1
|
Bowers M, Higginson IJ, Maddocks M. Patient and carer experiences of cancer cachexia and its management. Curr Opin Support Palliat Care 2024; 18:132-137. [PMID: 38980806 DOI: 10.1097/spc.0000000000000710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
PURPOSE OF REVIEW To explore the contributions of recent qualitative literature in progressing understanding of the experiences of cancer cachexia, and its management, from the perspectives of patients and unpaid/family carers. RECENT FINDINGS Challenges with conducting everyday activities, maintaining independence, and continuing usual roles within the family are sources of distress. Patients and carers value individualization, flexibility, and carer involvement in physical activity/exercise interventions. In psychosocial/educational interventions that were positively perceived, the opportunity to talk about cachexia was appreciated, leading to improved health literacy, awareness about nutrition, and relationships with food. However, the general patient and carer experience around clinical acknowledgement and management of cachexia remains poor. SUMMARY Eating-related distress and conflicts, lack of understanding about cachexia, and the visibility of weight loss remain recurring themes amongst literature on experiences of cancer cachexia. Studies exploring preferences for, and experiences of, interventions have primarily focused on physical activity or exercise. Psychosocial/educational and physical activity/exercise interventions are valued and perceived to alleviate some of the key quality of life issues amongst patients with cancer cachexia and their unpaid/family carers.
Collapse
Affiliation(s)
- Megan Bowers
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | | | | |
Collapse
|
2
|
Hjermstad MJ, Jakobsen G, Arends J, Balstad TR, Brown LR, Bye A, Coats AJ, Dajani OF, Dolan RD, Fallon MT, Greil C, Grzyb A, Kaasa S, Koteng LH, May AM, McDonald J, Ottestad I, Philips I, Roeland EJ, Sayers J, Simpson MR, Skipworth RJ, Solheim TS, Sousa MS, Vagnildhaug OM, Laird BJ. Quality of life endpoints in cancer cachexia clinical trials: Systematic review 3 of the cachexia endpoints series. J Cachexia Sarcopenia Muscle 2024; 15:794-815. [PMID: 38553255 PMCID: PMC11154790 DOI: 10.1002/jcsm.13453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/22/2023] [Accepted: 02/14/2024] [Indexed: 06/07/2024] Open
Abstract
The use of patient-reported outcomes (PROMs) of quality of life (QOL) is common in cachexia trials. Patients' self-report on health, functioning, wellbeing, and perceptions of care, represent important measures of efficacy. This review describes the frequency, variety, and reporting of QOL endpoints used in cancer cachexia clinical trials. Electronic literature searches were performed in Medline, Embase, and Cochrane (1990-2023). Seven thousand four hundred thirty-five papers were retained for evaluation. Eligibility criteria included QOL as a study endpoint using validated measures, controlled design, adults (>18 years), ≥40 participants randomized, and intervention exceeding 2 weeks. The Covidence software was used for review procedures and data extractions. Four independent authors screened all records for consensus. Papers were screened by titles and abstracts, prior to full-text reading. PRISMA guidance for systematic reviews was followed. The protocol was prospectively registered via PROSPERO (CRD42022276710). Fifty papers focused on QOL. Twenty-four (48%) were double-blind randomized controlled trials. Sample sizes varied considerably (n = 42 to 469). Thirty-nine trials (78%) included multiple cancer types. Twenty-seven trials (54%) featured multimodal interventions with various drugs and dietary supplements, 11 (22%) used nutritional interventions alone and 12 (24%) used a single pharmacological intervention only. The median duration of the interventions was 12 weeks (4-96). The most frequent QOL measure was the EORTC QLQ-C30 (60%), followed by different FACIT questionnaires (34%). QOL was a primary, secondary, or exploratory endpoint in 15, 31 and 4 trials respectively, being the single primary in six. Statistically significant results on one or more QOL items favouring the intervention group were found in 18 trials. Eleven of these used a complete multidimensional measure. Adjustments for multiple testing when using multicomponent QOL measures were not reported. Nine trials (18%) defined a statistically or clinically significant difference for QOL, five with QOL as a primary outcome, and four with QOL as a secondary outcome. Correlation statistics with other study outcomes were rarely performed. PROMs including QOL are important endpoints in cachexia trials. We recommend using well-validated QOL measures, including cachexia-specific items such as weight history, appetite loss, and nutritional intake. Appropriate statistical methods with definitions of clinical significance, adjustment for multiple testing and few co-primary endpoints are encouraged, as is an understanding of how interventions may relate to changes in QOL endpoints. A strategic and scientific-based approach to PROM research in cachexia trials is warranted, to improve the research base in this field and avoid the use of QOL as supplementary measures.
Collapse
Affiliation(s)
- Marianne J. Hjermstad
- Department of OncologyOslo University HospitalOsloNorway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Gunnhild Jakobsen
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)OsloNorway
- Cancer Clinic, St. Olavs HospitalTrondheim University HospitalTrondheimNorway
| | - Jann Arends
- Department of Medicine I, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Trude R. Balstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNTNU–Norwegian University of Science and TechnologyTrondheimNorway
- Department of Clinical Medicine, Clinical Nutrition Research Group, UiTThe Arctic University of NorwayTromsøNorway
| | - Leo R. Brown
- Department of Clinical SurgeryUniversity of EdinburghEdinburghUK
- Royal Infirmary of EdinburghEdinburghUK
| | - Asta Bye
- Department of OncologyOslo University HospitalOsloNorway
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet – Oslo Metropolitan UniversityOsloNorway
| | | | - Olav F. Dajani
- Department of OncologyOslo University HospitalOsloNorway
| | - Ross D. Dolan
- Academic Unit of SurgeryUniversity of Glasgow, Glasgow Royal InfirmaryGlasgowUK
| | - Marie T. Fallon
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
- St Columba's HospiceEdinburghUK
| | - Christine Greil
- Department of Medicine I, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | | | - Stein Kaasa
- Department of OncologyOslo University HospitalOsloNorway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Lisa H. Koteng
- Department of OncologyOslo University HospitalOsloNorway
| | - Anne M. May
- Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | | | - Inger Ottestad
- Department of Nutrition, Institute of Basic Medical SciencesUniversity of OsloOsloNorway
- Department of Clinical Service, Division of Cancer Medicine, Section of Clinical NutritionOslo University HospitalOsloNorway
| | - Iain Philips
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Eric J. Roeland
- Oregon Health and Science UniversityKnight Cancer InstitutePortlandORUSA
| | - Judith Sayers
- Academic Unit of SurgeryUniversity of Glasgow, Glasgow Royal InfirmaryGlasgowUK
| | - Melanie R. Simpson
- Department of Public Health and NursingNorwegian University of Science and TechnologyTrondheimNorway
| | | | - Tora S. Solheim
- Department of Public Health and Nursing, Cancer Clinic, St Olavs HospitalTrondheim University HospitalTrondheimNorway
- Department of Clinical and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
| | - Mariana S. Sousa
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT)University of TechnologySydneyNSWAustralia
| | - Ola M. Vagnildhaug
- Department of Public Health and Nursing, Cancer Clinic, St Olavs HospitalTrondheim University HospitalTrondheimNorway
- Department of Clinical and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
| | | | | |
Collapse
|
3
|
Bergman T. A care ethics approach to a reduced ability to eat. Nurs Ethics 2024; 31:420-431. [PMID: 37767623 PMCID: PMC11308360 DOI: 10.1177/09697330231197708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Patients with advanced cancer often experience a reduced ability to eat, which may result in tensions between patients and family members. Often with advanced cancer diagnoses, patients' appetites decline markedly, while family members focus on nutritional intake with the hope that this will postpone death. This hope might cause tensions between the patient and family; the family may expect healthcare professionals to encourage the patient to eat more, whereas the patient needs to be supported in their reduced ability to eat. When these tensions arise, healthcare professionals can experience challenges in providing good palliative care. To address these challenges in the provision of palliative care, healthcare professionals may adopt a care ethics approach. Similar to palliative care's focus on patient and family members' relationships, a care ethics approach emphasizes interdependency and social relationships. Using Joan Tronto's care ethics approach, we conducted a normative analysis of what caring for patients with reduced ability to eat and their family members should look like. Tronto's approach includes five phases of care: caring about, taking care of, care giving, care-receiving, and caring with. Based on our analysis and empirical studies on patients with advanced cancer and family members, concerns with their lack of appetite, we assert that healthcare professionals must be mindful of the potential of tensions related to appetite and be adept in dealing with these tensions. We urge that education is needed for healthcare professionals regarding the psychosocial impact of reduced ability to eat on both patients and family members and interprofessional collaboration is of the essence.
Collapse
Affiliation(s)
- Tessa Bergman
- Department of Public and Occupational Health, Amsterdam UMC Location VUmc, Netherlands
| |
Collapse
|
4
|
Luvián-Morales J, Delgadillo-González M, Castro-Eguiluz D, Oñate-Ocaña LF, Cetina-Pérez L. Quality of life but not cachexia definitions are associated with overall survival in women with cervical cancer: a STROBE-compliant cohort study. Jpn J Clin Oncol 2024; 54:416-423. [PMID: 38146122 DOI: 10.1093/jjco/hyad182] [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: 10/10/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Cancer-related cachexia (CRC) has a profound impact on health-related quality of life (HRQL), and both were reported to be associated with overall survival (OS). We hypothesize that HRQL and CRC are associated with OS. This study analyzed the impact of CRC on HRQL and its prognostic value in women with cervical cancer (CC). METHODS A cohort study including consecutive women with CC treated from October 2020 to October 2021 in a cancer center. Cox's model defined the associations of immune, biochemical and nutritional parameters, clinical cachexia classifications and HRQL with OS. RESULTS Two hundred forty-four consecutive women with CC were included. Cachexia classifications and several scales of the QLQ-C30 were associated with OS by bivariate but not by multivariate analysis. QLQ-CX24 scales were not associated with OS. The prognostic nutritional index (PNI) (hazard ratio (HR) 0.828; 95% confidence interval (CI) 0.766-0.896), Food aversion (HR 0.95; 95% CI 0.924-0.976), Eating difficulties (HR 1.041; 95% CI 1.013-1.071), Loss of control (HR 4.131; 95% CI 1.317-12.963), Forced self to eat (1.024; 95% CI 1.004-1.044) and Indigestion (HR 0.348; 95% CI 0.131-0.928) scales of the QLQ-CAX24 were independently associated with OS by multivariate analysis (p = 1.9×10-11). CONCLUSION This model permitted a clear stratification of prognostic subgroups. The PNI and several QLQ-CAX24 scales were associated with OS in women with CC. CRC, defined by several cachexia classifications, was not an independent prognostic factor. These findings require confirmation because of their possible diagnostic, therapeutic and prognostic implications.The prognostic nutritional index and several QLQ-CAX24 scales were associated with overall survival in women with cervical cancer. Cancer-related cachexia, defined by several cachexia classifications, was not an independent prognostic factor, neither The International Federation of Gynecology and Obstetrics (FIGO) stage classifications.
Collapse
Affiliation(s)
- Julissa Luvián-Morales
- Modelo Integral para la Atención del Cáncer Cervicouterino Localmente Avanzado y Avanzado (MICAELA), Instituto Nacional de Cancerología (INCan), Mexico City
| | - Merari Delgadillo-González
- Modelo Integral para la Atención del Cáncer Cervicouterino Localmente Avanzado y Avanzado (MICAELA), Instituto Nacional de Cancerología (INCan), Mexico City
| | - Denisse Castro-Eguiluz
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City
- Investigador por México, CONAHCyT, Mexico City, Mexico
| | - Luis F Oñate-Ocaña
- Modelo Integral para la Atención del Cáncer Cervicouterino Localmente Avanzado y Avanzado (MICAELA), Instituto Nacional de Cancerología (INCan), Mexico City
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City
| | - Lucely Cetina-Pérez
- Modelo Integral para la Atención del Cáncer Cervicouterino Localmente Avanzado y Avanzado (MICAELA), Instituto Nacional de Cancerología (INCan), Mexico City
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City
| |
Collapse
|
5
|
Santos LP, Calixto-Lima L, de Oliveira LC, Wiegert EVM. Nutritional support in palliative cancer care: quality of life in oral versus tube feeding. BMJ Support Palliat Care 2023:spcare-2023-004445. [PMID: 37827822 DOI: 10.1136/spcare-2023-004445] [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: 06/19/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Nutritional support (NS) offered through oral nutritional supplements (ONS) or enteral nutrition (EN) and its impact on quality of life (QoL) is a controversial topic in patients with cancer receiving palliative care (PC). AIMS To compare the QoL of patients without and with use of NS, including ONS or EN in patients with incurable cancer receiving PC. METHODS Cross-sectional analysis with patients that were evaluated at PC Unit between June 2021 and February 2023. QoL was assessed using the Quality of Life Questionnaire Core 15. Patients were classified into three groups according to the NS: ONS (n=72; 33%), EN (n=61; 28%) and control group (CG) (n=87; 39%), the last one being formed by patients not using NS. Adjusted logistic regression models were used to verify the association of the domains of QoL with the type of NS. RESULTS A total of 220 patients were included, with a median age of 64 (58-70) years, predominantly male (54.1%). The EN group had worse scores in physical function when compared with the ONS group (p=0.037) and appetite loss when compared with the CG (p=0.013). The ONS (OR: 2.70; 95% CI 1.32 to 5.49) and EN groups (OR: 2.61; 95% CI 1.24 to 5.49) were independently associated with a higher chance of presenting appetite loss in relation to the CG. CONCLUSION In general, there was no difference in the QoL of patients using NS when compared with patients not using NS. However, patients using NS have more chance of having appetite loss.
Collapse
Affiliation(s)
| | - Larissa Calixto-Lima
- Palliative Care Unit, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | |
Collapse
|
6
|
Aryal S, Bachman SL, Lyden K, Clay I. Measuring What Is Meaningful in Cancer Cachexia Clinical Trials: A Path Forward With Digital Measures of Real-World Physical Behavior. JCO Clin Cancer Inform 2023; 7:e2300055. [PMID: 37851933 PMCID: PMC10642875 DOI: 10.1200/cci.23.00055] [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: 04/03/2023] [Revised: 08/23/2023] [Accepted: 09/05/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE The burden of cancer cachexia on patients' health-related quality of life, specifically their physical functioning, is well documented, but clinical trials thus far have failed to show meaningful improvement in physical functioning. The purpose of this review is to summarize existing methods of assessing physical function in cancer cachexia, outline a path forward for measuring what is meaningful to patients using digital measures derived from digital health technologies (DHTs), and discuss the current landscape of digital measures from the clinical and regulatory standpoint. DESIGN For this narrative review, peer-reviewed articles were searched on PubMed, clinical trials records were searched on clinicaltrials.gov, and records of digital measures submitted for regulatory qualification were searched on the US Food and Drug Administration's Drug Development Tool Qualification Program database. RESULTS There are gaps in assessing aspects of physical function that matter to patients. Existing assessment methods such as patient-reported outcomes and objective performance outcomes have limitations, including their episodic nature and burden to patients. DHTs such as wearable sensors can capture real-world physical behavior continuously, passively, and remotely, and may provide a more comprehensive picture of patients' everyday functioning. Recent regulatory submissions showcase potential clinical implementation of digital measures in various therapeutic areas. CONCLUSION Digital measures of real-world physical behavior present an opportunity to detect and demonstrate improvements in physical functioning in cancer cachexia, but evidence-based development is critical. For their use in clinical and regulatory decision making, studies demonstrating meaningfulness to patients as well as feasibility and validation are necessary.
Collapse
|
7
|
Blum D, Vagnildhaug OM, Stene GB, Maddocks M, Sørensen J, Laird BJA, Prado CM, Skeidsvoll Solheim T, Arends J, Hopkinson J, Jones CA, Schlögl M. Top Ten Tips Palliative Care Clinicians Should Know About Cachexia. J Palliat Med 2023; 26:1133-1138. [PMID: 36723498 DOI: 10.1089/jpm.2022.0598] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Cachexia is a multifactorial syndrome that is common in cancer and chronic disease. It is often underdiagnosed and therefore goes untreated or undertreated. Cachexia causes suffering across biopsychosocial domains and affects patients and their loved ones. In this article, a group of clinicians and researchers across cancer care, nutrition, and exercise offers tips about assessment, classification, and management of cachexia, with attention to its stage. The required multimodal management of cachexia mirrors well the interprofessional collaboration that is the mainstay of interdisciplinary palliative care and attention to screening, diagnosis, and management of cachexia is critical to maximize patients' quality of life.
Collapse
Affiliation(s)
- David Blum
- Competence Center for Palliative Care, Department of Radiation Oncology, University Hospital Zurich, and University of Zurich UZH, Zurich, Switzerland
| | - Ola Magne Vagnildhaug
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology and Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Guro Birgitte Stene
- Faculty of Medicine and Health Science, Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Jonas Sørensen
- Department of Biomedical Sciences, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Oncology, Centre for Cancer and Organ Diseases, Rigshospitalet, Denmark
| | - Barry J A Laird
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom
| | - Carla M Prado
- Division of Human Nutrition, Department of Agricultural, Food and Nutritional Science, University of Alberta, Alberta, Canada
| | - Tora Skeidsvoll Solheim
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Faculty of Medicine and Health Sciences, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jann Arends
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jane Hopkinson
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mathias Schlögl
- Division of Geriatric Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| |
Collapse
|
8
|
Herodes M, Anderson LJ, Shober S, Schur EA, Graf SA, Ammer N, Salas R, Marcelli M, Garcia JM. Pilot clinical trial of macimorelin to assess safety and efficacy in patients with cancer cachexia. J Cachexia Sarcopenia Muscle 2023; 14:835-846. [PMID: 36860137 PMCID: PMC10067502 DOI: 10.1002/jcsm.13191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 01/05/2023] [Accepted: 01/22/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Cancer cachexia is associated with reduced body weight, appetite and quality of life (QOL) with no approved treatments. Growth hormone secretagogues like macimorelin have potential to mitigate these effects. METHODS This pilot study assessed the safety and efficacy of macimorelin for 1 week. Efficacy was defined a priori as 1-week change in body weight (≥0.8 kg), plasma insulin-like growth factor (IGF)-1 (≥50 ng/mL) or QOL (≥15%). Secondary outcomes included food intake, appetite, functional performance, energy expenditure and safety laboratory parameters. Patients with cancer cachexia were randomized to 0.5 or 1.0 mg/kg macimorelin or placebo; outcomes were assessed non-parametrically. RESULTS Participants receiving at least one of either macimorelin dose were combined (N = 10; 100% male; median age = 65.50 ± 2.12) and compared with placebo (N = 5; 80% male; median age = 68.00 ± 6.19). Efficacy criteria achieved: body weight (macimorelin N = 2; placebo N = 0; P = 0.92); IGF-1 (macimorelin N = 0; placebo N = 0); QOL by Anderson Symptom Assessment Scale (macimorelin N = 4; placebo N = 1; P = 1.00) or Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F; macimorelin N = 3; placebo N = 0; P = 0.50). No related serious or non-serious adverse events were reported. In macimorelin recipients, change in FACIT-F was directly associated with change in body weight (r = 0.92, P = 0.001), IGF-1 (r = 0.80, P = 0.01), and caloric intake (r = 0.83, P = 0.005), and inversely associated with change in energy expenditure (r = -0.67, P = 0.05). CONCLUSIONS Daily oral macimorelin for 1 week was safe and numerically improved body weight and QOL in patients with cancer cachexia compared with placebo. Longer term administration should be evaluated for mitigation of cancer-induced reductions in body weight, appetite and QOL in larger studies.
Collapse
Affiliation(s)
- Megan Herodes
- Division of Gerontology and Geriatric Medicine, School of MedicineUniversity of WashingtonSeattleWAUSA
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWAUSA
| | - Lindsey J. Anderson
- Division of Gerontology and Geriatric Medicine, School of MedicineUniversity of WashingtonSeattleWAUSA
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWAUSA
| | - Samuel Shober
- Division of Gerontology and Geriatric Medicine, School of MedicineUniversity of WashingtonSeattleWAUSA
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWAUSA
| | - Ellen A. Schur
- Division of General Internal Medicine, Department of MedicineUniversity of WashingtonSeattleWAUSA
| | - Solomon A. Graf
- Hospital and Specialty MedicineVeterans Affairs Puget Sound Health Care SystemSeattleWAUSA
- Division of Medical Oncology, Department of MedicineUniversity of WashingtonSeattleWAUSA
- Clinical Research DivisionFred Hutchinson Cancer CenterSeattleWAUSA
| | - Nicola Ammer
- Department of Clinical DevelopmentAeterna Zentaris GmbHFrankfurtGermany
| | - Ramiro Salas
- Departments of Psychiatry and NeuroscienceBaylor College of MedicineHoustonTXUSA
- The Menninger ClinicHoustonTXUSA
- Center for Translational Research on Inflammatory DiseasesMichael E. DeBakey Veterans Affairs Medical CenterHoustonTXUSA
| | - Marco Marcelli
- Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center; Department of Medicine, Endocrinology, Diabetes and MetabolismBaylor College of MedicineHoustonTXUSA
| | - Jose M. Garcia
- Division of Gerontology and Geriatric Medicine, School of MedicineUniversity of WashingtonSeattleWAUSA
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWAUSA
| |
Collapse
|
9
|
Paschos S, Lize N, Eussen S, van der Padt-Pruijsten A, van den Beuken-van Everdingen M, van Laarhoven H, den Boer M, de Graeff A, van den Borne B, Ten Have H, Kennis M, Beijer S, Raijmakers NJH, van de Poll-Franse L. Are gastrointestinal problems, nutritional care, and nutritional care needs associated with quality of life in patients with advanced cancer? Results of the observational eQuiPe study. Support Care Cancer 2023; 31:189. [PMID: 36847908 DOI: 10.1007/s00520-023-07646-1] [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: 08/26/2022] [Accepted: 02/15/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE To assess the association of gastrointestinal problems, received nutritional care, and nutritional care needs with quality of life (QoL) in patients with advanced cancer. METHODS A cross-sectional analysis within the observational prospective eQuiPe cohort study on experienced quality of care and QoL in patients with advanced cancer was performed. QoL and gastrointestinal problems were measured using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-C30. Received nutritional care (yes/no) and nutritional care needs (yes/a little bit/no) were measured by two questions. Gastrointestinal problems were categorized as clinically important based on the Giesinger thresholds. Univariable and multivariable linear regression analyses adjusted for age, gender, and treatment were used to analyze the association of gastrointestinal problems, received nutritional care, and nutritional care needs with QoL. RESULTS Half of the 1080 patients with advanced cancer had clinically important gastrointestinal problems, 17% experienced nutritional care needs, and 14% received nutritional care. Multivariable analyses revealed that the presence of clinically important gastrointestinal problems (β (95% CI): -13.0 (-15.6; -10.4)), received nutritional care (β (95% CI): -5.1 (-8.5; -1.7)), and nutritional care needs (β (95% CI): -8.7 (-11.9; -5.5)) were associated with a low QoL. CONCLUSION Many patients with advanced cancer experience gastrointestinal problems, while only few patients receive nutritional care. These gastrointestinal problems, nutritional care needs, and nutritional care are associated with lower QoL, probably due to reversed causality or the irreversible nature of these problems in the palliative phase. More research on the relation of nutritional care, gastrointestinal problems, and QoL is needed to optimize nutritional support in end-of-life care.
Collapse
Affiliation(s)
- Savvas Paschos
- Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501DB, Utrecht, the Netherlands
| | - Nora Lize
- Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501DB, Utrecht, the Netherlands
| | - Simone Eussen
- Department of Epidemiology of the Faculty of Health, Medicine and Life Sciences, School for Cardiovascular Diseases (CARIM) and Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | | | | | - Hanneke van Laarhoven
- Amsterdam University Medical Centers, Department of Medical Oncology, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Alexander de Graeff
- Department of Medical Oncology, UMC Utrecht Medical Center, Utrecht, the Netherlands
| | - Ben van den Borne
- Department of Pulmonology, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Marjolanda Kennis
- Institution Verbeeten, Tilburg, the Netherlands
- General Practice Klein Vlijmen, Vlijmen, the Netherlands
| | - Sandra Beijer
- Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501DB, Utrecht, the Netherlands
| | - Natasja J H Raijmakers
- Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501DB, Utrecht, the Netherlands.
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands.
| | - Lonneke van de Poll-Franse
- Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501DB, Utrecht, the Netherlands
- Netherlands Cancer Institute, Amsterdam, the Netherlands
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| |
Collapse
|
10
|
Lize N, Raijmakers N, van den Berg M, Emmaneel L, Kok A, Lagendijk M, van Leeuwen-Bouwhuis K, van Lieshout R, Nagel Z, Beijer S. Patients with cancer experience high impact of emotional consequences of reduced ability to eat: A cross sectional survey study. Eur J Cancer Care (Engl) 2022; 31:e13595. [PMID: 35474252 DOI: 10.1111/ecc.13595] [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: 06/18/2021] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Patients with cancer can experience emotional consequences of reduced ability to eat, their impact is unknown. This study assesses the impact of these emotional consequences, and patients' satisfaction with healthcare professionals' (HCPs) support. METHODS A cross-sectional survey was conducted among patients with head/neck, lung cancer and lymphoma, who experienced reduced ability to eat in the past year. Patients were recruited through patient organisations and hospitals. The questionnaire encompassed the impact of emotional consequences of reduced ability to eat (scale 1-10) and satisfaction with HCPs' support for reduced ability to eat (scale 1-10). The differences in patient characteristics between unsatisfied (Score < 6) and satisfied patients (score ≥6) were tested using independent t-tests and the chi-square or Fishers' exact tests. RESULTS Overall, 116 patients (48%) responded and 98 were included in the analyses. The most impactful emotional consequences were as follows: disappointment (mean ± SD: 8.31 ± 1.49), grief/sadness (7.90 ± 1.91), and anger (7.87 ± 1.41). Patients were less satisfied when more time had passed since their diagnosis (p < 0.002) and when they expected no improvements regarding their eating problems (p < 0.001). CONCLUSION The impact of emotional consequences of reduced ability to eat is high. Support for emotional consequences is needed, especially for patients with reduced ability to eat, which persists in recovery and remission.
Collapse
Affiliation(s)
- Nora Lize
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Natasja Raijmakers
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Netherlands Association for Palliative Care, Utrecht, The Netherlands
| | | | | | - Annemieke Kok
- University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | | | | | - Zola Nagel
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Sandra Beijer
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| |
Collapse
|
11
|
van Lieshout R, Lize N, Tick LW, van Deursen J, Driessen E, Janssen T, Custers S, Kranenburg S, van der Lee D, Koene HR, Beckers EAM, Schouten HC, Beijer S. Nutrition-related problems, nutritional support practices and barriers to adherence to nutritional guidelines during intensive treatment for acute myeloid leukemia: Patients' and hematology nurses' perspectives and experiences. Clin Nutr ESPEN 2022; 48:446-455. [PMID: 35331527 DOI: 10.1016/j.clnesp.2021.12.029] [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: 06/11/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS The updated guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) and for Blood and Marrow Transplantation (EBMT) on nutrition in intensively treated acute myeloid leukemia (AML) patients recommend enteral nutrition (EN) instead of parenteral nutrition (PN) as the first-choice medical nutrition therapy. Despite this, PN remains the preferred route of nutrition administration in daily practice. The aim of this qualitative study was to gain insight into the patients' and hematology nurses' experiences and perceptions regarding nutritional problems and nutritional support and the reasons for the low adherence to the ESPEN/EBMT guidelines. METHODS Semi-structured interviews were conducted in 23 patients from various Dutch hospitals who had completed intensive AML treatment. Interviews with 22 patients were audio-recorded and transcribed, one interview was summarized. The transcripts and summary were thematically analyzed using Atlas.ti. From each of the 22 Dutch hospitals providing intensive AML treatment, one hematology nurse participated in a telephone questionnaire survey. The results of this survey are presented in a descriptive way. RESULTS Nutritional problems were a major source of distress in most participating patients. Nutritional support often led to peace of mind and less concerns, provided that there were no conflicting nutritional support practices among treating hospitals. Patients perceived PN and EN as a life-line and necessary for the prevention of or recovery from physical decline, but they also experienced loss of independence, limited mobility, fear of unwanted body weight gain and problems related to the feeding equipment. Both patients and hematology nurses regarded PN as an easy method of nutrition administration, while EN was often seen as a necessary evil or was even refused by patients, owing to tube-related physical discomfort and EN intolerance. Both patients' and hematology nurses' reluctance to administer EN proved to be barriers to the ESPEN/EBMT nutritional guideline adherence. Among the surveyed hematology nurses, barriers to adherence included personal factors related to their knowledge (lack of awareness) and attitudes (negative outcome expectancy and lack of agreement), guideline-related factors (lack of evidence) and external factors (lack of collaboration). CONCLUSION Individualized nutritional support, including EN and PN, may reduce nutrition-related distress in intensively treated AML patients, provided that conflicting nutritional support practices among hospitals are avoided or explained. The barriers to adherence to the ESPEN/EBMT guidelines on EN and PN in this patient group may be reduced by enhancing hematology nurses' awareness and knowledge of the guidelines, incorporating the guidelines into multidisciplinary clinical pathways, improving outcome of EN by proper triage of patients eligible for EN and increasing the level of evidence of the guidelines.
Collapse
Affiliation(s)
- Rianne van Lieshout
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands.
| | - Nora Lize
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands
| | - Lidwine W Tick
- Department of Internal Medicine, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Judith van Deursen
- Department of Internal Medicine, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Eline Driessen
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Tina Janssen
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Stephanie Custers
- Department of Dietetics and Nutrition, P. Debyelaan 25, 6229 HX, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Suzanne Kranenburg
- Department of Dietetics and Nutrition, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - Debbie van der Lee
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Harry R Koene
- Department of Internal Medicine, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - Erik A M Beckers
- Department of Internal Medicine, Division Hematology, P. Debyelaan 25, 6229 HX, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Harry C Schouten
- Department of Internal Medicine, Division Hematology, P. Debyelaan 25, 6229 HX, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sandra Beijer
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands
| |
Collapse
|
12
|
Sato R, Naito T, Hayashi N. Barriers in Nursing Practice in Cancer Cachexia: A Scoping Review. Asia Pac J Oncol Nurs 2021; 8:498-507. [PMID: 34527779 PMCID: PMC8420920 DOI: 10.4103/apjon.apjon-2152] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/08/2021] [Indexed: 01/06/2023] Open
Abstract
This scoping review aims to identify the barriers in practice and clinical trials for oncology nurses in cancer cachexia. We used the framework proposed by Arksey and O'Malley and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Studies written in English and published between 2008 and 2021 were retrieved from five databases: MEDLINE, Cochrane Library, CINAHL, PsycINFO, and EMBASE. A total of 1075 studies were identified, and 34 full-text studies were assessed for eligibility by three researchers. Seventeen studies met the inclusion criteria. This review revealed several barriers to nursing practice and clinical trials in cancer cachexia. First, health-care professionals, including nurses, faced individual barriers (insufficient understanding and skills for diagnosis and management) and environmental barriers (lack of standardized screening tools or treatment options, difficulties in collaboration with other professions, and limited human resources) in practice. Second, studies on nurse-led interventions for cancer cachexia were relatively few and different in objectives, making it challenging to integrate the outcomes. Finally, there were no established educational programs for nurses that explicitly focused on cancer cachexia. This scoping review revealed individual and environmental barriers in nursing practice. In addition, there have relatively few clinical trials involving oncology nurses in cancer cachexia. Continuing education for nurses should cover cancer cachexia to improve the quality of oncology care in the future. It is also necessary to standardize practical assessment tools that are easy to assess daily and lead to interventions and develop nurse-led multidisciplinary care.
Collapse
Affiliation(s)
- Rika Sato
- Division of Nursing, Shizuoka Cancer Center, Shizuoka, Japan.,Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Naoko Hayashi
- Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
| |
Collapse
|
13
|
Experiences of patients with cancer with information and support for psychosocial consequences of reduced ability to eat: a qualitative interview study. Support Care Cancer 2021; 29:6343-6352. [PMID: 33880638 DOI: 10.1007/s00520-021-06217-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Patients with cancer may experience emotions such as anger or sadness due to tumour- or treatment-related reduced ability to eat. These emotions can be provoked by patients' own struggle with eating, by misunderstanding of their struggle by others, or by less pleasure in social activities. Literature indicates that patients with cancer may experience a lack of information and support regarding psychosocial consequences of reduced ability to eat. The aim of this qualitative study is to gain insights into experiences with this information and support. METHOD Transcripts of semi-structured interviews with 24 patients with cancer who experience(d) psychosocial consequences of reduced ability to eat were thematically analysed. Interviews were recorded, transcribed verbatim, and analysed using Atlas.ti. RESULTS Patients expressed positive experiences with information and support for psychosocial consequences of reduced ability to eat while receiving multidisciplinary recognition and personalised care. Patients expressed negative experiences when healthcare professionals only assessed topics within their own expertise, or when healthcare professionals mainly focused on their nutritional intake. Informal support for reduced ability to eat was positively evaluated when informal caregivers tried to understand their situation. Evaluation of informal practical support varied among patients. CONCLUSION Patients with cancer who experience psychosocial consequences of reduced ability to eat both need professional and informal support. Recognition of these consequences from healthcare professionals is important, as well as understanding from informal caregivers.
Collapse
|
14
|
Psychosocial consequences of a reduced ability to eat for patients with cancer and their informal caregivers: A qualitative study. Eur J Oncol Nurs 2020; 49:101838. [DOI: 10.1016/j.ejon.2020.101838] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/29/2020] [Accepted: 09/16/2020] [Indexed: 12/11/2022]
|
15
|
Nutrition support for treating cancer-associated weight loss: an update. Curr Opin Support Palliat Care 2018; 12:434-438. [DOI: 10.1097/spc.0000000000000383] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
16
|
Maricelli JW, Bishaw YM, Wang B, Du M, Rodgers BD. Systemic SMAD7 Gene Therapy Increases Striated Muscle Mass and Enhances Exercise Capacity in a Dose-Dependent Manner. Hum Gene Ther 2018; 29:390-399. [DOI: 10.1089/hum.2017.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Joseph W. Maricelli
- School of Molecular Biosciences, Washington State University, Pullman, Washington
- Washington Center for Muscle Biology, Washington State University, Pullman, Washington
| | - Yemeserach M. Bishaw
- School of Molecular Biosciences, Washington State University, Pullman, Washington
- Washington Center for Muscle Biology, Washington State University, Pullman, Washington
| | - Bo Wang
- Washington Center for Muscle Biology, Washington State University, Pullman, Washington
| | - Min Du
- Washington Center for Muscle Biology, Washington State University, Pullman, Washington
| | - Buel D. Rodgers
- Washington Center for Muscle Biology, Washington State University, Pullman, Washington
- AAVogen, Inc., Rockville, Maryland
| |
Collapse
|
17
|
Parmar MP, Vanderbyl BL, Kanbalian M, Windholz TY, Tran AT, Jagoe RT. A multidisciplinary rehabilitation programme for cancer cachexia improves quality of life. BMJ Support Palliat Care 2017; 7:441-449. [DOI: 10.1136/bmjspcare-2017-001382] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/06/2017] [Accepted: 07/19/2017] [Indexed: 12/28/2022]
|
18
|
Wheelwright SJ, Hopkinson JB, Darlington AS, Fitzsimmons DF, Fayers P, Balstad TR, Bredart A, Hammerlid E, Kaasa S, Nicolatou-Galitis O, Pinto M, Schmidt H, Solheim TS, Strasser F, Tomaszewska IM, Johnson CD. Development of the EORTC QLQ-CAX24, A Questionnaire for Cancer Patients With Cachexia. J Pain Symptom Manage 2017; 53:232-242. [PMID: 27810567 DOI: 10.1016/j.jpainsymman.2016.09.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/26/2016] [Accepted: 09/06/2016] [Indexed: 12/12/2022]
Abstract
CONTEXT Cachexia is commonly found in cancer patients and has profound consequences; yet there is only one questionnaire that examines the patient's perspective. OBJECTIVE To report a rigorously developed module for patient self-reported impact of cancer cachexia. METHODS Module development followed published guidelines. Patients from across the cancer cachexia trajectory were included. In Phase 1, health-related quality of life (HRQOL) issues were generated from a literature review and interviews with patients in four countries. The issues were revised based on patient and health care professional (HCP) input. In Phase 2, questionnaire items were formulated and translated into the languages required for Phase 3, the pilot phase, in which patients from eight countries scored the relevance and importance of each item, and provided qualitative feedback. RESULTS A total of 39 patients and 12 HCPs took part in Phase 1. The literature review produced 68 HRQOL issues, with 22 new issues arising from the patient interviews. After patient and HCP input, 44 issues were formulated into questionnaire items in Phase 2. One hundred ten patients took part in Phase 3. One item was reworded, and 20 items were deleted as a consequence of patient feedback. CONCLUSIONS The QLQ-CAX24 is a cancer cachexia-specific questionnaire, comprising 24 items, for HRQOL assessment in clinical trials and practice. It contains five multi-item scales (food aversion, eating and weight-loss worry, eating difficulties, loss of control, and physical decline) and four single items.
Collapse
Affiliation(s)
| | - Jane B Hopkinson
- Cardiff School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | | | - Peter Fayers
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Trude R Balstad
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Bredart
- Institut Curie, Paris, France; University Paris Descartes, Paris, France
| | - Eva Hammerlid
- Department of Otolaryngology Head & Neck Surgery, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Monica Pinto
- Istituto Nazionale Tumori "Fondazione Giovanni Pascale" - IRCCS, Naples, Italy
| | - Heike Schmidt
- Institute of Health and Nursing Sciences, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Tora S Solheim
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Cracow, Poland
| | | | | |
Collapse
|
19
|
Wheelwright S, Darlington AS, Hopkinson JB, Fitzsimmons D, Johnson C. A systematic review and thematic synthesis of quality of life in the informal carers of cancer patients with cachexia. Palliat Med 2016; 30:149-60. [PMID: 26024885 DOI: 10.1177/0269216315588743] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Informal carers of cancer patients with cachexia face additional challenges to those encountered by informal carers in general because of the central role food and eating play in everyday life. Patient weight loss and anorexia, core features of cancer cachexia, are frequent causes of distress in caregivers. Identification of quality of life issues can inform the development of interventions for both caregivers and patients and facilitate communication with healthcare professionals. AIM To identify quality of life issues that are relevant to carers of cancer patients with cachexia. DESIGN A systematic review and thematic synthesis of the qualitative literature were conducted. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES PubMed, ISI Web of Knowledge, EMBASE, MEDLINE, CINAHL, PsycINFO and PsycARTICLES were searched for publications dated from January 1980 to February 2015 using search terms relating to cancer, cachexia, quality of life and carers. Papers written in the English language, featuring direct quotes from the carers of adult patients with any cancer diagnosis and cachexia or problems with weight loss or anorexia, were included. RESULTS Five themes were extracted from the 16 identified studies. These highlighted the impact on everyday life, the attempts of some carers to take charge, the need for healthcare professional's input, conflict with the patient and negative emotions. CONCLUSION The complexity of caring for a cancer patient with cachexia translates into a range of problems and experiences for informal carers. By addressing the impact of caring for a patient with cancer cachexia on carers, both caregiver and patient quality of life may improve.
Collapse
Affiliation(s)
- Sally Wheelwright
- Cancer Sciences, University of Southampton, Southampton, UK University Surgical Unit (MP 816), Southampton General Hospital, Southampton, UK
| | | | - Jane B Hopkinson
- Cardiff School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Colin Johnson
- Cancer Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
20
|
Cooper C, Burden ST, Cheng H, Molassiotis A. Understanding and managing cancer-related weight loss and anorexia: insights from a systematic review of qualitative research. J Cachexia Sarcopenia Muscle 2015; 6:99-111. [PMID: 26136417 PMCID: PMC4435102 DOI: 10.1002/jcsm.12010] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/10/2014] [Accepted: 10/31/2014] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to summarize the existing qualitative literature in order to develop the evidence base for understanding and managing weight loss and anorexia, in order to make recommendations for clinical practice. A systematic search was performed to retrieve English language studies using electronic search and manual checks of selected reference lists. Keywords included qualitative, cancer cachexia, weight loss, anorexia, appetite, malnutrition, food, eating, and drinking. The selection and appraisal of papers were undertaken by two reviewers. Twenty-one qualitative articles were included in the review. There were three major findings emerging from the previous qualitative studies including 'the multidimensionality of weight loss and anorexia experience', 'patients and caregivers' responses to coping with weight loss and anorexia', and 'clinical assessment and management of weight loss and anorexia'. The literature review revealed the multidimensional nature of cachexia and weight loss experience by patients and caregivers, which was not recognized and adequately managed by healthcare professionals. Future research in this area would be helpful in enabling a deeper understanding of the complexity of cachexia and weight loss experience in order to move forward to develop an optimal model of supportive care for patients and caregivers.
Collapse
Affiliation(s)
- Christine Cooper
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Sorrel T Burden
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Huilin Cheng
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Alex Molassiotis
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.,School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| |
Collapse
|