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Sebo P, Haller DM, Kaiser C, Zaim A, Heimer O, Chauveau N, Maisonneuve H. Health-related quality of life associated with nocturnal leg cramps in primary care: a mixed methods study. Fam Pract 2022; 39:85-91. [PMID: 34278417 DOI: 10.1093/fampra/cmab082] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although nocturnal leg cramps are common, little research is available about their impact on quality of life. This mixed-methods study explored the impact of nocturnal leg cramps on health-related quality of life (HRQoL). METHODS The study included primary care patients (>50 years) who reported suffering from nocturnal leg cramps (2016-2017). In the quantitative phase, patients completed a questionnaire about their HRQoL (SF-36) and the frequency of their cramps, and we computed the SF-36 scores. Then, we conducted a qualitative study using semi-structured interviews with patients with various levels of HRQol to explore their perception of the impact of cramps on their lives. RESULTS A total of 114 patients (49%) agreed to participate in the quantitative study (mean age: 71, women: 62%) and 15 patients were included in the qualitative study (mean age: 69, women: 67%). The number of cramps in the previous week was low (mean: 1.6 (SD 1.5)). The SF-36 mean physical and mental summary scores were 43 and 50, respectively, and the domain scores were similar to a comparative general population. Whilst some patients reported little interference with their daily lives, others reported a major decrease in their HRQoL. SF-36 scores were not sufficient to describe the cramp-related impairment, as patients from all levels of SF-36 scores reported major impacts of NLC in the interviews. CONCLUSIONS Some patients describe a specific impact of cramps on their lives, regardless of their HRQoL. These patients should be the target of future intervention trials.
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Affiliation(s)
- Paul Sebo
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland
| | - Dagmar M Haller
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland.,Department of Community, Primary Care and Emergency Medicine, Geneva, Switzerland.,Department of Paediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Céline Kaiser
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland
| | - Armita Zaim
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland
| | - Olivier Heimer
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Chauveau
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland
| | - Hubert Maisonneuve
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland
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2
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Linares-Moya M, Rodríguez-Torres J, Heredia-Ciuró A, Granados-Santiago M, López-López L, Quero-Valenzuela F, Valenza MC. Psychological distress prior to surgery is related to symptom burden and health status in lung cancer survivors. Support Care Cancer 2021; 30:1579-1586. [PMID: 34541609 PMCID: PMC8727403 DOI: 10.1007/s00520-021-06537-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Patients with lung cancer experience a variety of distressing symptoms which could adversely affect quality of life. The aim of this study was to determine whether psychological distress prior to surgery is associated to health status and symptom burden in lung cancer survivors. METHODS A longitudinal observational study with 1-year follow-up was carried out. Health status was measured by the WHO Disability Assessment Scale (WHO-DAS 2.0), the Euroqol-5 dimensions (EQ-5D) and the Pittsburgh Sleep Quality Index (PSQI). Symptoms severity included dyspnoea (Multidimensional Profile of Dyspnoea); pain (Brief Pain Inventory); fatigue (Fatigue Severity Scale); and cough (Leicester Cough Questionnaire). RESULTS One hundred seventy-four lung cancer patients were included. Patients in the group with psychological distress presented a worse self-perceived health status, functionality and sleep quality. The group with psychological distress also presented higher dyspnoea, fatigue and pain. CONCLUSION Patients with psychological distress prior surgery present with a greater symptom burden and a poorer self-perceived health status, lower functionality and sleep quality, than patients without distress 1 year after the lung resection.
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Affiliation(s)
- Marta Linares-Moya
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016, Granada, Spain
| | - Janet Rodríguez-Torres
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016, Granada, Spain
| | - Alejandro Heredia-Ciuró
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016, Granada, Spain
| | - María Granados-Santiago
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016, Granada, Spain
| | - Laura López-López
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016, Granada, Spain
| | | | - Marie Carmen Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016, Granada, Spain.
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Kuo JC, Graham DM, Salvarrey A, Kassam F, Le LW, Shepherd FA, Burkes R, Hollen PJ, Gralla RJ, Leighl NB. A randomized trial of the electronic Lung Cancer Symptom Scale for quality-of-life assessment in patients with advanced non-small-cell lung cancer. ACTA ACUST UNITED AC 2020; 27:e156-e162. [PMID: 32489264 DOI: 10.3747/co.27.5651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction Improving health-related quality of life (hrqol) is a key goal of systemic therapy in advanced lung cancer, although routine assessment remains challenging. We analyzed the impact of a real-time electronic hrqol tool, the electronic Lung Cancer Symptom Scale (elcss-ql), on palliative care (pc) referral rates, patterns of chemotherapy treatment, and use of other supportive interventions in patients with advanced non-small-cell lung cancer (nsclc) receiving first-line chemotherapy. Methods Patients with advanced nsclc starting first-line chemotherapy were randomized to their oncologist receiving or not receiving their elcss-ql data before each clinic visit. Patients completed the elcss-ql at baseline, before each chemotherapy cycle, and at subsequent follow-up visits until disease progression. Prospective data about the pc referral rate, hrqol, and use of other supportive interventions were collected. Results For the 95 patients with advanced nsclc who participated, oncologists received real-time elcss-ql data for 44 (elcss-ql arm) and standard clinical assessment alone for 51 (standard arm). The primary endpoint, the pc referral rate, was numerically higher, but statistically similar, for patients in the elcss-ql and standard arms. The hrqol scores over time were not significantly different between the two study arms. Conclusions The elcss-ql is feasible as a tool for use in routine clinical practice, although no statistically significant effect of its use was demonstrated in our study. Improving access to supportive care through the collection of patient-reported outcomes and hrqol should be an important component of care for patients with advanced lung cancer.
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Affiliation(s)
- J C Kuo
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON.,University of New South Wales, Sydney, Australia
| | - D M Graham
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON.,Queen's University Belfast, Belfast, U.K
| | - A Salvarrey
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - F Kassam
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON.,Division of Medical Oncology, Southlake Regional Cancer Centre, Newmarket, ON
| | - L W Le
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - F A Shepherd
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - R Burkes
- Division of Medical Oncology, Mount Sinai Hospital, Toronto, ON
| | - P J Hollen
- School of Nursing, University of Virginia, Charlottesville, VA, U.S.A
| | - R J Gralla
- Albert Einstein College of Medicine, New York, NY, U.S.A
| | - N B Leighl
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
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Relationships Between Smoking Status and Psychological Distress, Optimism, and Health Environment Perceptions at Time of Diagnosis of Actual or Suspected Lung Cancer. Cancer Nurs 2020. [PMID: 29538022 DOI: 10.1097/ncc.0000000000000579] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND While much research and practice resources have addressed smoking cessation among cancer patients, less emphasis has been placed on personal psychological and environment factors associated with smoking at the time of diagnosis. OBJECTIVE The aim of this study was to examine differences in psychological distress, optimism, and perceptions of the health environment/illness experience based on smoking status in patients with current, former, and no smoking history with newly diagnosed suspected or actual lung cancer. METHODS Data were derived from a descriptive study of 52 patients (34 men and 18 women aged 37-83 years) undergoing diagnostic evaluation for actual or suspected lung cancer. Descriptive statistics were used to characterize data. Analysis of variance, χ, and Spearman correlation tests were used to determine relationships among main study variables (smoking status, anxiety, worry, perceived cognitive functioning, optimistic outlook, health environment/illness experience perceptions). RESULTS Current smoking status was associated with higher psychological distress (anxiety and worry) among patients facing a new suspected or actual cancer diagnosis. CONCLUSIONS The study was able to provide important information relative to smoking status and psychological distress at the time of diagnosis of suspected or actual lung cancer. Findings demonstrate needs for assessment and targeted interventions to reduce psychological distress and to promote long-term adaptation in patients smoking at time of diagnosis. IMPLICATIONS FOR PRACTICE Nurses are positioned to provide support and resources for cancer patients. It is critical that smoking cessation interventions also address nicotine craving, emotion regulation, and adaptive coping skills.
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Mosher CE, Secinti E, Hirsh AT, Hanna N, Einhorn LH, Jalal SI, Durm G, Champion VL, Johns SA. Acceptance and Commitment Therapy for Symptom Interference in Advanced Lung Cancer and Caregiver Distress: A Pilot Randomized Trial. J Pain Symptom Manage 2019; 58:632-644. [PMID: 31255586 PMCID: PMC6754796 DOI: 10.1016/j.jpainsymman.2019.06.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 11/24/2022]
Abstract
CONTEXT Advanced lung cancer patients typically have a poor prognosis and many symptoms that interfere with functioning, contributing to high rates of emotional distress in both patients and family caregivers. There remains a need for evidence-based interventions to improve functional outcomes and distress in this population. OBJECTIVES This pilot trial examined the feasibility and preliminary efficacy of telephone-based Acceptance and Commitment Therapy (ACT) for symptomatic, advanced lung cancer patients and their distressed family caregivers. Primary outcomes were patient symptom interference with functioning and patient and caregiver distress. METHODS Symptomatic, advanced lung cancer patients and distressed caregivers (n = 50 dyads) were randomly assigned to six sessions of ACT or an education/support condition. Patients completed measures of symptom interference and measures assessing the severity of fatigue, pain, sleep disturbance, and breathlessness. Patients and caregivers completed measures of distress and illness acceptance and struggle. RESULTS The eligibility screening rate (51%) and retention rate (76% at six weeks postintervention) demonstrated feasibility. No group differences were found with respect to patient and caregiver outcomes. Both groups showed a small, significant decrease in struggle with the illness over the study period, but did not show meaningful change in other outcomes. CONCLUSION Findings suggest that telephone-based ACT is feasible for many advanced lung cancer patients and caregivers, but may not substantially reduce symptom interference and distress. Low baseline levels of certain symptoms may have contributed to null findings. Next steps include applying ACT to specific, clinically meaningful symptom interference and varying intervention dose and modality.
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Affiliation(s)
- Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.
| | - Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Nasser Hanna
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lawrence H Einhorn
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Shadia I Jalal
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Richard L. Roudebush VAMC, Indianapolis, Indiana, USA
| | - Gregory Durm
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Shelley A Johns
- Indiana University School of Medicine, Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USA
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6
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Henoch I, Österlind J. Development of the 6S Dialogue Tool to facilitate person‐centred palliative care. J Adv Nurs 2019; 75:3138-3146. [DOI: 10.1111/jan.14115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Ingela Henoch
- Institute of Health and Care Sciences The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Angered Local Hospital Gothenburg Sweden
| | - Jane Österlind
- Department of Health Care Sciences/Palliative Research Centre Ersta Sköndal University College Stockholm Sweden
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Guirimand F, Martel-Samb P, Guy-Coichard C, Picard S, Devalois B, Copel L, Abel A, Ghadi V. Development and validation of a French questionnaire concerning patients' perspectives of the quality of palliative care: the QUALI-PALLI-Patient. BMC Palliat Care 2019; 18:19. [PMID: 30744627 PMCID: PMC6369559 DOI: 10.1186/s12904-019-0403-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/29/2019] [Indexed: 11/13/2022] Open
Abstract
Background Indicators for the quality of palliative care are a priority of caregivers and managers to allow improvement of various care settings and their comparison. The involvement of patients and families is of paramount, although this is rarely achieved in practice. No validated assessment tools are available in French. Simple cultural adaption of existing questionnaires may be insufficient, due to the varying organization of care in different countries. The purpose of this study was to develop and validate a new instrument to measure the quality of palliative care and satisfaction from the patient point of view. Methods Results from a qualitative study were used by a multi-professional workgroup to construct an initial set of 42 items exploring six domains. A cross-sectional survey was conducted in seven hospitals, encompassing three care settings: two palliative care units, one palliative care hospital, and four standard medical units with a mobile palliative care team. All items were assessed for acceptability. We conducted exploratory structural analysis using Principal Component Analysis (PCA), and evaluated external validity by comparison against global rating of satisfaction and the MD Anderson Symptom Inventory (MDASI) questionnaire. Results A total of 214 patients completed the questionnaire. After removing 7 items from the response distribution, PCA identified eight interpretable domains from the 35 final items: availability of caregivers, serenity, quality of information, pain management, caregivers’ listening skills, psychosocial and spiritual aspects, possibility to refuse (care or volunteers), and respect for the patient. Internal consistency was good or acceptable for all subscales (Cronbach’s α 0.5–0.84), except the last one (0.15). Factorial structure was found globally maintained across subgroups defined by age, sex, Palliative Performance Scale (PPS ≥ 60%, 40–50% and ≤ 30%), and care settings. General satisfaction was inversely correlated with the 2 scores of the MDASI questionnaire: symptoms’ severity and impact on life. Each subscale, except “possibility to refuse”, correlated with general satisfaction. Conclusions Quali-Palli-Pat appears to be a valid, reliable, and well-accepted French tool to explore the quality of care and the satisfaction of palliative care patients. It should be confirmed in a wider sample of care settings. Trial registration clinicaltrials.gov NCT02814682, registration date 28.6.2016. Electronic supplementary material The online version of this article (10.1186/s12904-019-0403-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frédéric Guirimand
- Pôle recherche SPES "Soins Palliatifs en Société", Maison Médicale Jeanne Garnier, 106 avenue Emile Zola, 75015, Paris, France.
| | - Patricia Martel-Samb
- Unité de Recherche Clinique URC HU PIFO, AP-HP, Hôpital Ambroise Paré, Boulogne, France
| | | | - Stéphane Picard
- Unité de Soins Palliatifs, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Bernard Devalois
- Centre de Recherche Interprofessionnel Bientraitance et Fin de Vie, Service de Médecine Palliative, Hôpital de Pontoise, Pontoise, France
| | - Laure Copel
- Unité de Soins Palliatifs, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Anne Abel
- Équipe Mobile de Soins Palliatifs, AP-HP, Hôpital Ambroise Paré, Boulogne, France
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Bayly J, Edwards BM, Peat N, Warwick G, Hennig IM, Arora A, Wilcock A, Higginson IJ, Maddocks M. Developing an integrated rehabilitation model for thoracic cancer services: views of patients, informal carers and clinicians. Pilot Feasibility Stud 2018; 4:160. [PMID: 30349735 PMCID: PMC6193311 DOI: 10.1186/s40814-018-0350-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/01/2018] [Indexed: 12/11/2022] Open
Abstract
Background Access to rehabilitation to prevent disability and optimise function is recommended for patients with cancer, including following cancer diagnosis. Models to integrate rehabilitation within oncology services as cancer treatment commences are required, but must be informed by those they are intended to support. We aimed to identify views of patients, carers and clinicians to develop and refine a rehabilitation model to be tested in a feasibility trial for people newly diagnosed with lung cancer or mesothelioma. Methods We conducted a focus group study with people affected by lung cancer or mesothelioma, their carers and clinicians providing their care to identify priorities for rehabilitation in this period. We sought views on core intervention components, processes and outcomes and integration with oncology services. Data were analysed using thematic analysis. Results Fifteen clinicians (oncologists, nurse specialists, physiotherapists and occupational therapists), nine patients and five carers participated. A proposed outline rehabilitation model was perceived as highly relevant for this population. Participants recommended prompt and brief rehabilitation input, delivered whilst people attend for hospital appointments or at home to maximise accessibility and acceptability. Participants recognised variation in need and all prioritised tailored support for symptom self-management, daily activities and the involvement of carers. Clinicians also prioritised achieving fitness for oncology treatment. Patients and carers prioritised a sensitive manner of approach, positivity and giving hope for the future. Participant's recommendations for outcome measurement related to confidence in usual daily activities, symptom control and oncology treatment completion rates over objective measures of cardiorespiratory fitness. Conclusion The importance of providing tailored rehabilitation around the time of diagnosis for people with lung cancer or mesothelioma was affirmed by all participants. The refined model of rehabilitation recommended for testing in a feasibility trial is flexible, tailored and short-term. It aims to support people to self-manage symptoms, tolerate cancer treatments and to remain active and independent in daily life. It is delivered alongside scheduled hospital appointments or at home by an expert practitioner sensitive to the psycho-social sequelae that follow a diagnosis of thoracic cancer.
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Affiliation(s)
- Joanne Bayly
- 1Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Kings College London, Bessemer Road, Denmark Hill, London, SE5 9PJ UK
| | - Bethany M Edwards
- 1Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Kings College London, Bessemer Road, Denmark Hill, London, SE5 9PJ UK
| | - Nicola Peat
- 2Guy's & St Thomas's NHS Foundation Trust, London, UK
| | | | - Ivo M Hennig
- 4Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Arvind Arora
- 4Nottingham University Hospitals NHS Trust, Nottingham, UK.,5University of Nottingham, Nottingham, UK
| | - Andrew Wilcock
- 4Nottingham University Hospitals NHS Trust, Nottingham, UK.,5University of Nottingham, Nottingham, UK
| | - Irene J Higginson
- 1Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Kings College London, Bessemer Road, Denmark Hill, London, SE5 9PJ UK
| | - Matthew Maddocks
- 1Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Kings College London, Bessemer Road, Denmark Hill, London, SE5 9PJ UK
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Sikorskii A, Victorson D, O'Connor P, Hankin V, Safikhani A, Crane T, Badger T, Wyatt G. PROMIS and legacy measures compared in a supportive care intervention for breast cancer patients and caregivers: Experience from a randomized trial. Psychooncology 2018; 27:2265-2273. [PMID: 29956396 DOI: 10.1002/pon.4825] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Accurate and efficient measurement of patient-reported outcomes is key in cancer symptom management trials. The newer Patient Reported Outcomes Measurement Information System (PROMIS) and previously developed measures of similar conceptual content (legacy) are available to measure symptoms and functioning. This report compares the performance of two sets of measures, PROMIS and legacy, in a recently completed trial of a supportive care intervention that enrolled breast cancer patients and their friend or family caregivers. METHODS Patient-caregiver dyads (N = 256) were randomized to either reflexology delivered by caregivers or usual care control. Post-intervention, PROMIS and legacy measures of symptoms and functioning were analyzed in relation to trial arm, while adjusting for baseline values. Responsiveness of the two sets of measures was assessed using effect sizes and P-values for the effect of trial arm on patients' and caregivers' symptom and functioning outcomes. RESULTS Similar conclusions about intervention effects were found using PROMIS and legacy measures for pain, fatigue, sleep, anxiety, physical, and social functioning. Different conclusions were obtained for patient and caregiver depression: legacy measures indicated the efficacy of reflexology, while PROMIS depression measure did not. CONCLUSION Evidence of similar responsiveness supports the use of either set of measures for symptoms and functioning in clinical and general populations. Differences between PROMIS and legacy measures of depression need to be considered when choosing instruments for use in trials of supportive care interventions and in clinical practice.
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Affiliation(s)
- Alla Sikorskii
- Department of Psychiatry, Department of Statistics and Probability, Michigan State University, East Lansing, MI, USA
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University, Evanston, IL, USA
| | | | - Vered Hankin
- Department of Medical Social Sciences, Northwestern University, Evanston, IL, USA
| | | | - Tracy Crane
- College of Nursing, University of Arizona, Tuczon, AZ, USA
| | - Terry Badger
- College of Nursing, University of Arizona, Tuczon, AZ, USA
| | - Gwen Wyatt
- College of Nursing, Michigan State University, East Lansing, MI, USA
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10
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Hsieh LY, Chou FJ, Guo SE. Information needs of patients with lung cancer from diagnosis until first treatment follow-up. PLoS One 2018; 13:e0199515. [PMID: 29928027 PMCID: PMC6013211 DOI: 10.1371/journal.pone.0199515] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 06/09/2018] [Indexed: 01/12/2023] Open
Abstract
The aim of this study was to analyze the information needs of lung cancer patients from diagnosis until first treatment follow-up. Sixty-nine participants with lung cancer were recruited from Ditmanson Medical Foundation Chia-Yi Christian Hospital in Midwest Taiwan. The Modified Toronto Informational Needs Questionnaire (TINQ) was used to assess information needs during visits to the outpatient oncology department. Generalized estimating equations were applied to compare changes in information needs over time and to examine correlates of information needs of lung cancer patients. The greatest concern of lung cancer patients was the cancer itself and access to recovery information. The need for information regarding food selection and social welfare resources was also high. However, the means of information needs for each domain significantly decreased over time. Demographic information (age, gender, disease stage, current treatment, education, work status, and having children) was significantly associated with information needs over time. The need for "disease-related information" remained high regardless of disease stage. Oncology nurses can use the results of this study to better address the information needs of patients in an effort to fill knowledge gaps between patients and healthcare providers. Further studies are needed to explore the use of an appropriate instrument, like that used in this study, to identify newly-diagnosed lung cancer patients' difficulties, concerns, and target interventions to improve their quality of life.
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Affiliation(s)
- Ling-Yu Hsieh
- Department of Nursing, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Fang-Ju Chou
- Cancer Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Su-Er Guo
- Graduate Institute of Nursing & Chronic Diseases and Health Promotion Research Centre, College of Nursing, Chang Gung University of Science and Technology, Puzi City, Chiayi County, Taiwan
- Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Puzi City, Chiayi County, Taiwan
- Department of Safety Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City, Taiwan
- * E-mail: ,
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11
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Nilan J, Doltani D, Harmon D. Assessment of patient concerns: a review. Ir J Med Sci 2018; 187:545-551. [PMID: 29368281 DOI: 10.1007/s11845-018-1741-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patient-centred communication is the mainstay of the medical consultation. It includes the assessment of patient concerns and is important in building the doctor-patient therapeutic relationship. Our aim was to perform a literature review to identify relevance of patient concern assessment, to identify what concerns are encountered in various clinical settings and to explore the different methodologies used to obtain them. METHODS A narrative review was performed. RESULTS Addressing patient concerns is associated with increased patient satisfaction. Unvoiced concerns are associated with unresolved health issues and poor doctor-patient relationships. Different specialities have focused on different aspects of concern assessment. Patient concern assessment studies are mostly qualitative in nature. Not all qualitative methods give similar results. Interviews are more reliable sources of information than questionnaires as no one questionnaire captures all patient concerns. The location where interviews take place is also relevant. CONCLUSIONS Assessing patient concerns is associated with positive outcomes. Patient concerns are handled differently by different clinical specialties. Various methodologies have been used for concern assessment. Interviews and questionnaires can often yield different results.
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Affiliation(s)
- Jemima Nilan
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Deepak Doltani
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Dominic Harmon
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland. .,Department of Anesthesia and Pain Medicine, Limerick University Hospital, Dooradoyle, Limerick, Ireland.
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12
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Ni J, Denehy L, Feng J, Xu L, Wu Y, Granger CL. Physical Activity Behavior After a Diagnosis of Lung Cancer Differs Between Countries: An Observational Cohort Study. Integr Cancer Ther 2017; 17:493-502. [PMID: 28574730 PMCID: PMC6041916 DOI: 10.1177/1534735417699513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Physical activity (PA) is important in lung cancer. OBJECTIVES To investigate PA levels and health-related quality of life (HRQoL) of patients with lung cancer in China and compare this to a similar cohort in Australia. METHODS Prospective cohort study. 71 patients from China (group CH) and 90 patients from Australia (group AU) with newly diagnosed lung cancer. Questionnaires assessed self-reported PA levels and HRQoL at baseline (diagnosis) and 8 weeks. RESULTS At baseline, group CH were engaged in less overall PA than group AU (Physical Activity Scale for the Elderly [PASE] total score: median [IQR] group CH, 56 [32-59]; group AU, 66 [38-116]; P < .005), and less occupational and household activity ( P < .005). However, at baseline, group CH reported significantly more walking time than group AU (median [IQR]: group CH, 210 [150-315] min/wk; group AU, 55[0-210] min/wk; P < .0005). Global HRQoL scores were similar between groups (P = .038). Over 8 weeks, group CH increased their overall PA levels ( P < .005) and walking time ( P = .008), and HRQoL remained unchanged. The comparison group AU experienced a reduction in PA levels ( P = .02) and HRQoL ( P < .005). CONCLUSIONS A diagnosis, patients in China were less physically active than those in Australia. Following diagnosis, patients in China increased their PA levels, whereas those in Australia reduced their PA levels. Research is required to explore potential reasons behind differences, and this may inform research/clinical services to facilitate patients with lung cancer to be more active.
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Affiliation(s)
- Jun Ni
- 1 Affiliated Hospital of Nantong University, Jiangsu, China.,2 Nantong University, Jiangsu, China
| | - Linda Denehy
- 3 The University of Melbourne, Australia.,4 Institute for Breathing and Sleep, Heidelberg, Australia
| | - Jian Feng
- 1 Affiliated Hospital of Nantong University, Jiangsu, China
| | - Liqin Xu
- 1 Affiliated Hospital of Nantong University, Jiangsu, China
| | - Yi Wu
- 1 Affiliated Hospital of Nantong University, Jiangsu, China
| | - Catherine L Granger
- 3 The University of Melbourne, Australia.,4 Institute for Breathing and Sleep, Heidelberg, Australia.,5 Royal Melbourne Hospital, Australia
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13
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Pati S, Chauhan AS, Mahapatra S, Nayak S, Nayak S, Weller D. Treatment Experiences of Women with Reproductive Cancers in Odisha, India: A Qualitative Exploration of Enablers and Barriers. Asian Pac J Cancer Prev 2017; 18:1019-1024. [PMID: 28545201 PMCID: PMC5494210 DOI: 10.22034/apjcp.2017.18.4.1019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction: Cancer continues to be a major menace to our Indian society notwithstanding significant progress in diagnosis and treatment. In India cancer mortality rates in women are high compared to other countries, despite efforts to improve survival through the development of effective detection techniques and increased numbers of viable treatment options. Indian women’s advanced stage of disease at diagnosis is largely attributable to delay in seeking treatment. The present qualitative inquiry was conducted with the aim of capturing the treatment experiences of patients with gynecology cancer at a tertiary care hospital and understanding the barriers, enablers, stress and apprehension they experience during the treatment phases. Methods: Twenty-one in-depth interviews were conducted with women diagnosed with gynecological cancers and undergoing at least one treatment intervention in the Inpatient Department (IPD). Theme guides were developed with a review of the literature and consultation with experts in the field. Data were collected by trained investigators who were well versed with the local language and analyzed using an inductive approach. Results are presented in the form of core- and sub-themes evolved during this process. Results: Out of the 21 respondents, 19 were married and 2 were widows. Nineteen had attained more than secondary qualifications. Nearly all women described themselves as ‘housewives’. Amongst participants, 13 were diagnosed with breast cancer, 5 with ovarian cancer and 3 with cervical cancer. Thematic framework analysis of the transcripts yielded six key themes: 1) best and worst experiences during the treatment process; 2) financial and emotional stress; 3) care giving and social support; 4) satisfaction with the medical staff; 5) preferences for a female gynecologist and female gynecology ward; and 6) prompt and free treatment. Quotable quotes were presented in the table against every theme. Conclusion: Strengths in the Indian health care delivery system need to be built upon, while attention should be paid to developing effective psychosocial interventions, with a robust financial protection plan for patients and their involvement in decision making. Counselling of patients should be made part of a routine protocol.
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Affiliation(s)
- Sanghamitra Pati
- Director, Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar,
Odisha 751023, India.
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14
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Browall M, Brandberg Y, Nasic S, Rydberg P, Bergh J, Rydén A, Xie H, Eriksson I, Wengström Y. A prospective exploration of symptom burden clusters in women with breast cancer during chemotherapy treatment. Support Care Cancer 2016; 25:1423-1429. [PMID: 27981366 PMCID: PMC5378737 DOI: 10.1007/s00520-016-3527-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/05/2016] [Indexed: 11/03/2022]
Abstract
PURPOSE The aim was to prospectively map symptom clusters in patients with stage I-IIIa breast cancer during standard chemotherapy treatment in a randomised study. METHODS Participants completed the Memorial Symptom Assessment Scale (MSAS) at baseline, day 12 after the first and third cycle of FEC 75 or FEC 100, and day 12 after the last cycle of Taxotere. Cut-off values for symptom scores, a mean value based on each individual reporting a symptom including occurrence, frequency, severity and distress for inclusion in analysis, were determined. RESULTS The symptom burden cluster analysis was conducted in two steps and included symptoms with high frequency and high levels of distress. The factor analysis revealed three symptom clusters; physical, gastro (phys/gastro) and emotional, with core symptoms that remained stable over time. The most prevalent symptoms for the total sample during all cycles were as follows: lack of energy (range between 48 and 90%), feeling sad (48-79%), difficulty sleeping (54-78%), difficulty concentrating (53-74%), worrying (54-74%) and pain (29-67%). CONCLUSION In summary, we have prospectively established that symptom clusters remain stable over time with a basis of core symptoms. This knowledge will aid in the development of effective core symptom-focused interventions to minimise symptom burden for patients treated with chemotherapy for breast cancer.
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Affiliation(s)
- Maria Browall
- Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden. .,School of Health and Education, University of Skövde, Skövde, Sweden.
| | - Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden
| | - Per Rydberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Bergh
- Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Rydén
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Hanjing Xie
- Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Irene Eriksson
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.,Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
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15
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Ball H, Moore S, Leary A. A systematic literature review comparing the psychological care needs of patients with mesothelioma and advanced lung cancer. Eur J Oncol Nurs 2016; 25:62-67. [DOI: 10.1016/j.ejon.2016.09.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 01/10/2023]
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16
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Patients' experiences of care and support at home after a family member's participation in an intervention during palliative care. Palliat Support Care 2016; 15:305-312. [PMID: 27748224 DOI: 10.1017/s1478951516000729] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Patients who receive palliative home care are in need of support from family members, who take on great responsibility related to caregiving but who often feel unprepared for this task. Increasing numbers of interventions aimed at supporting family members in palliative care have been described and evaluated. It is not known whether and how these interventions actually affect the care or support provided to a patient, even though it has been suggested that family members would be likely to provide better care and support and thus allow for positive experiences for patients. However, this has not been studied from the perspective of the patients themselves. The objective of our study was to explore patients' experiences of care and support at home after family members' participation in a psychoeducational intervention during palliative care. METHOD Our study took a qualitative approach, and interviews were conducted with 11 patients whose family members had participated in a psychoeducational intervention during palliative home care. The interviews were analyzed employing interpretive description. RESULTS Patients' experiences were represented by three themes: "safe at home," "facilitated and more honest communication," and "feeling like a unit of care." Patients felt that their needs were better met and that family members became more confident at home without risking their own health. Patients felt relieved when family members were given the opportunity to talk and reflect with others and hoped that the intervention would contribute to more honest communications between themselves and their family members. Further, it was of great importance to patients that family members receive attention from and be confirmed and supported by healthcare professionals. SIGNIFICANCE OF RESULTS Our findings show how an intervention targeted at family members during palliative home care also benefits the patients.
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17
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Moseholm E, Rydahl-Hansen S, Lindhardt BØ, Fetters MD. Health-related quality of life in patients with serious non-specific symptoms undergoing evaluation for possible cancer and their experience during the process: a mixed methods study. Qual Life Res 2016; 26:993-1006. [PMID: 27704305 DOI: 10.1007/s11136-016-1423-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 01/24/2023]
Abstract
PURPOSE The purpose of this research was to measure changes in HRQoL during the diagnostic evaluation of patients presenting with non-specific symptoms possibly attributable to cancer, to describe their experiences of HRQoL and to merge these findings with intent to obtain a more comprehensive understanding of their HRQoL experience during this stressful life event. METHODS A convergent mixed methods (MM) design was used and involved quantitative data about HRQoL measured by the EORTC-QLQ-C30 instrument and qualitative interview data about patients' HRQoL experiences. Participants completed the EORTC-QLQ-C30 questionnaire prior to and after evaluation. The baseline questionnaire informed the purposive sampling for the qualitative interview study, and open-end questions matched to the EORTC-QLQ-C30 constructs were used in the semi-structured interviews. RESULTS A total of 838 patients were enrolled in the quantitative study; 680 (81 %) also completed follow-up. Twenty-one patients participated in interviews. The MM findings are the meta-inferences drawn by looking across the matched quantitative and qualitative findings: physical function, social function, role function, emotional function, cognitive function, social function, symptoms and quality of life. CONCLUSION The survey results illustrate that HRQoL improved over time and the qualitative findings confirmed and further expanded the survey results. The MM analysis underlines that the HRQoL experience cannot be observed independently from context. Participants adapted to their situation over time, and this may change their perceptions of HRQoL. These findings can be used to enhance evidence-based care as clinicians need to be aware of how the context influences the HRQoL experience.
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Affiliation(s)
- E Moseholm
- Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, Nordsjælland, Dyrehavevej 29, Building 10, 3400, Hillerød, Denmark.
| | - S Rydahl-Hansen
- Research Unit of Clinical Nursing, Bispebjerg and Frederiksberg University Hospital, Bispebjerg Bakke 23, 20E, 2400, Copenhagen NV, Denmark.,Department of Public Health, Section for Nursing, Aarhus University, Århus, Denmark
| | - B Ø Lindhardt
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Kettegård Alle 30, Department 144, 2650, Hvidovre, Denmark
| | - M D Fetters
- Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI, 48104, USA
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18
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Falk H, Henoch I, Ozanne A, Öhlen J, Ung EJ, Fridh I, Sarenmalm EK, Falk K. Differences in Symptom Distress Based on Gender and Palliative Care Designation Among Hospitalized Patients. J Nurs Scholarsh 2016; 48:569-576. [PMID: 27668982 DOI: 10.1111/jnu.12254] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 01/18/2023]
Abstract
PURPOSE To explore patient-reported symptom distress in relation to documentation of symptoms and palliative care designation in hospital inpatients. DESIGN This cross-sectional study analyzed data from 710 inpatients at two large hospitals in Sweden using the Edmonton Symptom Assessment Scale and the Memorial Symptom Assessment Scale. Chart reviews focused on nurses' and physicians' symptom documentation and palliative turning point. METHODS Descriptive statistics were calculated for all variables and provided summaries about the sample. Patients were grouped according to gender, age, palliative care designation, and symptom documentation. The t test and chi-square test were used to calculate whether symptom distress varied between groups. A two-way analysis of variance was conducted for multiple comparisons to explore the impact of gender and age on mean symptom distress. FINDINGS Females reported higher levels of symptom distress than did males related to pain, fatigue, and nausea. When comparing symptom distress between males and females with documentation pertaining to symptoms, there were significant differences implying that females had to report higher levels of symptom distress than males in order to have their symptoms documented. CONCLUSIONS Females need to report higher levels of symptom distress than do males for healthcare professionals to identify and document their symptoms. It can be hypothesized that females are not receiving the same attention and symptom alleviation as men. If so, this highlights a serious inequality in care that requires further exploration. CLINICAL RELEVANCE Considering that common reasons why people seek health care are troublesome symptoms of illness, and that the clinical and demographic characteristics of inpatients are changing towards more advanced ages with serious illnesses, inadequate symptom assessment and management are a serious threat to the care quality.
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Affiliation(s)
- Hanna Falk
- Assistant Professor, The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden. .,Assistant Professor, University of Gothenburg, Centre for Ageing and Health (AGECAP), Gothenburg, Sweden.
| | - Ingela Henoch
- Associate Professor, University of Gothenburg, Centre for Ageing and Health (AGECAP), Gothenburg, Sweden
| | - Anneli Ozanne
- Assistant Professor, The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden
| | - Joakim Öhlen
- Professor, The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden.,Professor, Palliative Research Centre, Ersta Sköndal University College, Stockholm, Sweden.,Professor, University of Gothenburg, Centre for Person-Centred Care (GPCC), Gothenburg, Sweden
| | - Eva Jakobsson Ung
- Associate Professor, The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden
| | - Isabell Fridh
- Assistant Professor, Faculty of Caring Science, Work Life and Social Welfare University of Borås, Borås, Sweden
| | | | - Kristin Falk
- Associate Professor, University of Gothenburg, Centre for Ageing and Health (AGECAP), Gothenburg, Sweden.,Associate Professor, The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden
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19
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Wind A, Roeling MP, Heerink J, Sixma H, Presti P, Lombardo C, van Harten W. Piloting a generic cancer consumer quality index in six European countries. BMC Cancer 2016; 16:711. [PMID: 27589989 PMCID: PMC5010728 DOI: 10.1186/s12885-016-2752-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/26/2016] [Indexed: 11/16/2022] Open
Abstract
Background Accounting for patients’ perspective has become increasingly important. Based on the Consumer Quality Index method (founded on Consumer Assessment of Healthcare Providers and Systems) a questionnaire was recently developed for Dutch cancer patients. As a next step, this study aimed to adapt and pilot this questionnaire for international comparison of cancer patients experience and satisfaction with care in six European countries. Method The Consumer Quality Index was translated into the local language at the participating pilot sites using cross-translation. A minimum of 100 patients per site were surveyed through convenience sampling. Data from seven pilot sites in six countries was collected through an online and paper-based survey. Internal consistency was tested by calculating Cronbach’s alpha and validity by means of cognitive interviews. Demographic factors were compared as possible influencing factors. Results A total of 698 patients from six European countries filled the questionnaire. Cronbach’s alpha was good or satisfactory in 8 out of 10 categories. Patient satisfaction significantly differed between the countries. We observed no difference in patient satisfaction for age, gender, education, and tumor type, but satisfaction was significantly higher in patients with a higher level of activation. Conclusion This European Cancer Consumer Quality Index(ECCQI) showed promising scores on internal consistency (reliability) and a good internal validity. The ECCQI is to our knowledge the first to measure and compare experiences and satisfaction of cancer patients on an international level, it may enable healthcare providers to improve the quality of cancer care. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2752-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anke Wind
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Mark Patrick Roeling
- Department of Computer Science, University of Oxford, Parks Road, OX1 3QD, Oxford, UK
| | - Jana Heerink
- Department of Health Technology and Services Research, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Herman Sixma
- Netherlands Institute for Health Services Research (NIVEL), P.O. box 1568, 3500 BN, Utrecht, The Netherlands
| | - Pietro Presti
- European Cancer Patient Coalition (ECPC), 40 rue de Montoyer, Brussels, Belgium.,Department of Management, University of Torino, C.so Unione Sovietica 218 Bis, 10134, Turin, Italy
| | - Claudio Lombardo
- Organisation of the European Cancer Institute's (OECI), 11 Rue d'Egmont B-1000, Brussels, Belgium.,SOS Europe Srl, Via delle Campanule, 74, 16148, Genova, Italy
| | - Wim van Harten
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Department of Health Technology and Services Research, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands. .,CEO Rijnstate Hospital, Arnhem, The Netherlands.
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20
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Lehto RH. Symptom burden in lung cancer: management updates. Lung Cancer Manag 2016; 5:61-78. [PMID: 30643551 PMCID: PMC6310300 DOI: 10.2217/lmt-2016-0001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/20/2016] [Indexed: 12/25/2022] Open
Abstract
Lung cancer is recognized to carry a high symptom burden with associated lowered quality of life as compared with other cancers. Research has shown that symptom severity can be a prognostic indicator of poorer clinical outcomes and survival post treatment. The purpose of this paper is to review current literature relative to symptom burden associated with diagnosis, medical and/or surgical intervention, assessment and management updates, and emerging initiatives that promote positive outcomes based on updated evidence. Discussion relative to interdisciplinary coordination of supportive services and palliative care initiation is provided.
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Affiliation(s)
- Rebecca H Lehto
- C-344 Bogue, College of Nursing, Michigan State University, East Lansing, MI 48824-1317, USA
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21
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Pérol M, Ciuleanu TE, Arrieta O, Prabhash K, Syrigos KN, Goksel T, Park K, Kowalyszyn RD, Pikiel J, Lewanski CR, Thomas M, Dakhil S, Kim JH, Karaseva N, Yurasov S, Zimmermann A, Lee P, Carter GC, Reck M, Cappuzzo F, Garon EB. Quality of life results from the phase 3 REVEL randomized clinical trial of ramucirumab-plus-docetaxel versus placebo-plus-docetaxel in advanced/metastatic non-small cell lung cancer patients with progression after platinum-based chemotherapy. Lung Cancer 2016; 93:95-103. [PMID: 26898621 DOI: 10.1016/j.lungcan.2016.01.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES REVEL demonstrated that ramucirumab+docetaxel (RAM+DTX) improved overall survival, progression-free survival, and objective response rate in patients with advanced/metastatic non-small cell lung cancer with progression after platinum-based chemotherapy. This analysis examined quality of life (QoL) as assessed by the Lung Cancer Symptom Scale (LCSS) and clinician-reported functional status. MATERIALS AND METHODS The LCSS includes 6 symptom and 3 global items measured on a 0-100-mm scale; higher scores represent greater symptom burden. LCSS and ECOG PS data were collected at baseline, every 3-week cycle, the summary visit, and at the 30-day follow-up. LCSS total score and Average Symptom Burden Index (ASBI) were calculated. The primary analysis compared time to deterioration (TtD) between treatment arms for all individual items and summary scores, defined as increase from baseline by ≥ 15 mm using the Kaplan-Meier method and Cox regression. TtD to ECOG PS ≥ 2 was analyzed. RESULTS There were 1253 patients randomized to receive RAM+DTX or placebo+docetaxel (PL+DTX). Across all assessments, LCSS compliance was approximately 75% and balanced across arms. The mean (SD) baseline LCSS total score was 27.3mm (17.08 mm) on RAM+DTX and 29.6mm (17.59 mm) on PL+DTX. At 30-day follow-up, mean (SD) LCSS total score was 32.0 (19.03) on RAM+DTX and 32.5 (19.87) on PL+DTX. The TtD for all LCSS scores was similar between treatment arms. Stratified HRs (95% CI) for LCSS total score and ASBI were HR=0.99 (0.81, 1.22), p=0.932 and HR=0.93 (0.75, 1.15), p=0.514 with approximately 70% of patients censored. TtD to PS ≥ 2 was similar between treatment arms (HR=1.03 [95% CI: 0.85, 1.26], p=0.743) with approximately two-thirds of the patients censored. CONCLUSION In addition to improvement of clinical efficacy outcomes demonstrated in REVEL, these results suggest that adding ramucirumab to docetaxel did not impair patient QoL, symptoms, or functioning.
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Affiliation(s)
| | - Tudor-Eliade Ciuleanu
- Institute of Oncology Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania.
| | - Oscar Arrieta
- Instituto Nacional de Cancerologia, Mexico City, Mexico.
| | | | | | | | | | | | | | | | - Michael Thomas
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany.
| | | | - Joo-Hang Kim
- Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.
| | - Nina Karaseva
- City Clinical Oncology Dispensary, St. Petersburg, Russia.
| | | | - Annamaria Zimmermann
- Eli Lilly and Company, Indianapolis, IN, USA; LungenClinic Grosshansdorf, German Center for Lung Research, Grosshansdorf, Germany.
| | - Pablo Lee
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany.
| | - Gebra Cuyun Carter
- Eli Lilly and Company, Indianapolis, IN, USA; LungenClinic Grosshansdorf, German Center for Lung Research, Grosshansdorf, Germany
| | - Martin Reck
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany.
| | | | - Edward B Garon
- David Geffen School of Medicine at UCLA/Translational Research in Oncology-US Network, Los Angeles, CA, USA.
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Lindqvist O, Rasmussen BH, Fürst CJ, Tishelman C. Opening the doors a crack wider: palliative care research data in the public domain. BMJ Support Palliat Care 2016; 6:113-5. [PMID: 26781808 PMCID: PMC4789691 DOI: 10.1136/bmjspcare-2015-000959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/17/2015] [Indexed: 11/04/2022]
Abstract
This report builds further on OPCARE9, an EU 7th framework project aiming to identify knowledge gaps in care provision in the last days of life. This study began with curiosity about new ways of generating research questions to meet future challenges in palliative care (PC) and how to better engage disciplines not generally included in PC research. We here describe an innovative methodological approach to generating data; put data relevant for PC research in the public domain; and raise issues about open access in PC research. We aimed to compile research questions from different disciplines, based on raw data consisting of approximately 1000 descriptions of non-pharmacological caregiving activities (NPCAs), generated through previous research. 53 researchers from different fields were sent the full list of NPCAs and asked to generate research questions from their disciplinary perspective. Responses were received from 32 researchers from 9 countries, generating approximately 170 research topics, questions, reflections and ideas, from a wide variety of perspectives, which are presented here. Through these data, issues related to death and dying are addressed in several ways, in line with a new public health approach. By engaging a broader group of disciplines and facilitating availability of data in the public domain, we hope to stimulate more open dialogue about a wider variety of issues related to death and dying. We also introduce an innovative methodological approach to data generation, which resulted in a response rate at least equivalent to that in our Delphi survey of professionals in OPCARE9.
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Affiliation(s)
- Olav Lindqvist
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden Department of Nursing, Umeå University, Umeå, Sweden
| | - Birgit H Rasmussen
- Department of Health Sciences, Lund University, Lund, Sweden The Institute for Palliative Care, Lund University and Skåne Regional Council, Lund, Sweden
| | - Carl Johan Fürst
- The Institute for Palliative Care, Lund University and Skåne Regional Council, Lund, Sweden
| | - Carol Tishelman
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden Karolinska University Hospital, Innovation Centre, Stockholm, Sweden
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Bayly JL, Lloyd-Williams M. Identifying functional impairment and rehabilitation needs in patients newly diagnosed with inoperable lung cancer: a structured literature review. Support Care Cancer 2016; 24:2359-2379. [DOI: 10.1007/s00520-015-3066-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 12/21/2015] [Indexed: 01/01/2023]
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24
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Sparla A, Flach-Vorgang S, Villalobos M, Krug K, Kamradt M, Coulibaly K, Szecsenyi J, Thomas M, Gusset-Bährer S, Ose D. Individual difficulties and resources - a qualitative analysis in patients with advanced lung cancer and their relatives. Patient Prefer Adherence 2016; 10:2021-2029. [PMID: 27757022 PMCID: PMC5055045 DOI: 10.2147/ppa.s110667] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Lung cancer is a disease with a high percentage of patients diagnosed in an advanced stage. In a situation of palliative treatment, both patients and their relatives experience diverse types of distress and burden. Little research has been done to identify the individual difficulties and resources for patients with advanced lung cancer and their relatives. Especially, standardized questionnaire-based exploration may not assess the specific distressing issues that pertain to each individual on a personal level. The purpose of this qualitative study is to explore and compare individual difficulties and resources for lung cancer patients and their relatives within the palliative care context. METHODS Data were collected by qualitative interviews. A total of 18 participants, nine patients diagnosed with advanced lung cancer (International Classification of Diseases, tenth edition, diagnosis C-34, stage IV) starting or receiving palliative treatment and nine relatives, were interviewed. Data were interpreted through qualitative content analysis. RESULTS We identified four main categories of difficulties: communication and conflicts, home and everyday life, thinking about cancer, and treatment trajectory. In general, difficulties were related to interpersonal relationships as well as to impact of chemotherapy. Family, professional caregivers, and social life were significant resources and offered support to both patients and relatives. CONCLUSION Results suggest that patient and relative education could reduce difficulties in several areas. Patients seem to struggle with the fear of not having any perspective in therapy. Relatives seem to experience helplessness regarding their partner's deterioration and have to handle their own life and the care work simultaneously. The most important resource for both patients and relatives is their family. In addition, professional lung cancer nurses support relatives in an emotional and organizational way. Intense supportive care for relatives should be standardized.
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Affiliation(s)
- Anika Sparla
- Department of General Practice and Health Services Research, Heidelberg University Hospital
- Correspondence: Anika Sparla, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130, 69120 Heidelberg, Germany, Tel +49 6221 56 6263, Fax +49 6221 56 1972, Email
| | | | - Matthias Villalobos
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, Heidelberg University Hospital
| | - Martina Kamradt
- Department of General Practice and Health Services Research, Heidelberg University Hospital
| | - Kadiatou Coulibaly
- Department of General Practice and Health Services Research, Heidelberg University Hospital
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University Hospital
| | - Michael Thomas
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Sinikka Gusset-Bährer
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Dominik Ose
- Department of General Practice and Health Services Research, Heidelberg University Hospital
- University of Utah, Department of Population Health Sciences, Health System Innovation and Research, Salt Lake City, UT, USA
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Routine assessment of performance status during palliative chemotherapy when approaching end-of-life. Eur J Oncol Nurs 2015; 21:266-71. [PMID: 26639897 DOI: 10.1016/j.ejon.2015.11.001] [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: 04/08/2015] [Accepted: 11/09/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Palliative chemotherapy treatment (PCT) offered late in the cancer disease trajectory may be problematic. It is not easy to accurately calculate whether the potential benefits will outweigh the side-effects. This study investigates whether routine use of the Performance Status in Palliative Chemotherapy questionnaire (PSPC) affects the proportions of patients receiving PCT during the last month of life, care utilization, and documentation routines. A secondary aim was to gather registered nurses' experiences of the PSPC in routine use. METHODS Eighty incurable patients with cancer who had used the PSPC before PCT were compared to 160 matched controls, using non-parametric tests. Nurses' reflections on the PSPC were collected and reviewed. RESULTS No significant differences were found between users and non-users of the PSPC in terms of proportions receiving PCT during the last month of life. Higher proportions of patients older than 74 years received PCT than in previous studies (40% versus 17%). Nurses considered the questionnaires to be a valuable complement to verbal information when trying to acquire an accurate picture of patients' performance status. CONCLUSION At this point in the development of the PSPC we did not find any significant decreases in the proportion of patients receiving PCT during the last month in life. However, as the nurses valued the PSPC, it can be used as a complementary tool in assessment of performance status until further research is conducted.
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Kaptein AA, Kobayashi K, Matsuda A, Kubota K, Nagai S, Momiyama M, Sugisaki M, Bos BC, Warning TD, Dik H, Klink RV, Inoue K, Ramai R, Taube C, Kroep JR, Fischer MJ. We’re in this together: Patients’, caregivers’ and health care providers’ illness perceptions about non-small-cell lung cancer (NSCLC). Lung Cancer 2015; 90:575-81. [DOI: 10.1016/j.lungcan.2015.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/08/2015] [Accepted: 10/12/2015] [Indexed: 12/17/2022]
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Quality of life analyses from the randomized, open-label, phase III PointBreak study of pemetrexed-carboplatin-bevacizumab followed by maintenance pemetrexed-bevacizumab versus paclitaxel-carboplatin-bevacizumab followed by maintenance bevacizumab in patients with stage IIIB or IV nonsquamous non-small-cell lung cancer. J Thorac Oncol 2015; 10:353-9. [PMID: 25611228 DOI: 10.1097/jto.0000000000000277] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Treatment impact on quality of life (QoL) informs treatment management decisions in advanced nonsquamous non-small-cell lung cancer (NS NSCLC). QoL outcomes from the phase III PointBreak trial are reported. METHODS Chemonaive patients (n = 939) with stage IIIB/IV nonsquamous non-small-cell lung cancer and Eastern Cooperative Oncology Group performance status 0 to 1 were randomized (1:1) to pemetrexed-carboplatin-bevacizumab (pemetrexed arm) or paclitaxel-carboplatin-bevacizumab (paclitaxel arm). Patients without progressive disease received maintenance pemetrexed-bevacizumab (pemetrexed arm) or bevacizumab (paclitaxel arm). QoL was assessed using Functional Assessment of Cancer Therapy (FACT)-General (FACT-G), FACT-Lung (FACT-L), and FACT/Gynecologic Oncology Group-Neurotoxicity (FACT-Ntx) instruments. Subscale scores, total scores, and trial outcome indices were analyzed using linear mixed-effects models. Post hoc analyses examined the association between baseline FACT scores and overall survival (OS). RESULTS Mean score differences in change from baseline significantly favored the pemetrexed arm for the neurotoxicity subscale score, FACT-Ntx total scores, and FACT-Ntx trial outcome index. They occurred at cycle 2 (p < 0.001) and persisted through induction cycles 2 to 4 and six maintenance cycles. Investigator-assessed, qualitative, drug-related differences in grade 2 (1.6% versus 10.6%) and grade 3 (0.0% versus 4.1%) sensory neuropathy and grade 3/4 fatigue (10.9% versus 5.0%, p = 0.0012) were observed between the pemetrexed and paclitaxel arms. Baseline FACT-G, FACT-L, and FACT-Ntx scores were significant prognostic factors for OS (p < 0.001). CONCLUSIONS Randomized patients reported similar changes in QoL, except for less change from baseline in neurotoxicity on the pemetrexed arm; investigators reported greater neurotoxicity on the paclitaxel arm and greater fatigue on the pemetrexed arm. Higher baseline FACT scores were favorable prognostic factors for OS.
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Koller M, Warncke S, Hjermstad MJ, Arraras J, Pompili C, Harle A, Johnson CD, Chie WC, Schulz C, Zeman F, van Meerbeeck JP, Kuliś D, Bottomley A. Use of the lung cancer-specific Quality of Life Questionnaire EORTC QLQ-LC13 in clinical trials: A systematic review of the literature 20 years after its development. Cancer 2015; 121:4300-23. [PMID: 26451520 DOI: 10.1002/cncr.29682] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/24/2015] [Accepted: 07/02/2015] [Indexed: 12/19/2022]
Abstract
The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) covers 13 typical symptoms of lung cancer patients and was the first module developed in conjunction with the EORTC core quality-of-life (QL) questionnaire. This review investigates how the module has been used and reported in cancer clinical trials in the 20 years since its publication. Thirty-six databases were searched with a prespecified algorithm. This search plus an additional hand search generated 770 hits, 240 of which were clinical studies. Two raters extracted data using a coding scheme. Analyses focused on the randomized controlled trials (RCTs). Of the 240 clinical studies that were identified using the LC13, 109 (45%) were RCTs. More than half of the RCTs were phase 3 trials (n = 58). Twenty RCTs considered QL as the primary endpoint, and 68 considered it as a secondary endpoint. QL results were addressed in the results section of the article (n = 89) or in the abstract (n = 92); and, in half of the articles, QL results were presented in the form of tables (n = 53) or figures (n = 43). Furthermore, QL results had an impact on the evaluation of the therapy that could be clearly demonstrated in the 47 RCTs that yielded QL differences between treatment and control groups. The EORTC QLQ-LC13 fulfilled its mission to be used as a standard instrument in lung cancer clinical trials. An update of the LC13 is underway to keep up with new therapeutic trends and to ensure optimized and relevant QL assessment in future trials.
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Affiliation(s)
- Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Sophie Warncke
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Marianne J Hjermstad
- Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital and European Palliative Care Research Centre, Department of Cancer and Molecular Medicine, Norwegian University of Science and Technology, Norway
| | - Juan Arraras
- Oncology Departments, Navarra Hospital Complex, Pamplona, Spain
| | - Cecilia Pompili
- Division of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom
| | - Amelie Harle
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Colin D Johnson
- University Surgical Unit, University Hospital Southampton, Hampshire, United Kingdom
| | - Wei-Chu Chie
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Christian Schulz
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
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Support for Patients and Family Caregivers in Lung Cancer: Educational Components of an Interdisciplinary Palliative Care Intervention. J Hosp Palliat Nurs 2015; 17:309-318. [PMID: 26640416 DOI: 10.1097/njh.0000000000000165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Consistent with the recommendations of the Institute of Medicine Report on quality cancer care, attention to symptom management and quality of life concerns of patients with lung cancer should be addressed throughout the disease trajectory. As part of a NCI-funded Program Project grant, this paper reports on the patient and family caregiver education component of a nurse-lead, tailored palliative care intervention for patients with early (I-III, n=130) and late (IV, n=142) stage lung cancer. Patients and family caregivers received 4 separate educational sessions organized around the Quality of Life model domains (physical, psychological, social, and spiritual well-being). Each patient and caregiver was presented at a weekly interdisciplinary case conference which also informed the educational sessions. Based on needs and team suggestions, an individualized palliative care plan was created and a tailored educational intervention was designed based on topics chosen by each participant. The most common topics chosen by patients in each domain were fatigue, worry and fear, social support/isolation, and hope. Family caregivers most commonly chose fatigue, worry and fear, communication, and purpose and meaning in life. The mean time spent in each teaching session ranged from 31 to 44 minutes for patients and 25 to 35 minutes for family caregivers. There is a vital need for interdisciplinary palliative care interventions for patients across all stages and across the disease trajectory. Nurses are vital to integrating palliative care into routine care. Providing a tailored educational intervention is an important aspect of palliative care for patients and family caregivers. This paper focuses on the process of the tailored educational intervention.
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Lindberg P, Koller M, Steinger B, Lorenz W, Wyatt JC, Inwald EC, Klinkhammer-Schalke M. Breast cancer survivors' recollection of their illness and therapy seven years after enrolment into a randomised controlled clinical trial. BMC Cancer 2015; 15:554. [PMID: 26219863 PMCID: PMC4517565 DOI: 10.1186/s12885-015-1573-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 07/21/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Little is known about the subjective experience of breast cancer survivors after primary treatment. However, these experiences are important because they shape their communication about their illness in everyday life, usage and acceptance of healthcare, and expectations of new generations of patients. The present study investigated this topic by combining qualitative and quantitative methods. METHODS Breast cancer survivors in Bavaria, Germany were mailed a questionnaire up to seven years after enrolment into a randomised controlled clinical trial and start of their therapy. This enquired about their worst experiences during the breast cancer episode, positive aspects of the illness and any advice they would give to newly diagnosed patients. A category system for themes was systematically created and answers were categorised by two independent raters. Frequencies of key categories were then quantitatively analysed using descriptive statistics. In addition, local treating physicians gave their opinion on the response categories chosen by their patients. RESULTS 133 (80%) of 166 eligible patients who survived up to seven years returned the questionnaire. The most prominent worst experience reported by survivors was psychological distress (i.e. anxiety, uncertainty; prevalence 38%) followed by chemotherapy (25%), and cancer diagnosis (18%). Positive aspects of the illness were reported by 48% with the most frequent including change in life priorities (50%) and social support (22%). The most frequent advice survivors gave was fighting spirit (i.e. think positive, never give up; prevalence 42%). Overall, physicians' estimates of the frequency of these responses corresponded well with survivors' answers. CONCLUSIONS Although physicians' understanding of breast cancer patients was good, psychological distress and chemotherapy-related side effects were remembered as particularly burdensome by a substantial part of survivors. On the one hand, patients' quality of life needs to be assessed repeatedly during medical follow-up to identify such specific complaints also including specific recommendations to the physician for targeted psychosocial and medical support. On the other hand the advices and positive aspects of the disease, reported by the survivors, can be used to promote positive ways of coping with the illness.
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Affiliation(s)
- Patricia Lindberg
- Tumor Center Regensburg e.V., An-Institute of the University of Regensburg, Regensburg, Germany.
| | - Michael Koller
- Center for Clinical Trials, University Hospital Regensburg, Regensburg, Germany.
| | - Brunhilde Steinger
- Tumor Center Regensburg e.V., An-Institute of the University of Regensburg, Regensburg, Germany.
| | - Wilfried Lorenz
- Tumor Center Regensburg e.V., An-Institute of the University of Regensburg, Regensburg, Germany.
| | - Jeremy C Wyatt
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Elisabeth C Inwald
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany.
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QoL analyses from INFORM study, a phase III study of gefitinib versus placebo as maintenance therapy in advanced NSCLC. Sci Rep 2015; 5:11934. [PMID: 26137916 PMCID: PMC4490396 DOI: 10.1038/srep11934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 06/10/2015] [Indexed: 12/19/2022] Open
Abstract
This report aimed to provide the full results of QoL assessment in INFORM study. QoL was assessed by FACT-L questionnaire. QoL improvement ratio in gefitinib arm was higher than placebo arm (FACT-L: 46% vs. 22%, p < 0.001; TOI: 41% vs. 18%, p < 0.001; LCS: 46% vs. 22%, p < 0.001). Gefitinib prolonged time-to-worsening of QoL (FACT-L: 2.8 m vs 1.4 m, p = 0.019; TOI: 3.5 m vs 1.4 m, p = 0.006; LCS: 2.8 vs 1.4 m, p = 0.028). Patients with an improvement in QoL had longer PFS (FACT-L: 9.4 m vs. 2.8 m vs. 2.7 m, P < 0.001; TOI: 9.9 m vs. 2.8 m vs. 2.1 m, P < 0.001; LCS: 9.4 m vs. 2.9 m vs. 2.1 m, P < 0.001) and OS (FACT-L: 25.4 m vs. 19.9 m vs. 14.4 m, P = 0.003; TOI: 25.7 m vs. 19.0 m vs. 12.7 m, P = 0.002; LCS: 25.4 m vs. 19.3 m vs. 14.7 m, P = 0.004) compared with patients with stable or worsened QoL. Furthermore, in patients with good QoL at baseline, the treatment of gefitinib couldn't improve OS compared to placebo, whereas patients with low QoL experienced marginal significant improvement in OS (20.6 m vs 14.4, p = 0.051). Our study indicated that gefitinib could improve patients' QoL, confirmed the prognostic value of QoL changes during treatment, and implied patients with low QoL at baseline may be the potential population which will gain OS benefit from maintenance EGFR-TKI therapy.
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Browall M, Kenne Sarenmalm E, Persson LO, Wengström Y, Gaston-Johansson F. Patient-reported stressful events and coping strategies in post-menopausal women with breast cancer. Eur J Cancer Care (Engl) 2015; 25:324-33. [PMID: 25690645 DOI: 10.1111/ecc.12294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2014] [Indexed: 01/11/2023]
Abstract
The objective of this paper was to explore what stressful events post-menopausal women with primary or recurrent breast cancer experience, how bothersome these events were and which coping strategies these women used. Data were collected from 131 patients diagnosed with primary or recurrent breast cancer. The Daily Coping Assessment was used. Thematic analysis was applied to form themes of stressful events. Six types of stressful events were extracted. The most frequently experienced events for women with primary cancer and those with recurrent cancer were 'distressing bodily symptoms'. The most bothersome event among primary cancer was 'everyday concerns' and in the recurrent group, 'distressing psychological reactions'. The most commonly used strategies were 'acceptance', 'distraction' and 'relaxation'. This study shows that women in different parts of the cancer trajectory differ in what they perceive to be stressful events when reporting them in their own words in a diary. The differences have an impact on the subsequent coping strategies they used.
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Affiliation(s)
- M Browall
- School of Health and Education, University of Skövde, Skövde, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
| | | | - L-O Persson
- Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Y Wengström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
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Henoch I, Sawatzky R, Falk H, Fridh I, Jakobsson Ung E, Sarenmalm EK, Ozanne A, Öhlén J, Falk K. Symptom Distress Profiles in Hospitalized Patients in Sweden: A Cross-Sectional Study. Res Nurs Health 2014; 37:512-23. [DOI: 10.1002/nur.21624] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Ingela Henoch
- Associate Professor, Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Box 457 SE-405 30 Göteborg Sweden
- Associate Professor, Centre for Person-Centred Care (GPCC); Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Richard Sawatzky
- Associate Professor, Trinity Western University School of Nursing; Vancouver Canada
- Centre for Health Evaluation and Outcome Sciences; Providence Health Care; Vancouver Canada
| | - Hanna Falk
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Institute of Neuroscience and Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Isabell Fridh
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- School of Health Sciences; University of Borås; Borås Sweden
| | - Eva Jakobsson Ung
- Associate Professor, Centre for Person-Centred Care (GPCC); Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Elisabeth Kenne Sarenmalm
- Research and Development Centre; Skaraborg Hospital; Skövde Sweden
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
| | - Anneli Ozanne
- Institute of Neuroscience and Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Joakim Öhlén
- Associate Professor, Centre for Person-Centred Care (GPCC); Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
| | - Kristin Falk
- Associate Professor, Centre for Person-Centred Care (GPCC); Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Slota C, Ulrich CM, Miller-Davis C, Baker K, Wallen GR. Qualitative inquiry: a method for validating patient perceptions of palliative care while enrolled on a cancer clinical trial. BMC Palliat Care 2014; 13:43. [PMID: 25276094 PMCID: PMC4178548 DOI: 10.1186/1472-684x-13-43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 08/28/2014] [Indexed: 12/25/2022] Open
Abstract
Background Palliative care is a vital component of patient-centered care. It has increasingly become central to the management and care of seriously ill patients by integrating physical, psychosocial, and spiritual supportive services. Through qualitative inquiry, this paper examines cancer patients’ perceptions of the process and outcomes of the pain and palliative care consultative services they received while enrolled in a clinical trial. Methods A qualitative analysis of open-ended questions was conducted from a sub-sample of patients (n = 34) with advanced cancers enrolled in a randomized controlled trial exploring the efficacy of a palliative care consult service. Two open-ended questions focused on patient perceptions of continued participation on their primary cancer clinical trials and their perceptions of interdisciplinary communication. Results Three overarching themes emerged when asked whether receiving pain and palliative care services made them more likely to remain enrolled in their primary cancer clinical trial: patients’ past experiences with care, self-identified personal characteristics and reasons for participation, and the quality of the partnership. Four themes emerged related to interdisciplinary communication including: the importance of developing relationships, facilitating open communication, having quality communication, and uncertainty about communication between the cancer clinical trial and palliative care teams. Conclusions Our findings suggest the importance of qualitative inquiry methods to explore patient perceptions regarding the efficacy of palliative care services for cancer patients enrolled in a cancer clinical trial. Validation of patient perceptions through qualitative inquiry regarding their pain and palliative care needs can provide insight into areas for future implementation research. Trial registration NIH Office of Human Subjects Research Protection OHSRP5443 and University of Pennsylvania 813365
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Affiliation(s)
- Christina Slota
- Department of Medical Ethics and Health Policy, New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Connie M Ulrich
- Department of Medical Ethics and Health Policy, New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Claiborne Miller-Davis
- National Institutes of Health Clinical Center, 10 Center Drive, 2B-09, Bethesda, MD 20892, USA
| | - Karen Baker
- Pain and Palliative Care Service, National Institutes of Health Clinical Center, 10 Center Drive, 2-1733 MSC 1517, Bethesda, MD 20892, USA
| | - Gwenyth R Wallen
- National Institutes of Health Clinical Center, 10 Center Drive, 2B-09, Bethesda, MD 20892, USA
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Miyashita M, Wada M, Morita T, Ishida M, Onishi H, Tsuneto S, Shima Y. Care evaluation scale-patient version: measuring the quality of the structure and process of palliative care from the patient's perspective. J Pain Symptom Manage 2014; 48:110-8. [PMID: 24680624 DOI: 10.1016/j.jpainsymman.2013.08.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 08/23/2013] [Accepted: 08/28/2013] [Indexed: 11/12/2022]
Abstract
CONTEXT Recently, greater emphasis has been placed on patient-reported outcomes. However, there are only a few measures to evaluate the quality of care from the patient's perspective. OBJECTIVES To report the development of a scale to measure the quality of the structure and process in palliative care from the patient's perspective and examine the reliability and validity of the scale. METHODS A cross-sectional anonymous questionnaire was administered to cancer patients who were being treated on an oncology inpatient ward, who visited an oncology outpatient clinic at Saitama Medical University International Medical Center, or who were in an inpatient palliative unit in Japan between August 2007 and March 2008. RESULTS A total of 405 cancer patients participated in the study. Factor analysis revealed that the Care Evaluation Scale-Patient version (CES-P) consisted of 23 items with eight subscales: physical care by physicians, physical care by nurses, psychoexistential care, help with decision making for patients, environment, cost, availability, and coordination/consistency. The total CES-P score was correlated with satisfaction (r = 0.63) but not with quality of life (r = 0.18). The Cronbach α coefficient of the total score was 0.97, and the intraclass correlation coefficient of the total score was 0.67. The CES-P total score was not significantly correlated with the self-reported Eastern Cooperative Oncology Group performance status (ρ = -0.05). CONCLUSION The CES-P has sufficient validity and reliability. In addition, this scale is independent of the general physical condition of the patient.
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Affiliation(s)
- Mitsunori Miyashita
- Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing Sciences, Graduate School of Medicine, The University of Tokyo, Sendai, Japan.
| | - Makoto Wada
- Department of Psycho-Oncology and Palliative Medicine, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Shizuoka, Japan
| | - Mayumi Ishida
- Department of Psycho-Oncology, Saitama Cancer Center, Saitama, Japan
| | - Hideki Onishi
- Department of Psycho-Oncology, Saitama Cancer Center, Saitama, Japan
| | - Satoru Tsuneto
- Department of Palliative Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Ibaraki, Japan
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Tang JA, Oh T, Scheer JK, Parsa AT. The current trend of administering a patient-generated index in the oncological setting: a systematic review. Oncol Rev 2014; 8:245. [PMID: 25992233 PMCID: PMC4419610 DOI: 10.4081/oncol.2014.245] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/05/2014] [Accepted: 04/27/2014] [Indexed: 01/07/2023] Open
Abstract
The patient-generated index (PGI) is a more novel approach to evaluating health-related quality of life (HRQOL) that allows patients to formulate their own responses in an open-ended format in order to measure HRQOL based on each patient’s own stated goals and expectations. To date the use of PGI in the setting of patients diagnosed with cancer remains relatively less common compared to other health conditions. This systematic review primarily aims to identify current literature in which PGI has been used as a tool to assess quality of life in cancer patients. A systematic review using the MEDLINE database from January 1990 to July 2013 was performed with the following search terms to identify the implementation of PGI in oncology settings: (PGI OR patient generated index OR patient-generated OR patient-reported OR patient generated OR patient reported) AND (cancer OR oncology OR tumor OR neoplasm OR malignancy). Of the 2167 papers initially identified, 10 papers evaluated quality of life in oncology patients by collecting free-form responses from the patient, 4 of which actually used PGI. An overarching theme observed in these studies highlighted the concerns mentioned by patients that were not targeted or detected by standardized quality of life measures. While implementing the PGI may require slightly more investment of resources in the beginning, the potential implications of allowing patients to characterize their quality of life on their own terms are tremendous.
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Affiliation(s)
- Jessica A Tang
- Department of Neurological Surgery, Northwestern University , Chicago, IL, USA
| | - Taemin Oh
- Department of Neurological Surgery, Northwestern University , Chicago, IL, USA
| | - Justin K Scheer
- Department of Neurological Surgery, Northwestern University , Chicago, IL, USA
| | - Andrew T Parsa
- Department of Neurological Surgery, Northwestern University , Chicago, IL, USA
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The influence of symptom clusters and the most distressing concerns regarding quality of life among patients with inoperable lung cancer. Eur J Oncol Nurs 2014; 18:236-41. [DOI: 10.1016/j.ejon.2013.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/29/2013] [Accepted: 12/04/2013] [Indexed: 01/22/2023]
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Fridh I, Kenne Sarenmalm E, Falk K, Henoch I, Öhlén J, Ozanne A, Jakobsson Ung E. Extensive human suffering: a point prevalence survey of patients' most distressing concerns during inpatient care. Scand J Caring Sci 2014; 29:444-53. [DOI: 10.1111/scs.12148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Isabell Fridh
- School of Health Sciences; University of Borås; Borås Sweden
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Elisabeth Kenne Sarenmalm
- Head of Research and Development Centre; Skaraborg Hospital; Skövde
- Palliative Research Centre; Ersta Sköndal University College; Ersta Hospital; Stockholm Sweden
| | - Kristin Falk
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Centre for Person-Centered Care (GPCC); Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Ingela Henoch
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Centre for Person-Centered Care (GPCC); Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Palliative Research Centre; Ersta Sköndal University College; Ersta Hospital; Stockholm Sweden
- Centre for Person-Centered Care (GPCC); Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Anneli Ozanne
- Department of Neurology; Institute of Neuroscience and Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Eva Jakobsson Ung
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Centre for Person-Centered Care (GPCC); Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Ediebah DE, Coens C, Zikos E, Quinten C, Ringash J, King MT, Schmucker von Koch J, Gotay C, Greimel E, Flechtner H, Weis J, Reeve BB, Smit EF, Taphoorn MJB, Bottomley A. Does change in health-related quality of life score predict survival? Analysis of EORTC 08975 lung cancer trial. Br J Cancer 2014; 110:2427-33. [PMID: 24743709 PMCID: PMC4021536 DOI: 10.1038/bjc.2014.208] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/19/2014] [Accepted: 03/24/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Little is known about whether changes in health-related quality of life (HRQoL) scores from baseline during treatment also predict survival, which we aim to investigate in this study. METHODS We analysed data from 391 advanced non-small-cell lung cancer (NSCLC) patients enrolled in the EORTC 08975 study, which compared palliative chemotherapy regimens. HRQoL was assessed at baseline and after each chemotherapy cycle using the EORTC QLQ-C30 and QLQ-LC13. The prognostic significance of HRQoL scores at baseline and their changes over time was assessed with Cox regression, after adjusting for clinical and socio-demographic variables. RESULTS After controlling for covariates, every 10-point increase in baseline pain and dysphagia was associated with 11% and 12% increased risk of death with hazard ratios (HRs) of 1.11 and 1.12, respectively. Every 10-point improvement of physical function at baseline (HR=0.93) was associated with 7% lower risk of death. Every 10-point increase in pain (HR=1.08) was associated with 8% increased risk of death at cycle 1. Every 10-point increase in social function (HR=0.91) at cycle 2 was associated with 9% lower risk of death. CONCLUSIONS Our findings suggest that changes in HRQoL scores from baseline during treatment, as measured on subscales of the EORTC QLQ-C30 and QLQ-LC13, are significant prognostic factors for survival.
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Affiliation(s)
- D E Ediebah
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Avenue Mounier, 83 b11, 1200 Brussels, Belgium
| | - C Coens
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Avenue Mounier, 83 b11, 1200 Brussels, Belgium
| | - E Zikos
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Avenue Mounier, 83 b11, 1200 Brussels, Belgium
| | - C Quinten
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Avenue Mounier, 83 b11, 1200 Brussels, Belgium
- Department of Biostatistics, European Centre for Disease Prevention and Control, Surveillance and Response Support Unit, Tomtebodavägen 11a, 171 83 Stockholm, Sweden
| | - J Ringash
- Department of Radiation Oncology, The Princess Margaret Hospital and the University of Toronto, 610 University Avenue, Toronto, Ontario, Canada M5G 2M9
| | - M T King
- Department of Psychology, Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, New South Wales NSW 2006, Australia
| | - J Schmucker von Koch
- Department of Ethics, University of Regensburg, Medical Ethics, Universitaetsstrasse 31, D-93040 Regensburg, Germany
| | - C Gotay
- School of Population and Public Health, University of British Columbia, Room 162—2206 East Mall, Vancouver, British Columbia, Canada BC V6T 1Z3
| | - E Greimel
- Department of Obstetrics and Gynecology, Medical University Graz, Auenbruggerplatz 14, AT 8036 Graz, Austria
| | - H Flechtner
- Department of Child and Adolescent Psychiatry, University Magdeburg, Leipziger Str 44, 39120 Magdeburg, Germany
| | - J Weis
- Psychosocial Department, Tumor Biology Center at the University of Freiburg, Breisacher Str. 117, 79106 Freiburg, Germany
| | - B B Reeve
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 1101-D McGavran-Greenberg Building Chapel Hill, Chapel Hill, NC 27599, USA
| | - E F Smit
- Department of Pulmonology, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - M J B Taphoorn
- Department of Neurology, VU University Medical Center/Medical Center Haaglanden 2501 CK, The Hague, The Netherlands
| | - A Bottomley
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Avenue Mounier, 83 b11, 1200 Brussels, Belgium
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Edvardsson D, Varrailhon P, Edvardsson K. Promoting Person-Centeredness in Long-Term Care: An Exploratory Study. J Gerontol Nurs 2014; 40:46-53. [DOI: 10.3928/00989134-20131028-03] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 09/09/2013] [Indexed: 11/20/2022]
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Grant M, Sun V, Fujinami R, Sidhu R, Otis-Green S, Juarez G, Klein L, Ferrell B. Family caregiver burden, skills preparedness, and quality of life in non-small cell lung cancer. Oncol Nurs Forum 2014; 40:337-46. [PMID: 23803267 DOI: 10.1188/13.onf.337-346] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe burden, skills preparedness, and quality of life (QOL) for caregivers of patients with non-small cell lung cancer (NSCLC), and describe how the findings informed the development of a caregiver palliative care intervention that aims to reduce caregiver burden, improve caregiving skills, and promote self-care. DESIGN Descriptive, longitudinal. SETTING A National Cancer Institute-designated comprehensive cancer center in southern California. SAMPLE 163 family members or friends aged 18 years or older and identified by patients as being a caregiver. METHODS All eligible caregivers were approached by advanced practice nurses during a regularly scheduled patient clinic visit. Informed consent was obtained prior to study participation. Outcome measures were completed at baseline and repeated at 7, 12, 18, and 24 weeks. Descriptive statistics were computed for all variables, and one-way repeated-measures analysis of variance was used to test for change over time for all predictor and outcome variables. MAIN RESEARCH VARIABLES Caregiver burden, skills preparedness, psychological distress, and QOL. FINDINGS Caregivers were highly functional. Caregiver burden related to subjective demands increased significantly over time. Perceived skills preparedness was high at baseline but decreased over time. Psychological distress was moderate but increased in the study period. Overall QOL was moderate at baseline and decreased significantly over time. Psychological well-being had the worst QOL score. CONCLUSIONS Caregivers experienced high levels of caregiver burden and reported deteriorations in psychological well-being and overall QOL. IMPLICATIONS FOR NURSING Oncology nurses need to ensure that caregivers receive information that supports the caregiving role throughout the cancer trajectory. KNOWLEDGE TRANSLATION Although family caregivers are profoundly impacted by a loved one's lung cancer diagnosis, the literature about caregiver burden, skills preparedness, and QOL is limited. Current evidence suggests that family caregivers can be negatively impacted by a loved one's cancer diagnosis. Caregiver-specific support interventions are needed to eliminate the burden of caregiving in lung cancer.
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Affiliation(s)
- Marcia Grant
- Nursing Research and Education, Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA.
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Gupta D, Rodeghier M, Lis CG. Patient satisfaction with service quality in an oncology setting: implications for prognosis in non-small cell lung cancer. Int J Qual Health Care 2013; 25:696-703. [PMID: 24123242 PMCID: PMC3842127 DOI: 10.1093/intqhc/mzt070] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective To evaluate the relationship between self-reported satisfaction with service quality and overall survival in non-small cell lung cancer (NSCLC). Design A prospective cohort study. Setting Cancer Treatment Centers of America® from July 2007 and December 2010. Participants Nine hundred and eighty-six returning NSCLC patients. Intervention Overall patient experience ‘considering everything, how satisfied are you with your overall experience’ was measured on a 7-point Likert scale ranging from ‘completely dissatisfied’ to ‘completely satisfied.’. Main Outcome Measure Patient survival was the primary end point. Results The response rate for this study was 69%. Six hundred patients were newly diagnosed, while 386 were previously treated. Four hundred sixty-nine were males, while 517 were females. 101, 59, 288 and 538 patients had stage I, II, III and IV disease, respectively. Mean age was 58.9 years. Six hundred and thirty (63.9%) patients had expired at the time of this analysis. Seven hundred and sixty-two (77.3%) patients were ‘completely satisfied’. Median overall survival was 12.1 months (95% confidence interval (CI): 10.9–13.2 months). On univariate analysis, ‘completely satisfied’ patients had a significantly lower risk of mortality compared with those not ‘completely satisfied’ [hazard ratio (HR) = 0.70; 95% CI: 0.59–0.84; P < 0.001]. On multivariate analysis controlling for stage at diagnosis, prior treatment history, age and gender, ‘completely satisfied’ patients demonstrated significantly lower mortality (HR = 0.71; 95% CI: 0.60–0.85; P < 0.001) compared with those not ‘completely satisfied’. Conclusions Self-reported experience with service quality was an independent predictor of survival in NSCLC patients undergoing oncologic treatment, a novel finding in the literature. Based on these provocative findings, further exploration of this relationship is warranted in well-designed prospective studies.
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Affiliation(s)
- Digant Gupta
- Cancer Treatment Centers of America, 1336 Basswood Road, Schaumburg, IL 60173, USA.
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Maguire R, Papadopoulou C, Kotronoulas G, Simpson MF, McPhelim J, Irvine L. A systematic review of supportive care needs of people living with lung cancer. Eur J Oncol Nurs 2013; 17:449-64. [PMID: 23246484 DOI: 10.1016/j.ejon.2012.10.013] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/23/2012] [Accepted: 10/30/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Roma Maguire
- School of Nursing & Midwifery, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, UK.
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Interdisciplinary palliative care intervention in metastatic non-small-cell lung cancer. Clin Lung Cancer 2013; 14:736-44. [PMID: 23871439 DOI: 10.1016/j.cllc.2013.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 05/15/2012] [Accepted: 06/28/2012] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Challenges and barriers continue to hinder the integration of palliative care models into comprehensive, ambulatory oncology care. This article aims to describe how symptoms, distress, and quality of life (QOL) data from the usual care phase of a National Cancer Institute-supported Program Project informed the development of an interdisciplinary, tailored palliative care intervention for patients with metastatic non-small-cell lung cancer (NSCLC). METHODS Patients receiving usual care for metastatic NSCLC were recruited into this prospective longitudinal study over a 1-year period. A total of 130 patients with stage IV NSCLC were accrued, and 114 patients had evaluable data. Research nurses assisted patients in completing the clinical section of the data forms, and patients completed surveys and self-reports at baseline and 6, 12, and 24 weeks. RESULTS Patients ranged in age from 40 to 84 years, and 61% were Caucasian non-Hispanic. Sixty-six former (N = 59) and current smokers had an average of 38 pack-year history of smoking. The Karnofsky Performance Status, Instrumental Activities of Daily Living, and Cognitive scores deteriorated significantly (P = .001, .009, and .042, respectively). Social Activity was stable, whereas Social Support increased significantly. Overall symptom distress score and Total symptom score both significantly increased at 24 weeks (P = .003 and .017, respectively). Physical Well-Being decreased significantly (P = .036), whereas the Functional Assessment of Cancer Therapy-Lung, Functional Assessment of Chronic Illness Therapy-Spirituality Subscale, and Distress scores remained statistically stable over time. CONCLUSIONS Patients with metastatic NSCLC continue to experience high symptom burden and diminished physical well-being over time while receiving cancer treatments. An interdisciplinary palliative care intervention is currently being tested to improve symptom burden and overall QOL.
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Browall M, Kenne Sarenmalm E, Nasic S, Wengström Y, Gaston-Johansson F. Validity and reliability of the Swedish version of the Memorial Symptom Assessment Scale (MSAS): an instrument for the evaluation of symptom prevalence, characteristics, and distress. J Pain Symptom Manage 2013. [PMID: 23195392 DOI: 10.1016/j.jpainsymman.2012.07.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT There are few scales in Swedish that assess symptoms in the dimensions of frequency, severity, and distress. OBJECTIVES The purpose of this study was to translate and determine the validity and reliability of the Memorial Symptom Assessment Scale (MSAS) in a Swedish population of postmenopausal women newly diagnosed with primary or recurrent breast cancer. METHODS The original 32-item MSAS, a self-report measure for assessing symptom distress and frequency in cancer patients, was translated and administered to 206 patients (primary, n = 150 and recurrent, n = 56). RESULTS The MSAS psychological symptom subscale correlated with the emotional and cognitive functioning subscales of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and showed the highest correlation with the EORTC QLQ-C30 emotional functioning subscale (r = -0.78; P < 0.01). The psychological symptom subscale also correlated with the Hospital Anxiety and Depression Scale (HADS) within values for anxiety (r = 0.68; P < 0.01) and with the EORTC QLQ-C30 within cognitive functioning values (r = -0.58; P < 0.01). The Global Distress Index (GDI)-MSAS showed satisfactory correlations with the EORTC QLQ-C30 emotional functioning subscale (r = -0.75; P < 0.01), whereas the correlation between the GDI-MSAS and the EORTC QLQ-C30 cognitive functioning subscale was somewhat lower (r = -0.54; P < 0.01). Correlations between the GDI-MSAS and the HADS anxiety subscale were confirmed (r = 0.62; P < 0.01), and a correlation between the MSAS physical symptom items and symptom items in the EORTC-QLQ-C30 was evident (r = 0.60-0.85; P < 0.01). Cronbach's alpha coefficients for the MSAS and MSAS subscales based on symptom scores ranged from 0.80 to 0.89. The internal consistency at different time points was satisfactory, ranging from 0.86 (baseline) to 0.90 (follow-up). CONCLUSION The Swedish version of the MSAS presents as a valid and reliable measure for assessing symptom distress, severity, and frequency in Swedish patients diagnosed with primary and recurrent breast cancer.
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Affiliation(s)
- Maria Browall
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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Schofield P, Ugalde A, Gough K, Reece J, Krishnasamy M, Carey M, Ball D, Aranda S. A tailored, supportive care intervention using systematic assessment designed for people with inoperable lung cancer: a randomised controlled trial. Psychooncology 2013; 22:2445-53. [PMID: 23733720 DOI: 10.1002/pon.3306] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 03/27/2013] [Accepted: 04/22/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVE People with inoperable lung cancer experience higher levels of distress, more unmet needs and symptoms than other cancer patients. There is an urgent need to test innovative approaches to improve psychosocial and symptom outcomes in this group. This study tested the hypothesis that a tailored, multidisciplinary supportive care programme based on systematic needs assessment would reduce perceived unmet needs and distress and improve quality of life. METHODS A randomised controlled trial design was used. The tailored intervention comprised two sessions at treatment commencement and completion. Sessions included a self-completed needs assessment, active listening, self-care education and communication of unmet psychosocial and symptom needs to the multidisciplinary team for management and referral. Outcomes were assessed with the Needs Assessment for Advanced Lung Cancer Patients, Hospital Anxiety and Depression Scale, Distress Thermometer and European Organization of Research and Treatment of Cancer Quality of Life Q-C30 V2.0. RESULTS One hundred and eight patients with a diagnosis of inoperable lung or pleural cancer (including mesothelioma) were recruited from a specialist facility before the trial closed prematurely (original target 200). None of the primary contrasts of interest were significant (all p > 0.10), although change score analysis indicated a relative benefit from the intervention for unmet symptom needs at 8 and 12 weeks post-assessment (effect size = 0.55 and 0.40, respectively). CONCLUSION Although a novel approach, the hypothesis that the intervention would benefit perceived unmet needs, psychological morbidity, distress and health-related quality of life was not supported overall.
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Affiliation(s)
- Penelope Schofield
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia; School of Behavioural Science, The University of Melbourne, Parkville, Australia; School of Nursing, The University of Melbourne, Parkville, Australia
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Booij JC, Zegers M, Evers PMPJ, Hendriks M, Delnoij DMJ, Rademakers JJDJM. Improving cancer patient care: development of a generic cancer consumer quality index questionnaire for cancer patients. BMC Cancer 2013; 13:203. [PMID: 23617741 PMCID: PMC3648393 DOI: 10.1186/1471-2407-13-203] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 04/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To develop a Consumer Quality Index (CQI) Cancer Care questionnaire for measuring experiences with hospital care of patients with different types of cancer. METHODS We derived quality aspects from focus group discussions, existing questionnaires and literature. We developed an experience questionnaire and sent it to 1,498 Dutch cancer patients. Another questionnaire measuring the importance of the quality aspects was sent to 600 cancer patients. Data were psychometrically analysed. RESULTS The response to the experience questionnaire was 50 percent. Psychometric analysis revealed 12 reliable scales. Patients rated rapid and adequate referral, rapid start of the treatment after diagnosis, enough information and confidence in the healthcare professionals as most important themes. Hospitals received high scores for skills and cooperation of healthcare professionals and a patient-centered approach by doctors; and low scores for psychosocial guidance and information at completion of the treatment. CONCLUSIONS The CQI Cancer Care questionnaire is a valuable tool for the evaluation of the quality of cancer care from the patient's perspective. Large scale implementation is necessary to determine the discriminatory powers of the questionnaire and may enable healthcare providers to improve the quality of cancer care. Preliminary results indicate that hospitals could improve their psychosocial guidance and information provision.
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Affiliation(s)
- Judith C Booij
- Department of Demand-Driven Healthcare, Netherlands Institute for Health Services Research (NIVEL), PO box 1568, Utrecht, 3500 BN, The Netherlands
| | - Marieke Zegers
- Department of Demand-Driven Healthcare, Netherlands Institute for Health Services Research (NIVEL), PO box 1568, Utrecht, 3500 BN, The Netherlands
| | - Pauline MPJ Evers
- Dutch Federation of Cancer Patient Organisations (NFK), PO box 8152, Utrecht, 3503 RD, The Netherlands
| | - Michelle Hendriks
- Department of Demand-Driven Healthcare, Netherlands Institute for Health Services Research (NIVEL), PO box 1568, Utrecht, 3500 BN, The Netherlands
| | - Diana MJ Delnoij
- Centre for Consumer Experience in Healthcare (Centrum Klantervaring Zorg, CKZ), Utrecht, The Netherlands/Tranzo (Scientific Centre for Transformation in Health and Social Care), Tilburg University, PO box 1568, Utrecht, 3500 BN, The Netherlands
| | - Jany JDJM Rademakers
- Department of Demand-Driven Healthcare, Netherlands Institute for Health Services Research (NIVEL), PO box 1568, Utrecht, 3500 BN, The Netherlands
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Abstract
PURPOSE OF REVIEW Mixed methods research designs have been recognized as important in addressing complexity and are recommended particularly in the development and evaluation of complex interventions. This article reports a review of studies in palliative care published between 2010 and March 2012 that combine qualitative and quantitative approaches. RECENT FINDINGS A synthesis of approaches to mixed methods research taken in 28 examples of published research studies of relevance to palliative and supportive care is provided, using a typology based on a classic categorization put forward in 1992. SUMMARY Mixed-method studies are becoming more frequently employed in palliative care research and resonate with the complexity of the palliative care endeavour. Undertaking mixed methods research requires a sophisticated understanding of the research process and recognition of some of the underlying complexities encountered when working with different traditions and perspectives on issues of: sampling, validity, reliability and rigour, different sources of data and different data collection and analysis techniques.
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Koczywas M, Williams AC, Cristea M, Reckamp K, Grannis FW, Tiep BL, Uman G, Ferrell B. Longitudinal changes in function, symptom burden, and quality of life in patients with early-stage lung cancer. Ann Surg Oncol 2012; 20:1788-97. [PMID: 23143593 DOI: 10.1245/s10434-012-2741-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Emerging evidence supports the integration of palliative care concurrently with disease-focused care in patients with serious illnesses, such as lung cancer. This paper describes how longitudinal changes in physical function, symptom burden, and QOL of patients with early-stage non-small cell lung cancer (NSCLC) informed the development of an interdisciplinary, tailored palliative care intervention. METHODS Patients with early stage (I-IIIB) NSCLC were accrued into the usual care phase (Phase 1) of an NCI-funded Program Project Grant. Baseline and longitudinal (up to 52 weeks post-accrual) physical function, symptoms, and QOL were assessed in the thoracic ambulatory clinics of one NCI-designated Comprehensive Cancer Center. Outcome measures included geriatric assessments, psychological distress, symptoms, and QOL. The association between disease stage (I-II vs. III) and longitudinal changes in these domains was evaluated. RESULTS A total of 103 patients were accrued. Stage I-II patients were significantly more likely to complete the study (p = 0.005). The stages (I-II vs. III) were equivalent at baseline on all demographic variables, clinical, and functional status. Physical function fluctuated longitudinally and was higher at 6 and 24 weeks than at baseline and 12 weeks. There was a longitudinal decrease in total number of symptoms (p < 0.001). Physical and social/family QOL fluctuated longitudinally (p < 0.001 and p = 0.016, respectively). CONCLUSIONS Patients with early-stage NSCLC report a significant longitudinal decrease in physical QOL, and fluctuations in objective and subjective measures of physical function over time were observed regardless of disease stage category. An interdisciplinary palliative care intervention is currently being tested to decrease symptom burden and improve QOL.
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Affiliation(s)
- Marianna Koczywas
- Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
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