberation, they reported decreases in scan-related anxiety for that day. Finally, a significant interaction was found such that on days when middle-aged adults reported increases in problem analysis, they also reported increases in scan-related anxiety for that day. Conclusion: These findings are the first to characterize how participants' coping and scanxiety fluctuate in the months and days prior to their CT scans. Results indicated that focusing on the present may be more beneficial in reducing scan-related anxiety rather than thinking about the future. Future work should implement strategies to reduce scanxiety by focusing on the present among those with lung cancer.
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Affiliation(s)
- Victoria J Dunsmore
- Department of Psychology, 6798North Carolina State University, Raleigh, NC, USA
- Lineberger Comprehensive Cancer Center, 2331UNC, Chapel Hill, NC, USA
| | - Shevaun D Neupert
- Department of Psychology, 6798North Carolina State University, Raleigh, NC, USA
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Derry-Vick HM, Heathcote LC, Glesby N, Stribling J, Luebke M, Epstein AS, Prigerson HG. Scanxiety among Adults with Cancer: A Scoping Review to Guide Research and Interventions. Cancers (Basel) 2023; 15:1381. [PMID: 36900174 PMCID: PMC10000102 DOI: 10.3390/cancers15051381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Background: Scan-related anxiety ("scanxiety") is distressing to people living with and beyond cancer. We conducted a scoping review to promote conceptual clarity, identify research practices and gaps, and guide intervention strategies for adults with a current or prior cancer diagnosis. Methods: Following a systematic search, we screened 6820 titles and abstracts, evaluated 152 full-text articles, and selected 36 articles. Definitions, study designs, measurement methods, correlates, and consequences of scanxiety were extracted and summarized. Results: The reviewed articles included individuals living with current cancer (n = 17) and those in the post-treatment phase (n = 19), across a breadth of cancer types and disease stages. In five articles, authors explicitly defined scanxiety. Multiple components of scanxiety were described, including those related to scan procedures (e.g., claustrophobia, physical discomfort) and scan results (e.g., implications for disease status and treatment), suggesting varied intervention approaches may be needed. Twenty-two articles used quantitative methods, nine used qualitative methods, and five used mixed methods. In 17 articles, symptom measures specifically referenced cancer scans; 24 included general measures without reference to scans. Scanxiety tended to be higher among those with lower education levels, less time since diagnosis, and greater baseline anxiety levels (three articles each). Although scanxiety often decreased immediately pre- to post-scan (six articles), participants reported the waiting period between scan and results to be particularly stressful (six articles). Consequences of scanxiety included poorer quality of life and somatic symptoms. Scanxiety promoted follow-up care for some patients yet hindered it for others. Conclusions: Scanxiety is multi-faceted, heightened during the pre-scan and scan-to-results waiting periods, and associated with clinically meaningful outcomes. We discuss how these findings can inform future research directions and intervention approaches.
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Affiliation(s)
- Heather M. Derry-Vick
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
- Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
| | - Lauren C. Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE1 9RT, UK
| | | | | | - Matthew Luebke
- Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
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Antoni MH, Moreno PI, Penedo FJ. Stress Management Interventions to Facilitate Psychological and Physiological Adaptation and Optimal Health Outcomes in Cancer Patients and Survivors. Annu Rev Psychol 2023; 74:423-455. [PMID: 35961041 PMCID: PMC10358426 DOI: 10.1146/annurev-psych-030122-124119] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Cancer diagnosis and treatment constitute profoundly stressful experiences involving unique and common challenges that generate uncertainty, fear, and emotional distress. Individuals with cancer must cope with multiple stressors, from the point of diagnosis through surgical and adjuvant treatments and into survivorship, that require substantial psychological and physiological adaptation. This can take a toll on quality of life and well-being and may also promote cellular and molecular changes that can exacerbate physical symptoms and facilitate tumor growth and metastasis, thereby contributing to negative long-term health outcomes. Since modifying responses tostressors might improve psychological and physiological adaptation, quality of life, and clinical health outcomes, several randomized controlled trials have tested interventions that aim to facilitate stress management. We review evidence for the effects of stress management interventions on psychological and physiological adaptation and health outcomes in cancer patients and survivors and summarize emerging research in the field to address unanswered questions.
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Affiliation(s)
- Michael H Antoni
- Department of Psychology, University of Miami, Coral Gables, Florida, USA;
- Cancer Control Research Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Patricia I Moreno
- Cancer Control Research Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, Florida, USA;
- Cancer Control Research Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
- Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA
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30
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Flore J, Kokanović R, Broom A, Heynemann S, Lai-Kwon J, Jefford M. Entanglements and imagined futures: The subject(s) of precision in oncology. Soc Sci Med 2023; 317:115608. [PMID: 36549013 DOI: 10.1016/j.socscimed.2022.115608] [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: 03/24/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
Precision oncology holds an increasingly powerful social function. In the era of precision, how people encounter, live with, and experience cancer, how they imagine their lives, how they navigate treatment regimens, and experience side effects, have been radically transformed. Innovations in oncology - in this case precision-related - are always more-than-clinical; their circulation exceeds the laboratory and the hospital, but what this 'circulation of innovation' produces has been thus far opaque. To begin to comprehend what is emergent at the cancer-precision nexus in people's everyday lives, we draw on qualitative interviews with twenty people diagnosed with metastatic non-small cell lung cancer undergoing immunotherapy and/or targeted therapy and we discuss how precision inflects survivorship, entangles subjects in chronic living, and induces novel temporalities. Through such inflections of survivorship, precision innovation re-shapes expectations and possibilities, and sometimes enacts new, unexpected (or, for some, unwanted) futures. Such illness and survivorship narratives indicate the importance of orientating the social science scholarship toward considerations of temporality and entanglements for comprehending precision innovation in oncology. And in doing so, provide a nuanced account of how innovations unsettle and recast, rather than unravel, the normative scene of cancer.
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Affiliation(s)
- Jacinthe Flore
- Social and Global Studies Centre, School of Global, Urban and Social Studies, RMIT University, Melbourne, Victoria, Australia.
| | - Renata Kokanović
- Social and Global Studies Centre, School of Global, Urban and Social Studies, RMIT University, Melbourne, Victoria, Australia
| | - Alex Broom
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Heynemann
- Department of Medical Oncology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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31
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Derks S, de Joode K, Mulder E, Ho L, Joosse A, de Jonge M, Verhoef C, Grünhagen D, Smits M, van den Bent M, van der Veldt A. The meaning of screening: detection of brain metastasis in the adjuvant setting for stage III melanoma. ESMO Open 2022; 7:100600. [PMID: 36265261 PMCID: PMC9808474 DOI: 10.1016/j.esmoop.2022.100600] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/07/2022] [Accepted: 09/11/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The incidence of melanoma is increasing and 37% of patients with metastatic melanoma eventually have brain metastasis (BM). Currently, there is no consensus on screening for BM in patients with resected stage III melanoma. However, given the high incidence of BM, routine screening magnetic resonance imaging (MRI) of the brain is considered in patients with completely resected stage III melanoma before the start of adjuvant treatment. The aim of this study was to assess the yield of screening for BM in these patients. MATERIALS AND METHODS A single-center cohort study was carried out in the Erasmus MC, Rotterdam, The Netherlands, a large tertiary referral center for patients with melanoma. Eligible patients with complete resection of stage III melanoma and a screening MRI of the brain, made within 12 weeks after resection and before adjuvant treatment (programmed cell death protein 1 inhibitors, dabrafenib-trametinib), available between 1 August 2018 and 1 January 2021, were included. RESULTS A total of 202 patients were included. Eighteen (8.9%) of 202 patients had extracranial metastasis at screening. Two (1.1%) of the remaining 184 patients had BM at screening, resulting in a switch from adjuvant treatment to ipilimumab-nivolumab. At a median follow-up of 21.2 months, BM was detected in another 4 (2.4%) of 166 patients who started with adjuvant treatment. CONCLUSIONS The yield of screening MRI of the brain is low after complete resection of stage III melanoma, before the start of adjuvant treatment. Therefore, routine screening MRI is not recommended in this setting.
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Affiliation(s)
- S.H.A.E. Derks
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands,Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands,Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - K. de Joode
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands,Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - E.E.A.P. Mulder
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands,Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - L.S. Ho
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - A. Joosse
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M.J.A. de Jonge
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - C. Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - D.J. Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M. Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - M.J. van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - A.A.M. van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands,Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands,Correspondence to: Dr A. A. M. van der Veldt, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015GD Rotterdam, the Netherlands. Tel: +31-010-704 17 54
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Schoenmaekers JJO, Bruinsma J, Wolfs C, Barberio L, Brouns A, Dingemans AMC, Hendriks LE. Screening for Brain Metastases in Patients With NSCLC: A Qualitative Study on the Psychologic Impact of Being Diagnosed With Asymptomatic Brain Metastases. JTO Clin Res Rep 2022; 3:100401. [PMID: 36188631 PMCID: PMC9516448 DOI: 10.1016/j.jtocrr.2022.100401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/02/2022] [Accepted: 08/15/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction The brain is a frequent site of metastases in NSCLC, and screening for asymptomatic brain metastases (BM) is increasingly advised in NSCLC guidelines. An asymptomatic BM diagnosis may trigger anxiety for future neurologic problems and can negatively affect quality of life of patients and their relatives. Therefore, we performed this qualitative study. Methods Three focus group discussions were organized with patients with NSCLC and asymptomatic BM (N = 3–4 per group) and separately with their relatives, to explore this psychosocial impact. Two researchers independently performed an inductive content analysis. Results A total of 10 patients and 10 relatives participated in six focus groups. A diagnosis of BM caused feelings of distress and anxiety in both patients and relatives. These feelings diminished over time in case of a tumor responding to systemic therapy. The diagnosis of BM was not perceived as more distressful than other metastases, and scan-related anxiety was not experienced. Although magnetic resonance imaging screening and follow-up were thought of as burdensome, follow-up was valued. The coping strategies of both groups seemed related to personality and to the efficacy of the given systemic therapy. Relatives appreciated peer support of other relatives during the focus groups, and they seemed open for future psychological support. Conclusions Asymptomatic BM diagnosis can cause anxiety and distress, but this diminishes over time with effective systemic treatment. Although patients perceive magnetic resonance imaging as burdensome, they value follow-up screening and imaging. Relatives highly appreciated peer support, and psychological distress of relatives should not be overlooked.
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Bernstein J. Not the Last Word: Seeing Ourselves as Doctors See Us. Clin Orthop Relat Res 2022; 480:1653-1656. [PMID: 35916690 PMCID: PMC9384933 DOI: 10.1097/corr.0000000000002344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Joseph Bernstein
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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34
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Goffredo P, Klemen ND, Hassan I. Prevention of Anal Cancer. N Engl J Med 2022; 387:666-667. [PMID: 36070724 DOI: 10.1056/nejmc2209237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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35
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Goodfellow M, Lim C, Tustin H, Mentias Y, Cocks H. The diagnostic yield of head and neck imaging in symptomatic patients with a normal clinical examination. Head Neck 2022; 44:2564-2570. [DOI: 10.1002/hed.27168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/04/2022] [Accepted: 07/21/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Christian Lim
- School of Medical Education, The Faculty of Medical Sciences, Cookson Building Newcastle University Newcastle upon Tyne UK
| | - Harry Tustin
- Department of Otolaryngology Sunderland Royal Hospital Sunderland UK
| | - Youssef Mentias
- Department of Otolaryngology Sunderland Royal Hospital Sunderland UK
| | - Helen Cocks
- Department of Otolaryngology Sunderland Royal Hospital Sunderland UK
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Heathcote LC, Cunningham SJ, Webster SN, Tanna V, Mattke E, Loecher N, Spunt SL, Simon P, Dahl G, Walentynowicz M, Murnane E, Tutelman PR, Schapira L, Simons LE, Mueller C. Smartphone-based Ecological Momentary Assessment to study "scanxiety" among Adolescent and Young Adult survivors of childhood cancer: A feasibility study. Psychooncology 2022; 31:1322-1330. [PMID: 35411626 PMCID: PMC9545782 DOI: 10.1002/pon.5935] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Scan-related anxiety ("scanxiety") refers to the fear, stress, and anxiety in anticipation of tests and scans in follow-up cancer care. This study assessed the feasibility of Ecological Momentary Assessment (EMA) for real-world, real-time capture of scanxiety using patients' personal smartphone. METHODS Adolescent and Young Adult survivors of childhood cancer were prompted to complete EMA surveys on a smartphone app three times per day for 11 days (33 surveys total) around their routine surveillance scans. Participants provided structured feedback on the EMA protocol. RESULTS Thirty out of 46 contacted survivors (65%) enrolled, exceeding the preregistered feasibility cutoff of 55%. The survey completion rate (83%) greatly exceeded the preregistered feasibility cutoff of 65%. Participants generally found the smartphone app easy and enjoyable to use and reported low levels of distress from answering surveys. Participants reported significantly more daily fear of cancer recurrence (FCR) and negative affect in the days before compared to the days after surveillance scans, aligning with the expected trajectory of scanxiety. Participants who reported greater FCR and scanxiety using comprehensive measures at baseline also reported significantly more daily FCR around their surveillance scans, indicating validity of EMA items. Bodily threat monitoring was prospectively and concurrently associated with daily FCR, thus warranting further investigation as a risk factor for scanxiety. CONCLUSIONS Findings indicate the feasibility, acceptability, and validity of EMA as a research tool to capture the dynamics and potential risk factors for scanxiety.
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Affiliation(s)
- Lauren C. Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
| | - Sarah J. Cunningham
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Sarah N. Webster
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Vivek Tanna
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Elia Mattke
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Nele Loecher
- Department of Mental Health Law and PolicyUniversity of South FloridaTampaFloridaUSA
| | - Sheri L. Spunt
- Stanford Cancer Institute, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Pamela Simon
- Lucile Packard Children's Hospital at StanfordPalo AltoCaliforniaUSA
| | - Gary Dahl
- Stanford Cancer Institute, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Marta Walentynowicz
- Centre for the Psychology of Learning and Experimental Psychopathology, KU LeuvenLeuvenBelgium
- Psychological Science Research InstituteUniversité Catholique de LouvainLouvain‐la‐NeuveBelgium
| | | | | | - Lidia Schapira
- Stanford Cancer Institute, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Laura E. Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Claudia Mueller
- Department of Pediatrics, Stanford University School of MedicineStanfordCaliforniaUSA
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Ding S, Fontaine T, Serex M, Reis CSD. Interventions to improve patient experience in mammography: a scoping review protocol. JBI Evid Synth 2022; 20:2370-2377. [DOI: 10.11124/jbies-21-00376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Isabel Rodrigues Monteiro Grilo A, Catarina Inácio Ferreira A, Sofia Pedro Ramos M, Teresa Mata Almeida Carolino E, Filipa Pires A, da Conceição Capela de Oliveira Vieira L. Effectiveness of educational videos on patient's preparation for diagnostic procedures: Systematic Review and Meta-Analysis. Prev Med Rep 2022; 28:101895. [PMID: 35855928 PMCID: PMC9287602 DOI: 10.1016/j.pmedr.2022.101895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/27/2022] [Accepted: 07/01/2022] [Indexed: 11/06/2022] Open
Abstract
Patients’ anxiety and unfamiliarity are barriers to undergoing diagnostic procedures. Studies found educational videos more effective than other forms of information. Educational videos minimise anxiety and improve patient satisfaction. Educational videos enable medical procedures best practices.
Although diagnostic procedures are crucial for secondary prevention and patient disease control, they often trigger fear and anxiety. These reactions highlight the need to adopt effective interventions to improve patients’ experience and satisfaction. Recently, educational videos have been employed in preparing diagnostic procedures; however, there is no integrated understanding of their effects. This systematic review and meta-analysis aimed to assess the effectiveness of educational videos on patients’ anxiety and satisfaction regarding preparation for diagnostic procedures. Three scientific databases (PubMed; Web of Science, Scopus), were used in this systematic review. Studies about educational videos as a form of preparation for patients undergoing diagnostic procedures published between 2000 and 2021 were included. A meta-analysis was also conducted. Sixteen studies met the inclusion criteria for systematic review, and seven were included in the meta-analysis. Nine studies of the total sample were about vascular procedures and seven studies about other medical image procedures. Of the fourteen studies that evaluated the use of educational videos on patients’ anxiety, nine proved to reduce it significantly. Of the thirteen studies that evaluated satisfaction, seven showed a significant increase in the experimental group. Studies included in the meta-analysis show that educational video patient groups had lower anxiety levels than the control groups after the procedure. Although future studies are required, the results suggest that educational videos effectively prepare patients for diagnostic procedures, improving care quality.
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von Hippel-Lindau disease: Updated guideline for diagnosis and surveillance. Eur J Med Genet 2022; 65:104538. [PMID: 35709961 DOI: 10.1016/j.ejmg.2022.104538] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/29/2022] [Accepted: 06/06/2022] [Indexed: 11/21/2022]
Abstract
von Hippel Lindau disease (vHL) is caused by a hereditary predisposition to multiple neoplasms, especially hemangioblastomas in the retina and CNS, renal cell carcinomas (RCC), pheochromocytomas, neuroendocrine pancreatic tumours (PNET) and endolymphatic sac tumours. Evidence based approaches are needed to ensure an optimal clinical care, while minimizing the burden for the patients and their families. This guideline is based on evidence from the international vHL literature and extensive research of geno- and phenotypic characteristics, disease progression and surveillance effect in the national Danish vHL cohort. We included the views and preferences of the Danish vHL patients, ensured consensus among Danish experts and compared with international recommendations. RECOMMENDATIONS: vHL can be diagnosed on clinical criteria, only; however, in most cases the diagnosis can be supported by identification of a pathogenic or likely pathogenic variant in VHL. Surveillance should be initiated in childhood in persons with, or at risk of, vHL, and include regular examination of the retina, CNS, inner ear, kidneys, neuroendocrine glands, and pancreas. Treatment of vHL manifestations should be planned to optimize the chance of cure, without unnecessary sequelae. Most manifestations are currently treated by surgery. However, belzutifan, that targets HIF-2α was recently approved by the U.S. Food and Drug Administration (FDA) for adult patients with vHL-associated RCC, CNS hemangioblastomas, or PNETs, not requiring immediate surgery. Diagnostics, surveillance, and treatment of vHL can be undertaken successfully by experts collaborating in multidisciplinary teams. Systematic registration, collaboration with patient organisations, and research are fundamental for the continuous improvement of clinical care and optimization of outcome with minimal patient inconvenience.
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Mannion S, Martin NA, O'Connor J, Wieland J, Jatoi A. In Their Own Words, "Waiting Sucks:" A Qualitative Study of Medical Testing-Related Anxiety in Patients with Cancer. Am J Hosp Palliat Care 2022; 40:468-474. [PMID: 35635257 DOI: 10.1177/10499091221105502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This qualitative study sought to learn from patients with cancer -- in their own words -- about anxiety associated with medical testing. METHODS Patients with cancer or a history of cancer were recruited from an oncology clinic. After oral consent, each was interviewed in person. A semi-structured interview guide was used to help focus the interviews. Interviews were then recorded, transcribed, and analyzed with rigorous qualitative methods. RESULTS Twenty patients are the focus of this report, which highlights 2 main themes from the data. The first is that anxiety related to medical testing is a real entity. Although not all patients experienced it, those who did described it as such ("I was a little apprehensive." "It's the anticipation." "I don't think it bothers me until I get near the time for testing."). The second theme focused on coping. Patients offered insight on how to cope ("So I just deal with it and work." "And don't let myself sink into a pity pot …." "See your scan as a tool instead of … instead of um … a death sentence, I suppose."). CONCLUSION In patients with cancer, the anxiety from medical testing is real, could perhaps be mitigated by sharing coping methods from patient to patient, and merits further study.
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Affiliation(s)
| | | | | | - Jana Wieland
- Department of Medicine, 6915Mayo Clinic, Rochester, MN, USA
| | - Aminah Jatoi
- Department of Oncology, 4352Mayo Clinic, Rochester, MN, USA
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Mano MS, Morgan G. Telehealth, Social Media, Patient Empowerment, and Physician Burnout: Seeking Middle Ground. Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35561300 DOI: 10.1200/edbk_100030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The digital revolution is an ongoing process that has nevertheless profoundly affected century-old medical practice. Digitalization has many facets, ranging from telehealth to social media and even new instant communication devices, each of which affect both patients' and physicians' realities. Although the benefits of developments such as telehealth and novel applications of social media to medicine are more easily perceived by all stakeholders, they still have their own hurdles and risks, such as coldness and impersonal treatment in telehealth, and misinformation on social media. The widespread digitalization of health records has greatly facilitated patient access to health information, becoming a major patient empowerment tool; however, some forms of unrestricted access, such as to test results-in particular, prior to consultations-have unclear benefits to patients with cancer and have also become a hurdle for care teams. In addition, the advent of instant messaging, which is revolutionizing personal communication in many cultures, is gradually affecting patient-physician communication and, combined with unrestricted patient access to test results, is creating new challenges for physicians. How these transformations are affecting patients themselves and physicians' well-being and mental health are matters addressed in this text. Last, to address potential biases in an article written by two oncologists, and in line with this year's ASCO presidential theme of including a diversity of voices, we decided to give voice to patients with cancer by collecting the opinions of high-profile patient advocates about the controversial topics addressed in this text.
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Affiliation(s)
- Max S Mano
- Grupo Oncoclínicas, São Paulo, Brazil
- Academy of Leadership Sciences Switzerland, Zurich, Switzerland
| | - Gilberto Morgan
- Skåne University Hospital, Department of Clinical Oncology, Lund, Sweden
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Robertson S, Olanloye E, Hon Y, England A, McNair H, Cruickshank S. Are radiographers suffering from symptoms of compassion fatigue due to occupational stress: A systematic review. Radiography (Lond) 2022; 28:857-864. [DOI: 10.1016/j.radi.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/04/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
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Gimson E, Greca Dottori M, Clunie G, Yan Zheng C, Wiseman T, Joyce E, McGregor A, McNair H. Not as simple as "fear of the unknown": A qualitative study exploring anxiety in the radiotherapy department. Eur J Cancer Care (Engl) 2022; 31:e13564. [PMID: 35191096 PMCID: PMC10909434 DOI: 10.1111/ecc.13564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/17/2021] [Accepted: 01/26/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is understood about the anxiety experienced by cancer patients undergoing radiotherapy or investigative imaging. Our aim was to identify sources of anxiety, the points along the cancer journey where anxiety occurred and methods to alleviate it. METHODS Six focus groups were conducted with cancer patients (n = 17), caregivers (n = 3) and healthcare practitioners (HCPs; n = 10) in the radiotherapy department. Patients described specific elements in the care pathway which induced anxiety, while HCPs focused on their perception of the patient experience. Thematic analysis was used to analyse data. RESULTS Three broad themes emerged: The Environment, The Individual and The Unknown. The physical environment of the hospital, inside the scanner for example, emerged as a key source of anxiety. The impact of cancer on patients' individual lives was significant, with many feeling isolated. The majority of participants described anxiety associated with the unknown. HCPs reported difficulty in identifying the anxious patient. CONCLUSIONS Anxiety is experienced throughout the cancer pathway. Common sources include the physical environment and the uncertainty associated with having cancer. Identifying both anxiety-inducing factors, and the anxious patients themselves, is crucial to enable targeted interventions to alleviate anxiety.
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Affiliation(s)
- Eliza Gimson
- Faculty of Life Sciences and MedicineKing's College LondonLondonUK
| | | | - Gemma Clunie
- Faculty of MedicineDepartment of Surgery & Cancer, Imperial College LondonLondonUK
| | | | - Theresa Wiseman
- Applied Health ResearchThe Royal Marsden NHS Foundation TrustLondonUK
| | | | | | - Helen McNair
- The Royal Marsden NHS Foundation Trust, Translational Therapeutic RadiographyThe Institute of Cancer ResearchLondonUK
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Crockett C, Belderbos J, Levy A, McDonald F, Le Péchoux C, Faivre-Finn C. Prophylactic cranial irradiation (PCI), hippocampal avoidance (HA) whole brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS) in small cell lung cancer (SCLC): Where do we stand? Lung Cancer 2021; 162:96-105. [PMID: 34768007 DOI: 10.1016/j.lungcan.2021.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/31/2021] [Indexed: 12/25/2022]
Abstract
Small cell lung cancer (SCLC) is an aggressive form of lung cancer associated with an increased risk of develping brain metastases (BM), which are a significant cause of morbidity and mortality. Prophylactic cranial irradiation (PCI) was first introduced in the 1970s with the aim of reducing BM incidence and improving survival and quality of life (QoL). Prospective clinical trials and meta-analyses have demonstrated its effectiveness in reducing BM incidence and improving survival, across all stages of the disease following response to induction chemotherapy. Despite its long history, "unknowns" surrounding PCI use still exist and there are particular subgroups of patients for which its use remains controversial. PCI is known to cause neurocognitive toxicity which can have a significant impact on a patient's QoL. Strategies to minimise this, including the use of hippocampal avoidance radiotherapy techniques, neuroprotective drugs and stereotactic radiosurgery in place of whole brain radiotherapy for the treatment of BM, are under evaluation. This review offers a summary of the key PCI trials published to date and the current treatment recommendations based on available evidence. It also discusses the key questions being addressed in ongoing clinical trials and highlights others where there is currently a knowledge gap and therefore where further data are urgently required.
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Affiliation(s)
- Cathryn Crockett
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom.
| | - José Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Antonin Levy
- Department of Radiation Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, F-94805 Villejuif, France; Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremlin-Bicêtre, France
| | - Fiona McDonald
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Cecile Le Péchoux
- Department of Radiation Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, F-94805 Villejuif, France
| | - Corinne Faivre-Finn
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Bui KT, Kiely BE, Dhillon HM, Brown C, Xu K, Shafiei M, Blinman P. Prevalence and severity of scanxiety in people with advanced cancers: a multicentre survey. Support Care Cancer 2021; 30:511-519. [PMID: 34333717 DOI: 10.1007/s00520-021-06454-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Scan-associated anxiety ('scanxiety') is a problem for people with advanced cancer. We aimed to determine the prevalence, severity and associations of scanxiety in this population. METHODS People with advanced cancer and a computed tomography scan within the last 4 months completed a multicentre survey including self-rated presence (yes/no) and severity (distress thermometer, 0-10) of scanxiety, state anxiety (STAI-6), clinical anxiety and depression (HADS), and fear of progression (FOP-Q-SF). Associations with scanxiety were evaluated. RESULTS There were 222 participants: mean age 64 years (range 26 to 91), female (61%), most common cancer types (breast 37%, lung 19%, colorectal 16%) and > 1 year since cancer diagnosis (82%). Sixty-two percent had a scan within the last month, and 70% reported waiting > 2 days for the result. Over half (55%) of participants experienced scanxiety. On multivariable analysis, scanxiety was more prevalent in participants who were younger (mean age 62 years with v 66 years without scanxiety, p = 0.02) and more remote (v major city, OR 2.6, p = 0.04). Among participants with scanxiety, the mean severity score was 6 (range 1-10) with peak severity occurring when waiting for scan results. On multivariable analysis, scanxiety was 1.2 points higher in participants who had been diagnosed within the past year (v > 1 year, p = 0.04) and was higher in participants who had higher STAI-6 scores (β = 0.06, p = 0.004). CONCLUSION Scanxiety is common and can be severe. Strategies to reduce scanxiety are needed.
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Affiliation(s)
- Kim Tam Bui
- Medical Oncology, Concord Cancer Centre, 1A Hospital Road, Concord, NSW, 2139, Australia. .,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Belinda E Kiely
- Medical Oncology, Concord Cancer Centre, 1A Hospital Road, Concord, NSW, 2139, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.,Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown, NSW, Australia
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group, School of Psychology, University of Sydney, Sydney, NSW, Australia.,Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
| | - Chris Brown
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Kay Xu
- Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown, NSW, Australia
| | - Mohsen Shafiei
- Medical Oncology, Alan Coates Cancer Centre, Dubbo, NSW, Australia
| | - Prunella Blinman
- Medical Oncology, Concord Cancer Centre, 1A Hospital Road, Concord, NSW, 2139, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Experiences with scans and scanxiety in people with advanced cancer: a qualitative study. Support Care Cancer 2021; 29:7441-7449. [PMID: 34076779 DOI: 10.1007/s00520-021-06319-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Scan-associated anxiety ('scanxiety') in people with advanced cancer is a common clinical problem. This study aims to explore the experiences of scans and scanxiety in people with advanced cancer, including their strategies to reduce scanxiety. METHODS Semi-structured qualitative interviews were conducted with people with advanced cancers who had a computed tomography scan for monitoring of their cancer. Data was analysed with an interpretivist approach using framework analysis. RESULTS Interviews with 16 participants identified three key themes: the scan experience, the scanxiety experience and coping with scans. Scans were viewed as a routine and normal part of cancer care. Scanxiety was experienced differently by each person. Scanxiety often related to the scan result rather than the scan and led to psycho-cognitive manifestations. Adaptive coping strategies were often self-derived. CONCLUSION People with advanced cancer experience scanxiety, but often accept scanxiety as a normal part of the cancer process. The findings fit within a transactional model of stress and coping, which influences the level of scanxiety for each individual. Quantitative research to determine the scope of scanxiety will be useful to develop formal approaches to reduce scanxiety.
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