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Baum J, Lax H, Lehmann N, Merkel-Jens A, Beelen DW, Jöckel KH, Dührsen U. Patient-reported patterns of follow-up care in the 'Aftercare in Blood Cancer Survivors' (ABC) study. J Cancer Res Clin Oncol 2023; 149:10531-10542. [PMID: 37291404 PMCID: PMC10423115 DOI: 10.1007/s00432-023-04889-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/20/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Follow-up care provides long-term support for cancer survivors. Little is known about follow-up care in hematologic malignancies. METHODS Our questionnaire-based study included blood cancer survivors diagnosed at the University Hospital of Essen before 2010, with a ≥ 3-year interval since the last intense treatment. The primary goal of the retrospective study was the identification and characterization of follow-up institutions. RESULTS Of 2386 survivors meeting the inclusion criteria, 1551 (65.0%) consented to participate, with a follow-up duration > 10 years in 731. The university hospital provided care for 1045 participants (67.4%), non-university oncologists for 231 (14.9%), and non-oncological internists or general practitioners for 203 (13.1%). Seventy-two participants (4.6%) abstained from follow-up care. The disease spectrum differed among follow-up institutions (p < 0.0001). While allogeneic transplant recipients clustered at the university hospital, survivors with monoclonal gammopathy, multiple myeloma, myeloproliferative disorders, or indolent lymphomas were often seen by non-university oncologists, and survivors with a history of aggressive lymphoma or acute leukemia by non-oncological internists or general practitioners. Follow-up intervals mirrored published recommendations. Follow-up visits were dominated by conversations, physical examination, and blood tests. Imaging was more often performed outside than inside the university hospital. Satisfaction with follow-up care was high, and quality of life was similar in all follow-up institutions. A need for improvement was reported in psychosocial support and information about late effects. CONCLUSIONS The naturally evolved patterns identified in the study resemble published care models: Follow-up clinics for complex needs, specialist-led care for unstable disease states, and general practitioner-led care for stable conditions.
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Affiliation(s)
- Julia Baum
- Klinik für Hämatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Hildegard Lax
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universität Duisburg-Essen, Essen, Germany
| | - Nils Lehmann
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universität Duisburg-Essen, Essen, Germany
| | - Anja Merkel-Jens
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universität Duisburg-Essen, Essen, Germany
| | - Dietrich W Beelen
- Klinik für Knochenmarktransplantation, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universität Duisburg-Essen, Essen, Germany
| | - Ulrich Dührsen
- Klinik für Hämatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
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Mullis MD, Fisher CL, Kastrinos AL, Sae-Hau M, Weiss ES, Rajotte M, Bylund CL. Survivorship transitions in blood cancer: Identifying experiences and supportive care needs for caregivers. J Cancer Surviv 2023:10.1007/s11764-023-01422-0. [PMID: 37420150 PMCID: PMC11024982 DOI: 10.1007/s11764-023-01422-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE Survivorship care often refers to continued healthcare after cancer treatment. Jacobsen and colleagues advocated to expand this to include patients on extended treatments and maintenance/prophylactic therapies, recognizing the care continuum as more complex. Transitions of care for individuals diagnosed with a blood cancer can be complicated. We sought to better understand blood cancer caregivers' experiences as their diagnosed family member encountered "survivorship transitions" across the continuum. METHODS We conducted semi-structured interviews with adults caring for a parent or a child with a blood cancer. Caregivers were segmented into survivorship groups based on two transitional contexts: (1) when patients transitioned to a new line of therapy (active treatment or maintenance therapy); (2) when patients ended treatment. We conducted a thematic analysis and triangulated findings to compare transitional experiences. RESULTS Caregivers in both groups reported experiencing a "new normal," which included personal, relational, and environmental adjustments. Caregivers in the treatment transitions group (n = 23) also described uncertainty challenges (e.g., losing their "safety net") and disrupted expectations (e.g., feeling "caught off guard" by challenges). Whereas caregivers in the end-of-treatment transitions group (n = 15) described relief coupled with worry (e.g., feeling hopeful yet worried). CONCLUSIONS Survivorship transitions for caregivers are riddled with challenges that include difficult readjustments, uncertainty/worry, and unmet expectations. While there seems to be a cohesive experience of "survivorship transitions," each transition group revealed nuanced distinctions. IMPLICATIONS FOR CANCER SURVIVORS Tailored supportive resources are needed for caregivers throughout survivorship transitions.
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Affiliation(s)
- M Devyn Mullis
- College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Carla L Fisher
- College of Medicine, University of Florida, Gainesville, FL, USA
| | | | | | | | | | - Carma L Bylund
- College of Medicine, University of Florida, Gainesville, FL, USA
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3
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Loh KP, McLaughlin EM, Krok-Schoen JL, Odejide OO, El-Jawahri A, Qi L, Shadyab AH, Johnson LG, Paskett ED. Correlates of common concerns in older cancer survivors of leukemia and lymphoma: results from the WHI LILAC study. J Cancer Surviv 2023; 17:769-780. [PMID: 35982359 PMCID: PMC9938088 DOI: 10.1007/s11764-022-01249-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Older survivors of leukemia and lymphoma often experience long-term effects of chemotherapy. We described common concerns related to their cancer and treatment in older survivors of leukemia and non-Hodgkin lymphoma (NHL) and assessed correlates of these concerns. METHODS We utilized data from the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study that recruited post-menopausal women aged 50-79. Participants diagnosed with leukemia and NHL were included (n = 420). They were asked about 14 areas of current concerns related to their cancer and treatment and to rate each from 0 (no concern) to 2 (major concern), with total scores ranging from 0 to 28. Linear regression was used to assess factors correlated with the concern score, and logistic regression for factors correlated with the three most common concerns. RESULTS Mean age at assessment was 81 years (range 69-99); 72% reported at least one concern, and median concern score among these survivors was 3.5 (Q1-Q3 2-5). Factors significantly correlated with concern scores were sadness, pain, distress, higher prior symptom count, and loneliness (all p < 0.05). Significant factors correlated with common concerns were (1) fatigue/sleep: sadness/depression, distress, higher prior symptom count, greater loneliness, and worse physical functioning; (2) physical functioning/activity: older age, public insurance, higher body mass index, pain, worse QoL, and higher treatment-related comorbidities; (3) memory/concentration: prior chemotherapy or radiation, worse QoL, higher prior symptom count, and greater loneliness (all p < 0.05). CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS Almost three-quarters of older survivors of leukemia and lymphoma reported at least one concern; a multifaceted intervention may be needed to address these concerns.
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Affiliation(s)
- Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA.
| | - Eric M McLaughlin
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Jessica L Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Oreofe O Odejide
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Center for Lymphoma, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Areej El-Jawahri
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lihong Qi
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Lisa G Johnson
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Electra D Paskett
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, OH, USA
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Boland V, Drury A, Sheaf G, Brady AM. Living with or beyond lymphoma: A rapid review of the unmet needs of lymphoma survivors. Psychooncology 2022; 31:1076-1101. [PMID: 35670252 PMCID: PMC9545574 DOI: 10.1002/pon.5973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/04/2022] [Accepted: 05/29/2022] [Indexed: 11/08/2022]
Abstract
Objective To establish an understanding of the unmet needs of people living with or beyond a lymphoma diagnosis. Survivors of lymphoma are at increased risk of unmet needs due to cancer, treatment‐related toxicities and extended survivorship. Despite the rapidly growing numbers of lymphoma survivors, their needs and research priorities are underserved and undervalued, therefore left largely unaddressed. Methods A rapid review method and reflexive thematic analysis approach assimilated current knowledge. Eligibility criteria included quantitative, qualitative, or mixed approaches employing cross‐sectional, longitudinal, cohort or review designs focused on the needs of adult lymphoma survivors (any subtype or stage of disease). Five databases: CINAHL, EMBASE, Medline, PsycInfo and Scopus, were systematically searched. Results Forty‐seven studies met the inclusion criteria via a stringent screening process facilitated by NVivo. Almost 60 per cent of articles were published within the last five years and investigated a homogenous lymphoma sample. Most studies employed quantitative approaches (77%) and cross‐sectional designs (67%). Studies were of high methodological quality. Five major themes were identified: disparity in health service delivery, the psychological impact of cancer, impactful and debilitating concerns, the monetary cost of survival and insufficient provision of survivorship information. A meta‐analytical approach was not feasible due to the breadth of methodologies of included studies. Conclusions This review shows that lymphoma survivors experience a myriad of unmet needs across multiple domains, reinforcing the need for lymphoma‐specific research. However, more research is needed to advance and achieve informed decision‐making relating to survivorship care, placing due attention to the needs and research priorities of lymphoma survivors.
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Affiliation(s)
- Vanessa Boland
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland, D02 T283
| | - Amanda Drury
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland, D04 V1W8
| | - Greg Sheaf
- The Library of Trinity College Dublin, Dublin, 2, Ireland
| | - Anne-Marie Brady
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland, D02 T283
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5
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Hart NH, Crawford-Williams F, Crichton M, Yee J, Smith TJ, Koczwara B, Fitch MI, Crawford GB, Mukhopadhyay S, Mahony J, Cheah C, Townsend J, Cook O, Agar MR, Chan RJ. Unmet supportive care needs of people with advanced cancer and their caregivers: a systematic scoping review. Crit Rev Oncol Hematol 2022; 176:103728. [PMID: 35662585 DOI: 10.1016/j.critrevonc.2022.103728] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 01/11/2023] Open
Abstract
Examining and addressing unmet care needs is integral to improving the provision and quality of cancer services. This review explored the prevalence of unmet supportive care needs, and factors associated with unmet need, in adults with advanced cancers (solid and hematological malignancies) and their caregivers. Electronic databases (PubMed, CINAHL, EMBASE) were searched, producing 85 papers representing 81 included studies. People with advanced cancer reported the highest unmet needs in financial, health system and information, psychological, and physical and daily living domains, whereas caregivers reported the highest unmet needs in psychological, and patient care and support domains. Distress, depression, and anxiety were associated with higher unmet needs across all unmet need domains for people with advanced cancer and their caregivers. Substantial heterogeneity in study populations and methods was observed. Findings from this review can inform targeted strategies and interventions to address these unmet needs in people with advanced cancer.
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Affiliation(s)
- Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, SA, Australia; Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, WA, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia; Institute for Health Research, University of Notre Dame Australia, WA, Australia.
| | - Fiona Crawford-Williams
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, SA, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia
| | - Megan Crichton
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia; Nutrition and Dietetics Research Group, Bond University, QLD, Australia
| | - Jasmine Yee
- Centre for Medical Psychology and Evidence-Based Decision-Making, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Thomas J Smith
- Division of General Internal Medicine, John Hopkins Medical Institutions, Baltimore, MD, USA
| | - Bogda Koczwara
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, SA, Australia; Flinders Cancer and Innovation Centre, Flinders Medical Centre, SA, Australia
| | - Margaret I Fitch
- School of Graduate Studies, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Gregory B Crawford
- Discipline of Medicine, University of Adelaide, SA, Australia; Northern Adelaide Local Health Network, SA, Australia
| | - Sandip Mukhopadhyay
- Burdwan Medical College, West Bengal, Kolkata, India; Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Chan Cheah
- Internal Medicine, UWA Medical School, University of Western Australia, WA, Australia; Department of Haematology, Sir Charles Gairdner Hospital, WA, Australia; Department of Haematology, Hollywood Private Hospital, WA, Australia
| | | | - Olivia Cook
- McGrath Foundation, NSW, Australia; School of Nursing and Midwifery, Monash University, VIC, Australia
| | - Meera R Agar
- IMPACCT Centre, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, SA, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia
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6
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Ji X, Marchak JG, Mertens AC, Curseen KA, Zarrabi AJ, Cummings JR. National estimates of mental health service use and unmet needs among adult cancer survivors. Cancer 2021; 127:4296-4305. [PMID: 34378803 DOI: 10.1002/cncr.33827] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/07/2021] [Accepted: 06/24/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cancer survivors are at elevated risk for developing mental health (MH) disorders. This study assessed MH service use and unmet service needs among a nationally representative sample of cancer survivors. METHODS Respondents aged 18 to 64 years were identified from the 2015-2018 National Survey of Drug Use and Health data. Outcomes assessed past-year MH service use and self-reported unmet MH needs. Outcomes were compared between respondents who reported a cancer history (survivors) and those who did not (controls), descriptively and in adjusted analyses controlling for sociodemographic factors and health status. Analyses were stratified by age groups (18-34, 35-49, and 50-64 years). RESULTS Comparing 3540 survivors with 149,843 controls, within each age group, a higher proportion of survivors than controls received any MH service (P values < .05); this difference persisted among those aged 35 to 49 years (P = .004) in fully adjusted models. Moreover, a higher proportion of survivors than controls reported an unmet need for MH care; this difference was larger among young adults aged 18 to 34 years (20.8% vs 9.0%; P < .001) than those aged 35 to 49 years (9.4% vs 5.3%; P < .001) and 50 to 64 years (4.8% vs 3.4%; P = .029). In fully adjusted models, the survivor-control difference in self-reported unmet MH needs persisted among young adults (24% relative increase; P = .023). Among cancer survivors, young adult survivors had the highest likelihood of reporting unmet MH needs. CONCLUSIONS This nationally representative study found an increased perception of unmet needs for MH care among cancer survivors, particularly among young adult survivors, compared with the general population without cancer.
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Affiliation(s)
- Xu Ji
- Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Jordan Gilleland Marchak
- Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Ann C Mertens
- Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, Georgia
| | | | - Ali J Zarrabi
- Department of Medicine, Emory School of Medicine, Atlanta, Georgia
| | - Janet R Cummings
- Department of Health Policy and Management, Emory Rollins School of Public Health, Atlanta, Georgia
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Hörster L, Neusser S, Trautner A, Pahmeier K, Lax H, Merkel-Jens A, Lehmann N, Jöckel KH, Baum J, Dührsen U, Wasem J, Neumann A. Kosten der Nachsorge von Patienten mit hämatologischen Neoplasien. GESUNDHEITSÖKONOMIE & QUALITÄTSMANAGEMENT 2021. [DOI: 10.1055/a-1468-7124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Zielsetzung Im Gegensatz zu hämatologischen Neoplasien im Kindesalter gibt es für Erwachsene mit diesen Erkrankungen wenige bis keine einheitlichen Nachsorgemuster und dementsprechend auch keine rational begründeten Nachsorgepläne. Des Weiteren wurden bislang keine Studien zu den mit der Nachsorge einhergehenden Kosten veröffentlicht. Die vorliegende Studie dient zur Erfassung des Ressourcenverbrauchs und der damit einhergehenden Kosten von erwachsenen Patienten.
Methodik Die Daten des Ressourcenverbrauchs wurden 2014 retrospektiv für die letzten 12 Monate mittels eines standardisierten Fragebogens erfasst. Die Krankheitskosten (direkte medizinische sowie indirekte Kosten) wurden aus der gesellschaftlichen Perspektive ermittelt. Das Jahr 2014 dient als Basisjahr für die Berechnung der Preise. Zur Ermittlung der indirekten Kosten (Erwerbsminderung, Arbeitsunfähigkeit) wurde der Friktionskostenansatz mit einer Friktionsperiode von 90 Tagen herangezogen. Weiterhin erfolgte ein Vergleich mit Hilfe des Humankapitalansatzes.
Ergebnisse Insgesamt nahmen 1531 Patienten an der gesundheitsökonomischen Erhebung teil. 89,4 % der Teilnehmer wiesen im Erfassungszeitraum mindestens einen ambulanten Arztkontakt auf. 235 Teilnehmern (15,3 %) wurde mindestens ein der Nachsorge zuzuordnendes Medikament verabreicht. 9,7 % der Studienteilnehmer gaben keinerlei Inanspruchnahme aufgrund von Nachsorge der Krebserkrankung an. Insgesamt ergaben sich direkte medizinische Kosten von durchschnittlich ca. 3627 € pro Patient. Die indirekten Krankheitskosten beliefen sich unter Verwendung des Friktionskostenansatzes auf ca. 165 € pro Patient.
Schlussfolgerung Arzneimittelkosten verursachen mit etwa 60 % den Großteil der direkten Nachsorgekosten bei Patienten mit hämatologischen Neoplasien. Nach der zugrundeliegenden Erkrankung aufgeschlüsselt weisen myeloproliferative Erkrankungen mit einem Anteil von fast 60 % die höchsten Gesamtkosten auf. Unter Verwendung des Friktionskostenansatzes lassen sich die Nachsorgekosten in 95,7 % direkte Kosten und 4,3 % indirekte Kosten unterteilen. 9,7 % der Studienteilnehmer geben keinerlei Inanspruchnahme aufgrund von Nachsorge der Krebserkrankung an und scheinen somit komplett durch das Nachsorgesystem zu fallen.
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Affiliation(s)
- Laura Hörster
- Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen
| | - Silke Neusser
- Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen
| | | | | | - Hildegard Lax
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen
| | - Anja Merkel-Jens
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen
| | - Nils Lehmann
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen
| | - Karl-Heinz Jöckel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen
| | - Julia Baum
- Klinik für Hämatologie, Universitätsklinikum Essen
| | | | - Jürgen Wasem
- Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen
| | - Anja Neumann
- Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen
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8
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Tsatsou I, Konstantinidis T, Kalemikerakis I, Adamakidou T, Vlachou E, Govina O. Unmet Supportive Care Needs of Patients with Hematological Malignancies: A Systematic Review. Asia Pac J Oncol Nurs 2021; 8:5-17. [PMID: 33426184 PMCID: PMC7785074 DOI: 10.4103/apjon.apjon_41_20] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/27/2020] [Indexed: 12/12/2022] Open
Abstract
Hematological malignancies require intensive and long-term treatment, which brings a significant burden on patients, leading to unmet supportive care needs. The purpose of this review was to investigate the unmet supportive care needs of patients with hematological malignancies during and after active treatment as well as the factors that affect them. A systematic bibliographic search was carried out in the PubMed database for English articles published between 2009 and 2020 according to the Preferred Reporting Items for Systematic Reviews guidelines and under the terms: "unmet needs", "supportive care", "hematological malignancy" and "hematological cancer." Twenty studies were evaluated and reviewed. Hierarchical frequently reported unmet supportive care needs were informational, emotional, physical, daily living/practical (accessibility, transportation, and financial problems), and family life/relational needs. In particular, patients with multiple myeloma most frequently reported unmet needs at the informational, physical, emotional, and daily living/practical domain. Patients with myelodysplastic syndromes reported physical, emotional, practical, and relational needs. Patients with leukemia and lymphoma rated their needs as informational, physical, psychological, daily living, and sexual. Sexual and spiritual unmet needs were reported at a low level. Predictive indicators for increased unmet supportive care needs were the type of the hematological malignancy, younger age, marital status, female gender, monthly income, coexistence of anxiety and depression, and altered quality of life. To conclude with, the literature reports a significant number of unmet supportive care needs in patients with hematological malignancies, whose frequency and intensity were influenced by a variety of factors. However, the large heterogeneity of studies (design, sample, and needs assessment tools) makes the generalization of the results difficult.
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Affiliation(s)
- Ioanna Tsatsou
- Oncology-Hematology Department, Hellenic Airforce General Hospital, Heraklion, Greece
| | | | | | | | - Eugenia Vlachou
- Department of Nursing, University of West Attica, Athens, Greece
| | - Ourania Govina
- Department of Nursing, University of West Attica, Athens, Greece
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9
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Perez GK, Walsh EA, Quain K, Abramson JS, Park ER. A virtual resiliency program for lymphoma survivors: helping survivors cope with post-treatment challenges. Psychol Health 2020; 36:1352-1367. [PMID: 33251861 DOI: 10.1080/08870446.2020.1849699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives To adapt and test the feasibility, acceptability, and preliminary efficacy of an 8-week resiliency group program for posttreatment lymphoma survivors.Design and outcomes. This is an exploratory mixed methods study. Phase 1: We conducted qualitative interviews to inform program adaptation. Phase 2: Using a single-arm pilot design, we assessed program feasibility, acceptability, and preliminary efficacy (exploratory outcomes: stress coping, uncertainty intolerance, distress). We also examined the feasibility of collecting hair cortisol samples.Results. Phase 1: Survivors reported feeling socially isolated as they grappled with lingering symptoms that interfered with their return to normalcy. Fears about recurrence triggered bodily hypervigilance. Survivors desired wellness programs that 1) target their whole-body experience, 2) promote social connectedness, and 3) manage fear of recurrence. Phase 2: Thirty-seven survivors enrolled. Participants completed a median of 7/8 sessions, and 76.9% completed ≥6/8 sessions; 65% provided a hair sample. Survivors demonstrated improvements in stress coping (d = .67), uncertainty tolerance (d = .71), and anxiety (d = .41) at program completion.Conclusions. Findings suggest promising feasibility and efficacy of this program in addressing posttreatment survivorship challenges, particularly fears of uncertainty. A cancer care model that adopts early integration of this program posttreatment has the potential to improve survivors' emotional, social and physical well-being.
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Affiliation(s)
- Giselle K Perez
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Emily A Walsh
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Kit Quain
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeremy S Abramson
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Elyse R Park
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
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10
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Abstract
BACKGROUND Survivors of lymphoma experience multiple challenges after treatment. However, a lack of knowledge of in-depth experiences of lymphoma survivors in early aftercare persists. OBJECTIVE To gain an in-depth understanding of the experiences of lymphoma survivors in early aftercare who have received an aftercare consultation based on evidence-based guideline recommendations, with an advanced practice nurse. METHODS This study used a narrative design. We recruited lymphoma survivors after a best-practice aftercare consultation with an advanced practice nurse. A total of 22 lymphoma survivors and 9 partners participated. Data were collected through narrative interviews and analyzed according to thematic narrative analysis. RESULTS Six themes emerged: living and dealing with health consequences, coping with work and financial challenges, having a positive outlook and dealing with uncertainty, deriving strength from and experiencing tensions in relationships, getting through tough times in life, and receiving support from healthcare professionals. CONCLUSIONS The stories of lymphoma survivors in early aftercare revealed their experiences of how they coped with a range of challenges in their personal lives. Choosing an aftercare trajectory based on an aftercare consultation that encourages patients to think about their issues, goals, and possible aftercare options may be useful for their transition from treatment to survivorship. IMPLICATIONS FOR PRACTICE Survivors' social support and self-management capabilities are important aspects to be addressed in cancer care. An aftercare consultation involving shared goal setting and care planning may help nurses provide personalized aftercare.
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Watts TE, Bower J. Still lost in transition: a qualitative descriptive study of people's experiences following treatment completion for haematological cancer in Wales, UK. Ecancermedicalscience 2019; 13:985. [PMID: 32010209 PMCID: PMC6974372 DOI: 10.3332/ecancer.2019.985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to explore Welsh adults' experiences of the transition into survivorship from initial active systemic anti-cancer treatments for haematological cancers. An exploratory, qualitative descriptive study consisting of in-depth, face-to-face interviews was designed. A convenience sample of adults in Wales, UK, who had completed their initial systemic anti-cancer treatment for haematological cancer was recruited from one University Health Board. Data were generated in digitally recorded, individual, face-to-face interviews during 2017. Interviews were fully transcribed and analysed using a qualitative thematic approach. Seven people participated in interviews. Thematic analysis revealed three themes: encountering ambiguity, the pursuit of normality and navigating treatment completion. The transition from patient to survivor was characterised by trepidation and uncertainty. While participants sought to resume a sense of normality in their lives, they were beset by enduring treatment effects. They felt insufficiently prepared for these effects and were uncertain about the availability of the ongoing supportive care which met their individual needs. Participants articulated that they desired much more from haematology providers in preparing them for life beyond initial SACT.
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Affiliation(s)
- Tessa E Watts
- School of Healthcare Sciences, Cardiff University, Cardiff CF10 3AT, UK
- https://orcid.org/0000-002-1201-5192
| | - Janet Bower
- Chemotherapy Day Unit, Hywel Dda University Health Board, Withybush General Hospital, Haverfordwest SA61 2PZ, UK
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Konstantinidis TI, Spinthouri M, Ramoutsaki A, Marnelou A, Kritsotakis G, Govina O. Assessment of Unmet Supportive Care Needs in Haematological Cancer Survivors. Asian Pac J Cancer Prev 2019; 20:1487-1495. [PMID: 31127913 PMCID: PMC6857858 DOI: 10.31557/apjcp.2019.20.5.1487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Health needs assessment is crucial for the provision of individualized nursing care. However, many patients report a significant number of unmet needs. The aim of the present study was the assessment of self-reported unmet supportive care needs among haematological cancer survivors in Greece. Methods: 102 patients (mean age 66.2 years old) diagnosed with haematological cancer were included in a cross-sectional study, conducted in two major Greek public hospitals, between October and December 2016. Patients’ needs were assessed using the ‘Needs Evaluation Questionnaire’ (NEQ). Data analysis was conducted using the Statistical Package for Social Sciences software for Windows. Alfa-level (p-value) selected was 5%, bootstrap techniques were used for 95% CI estimation, χ2 was used for differentiation control and Kuder-Richardson coefficient for reliability score assessment (ρ = 0.922). Results: Patients reported higher needs levels “to receive less commiseration from other people” (48%), “more information about my future condition” (44.1%) and “to feel more useful within my family” (42.2%). In contrast, patients reported lower levels to the needs “to speak with a spiritual advisor” (11.8%), “to have more help with eating, dressing and going to the bathroom” (13.7%) and “better attention from nurses” (18.6%). The mean score of satisfied patients (≥8/10) was 8.9 (SD 1.7). Associations between socio-demographic, hospitalization data and unmet needs groups were identified. The less satisfied patients (<8/10) reported more informational needs about their diagnosis and their future condition (p-value=0.002), about their exams and treatments (p-value=0.001), communicative (p-value <0.001), assistance and treatment (p-value<0.001) and hospital infrastructure (p-value <0.001). Conclusion: Various factors seem to be associated to the prevalent unmet care needs among haematological cancer patients. Establishing NEQ as a routine needs assessment tool could aid health professionals to early identify patients’ needs in a busy clinical setting and implement more individualized and patient-centered quality care.
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Affiliation(s)
| | | | | | | | - George Kritsotakis
- Department of Nursing, Technological Educational Institute of Crete, Heraklion, Greece.
| | - Ourania Govina
- Faculty of Nursing, University of West Attica, Athens, Greece
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Schouten B, Avau B, Bekkering G(TE, Vankrunkelsven P, Mebis J, Hellings J, Van Hecke A. Systematic screening and assessment of psychosocial well-being and care needs of people with cancer. Cochrane Database Syst Rev 2019; 3:CD012387. [PMID: 30909317 PMCID: PMC6433560 DOI: 10.1002/14651858.cd012387.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Receiving a diagnosis of cancer and the subsequent related treatments can have a significant impact on an individual's physical and psychosocial well-being. To ensure that cancer care addresses all aspects of well-being, systematic screening for distress and supportive care needs is recommended. Appropriate screening could help support the integration of psychosocial approaches in daily routines in order to achieve holistic cancer care and ensure that the specific care needs of people with cancer are met and that the organisation of such care is optimised. OBJECTIVES To examine the effectiveness and safety of screening of psychosocial well-being and care needs of people with cancer. To explore the intervention characteristics that contribute to the effectiveness of these screening interventions. SEARCH METHODS We searched five electronic databases in January 2018: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, and CINAHL. We also searched five trial registers and screened the contents of relevant journals, citations, and references to find published and unpublished trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) and non-randomised controlled trials (NRCTs) that studied the effect of screening interventions addressing the psychosocial well-being and care needs of people with cancer compared to usual care. These screening interventions could involve self-reporting of people with a patient-reported outcome measures (PROMs) or a semi-structured interview with a screening interventionist, and comprise a solitary screening intervention or screening with guided actions. We excluded studies that evaluated screening integrated as an element in more complex interventions (e.g. therapy, coaching, full care pathways, or care programmes). DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data and assessed methodological quality for each included study using the Cochrane tool for RCTs and the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool for NRCTs. Due to the high level of heterogeneity in the included studies, only three were included in meta-analysis. Results of the remaining 23 studies were analysed narratively. MAIN RESULTS We included 26 studies (18 RCTs and 8 NRCTs) with sample sizes of 41 to 1012 participants, involving a total of 7654 adults with cancer. Two studies included only men or women; all other studies included both sexes. For most studies people with breast, lung, head and neck, colorectal, prostate cancer, or several of these diagnoses were included; some studies included people with a broader range of cancer diagnosis. Ten studies focused on a solitary screening intervention, while the remaining 16 studies evaluated a screening intervention combined with guided actions. A broad range of intervention instruments was used, and were described by study authors as a screening of health-related quality of life (HRQoL), distress screening, needs assessment, or assessment of biopsychosocial symptoms or overall well-being. In 13 studies, the screening was a self-reported questionnaire, while in the remaining 13 studies an interventionist conducted the screening by interview or paper-pencil assessment. The interventional screenings in the studies were applied 1 to 12 times, without follow-up or from 4 weeks to 18 months after the first interventional screening. We assessed risk of bias as high for eight RCTs, low for five RCTs, and unclear for the five remaining RCTs. There were further concerns about the NRCTs (1 = critical risk study; 6 = serious risk studies; 1 = risk unclear).Due to considerable heterogeneity in several intervention and study characteristics, we have reported the results narratively for the majority of the evidence.In the narrative synthesis of all included studies, we found very low-certainty evidence for the effect of screening on HRQoL (20 studies). Of these studies, eight found beneficial effects of screening for several subdomains of HRQoL, and 10 found no effects of screening. One study found adverse effects, and the last study did not report quantitative results. We found very low-certainty evidence for the effect of screening on distress (16 studies). Of these studies, two found beneficial effects of screening, and 14 found no effects of screening. We judged the overall certainty of the evidence for the effect of screening on HRQoL to be very low. We found very low-certainty evidence for the effect of screening on care needs (seven studies). Of these studies, three found beneficial effects of screening for several subdomains of care needs, and two found no effects of screening. One study found adverse effects, and the last study did not report quantitative results. We judged the overall level of evidence for the effect of screening on HRQoL to be very low. None of the studies specifically evaluated or reported adverse effects of screening. However, three studies reported unfavourable effects of screening, including lower QoL, more unmet needs, and lower satisfaction.Three studies could be included in a meta-analysis. The meta-analysis revealed no beneficial effect of the screening intervention on people with cancer HRQoL (mean difference (MD) 1.65, 95% confidence interval (CI) -4.83 to 8.12, 2 RCTs, 6 months follow-up); distress (MD 0.0, 95% CI -0.36 to 0.36, 1 RCT, 3 months follow-up); or care needs (MD 2.32, 95% CI -7.49 to 12.14, 2 RCTs, 3 months follow-up). However, these studies all evaluated one specific screening intervention (CONNECT) in people with colorectal cancer.In the studies where some effects could be identified, no recurring relationships were found between intervention characteristics and the effectiveness of screening interventions. AUTHORS' CONCLUSIONS We found low-certainty evidence that does not support the effectiveness of screening of psychosocial well-being and care needs in people with cancer. Studies were heterogeneous in population, intervention, and outcome assessment.The results of this review suggest a need for more uniformity in outcomes and reporting; for the use of intervention description guidelines; for further improvement of methodological certainty in studies and for combining subjective patient-reported outcomes with objective outcomes.
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Affiliation(s)
- Bojoura Schouten
- Hasselt UniversityResearch Group Health Care, Faculty of Medicine and Life SciencesHasseltLimburgBelgium3500
| | - Bert Avau
- Belgian Red CrossCentre for Evidence‐Based PracticeMotstraat 42MechelenBelgium2800
- Belgian Centre for Evidence‐Based Medicine ‐ Cochrane BelgiumKapucijnenvoer 33, blok JLeuvenBelgium3000
| | - Geertruida (Trudy) E Bekkering
- Belgian Centre for Evidence‐Based Medicine ‐ Cochrane BelgiumKapucijnenvoer 33, blok JLeuvenBelgium3000
- KU LeuvenDepartment of Public Health and Primary Care ‐ Faculty of MedicineKapucijnenvoer 33 Blok J Bus 7001LeuvenBelgium3000
| | - Patrick Vankrunkelsven
- Belgian Centre for Evidence‐Based Medicine ‐ Cochrane BelgiumKapucijnenvoer 33, blok JLeuvenBelgium3000
- KU LeuvenDepartment of Public Health and Primary Care ‐ Faculty of MedicineKapucijnenvoer 33 Blok J Bus 7001LeuvenBelgium3000
| | - Jeroen Mebis
- Jessa HospitalDepartment of Medical OncologyHasseltBelgium
- Hasselt UniversityResearch Group Immunology and BiochemistryFaculty of Medicine and Life SciencesHasseltBelgium
| | - Johan Hellings
- Hasselt UniversityResearch Group Health Care, Faculty of Medicine and Life SciencesHasseltLimburgBelgium3500
- AZ DeltaRode‐Kruisstraat 20RoeselareBelgium
| | - Ann Van Hecke
- Ghent UniversityUniversity Centre for Nursing and Midwifery, Department of Public HealthDe Pintelaan 185GhentBelgium9000
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14
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Parker PA, Banerjee SC, Matasar MJ, Bylund CL, Rogers M, Franco K, Schofield E, Li Y, Levin TT, Jacobsen PB, Astrow AB, Leventhal H, Horwitz S, Kissane D. Efficacy of a survivorship-focused consultation versus a time-controlled rehabilitation consultation in patients with lymphoma: A cluster randomized controlled trial. Cancer 2018; 124:4567-4576. [PMID: 30335188 DOI: 10.1002/cncr.31767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Survivors of cancer often describe a sense of abandonment after treatment along with heightened uncertainty and limited knowledge of what lies ahead. This study examined the efficacy of a survivorship care plan (SCP) intervention to help physicians to address survivorship issues through communication skills training plus a new consultation focused on the use of an SCP for patients with Hodgkin lymphoma and diffuse large B-cell lymphoma. METHODS This 4-site cluster randomized trial examined the efficacy of a survivorship planning consultation (SPC) in patients who achieved complete remission after the completion of first-line therapy (for the SPC, physicians received communication skills training and, using an SCP, applied those skills in a survivorship-focused office visit) versus a control arm in which physicians were trained in and subsequently provided a time-controlled, manualized wellness rehabilitation consultation (WRC) focused only on discussion of healthy nutrition and exercise as rehabilitation after chemotherapy. The primary outcomes for patients were changes in knowledge about lymphoma and adherence to physicians' recommendations for vaccinations and cancer screenings. RESULTS Forty-two physicians and 198 patients participated across the 4 sites. Patients whose physicians were in the SPC arm had greater knowledge about their lymphoma (P = .01) and showed greater adherence to physician recommendations for influenza vaccinations (P = .02) and colonoscopy (P = .02) than patients whose physicians were in the WRC arm. CONCLUSIONS A dedicated consultation using an SCP and supported by communication skills training may enhance patients' knowledge and adherence to some health promotion recommendations.
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Affiliation(s)
- Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
- Department of Psychiatry, Weill Cornell Medical College, New York
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
- Department of Psychiatry, Weill Cornell Medical College, New York
| | - Matthew J Matasar
- Department of Medicine, Weill Cornell Medical College, New York
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York
| | - Carma L Bylund
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
- STEM Translational Communication Center, University of Florida, Gainesville
| | - Madeline Rogers
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
| | - Kara Franco
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
- Department of Psychiatry, Weill Cornell Medical College, New York
| | - Tomer T Levin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
- Department of Psychiatry, Weill Cornell Medical College, New York
| | - Paul B Jacobsen
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Alan B Astrow
- Department of Medicine, New York Methodist Hospital, New York
- Hematology and Oncology, Weill Cornell Medical College, New York
| | - Howard Leventhal
- Department of Psychology, Rutgers University, New Brunswick, New Jersey
| | - Steven Horwitz
- Department of Medicine, Weill Cornell Medical College, New York
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York
| | - David Kissane
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
- Department of Psychiatry, Weill Cornell Medical College, New York
- Department of Psychiatry, Monash University, Clayton, Victoria, Australia
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15
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Schouten B, Bergs J, Vankrunkelsven P, Hellings J. Healthcare professionals’ perspectives on the prevalence, barriers and management of psychosocial issues in cancer care: A mixed methods study. Eur J Cancer Care (Engl) 2018; 28:e12936. [DOI: 10.1111/ecc.12936] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 07/02/2018] [Accepted: 09/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Bojoura Schouten
- Faculty of Medicine and Life Sciences; Hasselt University; Hasselt Belgium
| | - Jochen Bergs
- Faculty of Medicine and Life Sciences; Hasselt University; Hasselt Belgium
| | - Patrick Vankrunkelsven
- Department of Public Health and Primary Care, Faculty of Medicine; Katholieke Universiteit Leuven; Leuven Belgium
- Belgian Center for Evidence-Based Medicine (CEBAM); Leuven Belgium
| | - Johan Hellings
- Faculty of Medicine and Life Sciences; Hasselt University; Hasselt Belgium
- AZ Delta Hospital; Roeselare Belgium
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16
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Tzelepis F, Paul CL, Sanson-Fisher RW, Campbell HS, Bradstock K, Carey ML, Williamson A. Unmet supportive care needs of haematological cancer survivors: rural versus urban residents. Ann Hematol 2018. [DOI: 10.1007/s00277-018-3285-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Schouten B, Bekkering GE, Vankrunkelsven P, Mebis J, Van Hoof E, Hellings J, Van Hecke A. Systematic screening and assessment of psychosocial well-being and care needs of people with cancer. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Bojoura Schouten
- Hasselt University; Research Group Health Care, Faculty of Medicine and Life Sciences; Hasselt Limburg Belgium 3500
| | - Geertruida E Bekkering
- Belgian Centre for Evidence-Based Medicine - Cochrane Belgium; Kapucijnenvoer 33 Blok J Bus 7001 Leuven Belgium 3000
- KU Leuven; Department of Public Health and Primary Care - Faculty of Medicine; Kapucijnenvoer 33 Blok J Bus 7001 Leuven Belgium 3000
| | - Patrick Vankrunkelsven
- Belgian Centre for Evidence-Based Medicine - Cochrane Belgium; Kapucijnenvoer 33 Blok J Bus 7001 Leuven Belgium 3000
- KU Leuven; Department of Public Health and Primary Care - Faculty of Medicine; Kapucijnenvoer 33 Blok J Bus 7001 Leuven Belgium 3000
| | - Jeroen Mebis
- Jessa Hospital; Department of Medical Oncology; Hasselt Belgium
- Hasselt University; Research Group Immunology and Biochemistry; Faculty of Medicine and Life Sciences Hasselt Belgium
| | - Elke Van Hoof
- Jessa Hospital; Department of Medical Oncology; Hasselt Belgium
| | - Johan Hellings
- Hasselt University; Research Group Health Care, Faculty of Medicine and Life Sciences; Hasselt Limburg Belgium 3500
- Free University of Brussels; Department of Experimental and Applied Psychology, Faculty of Psychological and Educational Sciences; Brussels Belgium
| | - Ann Van Hecke
- Ghent University; University Centre for Nursing and Midwifery, Department of Public Health; De Pintelaan 185 Ghent Belgium 9000
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18
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Parker PA, Banerjee SC, Matasar MJ, Bylund CL, Franco K, Li Y, Levin TT, Jacobsen PB, Astrow AB, Leventhal H, Horwitz S, Kissane DW. Protocol for a cluster randomised trial of a communication skills intervention for physicians to facilitate survivorship transition in patients with lymphoma. BMJ Open 2016; 6:e011581. [PMID: 27354079 PMCID: PMC4932279 DOI: 10.1136/bmjopen-2016-011581] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/29/2016] [Accepted: 06/03/2016] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Survivors of cancer often describe a sense of abandonment post-treatment, with heightened worry, uncertainty, fear of recurrence and limited understanding of what lies ahead. This study examines the efficacy of a communication skills training (CST) intervention to help physicians address survivorship issues and introduce a new consultation focused on the use of a survivorship care plan for patients with Hodgkin's lymphoma and diffuse large B-cell lymphoma. METHODS AND ANALYSIS Specifically, this randomised, 4-site trial will test the efficacy of a survivorship planning consultation (physicians receive CST and apply these skills in a new survivorship-focused office visit using a survivorship plan) with patients who have achieved complete remission after completion of first-line therapy versus a control arm in which physicians are trained to subsequently provide a time-controlled, manualised wellness rehabilitation consultation focused only on discussion of healthy nutrition and exercise as rehabilitation postchemotherapy. The primary outcome for physicians will be uptake and usage of communication skills and maintenance of these skills over time. The primary outcome for patients is changes in knowledge about lymphoma and adherence to physicians' recommendations (eg, pneumococcus and influenza vaccinations); secondary outcomes will include perceptions of the doctor-patient relationship, decreased levels of cancer worry and depression, quality of life changes, satisfaction with care and usage of healthcare. This study will also examine the moderators and mediators of change within our theoretical model derived from Leventhal's Common-Sense Model of health beliefs. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Boards at Memorial Sloan Kettering Cancer Centers and all other participating sites. This work is funded by the National Cancer Institute (R01 CA 151899 awarded to DWK and SH as coprincipal investigators). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute (NCI) or the National Institutes of Health (NIH). The study findings will be disseminated to the research and medical communities through publication in peer-reviewed journals and through presentations at local, national and international conferences. TRIAL REGISTRATION NUMBER NCT01483664.
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Affiliation(s)
- Patricia A Parker
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Smita C Banerjee
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Matthew J Matasar
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carma L Bylund
- Department of Communication Studies, Hamad Medical Corporation, Doha, Qatar Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Kara Franco
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yuelin Li
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Tomer T Levin
- Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Paul B Jacobsen
- Divison of Population Science, Moffitt Cancer Center, Tampa, Florida, USA
| | - Alan B Astrow
- Department of Medicine, Mamonides Cancer Center, New York, New York, USA
| | - Howard Leventhal
- Department of Psychology, Rutgers University, New Brunswick, New Jersey, USA
| | - Steven Horwitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - David W Kissane
- Department of Psychiatry, Monash University, Clayton, Victoria, Australia
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19
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Syrjala KL. Filling the gaps in knowledge and treatments for sexual health in young adult male cancer survivors. Cancer 2016; 122:2134-7. [PMID: 27171248 DOI: 10.1002/cncr.29988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 02/29/2016] [Accepted: 03/01/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,University of Washington School of Medicine, Seattle, Washington
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20
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Kim SH, Lee S, Kim SH, Ok ON, Kim IR, Choi E, Kang YK, Kim SJ, Lee MH. Unmet needs of non-Hodgkin lymphoma survivors in Korea: prevalence, correlates, and associations with health-related quality of life. Psychooncology 2016; 26:330-336. [PMID: 27073128 DOI: 10.1002/pon.4136] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We aimed to describe the prevalence and correlates of unmet needs among non-Hodgkin lymphoma (NHL) survivors in Korea and to identify their association with health-related quality of life (HRQOL). METHODS Participants were 826 NHL survivors from three hospitals in South Korea diagnosed at least 24 months prior to participating (mean, 6.3 years; range, 2.1-20.9 years). We used self-reported questionnaires, including the Need Scale for Cancer Patients Undergoing Follow-up Care (NS-C) developed in Korea and the EORTC QLQ-C30. We defined an unmet need as a moderate to high level of unmet need in the NS-C response scale. RESULTS Among six domains, unmet need prevalence ranged from 1.7% to 38.3%. Most commonly reported domains with unmet needs were 'treatment and prognosis' (38.3%) and 'keeping mind under control' (30.5%). The three most frequently reported individual unmet needs were 'being informed about prevention of recurrence' (50.7%), 'being informed about prevention of metastasis' (49.7%), and 'having self-confidence of overcoming cancer' (42.7%). Multivariate logistic analyses revealed that younger age, being unmarried, and low monthly income were associated with unmet needs of multiple domains. Participants with unmet needs demonstrated significantly poorer HRQOL, and the most clinically meaningful differences were found in social function and emotional function. CONCLUSIONS Korean NHL survivors have substantial unmet needs, especially those who are younger, unmarried, and have a lower income. Initiating supportive care programs for meeting unmet needs may enhance their HRQOL. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Soo Hyun Kim
- Department of Nursing, Inha University, Incheon, South Korea
| | - Suyeon Lee
- Department of Oncology, Asan Medical Center, Seoul, South Korea
| | - So Hee Kim
- Cancer Edu-Info Center, Asan Medical Center, Seoul, South Korea
| | - Oh Nam Ok
- Division of Hematology-Oncology, Samsung Medical Center, Seoul, South Korea
| | - Im-Ryung Kim
- Cancer Education Center, Samsung Medical Center, Seoul, South Korea
| | - Eunju Choi
- Department of Nursing, Inha University, Incheon, South Korea
| | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Moon Hee Lee
- Division of Hematology-Oncology, Inha University Hospital and College of Medicine, Incheon, South Korea
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21
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Schouten B, Van Hoof E, Vankrunkelsven P, Schrooten W, Bulens P, Buntinx F, Mebis J, Vandijck D, Cleemput I, Hellings J. Assessing cancer patients' quality of life and supportive care needs: Translation-revalidation of the CARES in Flemish and exhaustive evaluation of concurrent validity. BMC Health Serv Res 2016; 16:86. [PMID: 26969509 PMCID: PMC4788884 DOI: 10.1186/s12913-016-1335-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/07/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The prevalence of cancer increases every year, leading to a growing population of patients and survivors in need for care. To achieve good quality care, a patient-centered approach is essential. Correct and timely detection of needs throughout the different stages of the care trajectory is crucial and can be supported by the use of screening and assessment in a stepped-care approach. The Cancer Rehabilitation Evaluation System (CARES) is a valuable and comprehensive quality of life and needs assessment instrument. For use in Flemish research and clinical practice, the CARES tool was translated for the Dutch-speaking part of Belgium (Flanders) from its original English format. This protocol paper describes the translation and revalidation of this Flemish CARES version. METHODS After forward-backward translation of the CARES into Flemish we aim to recruit 150 adult cancer patients with a primary cancer diagnosis (stage I, II or III) for validation. In this study with a combination of qualitative and a quantitative approach, qualitative data will be collected through focus groups and supplemented by two phases of quantitative data collection: i) an initial patient survey containing questions on socio-demographic and medical data, the CARES and seven concurrent instruments; and ii) a second survey administered after 1 week containing the CARES and supplementary questions to explore their impressions on the content and the feasibility of the CARES. DISCUSSION With this extensive data collection process, psychometric validity of the Flemish CARES can be tested thoroughly using classical test theory. Internal consistency of summary scales, test-retest reliability, content validity, construct validity, concurrent validity and feasibility of the instrument will be examined. If the Flemish CARES version is found reliable, valid and feasible, it will be used in future research and clinical practice. Comprehensive assessment with the CARES in a stepped-care approach can facilitate timely identification of cancer patients' psychosocial concerns and care needs so it can contribute to efficient provision of patient-centered quality care. TRIAL REGISTRATION ClinicalTrials.gov: NCT02282696 (July 16, 2014).
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Affiliation(s)
- Bojoura Schouten
- />Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
- />Department of Experimental and Applied Psychology, Faculty of Psychological and Educational Sciences, Free University of Brussels, Pleinlaan 2, 1050 Elsene, Belgium
| | - Elke Van Hoof
- />Department of Experimental and Applied Psychology, Faculty of Psychological and Educational Sciences, Free University of Brussels, Pleinlaan 2, 1050 Elsene, Belgium
| | - Patrick Vankrunkelsven
- />Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Kapucijnenvoer 33, PB 7001, 3000 Leuven, Belgium
- />Belgian Center for Evidence-Based Medicine (CEBAM), Kapucijnenvoer 33- blok J, 3000 Leuven, Belgium
| | - Ward Schrooten
- />Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Paul Bulens
- />Jessaziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Frank Buntinx
- />Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Kapucijnenvoer 33, PB 7001, 3000 Leuven, Belgium
| | - Jeroen Mebis
- />Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
- />Jessaziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Dominique Vandijck
- />Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
- />ICURO, Guimardstraat 1, 1040 Brussel, Belgium
| | - Irina Cleemput
- />KCE - Belgian Health Care Knowledge Centre, Kruidtuinlaan 55, 1000 Brussel, Belgium
| | - Johan Hellings
- />Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
- />AZ Delta, Rode-Kruisstraat 20, 8800 Roeselare, Belgium
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Core principles of sexual health treatments in cancer for men. Curr Opin Support Palliat Care 2016; 10:38-43. [PMID: 26814146 DOI: 10.1097/spc.0000000000000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The considerable prevalence of sexual health problems in men after cancer treatment coupled with the severity of impact and challenges to successful intervention make sexual dysfunction one of the most substantial health-related quality of life burdens in all of cancer survivorship. Surgeries, radiation therapies, and nontreatment (e.g., active surveillance) variously result in physical disfigurement, pain, and disruptions in physiological, psychological, and relational functioning. Although biomedical and psychological interventions have independently shown benefit, long-term, effective treatment for sexual dysfunction remains elusive. RECENT FINDINGS Recognizing the complex nature of men's sexual health in an oncology setting, there is a trend toward the adoption of a biopsychosocial orientation that emphasizes the active participation of the partner, and a broad-spectrum medical, psychological, and social approach. Intervention research to date provides good insight into the potential active ingredients of successful sexual rehabilitation programming. SUMMARY Combining a biopsychosocial approach with these active intervention elements forecasts an optimistic future for men's sexual rehabilitation programming within oncology. However, significant gaps remain in our understanding of patient experience and appropriate sexual health intervention for gay men and men of diverse race and culture.
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Goncalves P, Groninger H. Sexual Dysfunction in Cancer Patients and Survivors #293. J Palliat Med 2015; 18:714-5. [DOI: 10.1089/jpm.2015.0207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jones WC, Parry C, Devine S, Main DS, Okuyama S, Tran ZV. Prevalence and predictors of distress in posttreatment adult leukemia and lymphoma survivors. J Psychosoc Oncol 2015; 33:124-41. [PMID: 25581206 DOI: 10.1080/07347332.2014.992085] [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] [Indexed: 01/21/2023]
Abstract
This paper examines predictors of cancer-specific distress among posttreatment adult leukemia and lymphoma survivors (LLS). Using a survey mailed to LLS in the Colorado Central Cancer Registry (N = 477), the authors developed a multivariable risk profile for distress. Thirty one percent of LLS reported indicators of distress. Significantly higher distress was associated with younger age (p < 0.001) in bivariate analyses. The risk profile included fear of recurrence, financial burden, and younger age. Distress did not attenuate based on time since treatment completion and may persist up to 4 years posttreatment, suggesting a need for intervention, particularly among high-risk LLS.
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Affiliation(s)
- Whitney C Jones
- a Colorado School of Public Health, University of Colorado Denver , Aurora , CO , USA
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25
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Boyes AW, Clinton-McHarg T, Waller AE, Steele A, D'Este CA, Sanson-Fisher RW. Prevalence and correlates of the unmet supportive care needs of individuals diagnosed with a haematological malignancy. Acta Oncol 2015; 54:507-14. [PMID: 25238282 DOI: 10.3109/0284186x.2014.958527] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Information about the unmet supportive care needs of haematological cancer patients is needed for service planning and to inform clinical practice. This study described the prevalence of, and factors associated with, unmet supportive care needs among haematological cancer patients. MATERIAL AND METHODS A total of 380 adults diagnosed with haematological cancer were recruited from the outpatient department at three comprehensive cancer treatment centres in Australia. Of these, 311 completed a self-report questionnaire. Unmet needs were assessed using the 34-item Supportive Care Needs Survey (SCNS-SF34). The data were examined using descriptive statistics and logistic regression. RESULTS Overall, 51% (95% CI 45-57%) of participants reported having at least one 'moderate to high' level unmet need, while 25% (95% CI 20-30%) reported 'no need' for help with any items. Unmet needs were most commonly reported in the psychological (35%; 95% CI 30-41%) and physical aspects of daily living (35%; 95% CI 30-41%) domains. The three most frequently endorsed items of 'moderate to high' unmet need were: lack of energy/tiredness (24%; 95% CI 20-30%), not being able to do the things you used to do (21%; 95% CI 17-26%), and uncertainty about the future (21%; 95% CI 16-25%). Patients' sociodemographic characteristics influenced unmet needs more than disease characteristics. Patients who were female, aged less than 55 years or not in the labour force had higher odds of reporting 'moderate to high' level unmet supportive care needs. CONCLUSION Unmet supportive care needs are prevalent among haematological cancer patients, particularly in the psychological and physical aspects of daily living domains. These findings provide valuable insight about the range of resources, multidisciplinary linkages and referral pathways needed to address haematological cancer patients' unmet needs.
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Affiliation(s)
- Allison W Boyes
- Priority Research Centre for Health Behaviour, University of Newcastle , New South Wales , Australia
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26
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Jones WC, Parry C, Devine S, Main DS, Okuyama S. Understanding distress in posttreatment adult leukemia and lymphoma survivors: a lifespan perspective. J Psychosoc Oncol 2015; 33:142-62. [PMID: 25671408 DOI: 10.1080/07347332.2014.1002658] [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] [Indexed: 10/24/2022]
Abstract
Using in-depth interviews, this paper explores the nature and sources of cancer-specific distress among 51 posttreatment adult leukemia and lymphoma survivors (LLS), focusing on the role of lifespan stage in shaping reported stressors. LLS (all ages) reported physical aftereffects of cancer treatment, with reported sources of emotional and financial distress varying by lifespan stage. Young adult survivors (18-39) reported a greater number of distress sources. Distress may persist up to 4 years posttreatment, particularly among younger LLS, who appear to be at greater risk of distress in multiple domains.
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Affiliation(s)
- Whitney C Jones
- a Colorado School of Public Health, University of Colorado Denver , Aurora , CO , USA
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Goldfarb S, Mulhall J, Nelson C, Kelvin J, Dickler M, Carter J. Sexual and reproductive health in cancer survivors. Semin Oncol 2014; 40:726-44. [PMID: 24331193 DOI: 10.1053/j.seminoncol.2013.09.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
As patients live longer after cancer diagnosis and treatment, attention to symptoms and quality of life (QoL) are of increasing importance both during treatment and throughout survivorship. Two complications of multi-modal cancer treatment that can profoundly affect both men and women are sexual dysfunction and infertility. Survivors at highest risk for treatment-related sexual dysfunction are those with tumors that involve the sexual or pelvic organs and those whose treatment affects the hormonal systems mediating sexual function. Sexual dysfunction may not abate without appropriate intervention. Therefore, early identification and treatment strategies are essential. Likewise, multiple factors contribute to the risk of infertility from cancer treatment and many cancer patients of reproductive age would prefer to maintain their fertility, if possible. Fortunately, advances in reproductive technology have created options for young newly diagnosed patients to preserve their ability to have a biologic child. This paper will focus on the sexual and reproductive problems encountered by cancer survivors and discuss some treatment options.
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Affiliation(s)
- Shari Goldfarb
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY..
| | - John Mulhall
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Christian Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Joanne Kelvin
- Office of Physician-In-Chief Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Maura Dickler
- Department of Medicine, Weill Cornell Medical College, New York, NY.; Department of Medicine Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jeanne Carter
- Departments of Surgery and Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
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