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McHale C, Cruickshank S, Brown T, Torrens C, Armes J, Fenlon D, Banks E, Kelsey T, Humphris G. Mini-AFTERc: a controlled pilot trial of a nurse-led psychological intervention for fear of breast cancer recurrence. Pilot Feasibility Stud 2024; 10:3. [PMID: 38191445 PMCID: PMC10773079 DOI: 10.1186/s40814-023-01431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES To determine the feasibility and acceptability of implementing the Mini-AFTERc intervention. DESIGN Non-randomised cluster-controlled pilot trial. SETTING Four NHS out-patient breast cancer centres in Scotland. PARTICIPANTS Ninety-two women who had successfully completed primary treatment for breast cancer were screened for moderate levels of fear of cancer recurrence (FCR). Forty-five were eligible (17 intervention and 28 control) and 34 completed 3-month follow-up (15 intervention and 21 control). INTERVENTION Mini-AFTERc, a single brief (30 min) structured telephone discussion with a specialist breast cancer nurse (SBCN) trained to target the antecedents of FCR. OUTCOMES Feasibility and acceptability of Mini-AFTERc and the study design were assessed via recruitment, consent, retention rates, patient outcomes (measured at baseline, 2, 4, and 12 weeks), and post-study interviews with participants and SBCNs, which were guided by Normalisation Process Theory. RESULTS Mini-AFTERc was acceptable to patients and SBCNs. SBCNs believe the implementation of Mini-AFTERc to be feasible and an extension of discussions that already happen routinely. SBCNs believe delivery, however, at the scale required would be challenging given current competing demands for their time. Recruitment was impacted by variability in the follow-up practices of cancer centres and COVID-19 lockdown. Consent and follow-up procedures worked well, and retention rates were high. CONCLUSIONS The study provided invaluable information about the potential challenges and solutions for testing the Mini-AFTERc intervention more widely where limiting high FCR levels is an important goal following recovery from primary breast cancer treatment. TRIAL REGISTRATION ClinicalTrials.gov, NCT0376382 . Registered on 4 December 2018.
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Affiliation(s)
- Calum McHale
- Medical School, North Haugh, University of St Andrews, St Andrews, Fife, KY16 9TF, UK
| | | | | | | | - Jo Armes
- University of Surrey, Guildford, Surrey, UK
| | | | - Elspeth Banks
- Independent Cancer Patients' Voice, Carluke, Scotland, UK
| | - Tom Kelsey
- Computer Science, North Haugh, University of St Andrews, St Andrews, Fife, KY16 9TF, UK
| | - Gerald Humphris
- Medical School, North Haugh, University of St Andrews, St Andrews, Fife, KY16 9TF, UK.
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Sawma T, Choueiri P. The influence of family functioning on the severity of fear of cancer recurrence: A cross-sectional study in a sample of breast cancer survivors of Lebanese women. Eur J Oncol Nurs 2022; 60:102169. [DOI: 10.1016/j.ejon.2022.102169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/06/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022]
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Sasaki Y, Honyashiki M, Kinoshita T, Matsui A, Nakashoji A, Inagawa T, Ikezawa S, Yoshimura N, Yamamura R, Amano M, Tomo Y, Tachimori H, Matsuoka YJ, Okubo R. Perilla Oil and Bifidobacterium for Alleviating Fear of Cancer Recurrence in Breast Cancer Survivors: Study Protocol for a Three-Arm Phase II Randomized Controlled Study (POB Study). Methods Protoc 2021; 4:mps4030046. [PMID: 34287371 PMCID: PMC8293445 DOI: 10.3390/mps4030046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022] Open
Abstract
The fear of cancer recurrence (FCR) is the most common and most severe unmet need among cancer survivors. Safe treatments for the FCR that are easily disseminated are greatly needed. Our primary aim is a preliminary evaluation of the efficacy and effect size of perilla oil, which is rich in omega-3 fatty acids, and Bifidobacterium, a probiotic, on FCR in breast cancer survivors after the completion of chemotherapy. This study has been planned as an exploratory clinical study (phase II) and will be conducted as a three-arm, 12-week parallel group, masked-rater randomized controlled trial. Fifteen participants will be randomized with 1:1:1 allocation to receive Bifidobacterium plus perilla oil, Bifidobacterium alone, or no intervention (control). Interventions will end within 12 weeks after the random allocation of each participant. The participants will be outpatients with invasive breast cancer aged 20 years or older whose chemotherapy was completed at least 6 months before registration; hormone therapy may be ongoing. The primary outcome will be severity of FCR at 12 weeks assessed by masked raters using the 4-item Concerns about Recurrence Scale concerning overall fear of recurrence. The study protocol for the current study is registered in the Japan Registry of Clinical Trials (jRCTs031200029).
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Affiliation(s)
- Yohei Sasaki
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan; (Y.S.); (Y.T.); (H.T.)
| | - Mina Honyashiki
- Department of Psychiatry, Tokyo Medical University, Tokyo 113-8510, Japan;
| | - Takayuki Kinoshita
- Department of Breast Surgery, National Hospital Organization Tokyo Medical Center, Tokyo 187-8551, Japan; (T.K.); (A.M.); (A.N.)
| | - Akira Matsui
- Department of Breast Surgery, National Hospital Organization Tokyo Medical Center, Tokyo 187-8551, Japan; (T.K.); (A.M.); (A.N.)
| | - Ayako Nakashoji
- Department of Breast Surgery, National Hospital Organization Tokyo Medical Center, Tokyo 187-8551, Japan; (T.K.); (A.M.); (A.N.)
| | - Takuma Inagawa
- Department of Psychiatry, National Center Hospital of Neurology and Psychiatry, Tokyo 187-8551, Japan; (T.I.); (S.I.); (N.Y.)
| | - Satoru Ikezawa
- Department of Psychiatry, National Center Hospital of Neurology and Psychiatry, Tokyo 187-8551, Japan; (T.I.); (S.I.); (N.Y.)
| | - Naoki Yoshimura
- Department of Psychiatry, National Center Hospital of Neurology and Psychiatry, Tokyo 187-8551, Japan; (T.I.); (S.I.); (N.Y.)
| | - Ryodai Yamamura
- Division of Biomedical Oncology, Institute for Genetic Medicine, Hokkaido University, Sapporo 060-0815, Japan;
| | | | - Yui Tomo
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan; (Y.S.); (Y.T.); (H.T.)
| | - Hisateru Tachimori
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan; (Y.S.); (Y.T.); (H.T.)
| | - Yutaka J. Matsuoka
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo 104-0045, Japan;
- Lifestyle Medicine, Cooperative Graduate Program, The Jikei University Graduate School of Medicine, Tokyo 105-8461, Japan
| | - Ryo Okubo
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan; (Y.S.); (Y.T.); (H.T.)
- Correspondence: ; Tel.: +81-42-341-2712 (ext. 5843)
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Liptrott SJ, Bee P, Lovell K. Providing Telephone-Based Support for Patients With Haematological Malignancies: A Qualitative Investigation of Expert Nurses. Can J Nurs Res 2021; 54:121-133. [PMID: 33934610 DOI: 10.1177/08445621211013231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Telephone-based interventions are frequently used to address cancer patient's needs, often delivered by nurses; however, little is known about nurses' opinions of such interventions. PURPOSE The objective of this study was to investigate expert nurses' perceptions of hemato-oncology patient's needs, use of telephone interventions providing support and symptom management and intervention acceptability from a service provider perspective. A qualitative study was undertaken with focus group and individual interview. Inductive and deductive data analysis was performed using Framework Analysis and the Theoretical Framework of Acceptability. RESULTS Two themes emerged: (1) perceived needs of haemato-oncology patients across the cancer trajectory - multifactorial influences, dynamic information needs, and continuity of care, (2) acceptability for nurses delivering interventions was determined by identification of need, agreed expectations and organisational support for the intervention. CONCLUSIONS Greater understanding of contextual factors for recipients and individuals delivering healthcare interventions may contribute to identification of potential barriers and facilitators to adoption in clinical practice.
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Affiliation(s)
| | - Penny Bee
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Shaw J, Kamphuis H, Sharpe L, Lebel S, Smith AB, Hulbert-Williams N, Dhillon HM, Butow P. Setting an International Research Agenda for Fear of Cancer Recurrence: An Online Delphi Consensus Study. Front Psychol 2021; 12:596682. [PMID: 33692719 PMCID: PMC7938308 DOI: 10.3389/fpsyg.2021.596682] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background Fear of cancer recurrence (FCR) is common amongst cancer survivors. There is rapidly growing research interest in FCR but a need to prioritize research to address the most pressing clinical issues and reduce duplication and fragmentation of effort. This study aimed to establish international consensus among clinical and academic FCR experts regarding priorities for FCR research. Methods Members of the International Psycho-oncology Society (IPOS) Fear of Cancer Recurrence Special Interest Group (FORwards) were invited to participate in an online Delphi study. Research domains identified in Round 1 were presented and discussed at a focus group (Round 2) to consolidate the domains and items prior to presentation in further survey rounds (Round 3) aimed at gaining consensus on research priorities of international significance. Results Thirty four research items were identified in Round 1 and 33 of the items were consolidated into six overarching themes through a focus group discussion with FCR experts. The 33 research items were presented in subsequent rounds of the delphi technique. Twenty one participants contributed to delphi round 1, 16 in round 2, and 25 and 29 participants for subsequent delphi rounds. Consensus was reached for 27 items in round 3.1. A further four research items were identified by panelists and included in round 3.2. After round 3.2, 35 individual research items were ratified by the panelists. Given the high levels of consensus and stability between rounds, no further rounds were conducted. Overall intervention research was considered the most important focus for FCR research. Panelists identified models of care that facilitate greater access to FCR treatment and evaluation of the effectiveness of FCR interventions in real world settings as the two research items of highest priority. Defining the mechanisms of action and active components across FCR/P interventions was the third highest priority identified. Conclusion The findings of this study outline a research agenda for international FCR research. Intervention research to identify models of care that increase access to treatment are based on a flexible approach based on symptom severity and can be delivered within routine clinical care were identified as research areas to prioritize. Greater understanding of the active components and mechanisms of action of existing FCR interventions will facilitate increased tailoring of interventions to meet patient need.
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Affiliation(s)
- Joanne Shaw
- Psycho-oncology Co-operative Research Group, Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Helen Kamphuis
- Psycho-oncology Co-operative Research Group, Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Louise Sharpe
- Faculty of Science, School of Psychology, The University of Sydney, NSW, Australia
| | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Allan Ben Smith
- Centre for Oncology Education and Research Translation (CONCERT), South Western Sydney Clinical School, Ingham Institute for Applied Medical Research, University of New South Wales, Sydney, NSW, Australia
| | - Nicholas Hulbert-Williams
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, United Kingdom
| | - Haryana Mary Dhillon
- Psycho-oncology Co-operative Research Group, Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Faculty of Science, School of Psychology, The University of Sydney, NSW, Australia.,Faculty of Science, Centre for Medical Psychology and Evidence-based Decision-making, The University of Sydney, NSW, Australia
| | - Phyllis Butow
- Psycho-oncology Co-operative Research Group, Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
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Abstract
BACKGROUND Interventions by specialist breast cancer nurses (SBCNs) aim to support women and help them cope with the impact of the disease on their quality of life. OBJECTIVES To assess the effects of individual interventions carried out by SBCNs on indicators of quality of life, anxiety, depression, and participant satisfaction. SEARCH METHODS In June 2020, we searched MEDLINE, Embase, CENTRAL (Trials only), Cochrane Breast Cancer Group's Specialist Register (CBCG SR), CINAHL, PsycINFO, World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and Clinicaltrials.gov. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of interventions carried out by SBCNs for women with breast cancer, which reported indicators of quality of life, anxiety, depression, and participant satisfaction. DATA COLLECTION AND ANALYSIS The certainty of the evidence was evaluated using the GRADE approach. A narrative description of the results including structured tabulation was carried out. MAIN RESULTS We included 14 RCTs involving 2905 women. With the exception of one study (women with advanced breast cancer), all the women were diagnosed with primary breast cancer. Mean age ranged from 48 to 64 years. Psychosocial nursing interventions compared with standard care for women with primary breast cancer Eight studies (1328 women, low-quality evidence) showed small improvements in general health-related quality of life or no difference in effect between nine weeks and 18 months. Six studies (897 women, low-quality evidence) showed small improvements in cancer-specific quality of life or no difference in effect between nine weeks and 18 months. Six studies (951 women, low-quality evidence) showed small improvements in anxiety and depression between nine weeks and 18 months. Two studies (320 women, low-quality evidence) measured satisfaction during survivorship; one study measured satisfaction only in the intervention group and showed high levels of satisfaction with care; the second study showed equal satisfaction with care in both groups at six months. Psychosocial nursing interventions compared with other supportive care interventions for women with primary breast cancer Two studies (351 women, very-low quality evidence) measured general health-related quality of life. One study reported that psychological morbidity reduced over the 12-month period; scores were consistently lower in women supported by SBCNs alone compared to support from a voluntary organisation. The other study reported that at six months, women receiving psychosocial support by either SBCNs or psychologists clinically improved from "higher levels of distress" to "lower levels of distress". One study (179 women, very-low quality evidence) showed no between-group differences on subscales at all time points up to six months measured using cancer-specific quality of life questionnaires. There were significant group-by-time changes in the global quality of life, nausea and vomiting, and systemic therapy side effects subscales, for women receiving psychosocial support by either SBCNs or psychologists at six months. There were improvements in other subscales over time in both groups. Systemic therapy side effects increased significantly in the psychologist group but not in the SBCN group. Sexual functioning decreased in both groups. Two studies (351 women, very-low quality evidence) measured anxiety and depression. One study reported that anxiety subscale scores and state anxiety scores improved over six months but there was no effect on depression subscale scores in the SBCN group compared to the psychologist group. There was no group-by-time interaction on the anxiety and depression or state anxiety subscales. The other study reported that anxiety and depression scores reduced over the 12-month post-surgery period in the SBCN group; scores were consistently lower in women supported by SBCNs compared to support from a voluntary organisation. SBCN-led telephone interventions delivering follow-up care compared with usual care for women with primary breast cancer Three studies (931 women, moderate-quality evidence) reported general health-related quality of life outcomes. Two studies reported no difference in psychological morbidity scores between SBCN-led follow-up care and standard care at 18 to 24 months. One trial reported no change in feelings of control scores between SBCN-led follow-up care and standard care at 12 months. Two studies (557 women, moderate-quality evidence) reported no between-group difference in cancer-specific quality of life at 18 to 24 months. A SBCN intervention conducted by telephone, as a point-of-need access to specialist care, did not change psychological morbidity compared to routine clinical review at 18 months. Scores for both groups on the breast cancer subscale improved over time, with lower scores at nine and 18 months compared to baseline. The adjusted mean differences between groups at 18 months was 0.7 points in favour of the SBCN intervention (P = 0.058). A second study showed no differences between groups for role and emotional functioning measured using cancer-specific quality of life questionnaires in a SBCN-led telephone intervention compared with standard hospital care, both with and without an educational group programme at 12 months. At 12 months, mean scores were 78.4 (SD = 16.2) and 77.7 (SD = 16.2) respectively for SBCN-led telephone and standard hospital follow-up. The 95% confidence interval difference at 12 months was -1.93 to 4.64. Three studies (1094 women, moderate-quality evidence) reported no between-group difference in anxiety between 12 and 60 months follow-up. One of these studies also measured depression and reported no difference in depression scores between groups at five years (anxiety: RR 1.8; 95% CI 0.6 to 5.1; depression: RR 1.7 95% CI 0.4 to 7.2). Four studies (1331 women, moderate-quality evidence) demonstrated high levels of satisfaction with SBCN-led follow-up care by telephone between 12 and 60 months. Psychosocial nursing interventions compared with usual care for women with advanced breast cancer One study (105 women, low-quality evidence) showed no difference in cancer-specific quality of life outcomes at 3 months. AUTHORS' CONCLUSIONS Evidence suggests that psychosocial interventions delivered by SBCNs for women with primary breast cancer may improve or are at least as effective as standard care and other supportive interventions, during diagnosis, treatment and survivorship. SBCN-led telephone follow-up interventions were equally as effective as standard care, for women with primary breast cancer.
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Affiliation(s)
- Tamara Brown
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Susanne Cruickshank
- Applied Health Research, The Royal Marsden, The Royal Marsden NHS Foundation Trust, London, UK
| | - Maria Noblet
- Breast Unit, Queen Alexandra Hospital, Cosham, UK
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Brandt NG, McHale CT, Humphris GM. Development and Testing of a Novel Measure to Assess Fidelity of Implementation: Example of the Mini-AFTERc Intervention. Front Psychol 2020; 11:601813. [PMID: 33324299 PMCID: PMC7723987 DOI: 10.3389/fpsyg.2020.601813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Fidelity of implementation (FOI) reflects whether an intervention was implemented in clinical practice according to the originally developed manual and is a key aspect in understanding intervention effectiveness. To illustrate this process of developing a fidelity measure, this study uses the Mini-AFTERc, a brief psychological intervention aimed at managing breast cancer patients' fear of cancer recurrence, as an example. OBJECTIVES To illustrate the development of an FOI measure through (1) applying this process to the Mini-AFTERc intervention, by including the design of a scoring system and rating criteria; (2) content validating the FOI measure using thematic framework analysis as a qualitative approach; (3) testing consistency of the FOI measure using interrater reliability. METHODS The FOI measure was developed, its scoring system modified and the rating criteria defined. Thematic framework analysis was conducted to content validate the FOI measure using nine intervention discussions between four specialist cancer nurses and four breast cancer patients, and one simulated breast cancer patient. Intraclass-correlation was conducted to assess interrater reliability. RESULTS The qualitative findings suggested that the Mini-AFTERc FOI measure has content validity as it was able to measure all five components of the Mini-AFTERc intervention. The interrater reliability suggested a moderate to excellent degree of reliability among three raters, r ICC = 0.84, 95% CI [0.51, 0.96]. CONCLUSION The study has illustrated the steps that an FOI measure can be developed through a systematic approach applied to the Mini-AFTERc intervention. The FOI measure was found to have content validity and was consistently applied, independently, by three researchers familiar with the Mini-AFTERc intervention. Future studies should determine whether similar levels of interrater reliability can be obtained by distributing written and/or video instructions to researchers who are unfamiliar with the FOI measure, using a larger sample. Employing developed and validated FOI measures such as the one presented for the Mini-AFTERc would facilitate implementation of interventions in the FCR field in clinical practice as intended. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov, identifier: NCT03763825.
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Affiliation(s)
- Nathalie Georgia Brandt
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Calum Thomas McHale
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Gerald Michael Humphris
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, United Kingdom
- Edinburgh Cancer Centre, Western General Hospital, National Health Service Lothian, Edinburgh, United Kingdom
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