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Bilc MI, Pollmann N, Eisenmann C, Buchholz A, Pokhrel B, Lauche R, Cramer H. Yoga intervention for colorectal cancer survivors: a qualitative study exploring participants' expectations and experiences. Ann Med 2024; 56:2397571. [PMID: 39212243 DOI: 10.1080/07853890.2024.2397571] [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: 08/24/2023] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) survivors often struggle with side effects following treatment such as reduced quality of life, fatigue and psychological distress and need therefore efficient comprehensive interventions. The aim of this qualitative study was to explore CRC survivors' expectations before the yoga intervention as well as their unique experiences beyond those reported with standard questionnaires. METHODS Interpretative phenomenological approach was used in this qualitative study. Semi-structured interviews were conducted before and after a 10-week yoga program (90 min once a week, Hatha Yoga) with CRC survivors enrolled in a randomized controlled trial. Thematic analysis was used to uncover themes present in participants' accounts. RESULTS Nine patients participated in the interviews, mean interview duration was 27.49 min (SD = 7.71) before and 38.41 min (SD = 15.93) after the intervention. Our analysis identified following themes: (1) representations and expectations from the yoga intervention; (2) course structure and implementation; (3) perceptions and effects of the intervention; (4) differences between the study yoga intervention and other physical activities. The superordinate theme regarding effects of intervention included aspects of intervention at multiple levels such as emotional, physical, behavioral and spiritual. CONCLUSIONS This qualitative study provides valuable insight regarding CRC survivors' expectations and experiences following a 10-week yoga intervention. While expectations varied from skepticism to specific symptom improvement, the majority of participants had a positive, open attitude towards yoga. Consistent with participants' experiences, yoga may represent a promising intervention for CRC survivors if the groups' specific concerns are taken into account.
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Affiliation(s)
- Mirela-Ioana Bilc
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Nina Pollmann
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | | | - Analena Buchholz
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Bijay Pokhrel
- Medical Care Center of Recura Clinics, Beelitz-Heilstätten, Germany
| | - Romy Lauche
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
| | - Holger Cramer
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
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Ju A, Wiltink L, Walker J, White K, Rutherford C. Supportive care interventions for managing gastrointestinal symptoms following treatment for colorectal cancer: a systematic review. J Cancer Surviv 2024; 18:1640-1647. [PMID: 37280309 PMCID: PMC11424733 DOI: 10.1007/s11764-023-01403-3] [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: 12/05/2022] [Accepted: 05/09/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) is prevalent in the developed world, with unhealthy lifestyles and diet contributing to rising incidence. Advances in effective screening, diagnosis, and treatments have led to improved survival rates, but CRC survivors suffer poorer long-term gastrointestinal consequences than the general population. However, the current state of clinical practice around provision of health services and treatment options remains unclear. PURPOSE We aimed to identify what supportive care interventions are available to manage gastrointestinal (GI) symptoms for CRC survivors. METHODS We searched Cochrane Central Register of Controlled Trials, Embase, MEDLINE, PsycINFO, and CINAHL from 2000 to April 2022 for resources, services, programs, or interventions to address GI symptoms and functional outcomes in CRC. We extracted information about characteristics of supportive care interventions, the study design, and sample characteristics from included studies, and performed a narrative synthesis RESULTS: Of 3807 papers retrieved, seven met the eligibility criteria. Types of interventions for managing or improving GI symptoms included two rehabilitation, one exercise, one educational, one dietary, and one pharmacological. Pelvic floor muscle exercise may help to resolve GI symptoms more quickly in the post-operative recovery phase. Survivors may also benefit from rehabilitation programs through improved self-management strategies, especially administered soon after completing primary treatment. CONCLUSIONS/IMPLICATIONS FOR CANCER SURVIVORS Despite a high prevalence and burden of GI symptoms post-treatment, there is limited evidence for supportive care interventions to help manage or alleviate these symptoms. More, large-scale randomized controlled trials are needed to identify effective interventions for managing GI symptoms that occur post-treatment.
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Affiliation(s)
- Angela Ju
- School of Psychology, Sydney Quality of Life Office, The University of Sydney, Sydney, 2006, Australia.
| | - Lisette Wiltink
- School of Psychology, Sydney Quality of Life Office, The University of Sydney, Sydney, 2006, Australia
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jared Walker
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Kate White
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Cancer Care Research Unit (CCRU), The University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Claudia Rutherford
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Cancer Care Research Unit (CCRU), The University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
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Nguyen HTH, Nguyen OTK, Tran TN, Nguyen AC, Liamputtong P, Bui LK. The impacts of cancer treatment on lifestyle habits and mental health in Vietnamese women: an exploratory qualitative study. Support Care Cancer 2024; 32:654. [PMID: 39259391 DOI: 10.1007/s00520-024-08831-6] [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: 11/02/2023] [Accepted: 08/22/2024] [Indexed: 09/13/2024]
Abstract
AIMS This qualitative study explores the experiences of women after cancer treatment in terms of habit changes and mental health impact. METHOD The study involved 10 women who had undergone cancer treatment, recruited from three major hospitals in Hanoi, Vietnam. Data were collected through semi-structured interviews, which were transcribed and analyzed using thematic analysis. RESULTS The findings of the study shed light on the various factors influencing lifestyle behavior and mental health changes among women after cancer treatment. Ten participants, aged 39 to 64 years, shared experiences including dietary changes, sleep disruptions, and reliance on non-scientific sources for health decisions. Initially shocked by their diagnosis, many transitioned to acceptance, adopting a "giving-in" attitude. Cultural beliefs, word-of-mouth sharing, and social support networks played significant roles in shaping post-treatment lifestyle changes, coping mechanisms, information-seeking behaviors, and mental health. CONCLUSION The study highlights the need for accessible and scientifically verified information for women after cancer treatment to make informed decisions about their health. It emphasizes the importance of addressing traditional beliefs and promoting evidence-based practices. Moreover, the study underscores the importance of social support and relationships in coping with the challenges of post-cancer experiences.
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Affiliation(s)
- Huyen Thi Hoa Nguyen
- College of Health Sciences, VinUniversity, Hanoi, Vietnam.
- Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | | | - Tran Ngoc Tran
- College of Health Sciences, VinUniversity, Hanoi, Vietnam
| | | | - Pranee Liamputtong
- College of Health Sciences, VinUniversity, Hanoi, Vietnam
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Linh Khanh Bui
- College of Health Sciences, VinUniversity, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
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Naisby J, Baker K, Skarparis K, Murdoch J, Clark A, Stirling S, Turner D, Swart AM, Hernon J, Saxton J. The sustainability of exercise following colorectal surgery: A qualitative study of participants in the PREPARE-ABC trial. Clin Rehabil 2024:2692155241278936. [PMID: 39257057 DOI: 10.1177/02692155241278936] [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: 09/12/2024]
Abstract
OBJECTIVE This study aimed to explore perceptions regarding the sustainability of exercise following participation in a pre- and post-colorectal surgery exercise intervention trial (PREPARE-ABC). DESIGN Qualitative interview study. Data were analysed using framework analysis and independently coded by two researchers. SETTING Six United Kingdom National Health Service Trusts. PARTICIPANTS Eighteen interviews (hospital-based exercise n = 9, home-based exercise n = 3, standard care n = 6) were conducted with patients 12-15 months after being randomised in the trial, after their 12 month appointment. INTERVENTION Individuals who participated in one of two exercise intervention groups (hospital-supervised or home-supported exercise) or a standard care control group of the PREPARE-ABC trial were invited to interview. RESULTS The exercise interventions were reported to influence participants' recovery and future sustainability of exercise behaviour change. Several participants continued to engage in exercise over a year after their surgery. Reasons for this included being engaged with exercise prior to diagnosis, psychological benefits of exercise and wanting to be engaged with something to help recovery. Perceptions about the sustainability of active lifestyles were influenced by confidence to engage in structured exercise or physical activity and beliefs about its potential to promote future wellness. CONCLUSIONS Sustainability varies among individuals and early assessment of physical activity engagement could be beneficial. Physical activity interventions immediately following surgery may be important for future engagement.
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Affiliation(s)
- J Naisby
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - K Baker
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - K Skarparis
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - J Murdoch
- Department of Population Health Sciences, King's College London, London, UK
| | - A Clark
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - S Stirling
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - D Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - A M Swart
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - J Hernon
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - J Saxton
- School of Sport, Exercise and Rehabilitation Sciences, University of Hull, Hull, UK
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McGrogan M, Proctor C. Survivor to thriver: identifying and overcoming the psychological effects of a stoma. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S14-S18. [PMID: 39250440 DOI: 10.12968/bjon.2024.0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Stoma-forming surgery can have extensive, negative impacts on a patient's psychological wellbeing. Although this has been known for several decades, little progress has been made in addressing the issue. Several areas of concern have been repeatedly identified in the literature: loss of control; reduced self-esteem; psychosexual issues; and the impact of enhanced recovery on psychological outcomes. While these issues have the potential to significantly affect patients undergoing stoma-forming surgery, they can be mitigated against. While identifying and addressing psychological morbidity at an early stage is the most effective approach, additional interventions can also be useful. The promotion of self-care and independence can minimise the feeling of loss of control, the selection of discreet, leak-proof products can help address self-esteem issues, and open, honest conversation can significantly improve a patient's feelings regarding sexuality and intimacy.
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Affiliation(s)
- Marie McGrogan
- Clinical Adviser, Eakin Healthcare, Comber, Northern Ireland
| | - Chris Proctor
- Insights Manager - Ostomy, Eakin Healthcare, Comber, Northern Ireland
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Al-Khazraji Y, Muzammil MA, Javid S, Tangella AV, Gohil NV, Saifullah H, Kanagala SG, Fariha F, Muneer A, Ahmed S, Shariq A. Novel regimens and treatment strategies in neoadjuvant therapy for colorectal cancer: A systematic review. Int J Health Sci (Qassim) 2024; 18:43-58. [PMID: 39282125 PMCID: PMC11393386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024] Open
Abstract
Objective The objective of this systematic review was to describe novel regimens and treatment strategies in neoadjuvant therapy for colorectal cancer (CRC). The aim was to summarize the current advancements in neoadjuvant chemotherapy (NACT) for CRC, including the use of cytotoxic drugs, targeted treatments, and immunotherapy. The analysis aimed to provide insights into the potential benefits and drawbacks of these novel approaches and highlight the need for further research to optimize NACT use in CRC and improve patient outcomes. Methods From October 20, 2023, to December 10, 2023, a comprehensive literature search was conducted across multiple databases, including PubMed, Ovid, Web of Science, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, and Scopus. Studies addressing the use of and treatment strategies for CRC and neoadjuvant therapies were included. Screening was conducted in two steps, initially by title and abstract and then by full-text articles. English-language articles were considered, while preprints, non-English publications, and articles published as grey literature were excluded from the study. A total of 85 studies were selected for further analysis after screening and filtering. Results After filtering out duplicates and items that were irrelevant to our research query from the initial database search's 510 results, 397 unique articles were found. Eighty-five studies were chosen for additional analysis after the articles underwent two rounds of screening. Conclusion The review concluded that neoadjuvant therapy for CRC has evolved beyond conventional approaches and holds promise for improving patient outcomes. Future prospects for advancing neoadjuvant approaches are promising, with ongoing clinical trials investigating the refinement of strategies, identification of predictive biomarkers, and optimization of patient selection. The adoption of novel regimens, precision medicine, and immunotherapy offers opportunities to redefine treatment paradigms and enhance patient care in CRC.
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Affiliation(s)
| | | | - Saman Javid
- Department of Medicine, CMH Kharian Medical College, Kharian, Pakistan
| | | | - Namra Vinay Gohil
- Department of Medicine, Medical College Baroda, Vadodara, Gujarat, India
| | - Hanya Saifullah
- Department of Medicine, Medical College Baroda, CMH Lahore Medical College, Lahore, Pakistan
| | | | - Fnu Fariha
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Asim Muneer
- Department of Adult Hematology Oncology, Prince Faisal Ca ncer Centre Buraidah, Al qaseem, Saudi Arabia
| | - Sumaira Ahmed
- Department of Gastroenterology, King Fahad Hospital, Burydah, KSA
| | - Ali Shariq
- Department of Pathology, College of Medicine, Qassim University, Buraydah, Saudi Arabia
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Thomassen BJM, Gielen AHC, Baak J, Sosef M, Ancion E, Gielen CMJ, Gidding-Slok AHM, Breukink SO, Kimman ML. Supporting follow-up care in colorectal cancer patients: first experiences with the Assessment of Burden of ColoRectal Cancer (ABCRC)-tool. J Cancer Surviv 2024:10.1007/s11764-024-01652-w. [PMID: 39147941 DOI: 10.1007/s11764-024-01652-w] [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: 03/30/2024] [Accepted: 07/25/2024] [Indexed: 08/17/2024]
Abstract
PURPOSE The Assessment of Burden of ColoRectal Cancer (ABCRC)-tool is a unique tool that includes a PROM focused on health-related quality of life (HRQoL), functional outcomes and lifestyle assessment. Furthermore, it provides visualization of results and treatment advice. The tool aims to support follow-up consultations of colorectal cancer (CRC) patients. The purpose of this study was to evaluate the first experiences of patients and healthcare professionals (HCPs) with the ABCRC-tool. METHODS The ABCRC-tool was implemented in two Dutch hospitals and used by 25 patients and 5 HCPs during follow-up care. Consultations were audio-recorded and their content was analyzed independently by two researchers. Semi-structured interviews with patients and HCPs were conducted after the consultation. Interviews focused on the overall experience with the tool, ease of use, interpretation of the PROM and the visualized results and on the added value of the tool. RESULTS Audio recording revealed that multiple topics, relevant to patients, were discussed during consultations with the ABCRC-tool. Patients and HCPs appreciated the ABCRC-tool as it added structure to the consultation, was helpful in the preparation of consultations and provided useful and convenient treatment options. The tool was easy to use, and the visualization was clear and informative. HCPs suggested that the tool is likely to be most relevant for patients in the first year of follow-up. CONCLUSIONS This study implies that the ABCRC-tool is of added value for patients and their HCPs. Future research should focus on the evaluation of broad implementation, across a wide range of CRC patients. IMPLICATIONS FOR CANCER SURVIVORS The ABCRC-tool is a valid tool to support CRC survivors and HCPs to monitor and visualize experienced burden of disease and lifestyle parameters in order to optimize personalized care.
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Affiliation(s)
- Britt J M Thomassen
- Department of Surgery, Maastricht University Medical Centre+, Universiteitssingel 50 (UNS50) K5.442, 6229 ER, Maastricht, The Netherlands.
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
| | - Anke H C Gielen
- Department of Surgery, Maastricht University Medical Centre+, Universiteitssingel 50 (UNS50) K5.442, 6229 ER, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Jasmijn Baak
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Meindert Sosef
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Ester Ancion
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Christel M J Gielen
- Department of Surgery, Maastricht University Medical Centre+, Universiteitssingel 50 (UNS50) K5.442, 6229 ER, Maastricht, The Netherlands
| | - Annerika H M Gidding-Slok
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Stephanie O Breukink
- Department of Surgery, Maastricht University Medical Centre+, Universiteitssingel 50 (UNS50) K5.442, 6229 ER, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
| | - Merel L Kimman
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, The Netherlands
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Maalouf MF, Wang A, Robitaille S, Liberman AS, Fiore JF, Feldman LS, Lee L. Patient perspective on adapting to bowel dysfunction after rectal cancer surgery. Colorectal Dis 2024. [PMID: 39099084 DOI: 10.1111/codi.17118] [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: 09/13/2023] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 08/06/2024]
Abstract
AIM Bowel dysfunction continues to be a clinically significant consequence of rectal cancer surgery, affecting quality of life. Rectal cancer patients value self-empowerment and adaptation to change to improve their quality of life in the context of bowel dysfunction. There are limited qualitative data addressing patients' perspectives on adapting to bowel dysfunction. The aim of this study is to evaluate patients' perspectives on adapting to bowel dysfunction after rectal cancer surgery. METHOD Adult patients who underwent rectal cancer surgery with sphincter preservation at a single colorectal referral centre from July 2017 to July 2020 were included. Patients were excluded if they had surgery <1 year since recruitment, received a permanent stoma or developed recurrence or metastasis. Semistructured interviews were held by phone and transcribed verbatim. Bowel dysfunction was assessed via the low anterior resection syndrome (LARS) score. Thematic analysis was used to identify adaptations which patients found helpful for improving bowel dysfunction after rectal cancer surgery. RESULTS A total of 54 patient interviews were included. The distribution of patients with no, minor and major LARS was 39%, 22% and 39%, respectively. Four main themes were conceived from the analysis: implementing lifestyle changes, fostering supportive relationships and self-compassion, communication and access to resources, and adapting to social and cultural challenges. Associated subthemes were identified, namely forward planning, self-compassion and addressing social stigma. CONCLUSION Patients' valuable perspective on adapting to bowel dysfunction involve subtle themes which expand the existing literature. These themes inform a patient-centred approach, which may improve outcomes and quality of care for rectal cancer patients.
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Affiliation(s)
- Michael F Maalouf
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Anna Wang
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Stephan Robitaille
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - A Sender Liberman
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Julio F Fiore
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Liane S Feldman
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Lawrence Lee
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
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Han CJ, Ning X, Burd CE, Spakowicz DJ, Tounkara F, Kalady MF, Noonan AM, McCabe S, Von Ah D. Chemotoxicity and Associated Risk Factors in Colorectal Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024; 16:2597. [PMID: 39061235 PMCID: PMC11274507 DOI: 10.3390/cancers16142597] [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: 05/11/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) patients experience multiple types of chemotoxicity affecting treatment compliance, survival, and quality of life (QOL). Prior research shows clinician-reported chemotoxicity (i.e., grading scales or diagnostic codes) predicts rehospitalization and cancer survival. However, a comprehensive synthesis of clinician-reported chemotoxicity is still lacking. OBJECTIVES We conducted a systematic review and meta-analysis to determine chemotoxicity's prevalence and risk factors in CRC. METHODS A systematic search from 2009 to 2024 yielded 30 studies for review, with 25 included in the meta-analysis. RESULTS Pooled prevalences of overall, non-hematological, and hematological moderate-to-severe toxicities were 45.7%, 39.2%, and 25.3%, respectively. The most common clinician-reported chemotoxicities were gastrointestinal (GI) toxicity (22.9%) and neuropathy or neutropenia (17.9%). Significant risk factors at baseline were malnutritional status, frailty, impaired immune or hepato-renal functions, short telomere lengths, low gut lactobacillus levels, age, female sex, aggressive chemotherapy, and low QOL. Age was associated with neutropenia (β: -1.44) and GI toxicity (β:1.85) (p-values < 0.01). Older adults (>65 y.o.) had higher prevalences of overall (OR: 1.14) and GI (OR: 1.65) toxicities, but a lower prevalence of neutropenia (OR: 0.65) than younger adults (p-values < 0.05). CONCLUSIONS Our findings highlight the importance of closely monitoring and managing chemotoxicity in CRC patients receiving chemotherapy.
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Affiliation(s)
- Claire J. Han
- Center for Healthy Aging, Self-Management and Complex Care, College of Nursing, The Ohio State University, Columbus, OH 43210, USA; (S.M.); (D.V.A.)
- The Ohio State University–James: Cancer Treatment and Research Center, Columbus, OH 43210, USA
| | - Xia Ning
- Clinical Informatics and Implementation Science Biomedical Informatics (BMI), Computer Science and Engineering (CSE), College of Engineering, The Ohio State University, Columbus, OH 43210, USA;
| | - Christin E. Burd
- Departments of Molecular Genetics, Cancer Biology and Genetics, The Ohio State University, Columbus, OH 43210, USA;
| | - Daniel J. Spakowicz
- Pelotonia Institute for Immuno-Oncology, Division of Medical Oncology, The Ohio State University, Comprehensive Cancer Center, Columbus, OH 43210, USA;
| | - Fode Tounkara
- Department of Biomedical Informatics, Ohio State University College of Medicine, Columbus, OH 43210, USA;
| | - Matthew F. Kalady
- Division of Colon and Rectal Surgery, The Ohio State University–James: Cancer Treatment and Research Center, Columbus, OH 43210, USA;
| | - Anne M. Noonan
- GI Medical Oncology Selection, The Ohio State University–James: Cancer Treatment and Research Center, Columbus, OH 43210, USA;
| | - Susan McCabe
- Center for Healthy Aging, Self-Management and Complex Care, College of Nursing, The Ohio State University, Columbus, OH 43210, USA; (S.M.); (D.V.A.)
| | - Diane Von Ah
- Center for Healthy Aging, Self-Management and Complex Care, College of Nursing, The Ohio State University, Columbus, OH 43210, USA; (S.M.); (D.V.A.)
- The Ohio State University–James: Cancer Treatment and Research Center, Columbus, OH 43210, USA
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Goode C, Harley J. Treatment trajectories of individuals diagnosed with rectal cancer: an interpretative phenomenological study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:505-514. [PMID: 38850134 DOI: 10.12968/bjon.2023.0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
Rectal cancer affects almost every aspect of an individual's daily life. However, there are gaps in understanding the complete spectrum of experiences spanning from diagnosis to recovery. Therefore, the aim of this study was to explore the treatment trajectories of individuals diagnosed with rectal cancer. Adopting an interpretative phenomenological approach, seven participants were recruited using purposive sampling. Data were collected using semi-structured, in-depth interviews that were digitally recorded, transcribed and analysed using thematic analysis. Study rigour was established following the four-dimension criteria of credibility, dependability, transferability and confirmability. Four prominent themes emerged from the participants' experiences of undergoing rectal cancer treatment: uncovering the inner battles; navigating the physical challenges; anchors of support and conquering the summit. These findings contribute to knowledge and practice by highlighting the importance of providing a comprehensive and individualised treatment plan for individuals that takes account of the physical and psycho-emotional implications of rectal cancer treatment.
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Affiliation(s)
- Catherine Goode
- Colorectal and Stoma Care Nurse Specialist, Colorectal Service, Health & Community Services, St Helier, Jersey
| | - Jacqueline Harley
- Assistant Professor in Health Systems, University College Dublin, Belfield, Dublin, Ireland
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Luo X, Xu H, Zhang Y, Liu S, Xu S, Xie Y, Xiao J, Hu T, Xiao H. Identifying the unmet needs of post-treatment colorectal cancer survivors: A critical literature review. Eur J Oncol Nurs 2024; 70:102570. [PMID: 38574419 DOI: 10.1016/j.ejon.2024.102570] [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: 11/03/2023] [Revised: 03/11/2024] [Accepted: 03/16/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Following treatment completion, colorectal cancer (CRC) survivors experience various unmet needs. This review aims to synthesize the unmet needs of CRC survivors after treatment and to identify demographic, disease or treatment-related, healthcare-related, and psychosocial factors correlated with unmet needs. METHOD English or Chinese articles that focused on CRC survivors' post-treatment unmet needs were systematically searched from the five electronic databases, which included CINAHL, PubMed, Embase, PsycINFO, and the China Academic Journal Full-text Database, from the launch of databases to July 2023. The reference lists of the subsequent articles were further screened. RESULTS 136 individual needs extracted from 50 manuscripts were classified into nine domains based on the Supportive Care Framework. The top four unmet needs identified by CRC survivors were assistance with fears of cancer recurrence, information about managing illness and side effects at home, emotional or psychological support and reassurance, and help with sexuality problems. Following surgery, CRC survivors showed strong demand in the physical, psychological, and information domains. Survivors completed treatment within 1-year had more diverse needs than those who completed 1-3 years. Unmet needs may be greater among CRC survivors who were young, female, more educated, and unmarried. Furthermore, greater unmet needs were associated with distress, anxiety, depression, and worse quality of life. CONCLUSIONS Despite diverse needs experienced by post-treatment CRC survivors, a predominant focus on fears of cancer recurrence, information, psychological support, and sexuality needs is noted. Future studies should further explore the needs of CRC survivors after specific treatment and in different post-treatment periods.
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Affiliation(s)
- Xingjuan Luo
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Haiying Xu
- Nursing Department, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Yanting Zhang
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Sirun Liu
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Shan Xu
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Yali Xie
- Nursing Department, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Juan Xiao
- Institute of Neuroscience and Brain Diseases, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
| | - Tingting Hu
- Nursing Department, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
| | - Hong Xiao
- Nursing Department, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
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12
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Chong MY, Eussen SJPM, van Roekel EH, Pot GK, Koster A, Breukink SO, Janssen-Heijnen MLG, Keulen ETP, Stehouwer CDA, Weijenberg MP, Bours MJL. Longitudinal associations of circadian eating patterns with sleep quality, fatigue and inflammation in colorectal cancer survivors up to 24 months post-treatment. Br J Nutr 2024; 131:1166-1180. [PMID: 38012842 PMCID: PMC10918519 DOI: 10.1017/s0007114523002714] [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: 05/17/2023] [Revised: 09/29/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023]
Abstract
Fatigue and insomnia, potentially induced by inflammation, are distressing symptoms experienced by colorectal cancer (CRC) survivors. Emerging evidence suggests that besides the nutritional quality and quantity, also the timing, frequency and regularity of dietary intake (chrono-nutrition) could be important for alleviating these symptoms. We investigated longitudinal associations of circadian eating patterns with sleep quality, fatigue and inflammation in CRC survivors. In a prospective cohort of 459 stage I-III CRC survivors, four repeated measurements were performed between 6 weeks and 24 months post-treatment. Chrono-nutrition variables included meal energy contribution, frequency (a maximum of six meals could be reported each day), irregularity and time window (TW) of energetic intake, operationalised based on 7-d dietary records. Outcomes included sleep quality, fatigue and plasma concentrations of inflammatory markers. Longitudinal associations of chrono-nutrition variables with outcomes from 6 weeks until 24 months post-treatment were analysed by confounder-adjusted linear mixed models, including hybrid models to disentangle intra-individual changes from inter-individual differences over time. An hour longer TW of energetic intake between individuals was associated with less fatigue (β: -6·1; 95 % CI (-8·8, -3·3)) and insomnia (β: -4·8; 95 % CI (-7·4, -2·1)). A higher meal frequency of on average 0·6 meals/d between individuals was associated with less fatigue (β: -3·7; 95 % CI (-6·6, -0·8)). An hour increase in TW of energetic intake within individuals was associated with less insomnia (β: -3·0; 95 % CI (-5·2, -0·8)) and inflammation (β: -0·1; 95 % CI (-0·1, 0·0)). Our results suggest that longer TWs of energetic intake and higher meal frequencies may be associated with less fatigue, insomnia and inflammation among CRC survivors. Future studies with larger contrasts in chrono-nutrition variables are needed to confirm these findings.
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Affiliation(s)
- Marvin Y. Chong
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, CAPHRI School for Care and Public Health Research, Maastricht University, Maastricht, The Netherlands
| | - Simone J. P. M. Eussen
- Department of Epidemiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, CAPHRI School for Care and Public Health Research, Maastricht University, Maastricht, The Netherlands
| | - Eline H. van Roekel
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Gerda K. Pot
- Nutrition and Healthcare Alliance Hospital Gelderse Vallei, Ede, The Netherlands
| | - Annemarie Koster
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Stéphanie O. Breukink
- Department of Surgery, GROW School for Oncology and Reproduction, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maryska L. G. Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Eric T. P. Keulen
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre Sittard-Geleen, Geleen, The Netherlands
| | - Coen D. A. Stehouwer
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Matty P. Weijenberg
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Martijn J. L. Bours
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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13
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Degu A, Karimi PN, Opanga SA, Nyamu DG. Health-related quality of life among patients with esophageal, gastric, and colorectal cancer at Kenyatta National Hospital. Cancer Rep (Hoboken) 2024; 7:e2038. [PMID: 38507287 PMCID: PMC10953834 DOI: 10.1002/cnr2.2038] [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: 08/03/2023] [Revised: 01/17/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Despite the advancement of modern treatment approaches, several studies indicated a diminished health-related quality of life (HRQoL) in patients with gastrointestinal cancer. However, there is insufficient data about the HRQoL of gastrointestinal cancer patients in Kenya. AIMS The study aimed to investigate HRQoL and its determinants in gastrointestinal cancer patients at Kenyatta National Hospital. METHODS A cross-sectional study was employed among 160 esophageal, 103 gastric, and 96 colorectal cancer patients. The patient list, identified by unique hospital identification numbers, was obtained from records. Eligibility was assessed based on predetermined criteria, and the hospital identification numbers were reshuffled. Study participants were then randomly selected daily during the data collection period. Data were collected using a researcher-administered European Organization for Research and Treatment of Cancer quality of life questionnaire. The data entry and analysis were carried out using Statistical Package for the Social Sciences 26.0 statistical software. A bivariate and multivariate binary logistic regression analysis was employed to investigate determinants of HRQoL at a 0.05 level of significance. RESULTS Most esophageal (N = 118, 73.7%), gastric (N = 75, 72.8%), and colorectal (N = 72, 75%) cancer patients had poor overall HRQoL. In the social (p = .04) and cognitive (p = .02) domain of HRQoL, esophageal cancer patients had a significantly lower mean score as compared to gastric cancer patients. Colorectal cancer patients had the highest mean score in physical functioning (p = .01) as compared with gastric cancer patients. Nonetheless, gastric cancer patients had the highest mean score in emotional functioning domains of quality of life as compared to esophageal (p = .04) and colorectal (p < .001) cancer patients The study revealed a low mean HRQoL score in the majority of the symptom domains of quality of life. A statistically significant difference in all domains of HRQoL was not observed in various treatment modalities of gastrointestinal cancer. Advanced-stage (stages III and IV) and co-morbidities were significant determinants of poor HRQoL. CONCLUSIONS The overall HRQoL of gastrointestinal cancer patients was poor. Advanced-stage cancer and co-morbidities were significant determinants of poor HRQoL. Therefore, intensification of routine monitoring of the disease and the treatments should be actively implemented to improve the HRQoL.
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Affiliation(s)
- Amsalu Degu
- United States International University–Africa, Department of Pharmaceutics and Pharmacy PracticeSchool of Pharmacy and Health SciencesNairobiKenya
- University of Nairobi, Department of PharmacologyClinical Pharmacy and Pharmacy Practices, Faculty of Health SciencesNairobiKenya
| | - Peter N. Karimi
- University of Nairobi, Department of PharmacologyClinical Pharmacy and Pharmacy Practices, Faculty of Health SciencesNairobiKenya
| | - Sylvia A. Opanga
- University of Nairobi, Department of PharmacologyClinical Pharmacy and Pharmacy Practices, Faculty of Health SciencesNairobiKenya
| | - David G. Nyamu
- University of Nairobi, Department of PharmacologyClinical Pharmacy and Pharmacy Practices, Faculty of Health SciencesNairobiKenya
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14
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Kim B, White K, Tracy M, Mahadeva J, Marker J, Ostroff C, Acret L, Willcock S, Rutherford C. Experiences and perspectives of colorectal cancer survivors and general practitioners on the delivery of survivorship care in general practice: a mixed methods study. Aust J Prim Health 2024; 30:PY23140. [PMID: 38507782 DOI: 10.1071/py23140] [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: 08/01/2023] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Many colorectal cancer (CRC) survivors experience ongoing sequelae from their cancer treatment. Limited evidence exists regarding how CRC survivors and general practitioners (GPs) manage these sequelae in the community. This study aimed to explore the experiences and perspectives of CRC survivors and GPs on current approaches to monitoring and managing sequelae of CRC treatment. METHODS We conducted a mixed-methods study using cross-sectional national surveys and qualitative interviews with CRC survivors and GPs to explore: (1) treatment sequelae experienced by CRC survivors, (2) how these were monitored and managed by general practitioners, and (3) suggestions to improve ongoing management of the treatment sequelae. Survey responses were reported descriptively. Qualitative data were thematically analysed using an interpretive descriptive approach. RESULTS Seventy participants completed surveys: 51 CRC survivors and 19 GPs, and four interviews were conducted with GPs. CRC survivors experienced a range of treatment sequelae, but often did not discuss these with their GPs (experienced vs discussed: 86% vs 47% for fatigue/lack of energy, 78% vs 27% for psychological/emotional concern, 63% vs 22% for impaired sleep, 69% vs 29% for weight loss/gain, 59% vs 16% for sexual and intimacy concerns). GPs reported inadequate information transfer from cancer services and workload as major barriers to optimal care. CONCLUSIONS System-level changes that facilitate adequate information transfer from cancer services to GPs upon CRC treatment completion, as well as addressing time constraint issues essential for comprehensive monitoring and management of CRC treatment sequelae, could enhance the care of CRC survivors in the community setting.
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Affiliation(s)
- Bora Kim
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW 2050, Australia; and Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW 2050, Australia; and Cancer Care Research Unit, Sydney Local Health District, Sydney, NSW 2050, Australia
| | - Kate White
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW 2050, Australia; and Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW 2050, Australia; and Cancer Care Research Unit, Sydney Local Health District, Sydney, NSW 2050, Australia
| | - Marguerite Tracy
- General Practice Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Janani Mahadeva
- MQ Health, Macquarie University Hospital, Primary Care, Sydney, NSW 2109, Australia
| | - Julie Marker
- Consumer Representative, Adelaide, SA 5000, Australia; and Cancer Voices South Australia, Adelaide, SA 5068, Australia
| | - Cheri Ostroff
- Consumer Representative, Adelaide, SA 5000, Australia; and University of South Australia, Centre for Workplace Excellence, Adelaide, SA 5001, Australia
| | - Louise Acret
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW 2050, Australia; and Cancer Care Research Unit, Sydney Local Health District, Sydney, NSW 2050, Australia
| | - Simon Willcock
- MQ Health, Macquarie University Hospital, Primary Care, Sydney, NSW 2109, Australia
| | - Claudia Rutherford
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW 2050, Australia; and Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW 2050, Australia
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15
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Yoon PS, Navarro S, Barzi A, Ochoa-Dominguez CY, Arizpe A, Farias AJ. Racial and ethnic disparities in self-reported general and mental health status among colorectal cancer survivors: impact of sociodemographic factors and implications for mortality-a SEER-CAHPS study. Qual Life Res 2024; 33:793-804. [PMID: 38153617 PMCID: PMC10894139 DOI: 10.1007/s11136-023-03566-z] [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] [Accepted: 11/13/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE Patient-reported outcomes are recognized as strong predictors of cancer prognosis. This study examines racial and ethnic differences in self-reported general health status (GHS) and mental health status (MHS) among patients with colorectal cancer (CRC). METHODS A retrospective analysis of Medicare beneficiaries between 1998 and 2011 with non-distant CRC who underwent curative resection and completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey within 6-36 months of CRC diagnosis. Analysis included a stepwise logistic regression to examine the relationship between race and ethnicity and fair or poor health status, and a proportional hazards model to determine the mortality risk associated with fair or poor health status. RESULTS Of 1867 patients, Non-Hispanic Black (OR 1.56, 95% CI 1.06-2.28) and Hispanic (OR 1.48, 95% CI 1.04-2.11) patients had higher unadjusted odds for fair or poor GHS compared to Non-Hispanic White patients, also Hispanic patients had higher unadjusted odds for fair or poor MHS (OR 1.92, 95% CI 1.23-3.01). These relationships persisted after adjusting for clinical factors but were attenuated after subsequently adjusting for sociodemographic factors. Compared to those reporting good to excellent health status, patients reporting fair or poor GHS or MHS had an increased mortality risk (OR 1.52, 95% CI 1.31-1.76 and OR 1.63, 95% CI 1.34-1.99, respectively). CONCLUSION Racial and ethnic differences in GHS and MHS reported after CRC diagnosis are mainly driven by sociodemographic factors and reflect a higher risk of mortality. Identifying unmet biopsychosocial needs is necessary to promote equitable care.
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Affiliation(s)
- Paul S Yoon
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Stephanie Navarro
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Afsaneh Barzi
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Carol Y Ochoa-Dominguez
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Angel Arizpe
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA.
- The Gehr Family Center for Health System Science, Keck School of Medicine of USC, Los Angeles, CA, USA.
- Population and Public Health Sciences, Keck School of Medicine of USC, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA.
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16
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Gudenkauf LM, Li X, Hoogland AI, Oswald LB, Lmanirad I, Permuth JB, Small BJ, Jim HSL, Rodriguez Y, Bryant CA, Zambrano KN, Walters KO, Reblin M, Gonzalez BD. Feasibility and acceptability of C-PRIME: A health promotion intervention for family caregivers of patients with colorectal cancer. Support Care Cancer 2024; 32:198. [PMID: 38416143 DOI: 10.1007/s00520-024-08395-5] [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: 05/10/2023] [Accepted: 02/18/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE This study aimed to test the feasibility and acceptability of a digital health promotion intervention for family caregivers of patients with advanced colorectal cancer and explore the intervention's preliminary efficacy for mitigating the impact of caregiving on health and well-being. METHODS We conducted a single-arm pilot feasibility trial of C-PRIME (Caregiver Protocol for Remotely Improving, Monitoring, and Extending Quality of Life), an 8-week digital health-promotion behavioral intervention involving monitoring and visualizing health-promoting behaviors (e.g., objective sleep and physical activity data) and health coaching (NCT05379933). A priori benchmarks were established for feasibility (≥ 50% recruitment and objective data collection; ≥ 75% session engagement, measure completion, and retention) and patient satisfaction (> 3 on a 1-5 scale). Preliminary efficacy was explored with pre- to post-intervention changes in quality of life (QOL), sleep quality, social engagement, and self-efficacy. RESULTS Participants (N = 13) were M = 52 years old (SD = 14). Rates of recruitment (72%), session attendance (87%), assessment completion (87%), objective data collection (80%), and retention (100%) all indicated feasibility. All participants rated the intervention as acceptable (M = 4.7; SD = 0.8). Most participants showed improvement or maintenance of QOL (15% and 62%), sleep quality (23% and 62%), social engagement (23% and 69%), and general self-efficacy (23% and 62%). CONCLUSION The C-PRIME digital health promotion intervention demonstrated feasibility and acceptability among family caregivers of patients with advanced colorectal cancer. A fully powered randomized controlled trial is needed to test C-PRIME efficacy, mechanisms, and implementation outcomes, barriers, and facilitators in a divserse sample of family caregivers. TRIAL REGISTRATION The Caregiver Protocol for Remotely Improving, Monitoring, and Extending Quality of Life (C-PRIME) study was registered on clinicaltrials.gov, NCT05379933, in May 2022.
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Affiliation(s)
- Lisa M Gudenkauf
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
| | - Xiaoyin Li
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Iman Lmanirad
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jennifer B Permuth
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Brent J Small
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Yvelise Rodriguez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Crystal A Bryant
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Kellie N Zambrano
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Kerie O Walters
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Maija Reblin
- Department of Family Medicine, University of Vermont, Burlington, VT, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
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17
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O'Regan A, Fish LJ, Makarushka C, Somers T, Fitzgerald Jones K, Merlin JS, Dinan M, Oeffinger K, Check D. Managing Chronic Pain in Cancer Survivorship: Communication Challenges and Opportunities as Described by Cancer Survivors. Am J Hosp Palliat Care 2024; 41:78-86. [PMID: 36927121 DOI: 10.1177/10499091231164634] [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: 03/18/2023] Open
Abstract
OBJECTIVES Many cancer survivors experience chronic pain after completing curative-intent treatment. Based on available data, chronic pain may be undertreated in this context; however, little is known about cancer survivors' experiences with clinical management of chronic pain. The purpose of this study was to better understand cancer survivors' pain management experiences after curative-intent treatment. METHODS We conducted 13 semi-structured interviews with a convenience sample of cancer survivors who had completed treatment for stage I-III breast, head/neck, lung or colorectal cancer. We used a thematic approach to qualitative data analysis. RESULTS Participants described that chronic pain often goes unrecognized by their providers, potentially due to limitations in how pain is assessed clinically and the tendency of both cancer survivors and providers to minimize or invalidate the pain experience. To improve communication, participants suggested that providers ask more open-ended questions about their pain, help them to establish functional goals, and provide patients with options for pain management. SIGNIFICANCE OF RESULTS This study demonstrates the importance of provider-initiated communication around pain management for cancer survivors to make them feel more supported in their care. Communication and shared decision-making interventions may improve cancer survivor-provider communication around chronic pain management, addressing an important gap in survivorship care.
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Affiliation(s)
- Amy O'Regan
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Laura J Fish
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke School of Medicine Durham, NC, USA
| | - Christina Makarushka
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Tamara Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Katie Fitzgerald Jones
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Harvard University, Cambridge, MA, USA
| | - Jessica S Merlin
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michaela Dinan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT, USA
| | - Kevin Oeffinger
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Devon Check
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
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18
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Diez-Martínez M, Perpiñá-Galvañ J, Fernández-Alcántara M, García-Rodríguez G, Carreres M, Portilla J, Cabañero-Martínez MJ. Knowledge and Perceived Emotions Regarding an Anal Cancer Preventive Program in People Diagnosed With HIV: A Qualitative Study. Cancer Nurs 2024; 47:E18-E27. [PMID: 35984921 DOI: 10.1097/ncc.0000000000001156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To the best of our knowledge, no studies have yet examined the emotional repercussions of the care processes among people infected with the human immunodeficiency virus who participate in preventive anal cancer screening programs. OBJECTIVE This study aimed to explore the knowledge, emotions, sexuality, barriers, and facilitators perceived by this patient group during the process of anal cancer screening and diagnosis. METHODS Detailed, semistructured, qualitative interviews were completed with 17 men and 3 women to explore their knowledge, experiences, and emotions regarding the screening process. Purposive sampling was conducted on the basis of age, gender, and type of lesion diagnosed in the anal biopsy. RESULTS Four major themes were identified: 1) knowledge of the disease and its treatment, 2) emotions perceived by the patients, 3) the influence of screening on sexual practices, and 4) facilitators and obstacles during the care provision process. Patients reported appropriate knowledge of anal cancer and human papillomavirus. Predominant emotions were worry and fear with avoidance as one of the coping strategies. CONCLUSION These results suggest that communication of information and clinical results can be improved. IMPLICATION FOR PRACTICE Understanding the facilitators and barriers to the program will allow the integration of interventions designed to improve healthcare provision into direct care.
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Affiliation(s)
- Marcos Diez-Martínez
- Author Affiliations: Infectious Diseases Unit, Alicante University General Hospital (Mr Diez-Martínez, Mrs García-Rodríguez, Mrs Carreres, and Dr Portilla); Alicante Institute for Health and Biomedical Research (ISABIAL); Spanish AIDS Research Network, Carlos III Health Institute (Mr Diez-Martínez, Mrs García-Rodríguez, Mrs Carreres, and Dr Portilla), Madrid; Nursing Department, University of Alicante (Drs Perpiñá-Galvañ and Cabañero-Martínez); Department of Health Psychology, University of Alicante (Dr Fernández-Alcántara); and Department of Clinical Medicine, Miguel Hernandez University (Dr Portilla), Elche, Alicante, Spain
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19
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Ko HF, Wu MF, Lu JZ. A randomized control study: The effectiveness of multimedia education on self-care and quality of life in patients with enterostomy. Int Wound J 2023; 20:4244-4252. [PMID: 37488713 PMCID: PMC10681488 DOI: 10.1111/iwj.14326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
Colorectal cancer is typically treated through surgery, and self-care skills play a crucial role in disease adaptation and quality of life improvement. Therefore, this study aimed to investigate the effectiveness of a multimedia patient education intervention on enhancing the self-care and quality of life among patients with a postoperative stoma as well as on establishing an easy-to-use ostomy self-care skills assessment. The sample comprised 108 patients with new ostomies who were randomly assigned to two groups. Data were collected from June 2018 to March 2019. The conventional education service program group received individual education in the hospital environment, consisting of four 3-h sessions delivered over 4 consecutive days. The multimedia group viewed a multimedia educational program using a laptop. Data were collected at baseline and 3 months after the intervention using a demographic questionnaire, an ostomy self-care ability scale and the Stoma Quality of Life Scale. Before the intervention, there were no significant differences in self-care ability and quality of life scores between the two groups (p = 0.764 and p = 0.466, respectively). However, 3 months after the intervention, the group that received the multimedia software intervention showed significantly higher self-care ability and quality of life scores compared to the group that received conventional education services (p < 0.001). When a set threshold is reached, self-care ability and a good quality of life can be met. The threshold value of the ostomy self-care skill scale was determined to be 20 points, resulting in a sensitivity of 77.8% and a specificity of 75.5%. The results indicate that the multimedia education program enhanced home self-care ability and quality of life among patients with enterostomy.
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Affiliation(s)
- Hsing-Fang Ko
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Mei-Feng Wu
- Stoma Therapy Center, Division of Colon and Rectal Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Jian-Zhang Lu
- Division of Colon and Rectal Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
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20
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Rutherford C, Kim B, White K, Ostroff C, Acret L, Tracy M, Mahadeva J, Willcock SM. Experiences of colorectal cancer survivors in returning to primary coordinated healthcare following treatment. Aust J Prim Health 2023; 29:463-470. [PMID: 36872459 DOI: 10.1071/py22201] [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: 09/13/2022] [Accepted: 02/06/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Advances in screening and treatments for colorectal cancer (CRC) have improved survival rates, leading to a large population of CRC survivors. Treatment for CRC can cause long-term side-effects and functioning impairments. General practitioners (GPs) have a role in meeting survivorship care needs of this group of survivors. We explored CRC survivors' experiences of managing the consequences of treatment in the community and their perspective on the GP's role in post-treatment care. METHODS This was a qualitative study using an interpretive descriptive approach. Adult participants no longer actively receiving treatment for CRC were asked about: side-effects post-treatment; experiences of GP-coordinated care; perceived care gaps; and perceived GP role in post-treatment care. Thematic analysis was used for data analysis. RESULTS A total of 19 interviews were conducted. Participants experienced side-effects that significantly impacted their lives; many they felt ill-prepared for. Disappointment and frustration was expressed with the healthcare system when expectations about preparation for post-treatment effects were not met. The GP was considered vital in survivorship care. Participants' unmet needs led to self-management, self-directed information seeking and sourcing referral options, leaving them feeling like their own care coordinator. Disparities in post-treatment care between metropolitan and rural participants were observed. CONCLUSION There is a need for improved discharge preparation and information for GPs, and earlier recognition of concerns following CRC treatment to ensure timely management and access to services in the community, supported by system-level initiatives and appropriate interventions.
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Affiliation(s)
- Claudia Rutherford
- Cancer Care Research Unit, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; and The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Bora Kim
- Cancer Care Research Unit, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; and Nursing & Midwifery and Health Sciences, Faculty of Medicine, Notre Dame University, Sydney, NSW, Australia
| | - Kate White
- Cancer Care Research Unit, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; and The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia; and Sydney Local Health District, Sydney, NSW, Australia
| | - Cheri Ostroff
- Consumer Representative, Adelaide, SA, Australia; and University of South Australia, Centre for Workplace Excellence, Adelaide, SA, Australia
| | - Louise Acret
- Cancer Care Research Unit, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; and The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Marguerite Tracy
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Janani Mahadeva
- MQ Health General Practice, Macquarie University, Sydney, NSW, Australia
| | - Simon M Willcock
- MQ Health General Practice, Macquarie University, Sydney, NSW, Australia
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Kwon JY, Kopec J, Sutherland JM, Lambert LK, Anis AH, Sawatzky R. Patient-reported mental health and well-being trajectories in oncology patients during radiation therapy: an exploratory retrospective cohort analysis using the Ontario Cancer Registry. Qual Life Res 2023; 32:2899-2909. [PMID: 37140774 DOI: 10.1007/s11136-023-03430-0] [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] [Accepted: 04/22/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE Mental health and well-being trajectories are not expected to be homogeneous in diverse clinical populations. This exploratory study aims to identify subgroups of patients with cancer receiving radiation therapy who have different mental health and well-being trajectories, and examine which socio-demographic, physical symptoms, and clinical variables are associated with such trajectories. METHODS Retrospective analysis of radiation therapy patients diagnosed with cancer in 2017 was conducted using data from the Ontario Cancer Registry (Canada) and linked with administrative health data. Mental health and well-being were measured using items from the Edmonton Symptom Assessment System-revised questionnaire. Patients completed up to 6 repeated measurements. We used latent class growth mixture models to identify heterogeneous mental health trajectories of anxiety, depression, and well-being. Bivariate multinomial logistic regressions were conducted to explore variables associated with the latent classes (subgroups). RESULTS The cohort (N = 3416) with a mean age of 64.5 years consisted of 51.7% females. Respiratory cancer was the most common diagnosis (30.4%) with moderate to severe comorbidity burden. Four latent classes with distinct anxiety, depression, and well-being trajectories were identified. Decreasing mental health and well-being trajectories are associated with being female; living in neighborhoods with lower income, greater population density, and higher proportion of foreign-born individuals; and having higher comorbidity burden. CONCLUSIONS The findings highlight the importance of considering social determinants of mental health and well-being, in addition to symptoms and clinical variables, when providing care for patients undergoing radiation therapy.
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Affiliation(s)
- Jae-Yung Kwon
- School of Nursing, University of Victoria, HSD Building A402A, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
- Institute on Aging and Lifelong Health, Victoria, Canada.
| | - Jacek Kopec
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Leah K Lambert
- Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Vancouver, Canada
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Aslam H Anis
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Research, Vancouver, Canada
| | - Richard Sawatzky
- Centre for Health Evaluation and Outcome Sciences, Providence Research, Vancouver, Canada
- School of Nursing, Trinity Western University, Langley, Canada
- Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, Sweden
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22
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Moodley Y, van Wyk J, Ning Y, Wexner S, Gounden C, Naidoo V, Kader S, Neugut AI, Kiran RP. Self-adherence to post-colonoscopy consults in patients undergoing diagnostic colonoscopy: Findings from a cross-sectional, quantitative survey at a South African quaternary hospital. PLoS One 2023; 18:e0288752. [PMID: 37463177 PMCID: PMC10353782 DOI: 10.1371/journal.pone.0288752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023] Open
Abstract
Post-colonoscopy consults empower patients to make informed decisions around their subsequent treatment, and non-compliance with these consults ("no-shows") hinders disease management. There is a paucity in the literature regarding self-adherence to post-colonoscopy consults in resource-limited settings such as South Africa. An understanding of self-adherence to post-colonoscopy consults in this setting is required to establish whether improved interventions are needed, and what specific elements of self-adherence should be addressed with these interventions. The objective of this hypothesis-generating, cross-sectional, quantitative survey was to conduct a baseline assessment of cognitive, motivational, social, and behavioural variables related to self-adherence to post-colonoscopy consults in patients who underwent diagnostic colonoscopy at a South African quaternary hospital. The Adherence Determinants Questionnaire (ADQ) was administered in 47 patients to establish a baseline assessment of elements related to self-adherence to post-colonoscopy consults, including interpersonal aspects of care, perceived utility, severity, susceptibility, subjective norms, intentions, and supports/barriers. ADQ scores were transformed to a percentage of the maximum score for each element (100.0%). The overall mean transformed ADQ score was 57.8%. The mean transformed scores for specific ADQ components were as follows: subjective norms (40.8%), perceived severity (55.4%), perceived utility (56.6%), intentions (59.4%), supports/barriers (59.9%), interpersonal aspects (62.2%), and perceived susceptibility (65.9%). There were no statistically significant differences in overall mean transformed ADQ scores and individual ADQ elements across categories of participant age (p-values ranging between 0.180 and 0.949 when compared between participants ≤40 years and >40 years old), gender (p-values ranging between 0.071 and 0.946 when compared between males and females), and race (p-values ranging between 0.119 and 0.774 when compared between Black Africans and non-Black Africans). Our findings suggest a general need for appropriate interventions to improve self-adherence to post-colonoscopy consults in our setting.
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Affiliation(s)
- Yoshan Moodley
- Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jacqueline van Wyk
- Department of Health Sciences Education, University of Cape Town, Cape Town, South Africa
- School of Clinical Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Yuming Ning
- Department of Surgery, Columbia University, New York, NY, United States of America
| | - Steven Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, United States of America
| | - Cathrine Gounden
- Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Vasudevan Naidoo
- Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Shakeel Kader
- Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Alfred I. Neugut
- Department of Medicine and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, United States of America
| | - Ravi P. Kiran
- Department of Surgery, Columbia University, New York, NY, United States of America
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23
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Rutherford C, Ju A, Kim B, Wiltink L, Acret L, White K. How consequences of colorectal cancer treatment are managed: a qualitative study of stakeholder experiences about supportive care and current practices. Support Care Cancer 2023; 31:255. [PMID: 37041401 PMCID: PMC10090022 DOI: 10.1007/s00520-023-07713-7] [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: 08/16/2022] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE Colorectal cancer (CRC) survivors experience treatment-effects such as symptoms and functional impairments. There is limited evidence about how these are managed and what services or supports are available in the community. We aimed to identify current practice and available supports for managing consequences of treatment from clinician and CRC survivor perspectives. METHODS This qualitative study, informed by an interpretivist constructionist paradigm, included semi-structured interviews. Clinicians with experience of treating CRC patients and adult CRC survivors were recruited across Australia. Interviews explored experiences about problems experienced after CRC treatment and how these were managed. Data collection and analysis, using thematic analysis, was iterative whereby emergent themes during analysis were incorporated into subsequent interviews. RESULTS We interviewed 16 clinicians and 18 survivors. Survivors experienced a range of consequences of treatment amendable to support including allied health, information, and self-management. Barriers to support access included clinicians' worry about patient out-of-pocket expenses, long waitlists, lack of awareness about existing supports, and perception no therapeutic options were available. Healthcare professionals with expertise in CRC were often difficult to identify outside of cancer settings. Survivorship care could be improved with individualised timely information and identification of pathways to access healthcare providers with expertise in managing consequences of CRC treatment within primary care. CONCLUSIONS To improve CRC survivor lives posttreatment, routine assessment of consequences of treatment, individualised care planning involving relevant healthcare professionals, access to supportive care when needed, and improved information provision and engagement of a range of health professionals in follow-up care are needed.
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Affiliation(s)
- Claudia Rutherford
- Cancer Care Research Unit (CCRU), Susan Wakil School of Nursing, University of Sydney, Sydney, Australia.
- University of Sydney, Faculty Science, School of Psychology, Quality of Life Office, Sydney, Australia.
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia.
| | - Angela Ju
- University of Sydney, Faculty Science, School of Psychology, Quality of Life Office, Sydney, Australia
| | - Bora Kim
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Lisette Wiltink
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Louise Acret
- Cancer Care Research Unit (CCRU), Susan Wakil School of Nursing, University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Kate White
- Cancer Care Research Unit (CCRU), Susan Wakil School of Nursing, University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- Sydney Local Health District, Sydney, Australia
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24
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Cuthbert CA, O'Sullivan DE, Boyne DJ, Brenner DR, Cheung WY. Patient-Reported Symptom Burden and Supportive Care Needs of Patients With Stage II-III Colorectal Cancer During and After Adjuvant Systemic Treatment: A Real-World Evidence Study. JCO Oncol Pract 2023; 19:e377-e388. [PMID: 36608313 DOI: 10.1200/op.22.00462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Patients with colorectal cancer (CRC) experience a range of physical and psychologic symptoms, and supportive care needs throughout the illness trajectory. We used patient-reported outcomes and administrative health data to describe symptom burden and supportive care needs during and after adjuvant treatment and determine factors associated with changes to symptom burden. METHODS A retrospective population-based cohort study of patients who were newly diagnosed with stage II-III CRC in Alberta, Canada, between January 1, 2016, and January 31, 2019. Adults age 18 years or older who completed a patient-reported outcomes survey (Edmonton Symptom Assessment System) and supportive care needs (Canadian Problem Checklist) within 3 months after starting adjuvant treatment (during treatment) and > 7 months after starting treatment (after treatment) were included. Changes to symptom severity were stratified as stable, improved, or deteriorated. Multivariable logistic regression was used to evaluate factors associated with these changes. RESULTS We included 303 patients (median age 60 years, 62% male, 84.5% stage III, 51.2% rectal v colon). Prevalent symptoms included tiredness (80.5%), pain (50.8%), and poor well-being (50%) during treatment, and tiredness (71.3%), pain (44.2%), and poor well-being (62.1%) after treatment. The results were heterogeneous with respect to improvements, stability, or deterioration. Pain worsened for 25% of the cohort, tiredness for 28%, and depression, anxiety, and well-being for 21%, 22%, and 31%, respectively. Deterioration of some symptoms was associated with older age, stage II, comorbidities, rural setting, and higher income. CONCLUSION We demonstrated symptom severity was generally low and most symptoms remained stable or improved after treatment. Particular groups of patients were at greater risk for more severe and/or more persistent symptoms. Ongoing assessments and interventions to address physical and psychologic symptoms, and supportive care needs in patients with CRC during and after treatment are needed.
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Affiliation(s)
- Colleen A Cuthbert
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dylan E O'Sullivan
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Devon J Boyne
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Darren R Brenner
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Winson Y Cheung
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Cancer Care, Edmonton, Alberta, Canada
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25
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Sheikh-Wu SF, Anglade D, Downs C. Modèle de survie au cancer appliqué aux soins holistiques et à la recherche. Can Oncol Nurs J 2023; 33:17-30. [PMID: 36789217 PMCID: PMC9894373 DOI: 10.5737/2368807633117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Les progrès réalisés dans la lutte contre le cancer ont augmenté les taux de survie, entraînant un tel changement de paradigme que le cancer est maintenant considéré comme une maladie chronique; il nous faut donc évaluer notre connaissance de la survie au cancer (SC). C’est dans cette optique que les auteurs ont procédé à une recension exhaustive des écrits dans les référentiels CINAHL, MEDLINE et PUBMED de 2000 et 2021. En s’appuyant sur les concepts étudiés dans la littérature, ils ont répertorié les principaux facteurs qui influencent la survie au cancer dans l’ensemble des populations atteintes et ont proposé un modèle. Le présent article décrit ce modèle de survie au cancer (MSC). Le MSC prend en compte les facteurs prédisposant à la survie ainsi que les facteurs d’influence en jeu dans les trois phases de survie (aiguë, prolongée et permanente), à savoir le traitement et le traitement d’entretien (soins médicaux et psychosociaux), le bien-être, et d’autres éléments d’influence (expériences entraînant de profonds changements, incertitude, établissement de priorités, gestion du bien-être et conséquences indirectes) de même que les facteurs liés aux relations sociales qui jouent sur le fardeau des symptômes des survivants ainsi que l’expérience globale de la survie (état de santé et qualité de vie). Une étude de cas a d’ailleurs montré l’utilité du MSC. L’application du modèle est prometteuse pour l’avenir, tant pour améliorer la qualité de la survivance que pour guider la recherche et la pratique clinique en vue de favoriser et d’optimiser la bonne santé des survivants à long terme.
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Affiliation(s)
- Sameena F. Sheikh-Wu
- Auteure-ressource : Sameena F. Sheikh-Wu, École de soins infirmiers et de sciences de la santé, Université de Miami, 5030 Brunson Dr., Coral Gables, FL 33146. Courriel :
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26
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Sheikh-Wu SF, Anglade D, Downs C. A cancer survivorship model for holistic cancer care and research. Can Oncol Nurs J 2023; 33:4-16. [PMID: 36789222 PMCID: PMC9894370 DOI: 10.5737/236880763314] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Advancements in cancer have increased survival rates leading to a paradigm shift such that cancer is considered a chronic disease, necessitating an evaluation of our understanding of cancer survivorship (CS). For this purpose, a comprehensive literature search was performed, using CINAHL, MEDLINE, and PUBMED from 2000-2021. Drawing from the concepts in the literature, salient factors that affect CS across cancer populations were identified and a proposed model was developed. This paper describes the Cancer Survivorship Model (CSM). The CSM represents predisposing factors for survivors and survivorship's acute, extended, and long-term phases, influencing factors: treatment and maintenance (medical/ psychosocial care), well-being, influencing aspects (life-changing experience, uncertainty, prioritizing life, wellness management, and collateral damage), and social relationship factors that impact survivors' symptom burdens and overall survivorship experience (health outcomes and quality of life). A case study demonstrates the CSM utility. Future application of the model holds promise for improving the quality of survivorship and informing research and clinical practice to promote and optimize survivors' outcomes throughout the evolving survivorship.
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Affiliation(s)
- Sameena F. Sheikh-Wu
- Corresponding author: Sameena F. Sheikh-Wu, School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr. Coral Gables, FL 33146. E-mail:
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Yanting Z, Xv D, Long W, Wang J, Tang C, Feng M, Li X, Wang B, Zhong J. Experience and coping strategies of bowel dysfunction in postoperative patients with rectal cancer: a systematic review of qualitative evidence. PeerJ 2023; 11:e15037. [PMID: 36992944 PMCID: PMC10042155 DOI: 10.7717/peerj.15037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/20/2023] [Indexed: 03/31/2023] Open
Abstract
Aim Due to the changes of bowel physiological structure and functional disorders after rectal cancer surgery, patients will face many bowel dysfunction for a long time, which will greatly affect their quality of life. The purpose of this review is to integrate the qualitative research on the experience of bowel dysfunction and coping strategies in postoperative patients with rectal cancer. Methods Systematic retrieval of PubMed, EMbase, Cochrane Library, CINAHL, Web of Sciences, PsycINFO, Willey and other databases was carried out by using the method of subject words and keywords. The Critical Appraisal Skill Programme (CASP) Qualitative Studies Checklist was used for Qualitative assessment. The findings were extracted from the included study and synthesized into the final themes, which was evaluated strictly in accordance with the ConQual process. Results Nine studies involving 345 participants were included and two main themes were extracted: "Experience a series of changes caused by bowel dysfunction" and "nmet needs and coping strategies facing bowel dysfunction". The changes of rectal cancer patients who experience bowel dysfunction after operation mainly include three parts: bowel dysfunction is more than just a bowel reaction, which covers the bowel symptoms themselves and the subsequent body-related symptoms. The interruption of a normal life, mainly reflected in personal, family, and social life. Complex psychological reactions to bowel dysfunction, psychological changes have a dual nature, showing a positive and negative intertwined. There are two main aspects of unmet needs and coping strategies: the demand is mainly manifested in the need for information and support from medical professionals, while the coping strategy mainly includes diet, activity and drug management. Conclusion Rectal cancer patient often experience persistent bowel dysfunction after operation, which has a certain physical and mental effects. A series of new needs of postoperative patients are often not fully met, and patients often rely on their own empirical attempts to seek balance, less can get professional support. Future studies need to focus on how to provide continuous information support for postoperative rectal cancer patients, especially professional care from health care staff.
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Affiliation(s)
- Zhang Yanting
- Department of Nursing, Wuhan University Zhongnan Hospital, Wuhan, China
| | - Dandan Xv
- Department of Nursing, Wuhan University Zhongnan Hospital, Wuhan, China
| | - Wenjia Long
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jingyi Wang
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chen Tang
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Maohui Feng
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xuanfei Li
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bei Wang
- Department of Nursing, Wuhan University Zhongnan Hospital, Wuhan, China
| | - Jun Zhong
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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Aronsen S, Conway R, Lally P, Roberts A, Croker H, Beeken RJ, Fisher A. Determinants of sleep quality in 5835 individuals living with and beyond breast, prostate, and colorectal cancer: a cross-sectional survey. J Cancer Surviv 2022; 16:1489-1501. [PMID: 34750779 DOI: 10.1007/s11764-021-01127-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The present study aimed to quantify the level of sleep problems in 5835 breast, prostate, and colorectal cancer survivors, and explore a number of potential determinants of poor sleep quality in the present sample. BMI, diet, and physical activity were of particular interest as potential determinants. METHODS Participants who completed the 'Health and Lifestyle after Cancer' survey were adults who had been diagnosed with breast, prostate, or colorectal cancer (mean time since cancer diagnosis was 35.5 months, SD=13.56). Sleep quality was assessed using the Pittsburgh Sleep Quality Index. BMI was calculated from self-reported height and weight. Participants were categorised as meeting/not meeting the World Cancer Research Fund (WCRF) recommendations for fibre, fruit and vegetables, added sugar, red meat, processed meat, fat, alcohol, and physical activity. Analyses accounted for demographic and clinical factors. RESULTS Fifty-seven percent of those with sleep data were classified as poor sleepers (response rate 79%). Being female, having a higher number of cancer treatments, more comorbid conditions, and being more anxious/depressed increased the odds of being a poor sleeper. After adjustment for these factors, there were no associations between diet/alcohol/physical activity and sleep. However, BMI was associated with sleep. Individuals in the overweight and obese categories had 22% and 79% higher odds of being poor sleepers than individuals in the underweight/healthy weight category, respectively. CONCLUSIONS The findings suggest that there may be a need to develop sleep quality interventions for cancer survivors with obesity. Even after adjustment for multiple clinical and demographic factors, BMI (particularly obesity) was associated with poor sleep. Thus, researchers and health professionals should find ways to support individuals with overweight and obesity to improve their sleep quality. IMPLICATIONS FOR CANCER SURVIVORS The present findings highlight that poor sleep is a common issue in cancer survivors. Interventions seeking to improve outcomes for cancer survivors over the longer term should consider sleep quality.
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Affiliation(s)
- Silje Aronsen
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Rana Conway
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Phillippa Lally
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Anna Roberts
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Helen Croker
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Rebecca J Beeken
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Abigail Fisher
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
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Patient experiences of GP-led colon cancer survivorship care: a Dutch mixed-methods evaluation. Br J Gen Pract 2022; 73:e115-e123. [PMID: 36316164 PMCID: PMC9639600 DOI: 10.3399/bjgp.2022.0104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/20/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Colon cancer survivorship care constitutes both follow-up and aftercare. GP involvement may help to personalise care. AIM To explore patients' experiences of GP-led versus surgeon-led survivorship care. DESIGN AND SETTING Patients with stage I to III colon cancer were recruited from eight Dutch hospitals and randomised to receive care by either the GP or surgeon. METHOD A mixed-methods approach was used to compare GP-led care with surgeon-led care. After 1 year the Consumer Quality Index (CQI) was used to measure quality aspects of care. Next, interviews were performed at various time points (3-6 years after surgery) to explore patients' experiences in depth. RESULTS A total of 261 questionnaires were returned by patients and 25 semi-structured interviews were included in the study. Overall, patients were satisfied with both GP-led and surgeon-led care (ratings 9.6 [standard deviation {SD} 1.1] versus 9.4 [SD 1.1] out of 10). No important differences were seen in quality of care as measured by CQI. Interviews revealed that patients often had little expectation of care from either healthcare professional. They described follow-up consultations as short, medically oriented, and centred around discussing follow-up test results. Patients also reported few symptoms. Care for patients in the GP-led group was organised in different ways, ranging from solely on patient's initiative to shared care. Patients sometimes desired a more guiding role from their GP, whereas others preferred to be proactive themselves. CONCLUSION Patients experienced a high quality of colon cancer survivorship care from both GPs and surgeons. If the GP is going to be more involved, patients require a clear understanding of roles and responsibilities.
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The Quality of Life of Patients with Colorectal Carcinoma and Stoma. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2022-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Abstract
Surgical treatment and formation of a stoma can be lifesaving for colorectal cancer patients. However, the quality of life is often impaired in patients with stoma. The goal of this study is to determine the quality of life of patients with stoma and cancer, and the relationship between the quality of life and characteristics of these patients.
The study was conducted from 2018 to 2020 and included a total of 64 patients of both sexes with colorectal cancer and temporary or permanent stoma. The European Organization for Research and Treatment of Cancer with Quality of Life Questionnaire (EORTC QLQC29-30) and the anonymous WHO Quality of Life Questionnaire SF-36 were used for self-assessment of quality of life.
Our study included 39 (61.0%) men and 25 (39.0%) women. 24 patients (37.5%) had colostomy, 14 patients (21.9%) had ileostomy, and 26 patients (40.6%) underwent surgery for resection of colorectal cancer without stoma. A significant number of women were in the group of patients with a permanent stoma (p = 0.01). There was no statistically significant difference in the assessment of general health (p = 0.680) and quality of life (p = 0.721) during the past month in relation to gender. Patients without a stoma rated their general health better compared to those with stoma and the difference reached statistical significance (p = 0.035). There was no statistically significant difference in the assessment of quality of life between the group of patients with stoma and without stoma, as well as between the patients of different age groups.
Patients with stoma rated their general health as worse, but not their quality of life.
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Al-Shandudi M, Al-Moundhri M, Chan MF, Al-Hajri T, Al-Balushi M, Al-Azri M. Health-Related Quality of Life, Functioning, and Physical Symptoms of Adult Omani Colorectal Cancer Survivors. Asian Pac J Cancer Prev 2022; 23:3019-3027. [PMID: 36172664 PMCID: PMC9810320 DOI: 10.31557/apjcp.2022.23.9.3019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Colorectal (CRC) survivors often experience physical and psychological symptoms affecting their health-related quality of life (HRQoL). This study aimed to identify factors impacting HRQoL-related functioning and physical symptoms among adult Omani CRC survivors. METHODS A cross-sectional study of 124 adult CRC survivors was conducted at the two main oncology referral hospitals in Oman. A validated Arabic version of the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire 30 was used to collect data. RESULTS A total of 118 CRC survivors participated in the study (response rate: 95.2%). The mean age was 52 years and there were an equal number of male and female participants (n = 59 each; 50.0%). A total of 62 survivors (52.5%) had been diagnosed with CRC at stages III or IV. The overall score for global health was high (81.7). With regards to functioning, high mean scores were observed for domains of role (91.0) and social (90.7) functioning. In terms of symptoms, high mean scores were reported for constipation (25.4), insomnia (25.1), pain (20.1), and fatigue (18.9). Survivors under 60 years old (β=15.5, p=.004) and those with no comorbidities (β=16.0, p=.001) demonstrated better functional HRQoL. Being male was predictive of better functional HRQoL in the emotional (β=13.9, p<0.008), cognitive functioning (β=12.5, p=.013), role functioning (β=14.0, p=0.006) and physical functioning (β=17.8, p<0.001) domains. CONCLUSIONS Healthcare professionals in Oman should implement measures to enhance the HRQoL of CRC survivors, particularly women and those with coexisting morbidities.
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Affiliation(s)
- Maryam Al-Shandudi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
| | | | - Moon Fai Chan
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
| | | | - Muna Al-Balushi
- Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman.
| | - Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman. ,For Correspondence:
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Krogsgaard M, Kristensen HØ, Furnée EJB, Verkuijl SJ, Rama NJ, Domingos H, Maciel J, Solis-Peña A, Espín-Basany E, Hidalgo-Pujol M, Biondo S, Sjövall A, Emmertsen KJ, Thyø A, Christensen P. Life with a stoma across five European countries-a cross-sectional study on long-term rectal cancer survivors. Support Care Cancer 2022; 30:8969-8979. [PMID: 35930059 DOI: 10.1007/s00520-022-07293-y] [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: 01/26/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Stoma-related problems are known to be important to patients and potentially affect everyday life. The prevalence of stoma-related problems in rectal cancer survivors remains undetermined. This study aimed to examine aspects of life with a long-term stoma, stoma management, and stoma-related problems and explore the impact of stoma-related problems on daily life. METHODS In total, 2262 patients from 5 European countries completed a multidimensional survey. Stoma-related problems were assessed using the Colostomy Impact score. Multivariable regression analysis, after adjusting for potential confounding factors, provided odds ratio (OR) and 95% confidence intervals (CI) for stoma-related problems' association with restrictions in daily life. RESULTS The 2262 rectal cancer survivors completed the questionnaire at a median of 5.4 years (interquartile range 3.8-7.6) after stoma formation. In the total sample, leakage (58%) and troublesome odour (55%) were most prevalent followed by skin problems (27%) and pain (21%). Stoma-related problems were more prevalent in patients with parastomal bulging. A total of 431 (19%) reported feeling restricted in daily activities in life with a stoma. Leakage, odour, skin problems, stool consistency, and frequent appliance changes were significantly associated with restrictions in daily life. The highest risk of experiencing restrictions was seen for patients having odour (OR 2.74 [95% CI: 1.99-3.78]) more than once a week and skin problems (OR 1.77 [95% CI: 1.38-2.27]). CONCLUSION In this large cohort with rectal cancer, stoma-related problems were highly prevalent and impacted daily life. Supportive care strategies should entail outreach to patients with a long-term stoma.
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Affiliation(s)
- Marianne Krogsgaard
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Lykkebækvej 1, 4600, Koege, Denmark.
| | - Helle Ø Kristensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Danish Cancer Society Centre for Research On Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus, Denmark
| | - Edgar J B Furnée
- Department of Surgery, Division of Abdominal Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sanne J Verkuijl
- Department of Surgery, Division of Abdominal Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nuno José Rama
- Surgery - Colorectal Unit, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Hugo Domingos
- Colorectal Surgery Unit, Champalimaud Foundation, Lisbon, Portugal
| | - João Maciel
- Colorectal Surgery Unit, Instituto Português de Oncologia, Lisbon, Portugal
| | - Alejandro Solis-Peña
- Colorectal Surgery Unit, General Surgery Department, Universitat Autonoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery Unit, General Surgery Department, Universitat Autonoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain
| | - Marta Hidalgo-Pujol
- Department of General and Digestive Surgery, Coloproctology Unit, Bellvitge University Hospital, Barcelona, Spain.,University of Barcelona and IBIDELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Coloproctology Unit, Bellvitge University Hospital, Barcelona, Spain.,University of Barcelona and IBIDELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Annika Sjövall
- Division of Coloproctology, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Katrine J Emmertsen
- Danish Cancer Society Centre for Research On Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus, Denmark.,Department of Surgery, Regional Hospital Randers, Randers, Denmark
| | - Anne Thyø
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Danish Cancer Society Centre for Research On Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus, Denmark.,Department of Surgery, Regional Hospital Randers, Randers, Denmark
| | - Peter Christensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Danish Cancer Society Centre for Research On Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus, Denmark
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Rutherford C, Boehnke JR. Introduction to the special section "Reducing research waste in (health-related) quality of life research". Qual Life Res 2022; 31:2881-2887. [PMID: 35907111 DOI: 10.1007/s11136-022-03194-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Claudia Rutherford
- Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Cancer Care Research Unit (CCRU), The University of Sydney, Sydney, Australia. .,Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Sydney, Australia. .,The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia.
| | - Jan R Boehnke
- School of Health Sciences, University of Dundee, Dundee, UK
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Eymech O, Brunckhorst O, Deacon M, James C, Bowie J, Dasgupta P, Ahmed K. The impact of radical prostatectomy on the social well-being of prostate cancer survivors: A qualitative meta-synthesis. Eur J Cancer Care (Engl) 2022; 31:e13630. [PMID: 35754206 DOI: 10.1111/ecc.13630] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The impact of radical prostatectomy on the social well-being of survivors remains poorly understood. This meta-synthesis therefore aimed to integrate the findings of qualitative research evaluating the impact of surgery on the patient relationships with partners, family and wider societal interactions. METHODS Medline, CINAHL, PsycINFO and Embase were searched for qualitative studies evaluating social well-being dimensions. A thematic meta-synthesis was conducted to inductively construct descriptive themes and overarching analytical themes. RESULTS Thirty-one articles were included, with seven descriptive themes under two analytical themes generated to describe the experiences of 469 participants. 'Pathway to Conversion' encompassed three themes on the evolving social behaviour of men with both partners and family to adapt to their new normality postoperatively. 'A Man on My Own' discussed four themes focussing on both intimate and wider social relations, describing the stigma, shame and embarrassment felt by patients due to changes in their perceived body image and physical function. This resulted in men feeling alone, unsupported and seeking isolation. CONCLUSION Radical prostatectomy's impact on survivors' social well-being extends beyond surgery and causes a shift in their relationship dynamics with partner and family, highlighting the importance of preoperative and postoperative clinician's counselling to both patient and partner.
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Affiliation(s)
- Omar Eymech
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Matthew Deacon
- Department of Urology, King's College Hospital, London, UK
| | - Callum James
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Jessica Bowie
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK.,Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK.,Department of Urology, King's College Hospital, London, UK.,Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, UAE.,Khalifa University, Abu Dhabi, UAE
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Addressing colon cancer patients' needs during follow-up consultations at the outpatient clinic: a multicenter qualitative observational study. Support Care Cancer 2022; 30:7893-7901. [PMID: 35726108 PMCID: PMC9512715 DOI: 10.1007/s00520-022-07222-z] [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: 10/22/2021] [Accepted: 06/11/2022] [Indexed: 11/13/2022]
Abstract
Purpose To describe colon cancer patients’ needs and how healthcare providers respond to these needs during routine follow-up consultations in hospital. Methods A multicenter qualitative observational study, consisting of follow-up consultations by surgeons and specialized oncology nurses. Consultations were analyzed according to Verona Coding Definitions of Emotional Sequences. Patients’ questions, cues, and concerns were derived from the data and categorized into supportive care domains. Responses of healthcare providers were defined as providing or reducing space for disclosure. Patient satisfaction with care was measured with a short questionnaire. Results Consultations with 30 patients were observed. Questions typically centered around the health system and information domain (i.e., follow-up schedule and test results; 92%). Cues and concerns were mostly associated with the physical and daily living domain (i.e., experiencing symptoms and difficulties resuming daily routine; 43%), followed by health system and information (i.e., miscommunication or lack of clarity about follow-up; 28%), and psychological domain (i.e., fear of recurrence and complications; 28%). Problems in the sexuality domain hardly ever arose (0%). Healthcare providers provided space to talk about half of the cues and concerns (54%). Responses to cancer-related versus unrelated problems were similar. Overall, the patients were satisfied with the information and communication received. Conclusions Colon cancer patients express various needs during consultations. Healthcare providers respond to different types of needs in a similar fashion. We encourage clinicians to discuss all supportive care domains, including sexuality, and provide space for further disclosure. General practitioners are trained to provide holistic care and could play a greater role. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07222-z.
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van den Hurk CJG, Mols F, Eicher M, Chan RJ, Becker A, Geleijnse G, Walraven I, Coolbrandt A, Lustberg M, Velikova G, Charalambous A, Koczwara B, Howell D, Basch EM, van de Poll-Franse LV. A Narrative Review on the Collection and Use of Electronic Patient-Reported Outcomes in Cancer Survivorship Care with Emphasis on Symptom Monitoring. Curr Oncol 2022; 29:4370-4385. [PMID: 35735458 PMCID: PMC9222072 DOI: 10.3390/curroncol29060349] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/11/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Electronic patient-reported outcome (ePRO) applications promise great added value for improving symptom management and health-related quality of life. The aim of this narrative review is to describe the collection and use of ePROs for cancer survivorship care, with an emphasis on ePRO-symptom monitoring. It offers many different perspectives from research settings, while current implementation in routine care is ongoing. ePRO collection optimizes survivorship care by providing insight into the patients' well-being and prioritizing their unmet needs during the whole trajectory from diagnosis to end-of-life. ePRO-symptom monitoring can contribute to timely health risk detection and subsequently allow earlier intervention. Detection is optimized by automatically generated alerts that vary from simple to complex and multilayered. Using ePRO-symptoms during in-hospital consultation enhances the patients' conversation with the health care provider before making informed decisions about treatments, other interventions, or self-management. ePRO(-symptoms) entail specific implementation issues and complementary ethics considerations. The latter is due to privacy concerns, digital divide, and scarcity of adequately representative data for particular groups of patients.
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Affiliation(s)
- Corina J. G. van den Hurk
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), 3511 DT Utrecht, The Netherlands; (F.M.); (G.G.); (L.V.v.d.P.-F.)
- Correspondence:
| | - Floortje Mols
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), 3511 DT Utrecht, The Netherlands; (F.M.); (G.G.); (L.V.v.d.P.-F.)
- CoRPS—Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
| | - Manuela Eicher
- Institute of Higher Education and Research in Health Care (IUFRS), Faculty of Biology and Medicine, University of Lausanne and Lausanne University Hospital, CH-1010 Lausanne, Switzerland;
- Department of Oncology, Lausanne University Hospital, CH-1011 Lausanne, Switzerland
| | - Raymond J. Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
| | - Annemarie Becker
- Amsterdam UMC, Department of Pulmonary Diseases, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Gijs Geleijnse
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), 3511 DT Utrecht, The Netherlands; (F.M.); (G.G.); (L.V.v.d.P.-F.)
| | - Iris Walraven
- Radboudumc, Department for Health Evidence, 6525 GA Nijmegen, The Netherlands;
| | - Annemarie Coolbrandt
- Department of Oncology Nursing, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, 3000 Leuven, Belgium
| | - Maryam Lustberg
- Breast Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT 06520, USA;
- Breast Center at Smilow Cancer Hospital, New Haven, CT 06519, USA
| | - Galina Velikova
- Leeds Institute of Medical Research at St James’s, University of Leeds and Leeds Cancer Centre, St James’s University Hospital, Leeds LS9 7TF, UK;
| | - Andreas Charalambous
- Nursing Department, Cyprus University of Technology, Limassol 3036, Cyprus;
- Department of Nursing Science, University of Turku, 00074 CGI Turku, Finland
| | - Bogda Koczwara
- Flinders Medical Centre, Flinders University, Adelaide, SA 5042, Australia;
| | - Doris Howell
- Princess Margaret Cancer Research Institute, University of Toronto, Toronto, ON M5G 2M9, Canada;
| | - Ethan M. Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina Cancer Center, Chapel Hill, NC 27599, USA;
| | - Lonneke V. van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), 3511 DT Utrecht, The Netherlands; (F.M.); (G.G.); (L.V.v.d.P.-F.)
- CoRPS—Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
- Department of Psychosocial Research, Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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Querido NR, Kenkhuis MF, van Roekel EH, Breukink SO, van Duijnhoven FJB, Janssen-Heijnen ML, Keulen ET, Ueland PM, Vogelaar FJ, Wesselink E, Bours MJ, Weijenberg MP. Longitudinal associations between inflammatory markers and fatigue up to two years after colorectal cancer treatment. Cancer Epidemiol Biomarkers Prev 2022; 31:1638-1649. [PMID: 35654354 DOI: 10.1158/1055-9965.epi-22-0077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/14/2022] [Accepted: 05/20/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Fatigue is often reported by colorectal cancer survivors (CRC) and largely impacts their quality of life. Inflammation has been linked to fatigue mainly in breast cancer patients. Therefore, we investigated how inflammation is longitudinally associated with fatigue in CRC survivors, up to 2 years post-treatment. METHODS A total of 257 patients from the ongoing Energy for life after ColoRectal cancer (EnCoRe) cohort study were included in the analysis. Plasma levels of IL6, IL8, IL10, TNFα, hsCRP, and fatigue were measured at 6 weeks, 6, 12, and 24 months post-treatment. Fatigue was measured through the validated Checklist Individual Strength (CIS total, 20-140), consisting of four subscales - subjective fatigue (8-56), motivation (4-28), physical activity (3-21), and concentration (5-35), and the EORTC QLQ-C30 fatigue subscale (0-100). Linear mixed-models were used to assess the confounder-adjusted longitudinal associations between inflammatory markers and overall fatigue along with the subscales. RESULTS Mean levels of CIS fatigue decreased from 62.9 at 6 weeks to 53.0 at 24 months. In general, levels of inflammatory markers also decreased over time. No statistically significant longitudinal associations were found between IL6, IL8, IL10, TNFα, and fatigue. Higher levels of hsCRP were associated with more CIS fatigue (β per SD 3.21, 95% CI 1.42; 5.01) and EORTC fatigue (β 2.41, 95% CI 0.72; 4.10). CONCLUSION Increased levels of hsCRP are longitudinally associated with more post-treatment fatigue in CRC survivors. IMPACT These findings suggest that low-grade inflammation may play a role in fatigue reported by CRC survivors up to 2 years post-treatment.
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Sun V, Crane TE, Freylersythe S, Slack SD, Yung A, Krouse RS, Thomson CA. Altering Intake and Managing Symptoms: Feasibility of a Diet Modification Intervention for Post-Treatment Bowel Dysfunction in Rectal Cancer. Clin J Oncol Nurs 2022; 26:283-292. [PMID: 35604741 DOI: 10.1188/22.cjon.283-292] [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: 11/17/2022]
Abstract
BACKGROUND Bowel dysfunction is a common long-term effect of rectal cancer treatment that affects a survivor's quality of life, with few empirically based interventions for symptom management. OBJECTIVES The objective was to determine the acceptability of diet modification for bowel dysfunction in postsurgical rectal cancer survivors. METHODS 11 rectal cancer survivors who were at least six months post-treatment and reported moderate to severe bowel symptoms completed 10 telephone coaching sessions focusing on diet and symptom management over four months. Feasibility was assessed by study enrollment rate and intervention completion rate. FINDINGS Diet modification coaching for bowel symptom management is feasible for post-treatment rectal cancer survivors. The intervention can be evaluated for efficacy because of potential to serve as a scalable and accessible approach for effective bowel symptom management.
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He X, Li Z. Ostomy Does Not Lead to Worse Outcomes After Bowel Resection With Ovarian Cancer: A Systematic Review. Front Oncol 2022; 12:892376. [PMID: 35677154 PMCID: PMC9169036 DOI: 10.3389/fonc.2022.892376] [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: 03/09/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Debulking cytoreduction surgery with bowel resection is a common intervention for ovarian cancer. It is controversial whether ostomy causes worse survival outcomes and how clinical physicians should choose which patients to undergo ostomy. During this study, we performed a systematic review to determine whether ostomy leads to worse outcomes after bowel resection compared to anastomosis. We also summarized the possible indications for ostomy. Methods We searched PubMed, Embase, and Cochrane for articles containing the phrase "ovarian cancer with bowel resection" that were published between 2016 and 2021. We included studies that compared primary anastomosis with ostomy. We mainly focused on differences in the anastomotic leakage rate, length of hospital stay, overall survival, and other survival outcomes associated with the two procedures. Results and Conclusion Of the 763 studies, three were ultimately included in the systematic review (N=1411). We found that ostomy did not contribute to worse survival outcomes, and that the stoma-related complications were acceptable. Indications for ostomy require further study. Bowel resection segment margins and the distance from the anastomosis to the anal verge require consideration.
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Affiliation(s)
- Xinlin He
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhengyu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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Bahrami M, Masoumy M, Sadeghi A, Mosavizadeh R. Development, implementation and evaluation a palliative care program for colorectal cancer patients: a mixed methods protocol study. BMC Cancer 2022; 22:441. [PMID: 35459102 PMCID: PMC9028062 DOI: 10.1186/s12885-022-09538-9] [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: 10/29/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Colorectal cancer(CRC) patients are among the incurable groups who need comprehensive palliative care covering all aspects including physical, mental, social, and spiritual. The purpose of this study is to develop, implement, and evaluate a holistic palliative care program for CRC patients in order to improve quality of life of CRC patients. Methods This study is an exploratory mixed methods study which will be conducted using a sequential qualitative-quantitative design (QUAL quan) consists of four sequential steps using the approach proposed by Ewles & Sminett to develop the program. In the first phase, a qualitative study (semi-structured interview) will be conducted to discover the needs of CRC patients from the perspective of patients, family members and care providers. In the second phase, the literature review will be performed with the aim of confirming and completing the discovering new needs. In the third phase, in order to prioritize the identified needs and prepare a initial draft of the palliative care program will be done a panel of experts. In the fourth phase, the part of the developed program according to the opinions of the panel of experts, will be implemented as quasi-experimental intervention and the effect of intervention on quality of life will be evaluated. Discussion This results of this study are expected to meet the needs of CRC patients and their families through providing a holistic care and improve their quality of life in the socio-cultural context of Iran. This program can be useful in providing care, education, policy making and for future research.
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Affiliation(s)
- Masoud Bahrami
- Cancer Prevention Research Center, Department of Adult Health Nursing, Faculty Of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Masoumy
- Student Research Committee, Faculty Of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Alireza Sadeghi
- Cancer Prevention Research Center, Department of Hematology-Oncology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rohallah Mosavizadeh
- ALA Cancer Prevention and Control Center, Department of Islamic Education, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Rosenberg J, Oggesen BT, Hamberg MLS, Danielsen AK. Establishment of a nurse-led clinic for late complications after colorectal and anal cancer surgery: a descriptive study. Support Care Cancer 2022; 30:6243-6250. [PMID: 35445868 PMCID: PMC9022613 DOI: 10.1007/s00520-022-07061-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/11/2022] [Indexed: 12/03/2022]
Abstract
Purpose Survival rates after colorectal and anal cancer are increasing and more patients have late complications to treatment. This represents a clinical field under development, and we have established a specialized clinic for late complications after colorectal and anal cancer. With this paper, we want to give our experiences and present the organizational setup with a nurse as the primary contact person. Methods We have established a multidisciplinary clinic for the treatment of late complications and the clinic is organized with specialized nurses as the front persons. The structure includes a stepwise increase in expertise level when needed, and the patient has one common entry regardless of symptoms. Initial screening is performed by an electronic questionnaire which is followed up by a consultation with the nurse. The nurse can provide primary treatment according to local algorithms developed in the clinic and refer the patient to more specialized care if needed. Results Experiences from the first year of service show that more than half of the patients needs this and wants consultation in the late complication clinic. We also found that most of the consultations were performed successfully by phone instead of by physical visits, and the most common clinical problem was bowel symptoms including diarrhea and urge. Conclusion We have established a nurse-led clinic for late complications after colorectal and anal cancer. There seems to be a high need for this function in a department taking care of colorectal and anal cancer.
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Affiliation(s)
- Jacob Rosenberg
- Department of Surgery, Herlev Hospital, University of Copenhagen, 2730, Herlev, Denmark.
| | - Birthe Thing Oggesen
- Department of Surgery, Herlev Hospital, University of Copenhagen, 2730, Herlev, Denmark
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A multi-modal study examining long-term bowel, urinary, and sexual function after rectal cancer surgery. Am J Surg 2022; 224:562-568. [DOI: 10.1016/j.amjsurg.2022.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 11/19/2022]
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Wang W, Li H, Li Y, Fang S, Zhang S, Zhang X, Meng X, Su J, Sun J. Colorectal cancer survivors' experience of continuity of care provided by different health professionals: A qualitative evidence synthesis. J Clin Nurs 2022; 31:2985-2999. [PMID: 34985169 DOI: 10.1111/jocn.16189] [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: 07/03/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 12/09/2022]
Abstract
AIMS AND OBJECTIVES To systematically identify, synthesise and characterise the available qualitative evidence on the experience of adult colorectal cancer survivors with continuity of care led by different health professionals. BACKGROUND The limited evidence base for effective continuity of care led by different medical staff who assist colorectal cancer survivors with their unique survivorship care hampers the development of effective interventions. Synthesising the data on survivors' experience of care led by different health professionals is critical to develop such interventions. DESIGN A qualitative evidence synthesis using the Thomas and Harden method and the PRISMA 2020 checklist provided by the EQUATOR network were used. METHODS PubMed, Web of Science, Embase, Cochrane, CINAHL and PsycINFO were searched through November 2020 for qualitative and mixed methods studies in English. JBI-QARI was used to undertake a quality review of the identified studies. The review findings were synthesised by a team of researchers, and the level of confidence was evaluated using GRADE-CERQual. RESULTS Eleven studies met the criteria for inclusion in the review. The identified analytical themes included experience of diversity, preference for health professionals and space for enhancement to facilitate improved medical care delivery. Colorectal cancer survivors report diverse experiences regarding continuity of care led by different providers. Specifically, they attach substantial importance to trusted relationships with providers that are closely associated with their overall care experience. CONCLUSION Effective communication and good rapport among stakeholders are cornerstones for addressing the complexity of ongoing care. Future interventions should include adjusting the percentage of care from different providers to deliver cost-effective and personalised continuity of care. RELEVANCE TO CLINICAL PRACTICE Synthesising data on survivors' experience facilitates the development of practical approaches to increase the quality of continuity of care and may also foster the integration of providers' advantages to enable more cost-effective intervention. The limited capacity of primary care providers may be enhanced by better cooperation and communication with specialists and by additional professional cancer-related training.
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Affiliation(s)
- Wenxia Wang
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Huanhuan Li
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Yijing Li
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Shuyan Fang
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Shuang Zhang
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Xu Zhang
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Xiangfei Meng
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Jianping Su
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Jiao Sun
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
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Al-Shandudi M, Al-Mandhari M, Chan MF, Al-Hajri T, Al-Balushi M, Al-Azri M. Health-Related Quality of Life of Omani Colorectal Cancer Survivors. Cancer Control 2022; 29:10732748221084198. [PMID: 35275768 PMCID: PMC8921743 DOI: 10.1177/10732748221084198] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) patients often experience physical and psychological symptoms which affect quality of life (QOL). PURPOSE This study aimed to identify factors affecting QOL among adult Omani CRC survivors. METHODS A prospective cross-sectional study of 124 adult CRC survivors was conducted at the two main oncology referral hospitals in Oman. A validated Arabic version of the European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire for Colorectal Cancer-29 (EORTC QLQ-CR29) was used to collect data. RESULTS Of the 118 participants (response rate: 95.2%), 59 (50.0%) were male. The mean age was 52.7 years. Overall, 102 (86.4%) had been diagnosed with CRC at stages II or III. High mean scores on the QLQ-CR29 functional scale were reported for body image (88.9), weight (79.3), and anxiety (75.4). Mean scores for sexual interest were lower in men (31.4) compared to women (62.2). Severe anxiety was reported in 12 survivors (10.2%). Age, gender, the presence of comorbidities, and tumor location were significant predictors of QOL (P ≤.05). CONCLUSION Omani CRC survivors demonstrated satisfactory QOL, although men reported more anxiety and sexual problems. Healthcare providers in Oman should conduct regular assessments of CRC survivors and offer counseling services if necessary.
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Affiliation(s)
- Maryam Al-Shandudi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, 37611Sultan Qaboos University, Muscat, Oman
| | - Mansour Al-Mandhari
- Sultan Qaboos Comprehensive Cancer Care & Research Center, 37611Sultan Qaboos University, Muscat, Oman
| | - Moon Fai Chan
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, 37611Sultan Qaboos University, Muscat, Oman
| | | | - Muna Al-Balushi
- Sultan Qaboos Comprehensive Cancer Care & Research Center, 37611Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, 37611Sultan Qaboos University, Muscat, Oman
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Keller DS. Stop stigmatizing stomas. Colorectal Dis 2021; 23:2793-2794. [PMID: 34818463 DOI: 10.1111/codi.15961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Deborah S Keller
- Division of Colorectal Surgery, Department of Surgery, University of California at Davis Medical Center, Sacramento, California, USA
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Kenkhuis MF, van Duijnhoven FJB, van Roekel EH, Breedveld-Peters JJL, Breukink SO, Janssen-Heijnen ML, Keulen ETP, Mols F, Weijenberg MP, Bours MJL. Longitudinal associations of fiber, vegetable, and fruit intake with quality of life and fatigue in colorectal cancer survivors up to 24 months posttreatment. Am J Clin Nutr 2021; 115:822-832. [PMID: 34687207 PMCID: PMC8895214 DOI: 10.1093/ajcn/nqab360] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The increasing colorectal cancer (CRC) survivor population highlights the need for dietary recommendations in order to enhance health-related quality of life (HRQoL) and alleviate symptoms of fatigue, chemotherapy-induced peripheral neuropathy (CIPN), and gastrointestinal problems. OBJECTIVES Because of the therapeutic potential of dietary fiber on the gut, we aim to assess longitudinal associations of postdiagnostic dietary fiber, fruit, and vegetable intake, a major source of dietary fiber, with HRQoL, fatigue, CIPN, and gastrointestinal symptoms in CRC survivors from 6 wk to 24 mo posttreatment. METHODS In a prospective cohort among stage I-III CRC survivors (n = 459), 5 repeated study measurements between diagnosis and 24 mo posttreatment were executed. Dietary fiber intake and fruit and vegetable intake were measured by 7-d dietary records. HRQoL, fatigue, CIPN, and gastrointestinal symptoms were measured by validated questionnaires. We applied confounder-adjusted linear mixed models to analyze longitudinal associations from 6 wk until 24 mo posttreatment and used hybrid models to disentangle the overall association into intraindividual changes and interindividual differences over time. RESULTS Higher dietary fiber intake and fruit and vegetable intake were longitudinally associated with statistically significant better physical functioning and less fatigue. Intraindividual analyses showed that an increase of 10 g/d in dietary fiber within individuals over time was associated with better physical functioning (β: 2.3; 95% CI: 0.1, 4.4), role functioning (ability to perform daily activities; 5.9; 1.5, 10.3), and less fatigue (-4.1; -7.7, -0.5). An average increase in fruit and vegetable intake of 100 g/d between individuals over time was predominantly associated with less fatigue (-2.2; -4.2, -0.3). No associations were found with CIPN and gastrointestinal symptoms. CONCLUSIONS Our results suggest that increasing dietary fiber, fruit, and vegetable intake is related to better physical and role functioning and less fatigue in the first 2 y after the end of treatment for CRC.
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Affiliation(s)
| | | | - Eline H van Roekel
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - José J L Breedveld-Peters
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Stéphanie O Breukink
- Department of Surgery, GROW School for Oncology and Developmental Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maryska L Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands,Department of Clinical Epidemiology, Viecuri Medical Center, Venlo, The Netherlands
| | - Eric T P Keulen
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Floortje Mols
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Martijn J L Bours
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
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Duangchan C, Steffen A, Matthews AK. Perspectives and practices regarding colorectal cancer survivorship care: Online survey results from oncology nurses in Thailand. Eur J Oncol Nurs 2021; 55:102048. [PMID: 34634574 DOI: 10.1016/j.ejon.2021.102048] [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] [Received: 08/30/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Limited research has highlighted disparities in survivorship care in low- and middle-income countries. However, such care for colorectal cancer (CRC) survivors remains unexplored, especially in Thailand. This study examined Thai oncology nurses' perceptions of responsibility, confidence levels, and frequency of survivorship care practice for CRC survivors and identified factors impeding such care. METHODS A cross-sectional study utilizing an online survey approach was conducted between October and November 2020. Thai oncology nurses (N = 155) completed the survey's demographic questionnaire, 29-item survivorship care scale, and 16-item impeding factor scale. RESULTS Oncology nurses had high levels of perceived responsibility (mean = 73.37, SD = 12.12) and confidence (mean = 65.09, SD = 14.89) for providing CRC survivorship care. However, they reported less frequency of practice (mean = 47.60, SD = 21.03), especially concerning sexual, fertility, employment, and financial issues. Nurses with higher education had significantly higher responsibility perceptions, confidence levels, and frequency of practice (all p < .05). Also, nurses with specialty training in cancer care reported higher frequency of practice (p = .013). Common factors impeding survivorship care were lack of physical facilities (60.4%), knowledge/skills (57.4%), and educational resources for family members (52.3%) and survivors (51.6%). CONCLUSIONS This study revealed inconsistencies between oncology nurses' responsibility perceptions, confidence levels, and frequency of survivorship care practice. The results can guide nurse researchers, educators, leaders, and policymakers in enhancing the quality of CRC survivorship care in low- and middle-income countries such as Thailand. Future efforts should focus on developing educational resources and training programs for survivorship care for oncology nurses and addressing factors impeding such care during healthcare service planning.
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Affiliation(s)
- Cherdsak Duangchan
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA; Faculty of Nursing, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.
| | - Alana Steffen
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Alicia K Matthews
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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The relation between sleep quality, sleep quantity, and gastrointestinal problems among colorectal cancer survivors: result from the PROFILES registry. Support Care Cancer 2021; 30:1391-1398. [PMID: 34523041 PMCID: PMC8727422 DOI: 10.1007/s00520-021-06531-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/28/2021] [Indexed: 02/07/2023]
Abstract
Purpose Common residual symptoms among survivors of colorectal cancer (CRC) are sleep difficulties and gastrointestinal symptoms. Among patients with various gastrointestinal (inflammatory) diseases, sleep quality has been related to gastrointestinal symptoms. For CRC survivors, this relation is unclear; therefore, we examined the association between sleep quality and quantity with gastrointestinal symptoms among CRC survivors. Methods CRC survivors registered in the Netherlands Cancer Registry—Southern Region diagnosed between 2000 and 2009 received a survey on sleep quality and quantity (Pittsburgh Sleep Quality Index) and gastrointestinal symptoms (European Organisation for Research and Treatment of Cancer, Quality of Life Questionnaire-Colorectal 38, EORTC QLQ-CR38) in 2014 (≥ 4 years after diagnosis). Secondary cross-sectional data analyses related sleep quality and quantity separately with gastrointestinal symptoms by means of logistic regression analyses. Results In total, 1233 CRC survivors were included, of which 15% reported poor sleep quality. The least often reported gastrointestinal symptom was pain in the buttocks (15.1%) and most often reported was bloating (29.2%). CRC survivors with poor sleep quality were more likely to report gastrointestinal symptoms (p’s < 0.01). Survivors who slept < 6 h were more likely to report symptoms of bloating or flatulence, whereas survivors who slept 6–7 h reported more problems with indigestion. Conclusions Worse sleep quality and short sleep duration were associated with higher occurrence of gastrointestinal symptoms. Implications for cancer survivors Understanding the interplay between sleep quality and gastrointestinal symptoms and underlying mechanisms adds to better aftercare and perhaps reduction of residual gastrointestinal symptoms in CRC survivors by improving sleep quality.
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Saunders CH, Goldwag JL, Read JT, Durand MA, Elwyn G, Ivatury SJ. 'Because Everybody is so Different': a qualitative analysis of the lived experiences and information needs of rectal cancer survivors. BMJ Open 2021; 11:e043245. [PMID: 34011586 PMCID: PMC8137244 DOI: 10.1136/bmjopen-2020-043245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/08/2021] [Accepted: 04/22/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To (1) characterise (A) the lived experiences and (B) information needs of patients with rectal cancer; and (2) compare to the perceived lived experiences and information needs of colorectal surgeons. DESIGN We conducted 1-hour semistructured qualitative interviews, dual independent transcript coding and thematic analysis. SETTING/PARTICIPANTS Interviews included rectal cancer survivors (stages I-III), some accompanied by caregivers, at Dartmouth-Hitchcock Medical Center and experienced colorectal surgeons. RESULTS We performed 25 interviews involving 30 participants, including 15 patients with 5 caregivers, plus 10 physicians. Two major themes emerged. First, patients reported major impacts on their lives following rectal cancer, including on their everyday lives and leisure activities; identity, self-confidence and intimacy; mental health, especially anxiety. These impacts were mediated by their medical experiences, lifestyle and attitudes. Second, the diversity of effects on patients' lives means that care, counselling and information needs should be personalised for a better medical experience and outcomes. Surgeons did not report knowledge of the full range of patient experiences and reported limited counselling in key areas, particularly concerning intimacy and mental health. CONCLUSION Rectal cancer diagnosis, treatment and survivorship dramatically affect all people, regardless of which surgical treatment they undergo. Effects are varied and necessitate customised care, counselling and information, which surgeons are not currently providing. Because rectal cancer affects every part of patients' lives, they need holistic support and information. Patients would benefit from substantial support after treatment as they establish a new normal.
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Affiliation(s)
- Catherine H Saunders
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jenaya L Goldwag
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jackson T Read
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Glyn Elwyn
- Dartmouth College, Hanover, New Hampshire, USA
| | - Srinivas J Ivatury
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
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Lim CYS, Laidsaar-Powell RC, Young JM, Kao SCH, Zhang Y, Butow P. Colorectal cancer survivorship: A systematic review and thematic synthesis of qualitative research. Eur J Cancer Care (Engl) 2021; 30:e13421. [PMID: 33733545 DOI: 10.1111/ecc.13421] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/06/2020] [Accepted: 01/15/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION With rapid changes in treatments for colorectal cancer (CRC), qualitative research into CRC survivorship requires greater synthesis. This paper aims to fill this gap through a systematic review (PROSPERO CRD42019131576) and thematic synthesis of the qualitative literature on survivorship experiences across early-stage and advanced CRC survivors. METHODS CINAHL, Embase, MEDLINE, PsycINFO and PubMed were searched for qualitative CRC survivorship papers. Titles, abstracts and full texts were screened. Included articles (n = 81) underwent data extraction, CASP qualitative bias ratings and thematic synthesis. RESULTS Bowel dysfunction caused functional limitations and negative quality of life (QoL), while stomas posed threats to body image and confidence. Physical symptoms hindered return to work, increasing financial burdens. Survivors' unmet needs included information regarding symptom expectations and management, and ongoing support throughout recovery. Advanced and early-stage survivors shared similar experiences. Advanced survivors struggled with fear of cancer recurrence/progression and feelings of powerlessness. Functional limitations, financial impacts and sexuality in advanced survivors were underexplored areas. CONCLUSION CRC and its treatments impact survivors' QoL in all areas. A coordinated supportive care response is required to address survivors' unmet needs. Future qualitative studies should explore advanced CRC subpopulations, treatment-specific impacts on QoL and long-term (>5 years) impacts on CRC survivors.
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Affiliation(s)
- Chloe Yi Shing Lim
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Rebekah Clare Laidsaar-Powell
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Jane M Young
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,RPA Institute of Academic Surgery (IAS) and Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, Sydney, NSW, Australia
| | - Steven Chuan-Hao Kao
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Yuehan Zhang
- National Centre for Epidemiology and Population Health, Australian National University Research School of Population Health, Canberra, ACT, Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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