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Buiting HM, Sonke GS. Setting the Stage for Cancer: Stay Soft and Optimistic. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2024; 97:247-252. [PMID: 38947106 PMCID: PMC11202115 DOI: 10.59249/fqvx3500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
In the Netherlands, one out of two people will be confronted with the diagnosis of cancer sometime in their life. Against this increased number of patients, a large proportion luckily can be cured. Today, a rather high proportion of people receive treatment to control cancer growth or stabilize the disease, sometimes, for the rest of their lives. If such long-standing treatment is administered for more than 10-20 years, the stage of cancer is presently often not referred to as "palliative" anymore, but much more often as "chronic." It could be argued that regardless of the cancer disease stage you are in and whether you are or can be cured, your cancer diagnosis nevertheless has become part of your life, including the experience of chronicity. Discussions surrounding the chronicity of cancer in the context of cancer are still ongoing. This is especially the case because "experiencing chronicity" is dependent on the type of cancer and is less applicable in cancers where the prognosis is often less than one year, such as is more frequently the case with lung or pancreatic cancer. In all situations, experiencing chronicity nevertheless brings along uncertainty, either with or without chronic stress. Combatting stress by choosing the right wording, maintaining an optimistic stance along with physical activity and/or psychosocial education seems important to optimize well-being and to stabilize tumor growth or remove the tumor. In conclusion, chronicity in the context of treating and caring for cancer seems a somewhat gray area. However, regardless in how we, as medical professionals, speak about cancer with long-standing disease trajectories (that sometimes even can be cured), it first of all seems important to approach, take care, and treat patients well. This can facilitate discussions with patients about their disease and disease experiences. Moreover, it can stimulate patients themselves to take responsibility for their own health, which can be of added value to the entire disease trajectory.
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Affiliation(s)
- Hilde M. Buiting
- Antoni van Leeuwenhoek, Netherlands Cancer Institute,
Amsterdam, the Netherlands
- University of Amsterdam, Amsterdam, the
Netherlands
| | - Gabe S. Sonke
- Antoni van Leeuwenhoek, Netherlands Cancer Institute,
Amsterdam, the Netherlands
- University of Amsterdam, Amsterdam, the
Netherlands
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2
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Kalloger SE, Ho C, Mitton C, Regier DA. Mapping the experiences of people with advanced cancer across multiple cancer types-a scoping review. J Cancer Surviv 2024; 18:318-324. [PMID: 36180762 DOI: 10.1007/s11764-022-01263-3] [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: 07/01/2022] [Accepted: 09/23/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Through the introduction of tumor agnostic therapies, people with metastatic cancer and their treating physicians are facing new treatment choices that have differing side effect and efficacy profiles from conventional chemotherapy. OBJECTIVE The present study undertakes a scoping review of research into the experiences of people with advanced or metastatic cancer across various solid tumor types with the goal of developing a tumor-agnostic conceptual model. DESIGN Automated queries on three internet search engines were performed to identify qualitative interview studies that focused on people with metastatic cancer. No limits were imposed for dates nor location of studies. RESULTS Of the 173 hits generated from the searches, 25 peer-reviewed papers were selected for the review with dates that ranged from 2007 to 2022. All papers originated from the USA, Europe, Australia, or Japan. Three major themes emerged that formed the basis for the tumor-agnostic conceptual model: symptoms, loss of autonomy, and adaptation/coping. CONCLUSIONS The explication of the interplay between the physical and emotional symptoms experienced by those with advanced and metastatic cancer using a multi-tumor approach provides the potential to make generalizations about the needs of this population. An opportunity exists to potentially address these needs through matching patient needs and preferences with the characteristics of novel therapeutics. IMPLICATIONS FOR CANCER SURVIVORS In the era of tumor agnostic therapies, the elicitation of patient preferences across the spectrum of anatomical origins has the potential to enhance shared decision making in the setting of metastatic disease.
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Affiliation(s)
- Steve E Kalloger
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
- Cancer Control Research, BC Cancer, Vancouver, Canada.
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
| | - Cheryl Ho
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, Canada
| | - Craig Mitton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Dean A Regier
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Cancer Control Research, BC Cancer, Vancouver, Canada
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3
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de Araújo CP, Garcia ACM, Murad Júnior M. The expectations of metastatic cancer patients regarding palliative chemotherapy: A Brazilian-German qualitative study. Palliat Support Care 2024; 22:96-102. [PMID: 36606319 DOI: 10.1017/s1478951522001766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To explore the expectations of Brazilian and German patients regarding metastatic cancer and palliative chemotherapy. METHODS Interviews with 48 metastatic cancer patients from Brazil and Germany were conducted. The interviews were transcribed and analyzed using the thematic analysis approach to identify common themes. The sociodemographic data were collected using an instrument developed by the authors. RESULTS A total of 48 patients participated in the study (58% were Brazilian and 42% were German). Of all participants, 35% were men and 65% were women. The participants' mean age was 41 years. The general idea captured from the interviewees' speech was that their diseases were curable or "while there is chemotherapy, there is life"; thus, the data analysis enabled the elaboration of the central theme, entitled "Mistaken expectations of metastatic cancer patients regarding palliative chemotherapy: While there is chemotherapy, there is life," with 5 subthemes, namely: (1) communication and expectations; (2) normal life; (3) the person behind the disease; (4) religiosity and spirituality; and (5) the fortitude to choose between continuing or discontinuing treatment. SIGNIFICANCE OF RESULTS Regardless of cultural aspects, patients with metastatic cancer on palliative chemotherapy tend to believe in the healing potential of treatments. Dividing expectations only into curable or incurable is insufficient, as even patients who have acknowledged the incurability of their disease expect to live, as long as they remain under treatment as if the disease did not exist.
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Affiliation(s)
- Cynthia Pereira de Araújo
- First Regional Asset Recovery Coordination, Brazilian Federal Attorney General's Office, Belo Horizonte, MG, Brazil
| | - Ana Cláudia Mesquita Garcia
- Interdisciplinary Center for Studies in Palliative Care, School of Nursing, Federal University of Alfenas, Alfenas, MG, Brazil
| | - Munir Murad Júnior
- Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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van Eijk M, de Vries DH, Sonke GS, Buiting HM. Friendship during patients' stable and unstable phases of incurable cancer: a qualitative interview study. BMJ Open 2022; 12:e058801. [PMID: 36400727 PMCID: PMC9677003 DOI: 10.1136/bmjopen-2021-058801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/17/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Little is known about the added value of friendship during the care of intensive cancer disease trajectories. Friends, however, can play an important (caring-)role to increase their friends' (mental) well-being. We explored the experiences and desires of friends while their ill friends were-most of the time-in a stable phase of incurable cancer. DESIGN Qualitative study in the Netherlands based on 14 in-depth interviews with friends of patients living with incurable cancer. Interviews were performed at the home setting or the friend's office. Data gathering was inspired by grounded theory and analysed with a thematic analysis. SETTING The home setting/friend's office. RESULTS Friends reported to experience difficulties in how and how often they wanted to approach their ill friends. They emphasised the ever-present knowledge of cancer inside their friends' body as a 'time bomb'. They seemed to balance between the wish to take care for their ill friend, having a good time and not knowing what their ill friend desired at specific times. Some friends felt burdened with or forced to provide more care than they could, although they acknowledged that this relationship provided space to reflect about their own life. CONCLUSIONS Friends are constantly negotiating and renegotiating their relationship depending on the severity of the disease, transparency of patients about their illness, their previous experiences and personal circumstances in life. Although a decrease in friendship may impact a patient's quality of life, friends also need to be protected against providing more care than they are willing or able to give. Healthcare professionals, being aware of this phenomenon, can assist in this.
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Affiliation(s)
- Michelle van Eijk
- Faculty of Social and Behavioural Science, Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Cancer Institute / Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Daniel H de Vries
- Faculty of Social and Behavioural Science, Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
| | - Hilde M Buiting
- University of Amsterdam, Amsterdam, The Netherlands
- Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, The Netherlands
- University Medical Center Utrecht, Utrecht, The Netherlands
- O2PZ Platform of Palliative care, Amsterdam, The Netherlands
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van der Velden NC, van Laarhoven HW, Nieuwkerk PT, Kuijper SC, Sommeijer DW, Ottevanger PB, Fiebrich HB, Dohmen SE, Creemers GJ, de Vos FY, Smets EM, Henselmans I. Attitudes Toward Striving for Quality and Length of Life Among Patients With Advanced Cancer and a Poor Prognosis. JCO Oncol Pract 2022; 18:e1818-e1830. [DOI: 10.1200/op.22.00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE: When deliberating palliative cancer treatment, insight into patients' attitudes toward striving for quality of life (QL) and length of life (LL) may facilitate goal-concordant care. We investigated the (1) attitudes of patients with advanced cancer toward striving for QL and/or LL and whether these change over time, and (2) characteristics associated with these attitudes (over time). METHODS: We performed a secondary analysis of a randomized controlled trial on improving shared decision making (SDM), without differentiation between intervention arms. Patients (n = 173) with advanced cancer, a median life expectancy of < 12 months without anticancer treatment, and a median survival benefit of < 6 months from systemic therapy were included in seven Dutch hospitals. We used audio-recorded consultations and surveys at baseline (T0), shortly after the consultation (T2), at 3 and 6 months (T3 and T4). Primary outcomes were patients' attitudes toward striving for QL and LL (Quality Quantity Questionnaire; T2, T3, and T4). RESULTS: Overall, patients' attitudes toward striving for QL became less positive over 6 months ( P < .01); attitudes toward striving for LL did not change on group level. Studying individual patients, 76% showed changes in their attitudes toward striving for QL and/or LL at some point during the study, which occurred in various directions. More helplessness/hopelessness ( P < .001), less fighting spirit ( P < .05), less state anxiety ( P < .001), and more observed SDM ( P < .05) related to more positive attitudes toward striving for QL. Lower education, less helplessness/hopelessness, more fighting spirit, and more state anxiety ( P < .001) related to more positive attitudes toward striving for LL. CONCLUSION: Oncologists may explore patients' attitudes toward striving for QL and LL repeatedly and address patients' coping style and emotions during SDM to facilitate goal-concordant care throughout the last phase of life.
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Affiliation(s)
- Naomi C.A. van der Velden
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Hanneke W.M. van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Pythia T. Nieuwkerk
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Steven C. Kuijper
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Dirkje W. Sommeijer
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Department of Medical Oncology, Flevoziekenhuis, Almere, the Netherlands
| | - Petronella B. Ottevanger
- Department of Medical Oncology, Radboud University Medical Center, Radboud University, Nijmegen, the Netherlands
| | | | - Serge E. Dohmen
- Department of Medical Oncology, BovenIJ Ziekenhuis, Amsterdam, the Netherlands
| | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Filip Y.F.L. de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ellen M.A. Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Inge Henselmans
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
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Jespersen E, Minet LR, Nissen N. Symptoms of total pain experienced by older people with advanced gastrointestinal cancer receiving palliative chemotherapy. Eur J Cancer Care (Engl) 2022; 31:e13674. [PMID: 35973729 PMCID: PMC9788272 DOI: 10.1111/ecc.13674] [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: 03/30/2022] [Revised: 06/23/2022] [Accepted: 07/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Little is known about concurrent physical, psychological, social and spiritual distress experienced by older patients during early stages of advanced cancer while receiving life-prolonging treatment. Drawing on the concept of total pain, this study explored the multi-faceted symptoms of pain in older patients with advanced gastrointestinal cancer while receiving palliative chemotherapy. METHODS A total of 14 in-depth interviews with seven participants were conducted, one interview at the beginning and one after completion of chemotherapy. Participants were ≥70 years, diagnosed with advanced gastrointestinal cancer and receiving palliative chemotherapy. RESULTS Thematic analysis revealed four themes: variability and inevitability of physical pain, ways of coping with psychological pain, mitigating social pain through contributions to social life and the anticipation of existential pain in old age. Conducting two interviews with each participant foregrounded the changing nature of the participants' experienced symptoms and life perspectives while receiving palliative chemotherapy. Further, old age was experienced as integral to how participants described their situation and indicated an acceptance of old age. CONCLUSION Older adults with advanced cancer are affected by multiple-faceted symptoms resulting from cancer and its treatment. The concept of total pain is suggested to guide interdisciplinary palliative care in earlier stages of advanced cancer.
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Affiliation(s)
- Eva Jespersen
- Department of OncologyAcademy of Geriatric Cancer Research, AgeCare, Odense University HospitalOdenseDenmark,Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Lisbeth Rosenbek Minet
- Geriatric Research Unit, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
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Kolsteren EEM, Deuning-Smit E, Chu AK, van der Hoeven YCW, Prins JB, van der Graaf WTA, van Herpen CML, van Oort IM, Lebel S, Thewes B, Kwakkenbos L, Custers JAE. Psychosocial Aspects of Living Long Term with Advanced Cancer and Ongoing Systemic Treatment: A Scoping Review. Cancers (Basel) 2022; 14:cancers14163889. [PMID: 36010883 PMCID: PMC9405683 DOI: 10.3390/cancers14163889] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Studies examining the psychosocial impact of living long term on systemic treatment in advanced cancer patients are scarce. This scoping review aimed to answer the research question “What has been reported about psychosocial factors among patients living with advanced cancer receiving life-long systemic treatment?”, by synthesizing psychosocial data, and evaluating the terminology used to address these patients; (2) Methods: This scoping review was conducted following the five stages of the framework of Arksey and O’Malley (2005); (3) Results: 141 articles published between 2000 and 2021 (69% after 2015) were included. A large variety of terms referring to the patient group was observed. Synthesizing qualitative studies identified ongoing uncertainty, anxiety and fear of disease progression or death, hope in treatment results and new treatment options, loss in several aspects of life, and worries about the impact of disease on loved ones and changes in social life to be prominent psychosocial themes. Of 82 quantitative studies included in the review, 76% examined quality of life, 46% fear of disease progression or death, 26% distress or depression, and 4% hope, while few studies reported on adaptation or cognitive aspects. No quantitative studies focused on uncertainty, loss, or social impact; (4) Conclusion and clinical implications: Prominent psychosocial themes reported in qualitative studies were not included in quantitative research using specific validated questionnaires. More robust studies using quantitative research designs should be conducted to further understand these psychological constructs. Furthermore, the diversity of terminology found in the literature calls for a uniform definition to better address this specific patient group in research and in practice.
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Affiliation(s)
- Evie E. M. Kolsteren
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, 6525 Nijmegen, The Netherlands
- Correspondence:
| | - Esther Deuning-Smit
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, 6525 Nijmegen, The Netherlands
| | - Alanna K. Chu
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Yvonne C. W. van der Hoeven
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, 6525 Nijmegen, The Netherlands
| | - Judith B. Prins
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, 6525 Nijmegen, The Netherlands
| | - Winette T. A. van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, 1066 Amsterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus Medical Center, 3015 Rotterdam, The Netherlands
| | - Carla M. L. van Herpen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Oncology, 6525 Nijmegen, The Netherlands
| | - Inge M. van Oort
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Urology, 6525 Nijmegen, The Netherlands
| | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Belinda Thewes
- School of Psychology, Sydney University, Camperdown 2050, Australia
| | - Linda Kwakkenbos
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, 6525 Nijmegen, The Netherlands
- Clinical Psychology, Radboud University, 6525 Nijmegen, The Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, 6525 Nijmegen, The Netherlands
- Radboud University Medical Center, Radboudumc Center for Mindfulness, Department of Psychiatry, 6525 Nijmegen, The Netherlands
| | - José A. E. Custers
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, 6525 Nijmegen, The Netherlands
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Paiva CE, Teixeira AC, Minto Lourenço B, Preto DD, Valentino TCDO, Mingardi M, Paiva BSR. Anticancer Treatment Goals and Prognostic Misperceptions among Advanced Cancer Outpatients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6272. [PMID: 35627808 PMCID: PMC9141160 DOI: 10.3390/ijerph19106272] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/14/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022]
Abstract
(1) Background: In the context of cancer incurability, the communication processes involving clinicians and patients with cancer are frequently complex. (2) Methods: A cross-sectional study that investigated outpatients with advanced cancers and their oncologists. Both were interviewed immediately after a medical appointment in which there was disease progression and/or clinical deterioration, and were asked about the patient’s chance of curability and the goals of the prescribed cancer treatment. The patients were asked whether they would like to receive information about prognosis and how they would like to receive it. The analyses of agreement on perceptions were performed using the Kappa’s test. (3) Results: the sample consisted of 90 patients and 28 oncologists. Seventy-eight (87.6%) patients answered that they wanted their oncologist to inform them about their prognosis; only 35.2% (n = 31) of them said they received such information at their present appointment. Regarding how they would prefer prognostic disclosure, 61.8% (n = 55) mentioned that the oncologist should consider ways to keep the patient’s hope up; 73% (n = 65) of the patients reported odds >50% of cure. The agreement between oncologists’ and their patients’ perceptions regarding the treatment goals and curability was slight (k = 0.024 and k = 0.017, respectively). (4) Conclusions: The perceptions of patients and their oncologists regarding the goals of treatment and their chances of cure were in disagreement. New approaches are needed to improve the communication process between oncologists and patients with advanced cancer.
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Affiliation(s)
- Carlos Eduardo Paiva
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil; (A.C.T.); (B.M.L.); (D.D.P.); (T.C.d.O.V.); (M.M.); (B.S.R.P.)
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil
- Researcher Support Centre, Learning and Research Institute, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil
| | - Ana Clara Teixeira
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil; (A.C.T.); (B.M.L.); (D.D.P.); (T.C.d.O.V.); (M.M.); (B.S.R.P.)
| | - Bruna Minto Lourenço
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil; (A.C.T.); (B.M.L.); (D.D.P.); (T.C.d.O.V.); (M.M.); (B.S.R.P.)
| | - Daniel D’Almeida Preto
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil; (A.C.T.); (B.M.L.); (D.D.P.); (T.C.d.O.V.); (M.M.); (B.S.R.P.)
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil
| | - Talita Caroline de Oliveira Valentino
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil; (A.C.T.); (B.M.L.); (D.D.P.); (T.C.d.O.V.); (M.M.); (B.S.R.P.)
| | - Mirella Mingardi
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil; (A.C.T.); (B.M.L.); (D.D.P.); (T.C.d.O.V.); (M.M.); (B.S.R.P.)
| | - Bianca Sakamoto Ribeiro Paiva
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil; (A.C.T.); (B.M.L.); (D.D.P.); (T.C.d.O.V.); (M.M.); (B.S.R.P.)
- Researcher Support Centre, Learning and Research Institute, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil
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Chen CH, Wen FH, Chou WC, Chen JS, Chang WC, Hsieh CH, Tang ST. Associations of prognostic-awareness-transition patterns with end-of-life care in cancer patients' last month. Support Care Cancer 2022; 30:5975-5989. [PMID: 35391576 DOI: 10.1007/s00520-022-07007-4] [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: 11/05/2021] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Cancer patients heterogeneously develop prognostic awareness, and end-of-life cancer care has become increasingly aggressive to the detriment of patients and healthcare sustainability. We aimed to explore the never-before-examined associations of prognostic-awareness-transition patterns with end-of-life care. METHODS Prognostic awareness was categorized into four states: (1) unknown and not wanting to know; (2) unknown but wanting to know; (3) inaccurate awareness; and (4) accurate awareness. We examined associations of our previously identified three prognostic-awareness-transition patterns during 334 cancer patients' last 6 months (maintaining accurate prognostic awareness, gaining accurate prognostic awareness, and maintaining inaccurate/unknown prognostic awareness) and end-of-life care (cardiopulmonary resuscitation, intensive care unit care, mechanical ventilation, chemotherapy/immunotherapy, and hospice care) in cancer patients' last month by multivariate logistic regressions. RESULTS Cancer patients in the maintaining-accurate-prognostic-awareness and gaining-accurate-prognostic-awareness groups had significantly lower odds of cardiopulmonary resuscitation (adjusted odds ratio [95% confidence interval]: 0.22 [0.06-0.78]; and 0.10 [0.01-0.97], respectively) but higher odds of hospice care (3.44 [1.64-7.24]; and 3.28 [1.32-8.13], respectively) in the last month than those in the maintaining inaccurate/unknown prognostic awareness. The maintaining-accurate-prognostic-awareness group had marginally lower odds of chemotherapy or immunotherapy received than the gaining-accurate-prognostic-awareness group (0.58 [0.31-1.10], p = .096]). No differences in intensive care unit care and mechanical ventilation among cancer patients in different prognostic-awareness-transition patterns were observed. CONCLUSION End-of-life care received in cancer patients' last month was associated with the three distinct prognostic-awareness-transition patterns. Cancer patients' accurate prognostic awareness should be facilitated earlier to reduce their risk of receiving aggressive end-of-life care, especially for avoiding chemotherapy/immunotherapy close to death. TRIAL REGISTRATION ClinicalTrials.gov:NCT01912846.
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Affiliation(s)
- Chen Hsiu Chen
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, Republic of China
| | - Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, Republic of China
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, Republic of China
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, Republic of China
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, Republic of China
| | - Chia-Hsun Hsieh
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, Republic of China.,Division of Hematology-Oncology, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan, Republic of China
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, Republic of China. .,Department of Nursing, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China. .,School of Nursing, Medical College, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Taiwan, 333, Republic of China.
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10
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van Meurs J, Stommel W, Leget C, van de Geer J, Kuip E, Vissers K, Engels Y, Wichmann A. Oncologist responses to advanced cancer patients' lived illness experiences and effects: an applied conversation analysis study. BMC Palliat Care 2022; 21:37. [PMID: 35300674 PMCID: PMC8928655 DOI: 10.1186/s12904-022-00917-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND An advanced cancer patient's life is often disturbed by fear of cancer recurrence, cancer progress, approaching suffering, and fear of dying. Consequently, the role of the medical oncologist is not only to provide best quality anti-cancer treatment, but also to address the impact of disease and treatment on a patient's life, the lived illness experience. We aimed to gain insights into whether and how medical oncologists working at an outpatient clinic identify and explore lived illness experiences raised by patients with advanced cancer, and how this influences patients' responses. METHODS Conversation Analysis was applied to analyse 16 verbatim transcribed audio-recorded consultations. RESULTS We identified 37 fragments in which patients expressed a lived experience from 11 of the 16 consultations. We found differing responses from different oncologists. Patients continued talking about their lived experiences if the listener produced a continuer such as humming or tried to capture the experience in their own words. In contrast, a response with optimistic talking or the presentation of medical evidence prevented patients from further unfolding the experience. In consultations in which the lived illness experience was most extensively unfolded, medical oncologists and patients could constantly see each other's facial expressions. CONCLUSIONS When a patient with advanced cancer spontaneously introduces a lived illness experience, it helps to identify and explore it when the medical oncologist produces a continuer or tries to capture this experience in their own words. Our findings can be implemented in training sessions, followed by frequent reinforcement in daily care.
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Affiliation(s)
- Jacqueline van Meurs
- Department of Spiritual and Pastoral Care & Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, P.O. Box 9101 (714), Nijmegen, 6500 HB, Netherlands.
| | - Wyke Stommel
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands
| | - Carlo Leget
- Department of Care and Welfare, University of Humanistic Studies, Utrecht, The Netherlands
| | - Joep van de Geer
- Academic Hospice Demeter, Bilthoven & Agora, De Bilt, the Netherlands
| | - Evelien Kuip
- Department of Medical Oncology & Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Anne Wichmann
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
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11
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Mukhopadhyay D, Sano C, AlSawaftah N, El-Awady R, Husseini GA, Paul V. Ultrasound-Mediated Cancer Therapeutics Delivery using Micelles and Liposomes: A Review. Recent Pat Anticancer Drug Discov 2021; 16:498-520. [PMID: 34911412 DOI: 10.2174/1574892816666210706155110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/02/2021] [Accepted: 03/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Existing cancer treatment methods have many undesirable side effects that greatly reduce the quality of life of cancer patients. OBJECTIVE This review will focus on the use of ultrasound-responsive liposomes and polymeric micelles in cancer therapy. METHODS This review presents a survey of the literature regarding ultrasound-triggered micelles and liposomes using articles recently published in various journals, as well as some new patents in this field. RESULTS Nanoparticles have proven promising as cancer theranostic tools. Nanoparticles are selective in nature, have reduced toxicity, and controllable drug release patterns making them ideal carriers for anticancer drugs. Numerous nanocarriers have been designed to combat malignancies, including liposomes, micelles, dendrimers, solid nanoparticles, quantum dots, gold nanoparticles, and, more recently, metal-organic frameworks. The temporal and spatial release of therapeutic agents from these nanostructures can be controlled using internal and external triggers, including pH, enzymes, redox, temperature, magnetic and electromagnetic waves, and ultrasound. Ultrasound is an attractive modality because it is non-invasive, can be focused on the diseased site, and has a synergistic effect with anticancer drugs. CONCLUSION The functionalization of micellar and liposomal surfaces with targeting moieties and the use of ultrasound as a triggering mechanism can help improve the selectivity and enable the spatiotemporal control of drug release from nanocarriers.
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Affiliation(s)
- Debasmita Mukhopadhyay
- Department of Chemical Engineering, American University of Sharjah, Sharjah, United Arab Emirates
| | - Catherine Sano
- Department of Chemical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Nour AlSawaftah
- Department of Chemical Engineering, American University of Sharjah, Sharjah, United Arab Emirates
| | - Raafat El-Awady
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Ghaleb A Husseini
- Department of Chemical Engineering, American University of Sharjah, Sharjah, United Arab Emirates
| | - Vinod Paul
- Department of Chemical Engineering, American University of Sharjah, Sharjah, United Arab Emirates
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12
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Mossman B, Perry LM, Walsh LE, Gerhart J, Malhotra S, Horswell R, Chu S, Raines AM, Lefante J, Blais CM, Miele L, Melancon B, Alonzi S, Voss H, Freestone L, Dunn A, Hoerger M. Anxiety, depression, and end-of-life care utilization in adults with metastatic cancer. Psychooncology 2021; 30:1876-1883. [PMID: 34157174 DOI: 10.1002/pon.5754] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/15/2021] [Accepted: 06/07/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE End-of-life care for patients with cancer is often overly burdensome, and palliative and hospice care are underutilized. The objective of this study was to evaluate whether the mental health diagnoses of anxiety and depression were associated with variation in end-of-life care in metastatic cancer. METHODS This study used electronic health data from 1,333 adults with metastatic cancer who received care at two academic health centers in Louisiana, USA, and died between 1/1/2011-12/31/2017. The study used descriptive statistics to characterize the sample and logistic regression to examine whether anxiety and depression diagnoses in the six months before death were associated with utilization outcomes (chemotherapy, intensive care unit [ICU] visits, emergency department visits, mechanical ventilation, inpatient hospitalization, palliative care encounters, and hospice utilization), while controlling for key demographic and health covariates. RESULTS Patients (56.1% male; 65.6% White, 31.1% Black) commonly experienced depression (23.9%) and anxiety (27.2%) disorders within six months of death. Anxiety was associated with an increased likelihood of chemotherapy (odds ratio [OR] = 1.42, p = 0.016), ICU visits (OR = 1.40, p = 0.013), and inpatient hospitalizations (OR = 1.85, p < 0.001) in the 30 days before death. Anxiety (OR = 1.95, p < 0.001) and depression (OR = 1.34, p = 0.038) were associated with a greater likelihood of a palliative encounter. CONCLUSIONS Patients with metastatic cancer who had an anxiety disorder were more likely to have burdensome end-of-life care, including chemotherapy, ICU visits, and inpatient hospitalizations in the 30 days before death. Depression and anxiety both increased the odds of palliative encounters. These results emphasize the importance of mental health considerations in end-of-life care.
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Affiliation(s)
- Brenna Mossman
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Laura M Perry
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Leah E Walsh
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - James Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Sonia Malhotra
- Department of Palliative Medicine & Supportive Care, University Medical Center, New Orleans, Louisiana, USA.,Section of General Internal Medicine & Geriatrics, Deming Department of Medicine, Tulane School of Medicine, New Orleans, Louisiana, USA
| | - Ronald Horswell
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - San Chu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, Louisiana, USA.,South Central Mental Illness Research, Education and Clinical Center (MIRECC), New Orleans, Louisiana, USA.,Department of Psychiatry, School of Medicine, Louisiana State University, New Orleans, Louisiana, USA
| | - John Lefante
- Department of Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Christopher M Blais
- Department of Infectious Disease, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Lucio Miele
- Department of Genetics and Louisiana Cancer Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Brian Melancon
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Sarah Alonzi
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Hallie Voss
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Lily Freestone
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Addison Dunn
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA.,Department of Palliative Medicine & Supportive Care, University Medical Center, New Orleans, Louisiana, USA.,Departments of Psychiatry and Medicine, Tulane Cancer Center, and Freeman School of Business, Tulane University, New Orleans, Louisiana, USA
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13
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van Vliet LM, Meijers MC, van Dulmen S, van der Wall E, Plum N, Stouthard J, Francke AL. Addressing challenges in information-provision: a qualitative study among oncologists and women with advanced breast cancer. BMC Palliat Care 2021; 20:142. [PMID: 34521393 PMCID: PMC8442372 DOI: 10.1186/s12904-021-00836-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a need for more insight into how to address challenges of information-provision for women with advanced breast cancer. We aimed to explore oncologists' and patients' views on (i) the challenges of information-provision, and (ii) possible strategies to address these challenges, meanwhile (iii) exploring the possible facilitating role of positive expectations and empathy. METHODS Semi-structured interviews were held with oncologists (n = 10) and women with advanced breast cancer (n = 14). Principles of Thematic Analysis were followed, with two researchers analyzing transcribed data, supported by Atlas.ti software. RESULTS Taken together the data from oncologists and patients, we found that when communicating with patients with advanced cancer, oncologists face challenges, including handling patients' unrealistic disease (status) beliefs, and choosing approaches for discussing available treatment options and their side effects. Possible strategies to address these challenges include balancing information with acceptance of denial, and using medical expertise to guide treatment discussions. A sensitive issue is whether to discuss the option of no anti-cancer treatment. Meanwhile, approaches and preferences for discussions of side effects vary. Positive expectations and empathy can facilitate information-provision by creating space and helping patients to open up more. CONCLUSIONS Integrating oncologists' and patients' views, oncologists can provide realistic information while also, temporarily, accepting denial, and can use their medical expertise to address challenges around unrealistic beliefs and discussion of treatment options. Finding ways to tailor discussions of no anti-cancer treatment and side-effect information are needed. Positive expectations and empathy might facilitate - tailored - information-provision, leading ultimately to patient-centered care lying at the heart of medicine.
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Affiliation(s)
- Liesbeth M van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands.
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, the Netherlands.
| | - Maartje C Meijers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Elsken van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nicole Plum
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Anneke L Francke
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Amsterdam Public Health Institute, Vrije Universiteit, Amsterdam, the Netherlands
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14
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Mendonça AB, Pereira ER, Magnago C, Medeiros AYBBV, Silva RMCRA, Martins ADO, Meira KC. Suffering experiences of people with cancer undergoing chemotherapy: A meta-ethnographic study. Nurs Health Sci 2021; 23:586-610. [PMID: 33817939 DOI: 10.1111/nhs.12839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/14/2022]
Abstract
This meta-ethnography had the objectives of identifying, evaluating, and summarizing the findings of qualitative studies regarding the suffering experiences of people undergoing chemotherapy, as well as developing an explanatory conceptual structure regarding what affects these experiences. A systematic literature review was carried out, covering the past 10 years, in the following databases: CINAHL, Embase, Medline, LILACS and Scopus. By using meta-ethnographic synthesis methods, the following themes were found: the pain of loss; evaluating, measuring, and neutralizing the threat; and social contours of suffering. The experience of living with cancer and undergoing chemotherapy was synthesized into a theoretical-explanatory model with a structure that resembles barbed-wire loops. The model expresses people's suffering experiences as marked by the feeling of loss, restraint of emotions, and resilience. While transcendent movements broke the cycle of suffering, resilience emerged as a learning experience that made patients more resistant to the pain of loss. The results indicated a complex and diverse set of factors that influence suffering, which confirmed that experiences are individual, comprehensive, and continuously reinterpreted.
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Affiliation(s)
- Angelo Braga Mendonça
- Healthcare Sciences Program, School of Nursing, Universidade Federal Fluminense, Niterói, Brazil
| | - Eliane Ramos Pereira
- Healthcare Sciences Program, School of Nursing, Universidade Federal Fluminense, Niterói, Brazil
| | - Carinne Magnago
- Public Health Faculty, Universidade de São Paulo, Niterói, Brazil
| | | | | | | | - Karina Cardoso Meira
- Health Sciences School, Universidade Federal do Rio Grande do Norte, Natal, Brazil
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15
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Rodenbach RA, Althouse AD, Schenker Y, Smith TJ, Chu E, White DB, Bakitas M, Arnold RM. Relationships Between Advanced Cancer Patients' Worry About Dying and Illness Understanding, Treatment Preferences, and Advance Care Planning. J Pain Symptom Manage 2021; 61:723-731.e1. [PMID: 32926962 PMCID: PMC7952460 DOI: 10.1016/j.jpainsymman.2020.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/29/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT Patients with advanced cancer often worry about dying. Less is known about the role of worry in decision making regarding future care. OBJECTIVES To explore relationships between patients' worry about dying and their illness understanding, treatment preferences, and advance care planning (ACP). METHODS This cross-sectional study used baseline data from a primary palliative care intervention trial. All participants had metastatic solid tumors. Using patients' response to I worry about dying from the Functional Assessment of Chronic Illness-Palliative Care survey instrument, univariate and multivariate analyses assessed associations with illness understanding, treatment preferences, and ACP. RESULTS Of 672 patients, 47% reported worrying about dying not at all, whereas 9.7% worried quite a bit or very much. In regression analysis, compared with patients who reported not worrying about dying, those who reported high levels of worry were more likely to describe themselves as terminally ill (adjusted odds ratio [AOR] = 1.98; 95% CI = 1.10-3.54; P = 0.021) and prefer life-extending therapy over symptom-focused care (AOR = 2.61; 95% CI = 1.30-5.22; P = 0.007). They were less likely to have completed an advance directive (AOR = 0.49; 95% CI = 0.25-0.94; P = 0.032). The same relationships were seen using patients' response to I feel scared about my future from the Herth Hope Index. CONCLUSION Patients with advanced cancer who worry about dying are more likely to identify as terminally ill and desire life-extending treatment and are less likely to engage in ACP. Understanding how patients cope with worry and make medical decisions is important in providing quality care to these patients.
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Affiliation(s)
- Rachel A Rodenbach
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Hematology, Medical Oncology and Palliative Care, University of Wisconsin-Madison, Madison, Wisconsin, USA.
| | - Andrew D Althouse
- Division of General Internal Medicine, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas J Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Edward Chu
- Division of Hematology-Oncology and Cancer Therapeutics Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Douglas B White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marie Bakitas
- School of Nursing, Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Center for Palliative and Supportive Care, Birmingham, Alabama, USA
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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16
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Rashid F, Saeed A, Iqbal J. In Vitro Anticancer Effects of Stilbene Derivatives: Mechanistic Studies on HeLa and MCF-7 Cells. Anticancer Agents Med Chem 2021; 21:793-802. [PMID: 32781966 DOI: 10.2174/1871520620666200811123230] [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: 02/13/2020] [Revised: 04/14/2020] [Accepted: 05/10/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE The growing prevalence of cancer and the resulting chemoresistance exert a huge burden on healthcare systems and impose a great challenge to public health around the world. In efforts to develop new chemotherapeutic agents for cancer treatment, a class of heterocyclic compounds i.e. triazine-based molecules were investigated as anticancer agents. MATERIALS AND METHODS New triazine hybrids of stilbene were synthesized and evaluated as anticancer agents for cervical (HeLa) and breast (MCF-7) carcinoma cells. The compound (7e), sodium (E)-6,6'-(ethene-1,2- diyl)bis(3-((4-chloro-6-((3-luorophenyl)amino)-1,3,5-triazin-2-yl)amino)benzenesulfonate) was found to be most potent among synthesized derivatives and was explored further for detailed mechanistic studies. RESULTS In a set comprised of twelve derivatives, compound 7e, sodium (E)-6,6'-(ethene-1,2-diyl)bis(3-((4- chloro-6-((3-luorophenyl)amino)-1,3,5-triazin-2-yl)amino)benzenesulfonate) was found most potent inhibitor for HeLa and MCF-7 cells. DISCUSSION The present study has revealed that compound 7e may activate mitochondrial pathway of apoptosis in HeLa and MCF-7 cells which was assessed by DNA binding studies, estimation of the release of Lactate Dehydrogenase (LDH), fluorescence imaging, production of Reactive Oxygen Species (ROS) in cancer cells, analysis of cell cycle by flow cytometry, change in Mitochondrial Membrane Potential (MMP) and activation of caspase-9 and caspase-3. CONCLUSION Compound 7e may serve as a lead in designing new anticancer compounds based on stilbene scaffold.
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Affiliation(s)
- Faisal Rashid
- Centre for Advanced Drug Research, COMSATS University Islamabad, Abbottabad Campus, Abbottabad-22060, Pakistan
| | - Aamer Saeed
- Department of Chemistry, Quaid-i-Azam University, Islamabad, Pakistan
| | - Jamshed Iqbal
- Centre for Advanced Drug Research, COMSATS University Islamabad, Abbottabad Campus, Abbottabad-22060, Pakistan
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17
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Dönmez ÇF, Johnston B. Living in the moment for people approaching the end of life: A concept analysis. Int J Nurs Stud 2020; 108:103584. [PMID: 32450405 DOI: 10.1016/j.ijnurstu.2020.103584] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/26/2020] [Accepted: 03/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND 'Living in the moment' is an essential part of dignity-conserving practice in end-of-life care settings. Although living in the moment is important for care at the end of life, from the perspective of both the person and their family, there is no clear conceptual understanding of what it represents. OBJECTIVE To explore the concept of 'living in the moment' in the context of dignity-conserving care at the end of life. DESIGN A concept analysis. DATA SOURCES The databases of Medline, CinAHL, PubMed, Web of Science, PsycINFO, SocINDEX and Cochrane were searched for studies published between 1941 and 2019, and searches of dictionaries and grey literature, as well as hand-searching were conducted, to yield qualitative, mixed methods and systematic reviews published in English, related to the term 'living in the moment'. METHOD The methods of Walker and Avant were used to identify antecedents, attributes and consequences of the concept of 'living in the moment'. RESULTS The literature review generated a total of 37 papers for this concept analysis. The attributes identified were (1) simple pleasure, (2) prioritising relationships, (3) living each day to the fullest, (4) maintaining normality, and (5) not worrying about the future. The antecedents were (1) awareness of dying, (2) living with life-threatening illness, (3) positive individual growth, and (4) living with an uncertain future. The consequences were (1) a good quality of life, (2) preserving dignity, and (3) coping with the uncertainty of life. CONCLUSIONS A universal definition and conceptual model of the main concept, including theoretical relationships between its antecedents, attributes and consequences, was developed. The definition and proposed conceptual model can allow instruments to be developed that measure the effects, existence or attributes of the concept, and identify a theoretical model, and can also lead to new perspectives and strategies for implementation by nurses to improve dignified person-centred care at the end of life.
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Affiliation(s)
- Çiğdem Fulya Dönmez
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK; School of Heath Sciences, Department of Nursing, Istanbul Arel University, Istanbul, Turkey.
| | - Bridget Johnston
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK; Florence Nightingale Foundation Clinical Professor of Nursing, School of Medicine, Dentistry & Nursing, and NHS Greater Glasgow and Clyde, College of Medical, Veterinary & Life Sciences, University of Glasgow, 57-61 Oakfield Avenue, Glasgow G12 8LL, Scotland, UK.
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18
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Affiliation(s)
| | - Gert Olthuis
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
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19
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George LS, Prigerson HG, Epstein AS, Richards KL, Shen MJ, Derry HM, Reyna VF, Shah MA, Maciejewski PK. Palliative Chemotherapy or Radiation and Prognostic Understanding among Advanced Cancer Patients: The Role of Perceived Treatment Intent. J Palliat Med 2019; 23:33-39. [PMID: 31580753 PMCID: PMC6931912 DOI: 10.1089/jpm.2018.0651] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: As patients' accurate understanding of their prognosis is essential for informed end-of-life planning, identifying associated factors is important. Objective: We examine if receiving palliative chemotherapy or radiation, and the perception of those treatments as curative or noncurative, is associated with prognostic understanding. Design: Cross-sectional analyses from a multisite, observational study. Setting/Subjects: Patients with advanced cancers refractory to at least one chemotherapy regimen (N = 334). Measurements: In structured interviews, patients reported whether they were receiving chemotherapy or radiation, and whether its intent was curative or not. Their responses were categorized into three groups: patients not receiving chemotherapy/radiation (no cancer treatment group); patients receiving chemotherapy/radiation and misperceiving it as curative (treatment misperception group); and patients receiving chemotherapy/radiation and accurately perceiving it as noncurative (accurate treatment perception group). Patients also reported on various aspects of their prognostic understanding (e.g., life expectancy). Results: Eighty-six percent of the sample was receiving chemotherapy or radiation; of those, 16.7% reported the purpose of treatment to be curative. The no-treatment group had higher prognostic understanding scores compared with the treatment misperception group (adjusted odds ratio [AOR] = 5.00, p < 0.001). However, the accurate treatment perception group had the highest prognostic understanding scores in comparison to the no-treatment group (AOR = 2.04, p < 0.05) and the treatment misperception group (AOR = 10.19, p < 0.001). Conclusions: Depending on patient perceptions of curative intent, receipt of palliative chemotherapy or radiation is associated with better or worse prognostic understanding. Research should examine if enhancing patients' understanding of treatment intent can improve accurate prognostic expectations.
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Affiliation(s)
- Login S George
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Holly G Prigerson
- Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Kristy L Richards
- Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Megan J Shen
- Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Heather M Derry
- Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Valerie F Reyna
- Center for Behavioral Economics and Decision Research, College of Human Ecology, Cornell University, Ithaca, New York
| | - Manish A Shah
- Meyer Cancer Center of Weill Cornell Medical College, Medical Oncology/Solid Tumor Program, New York, New York
| | - Paul K Maciejewski
- Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medicine, New York, New York.,Department of Radiology, Weill Cornell Medicine, New York, New York
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20
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Ozeki-Hayashi R, Fujita M, Tsuchiya A, Hatta T, Nakazawa E, Takimoto Y, Akabayashi A. Beliefs held by breast surgeons that impact the treatment decision process for advanced breast cancer patients: a qualitative study. BREAST CANCER-TARGETS AND THERAPY 2019; 11:221-229. [PMID: 31410054 PMCID: PMC6645069 DOI: 10.2147/bctt.s208910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/17/2019] [Indexed: 11/23/2022]
Abstract
Introduction Although guidelines do not recommend chemotherapy for patients with advanced cancer when death is imminent, many reports suggest the tendency to continue this treatment has been increasing every year. This study aimed to construct a model to clarify the beliefs and communication of doctors who administer chemotherapy to patients with recurrent or metastatic (hereafter, “recurrent/metastatic”) breast cancer, and determine how these beliefs are related to the process of treating patients. Materials and methods Semi-structured interviews were conducted with 21 breast surgeons, and interview contents were analyzed using the grounded theory approach in order to conceptualize the treatment process. Results The process of chemotherapy for patients with recurrent/metastatic breast cancer differed based on two beliefs held by doctors. One was a “belief that the patient is an entity who cannot accept death,” and throughout the treatment process, these doctors consistently avoided sharing bad news that might hurt patients, and always discussed aggressive chemotherapy. They proposed treatments as long as options remained, and when they ultimately judged that the physical condition of patients could not withstand further treatment, treatment was terminated despite the patient hoping for continuation. The other was a “belief that the patient is an entity who can accept death.” From early on after recurrence/metastasis, these doctors repeatedly gave patients information including bad news about prognosis, and when they judged that further treatment would hinder a patient’s ability to have a good death, they proposed terminating treatment. Conclusion We demonstrated that breast surgeons treating recurrent/metastatic breast cancer patients have two beliefs and constructed a model of the treatment process based on those beliefs. This offered breast surgeons, who make decisions regarding treatment without clearly-defined guidelines, a chance to reflect on their own care style, which we believe will contribute to optimal patient care.
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Affiliation(s)
- Reina Ozeki-Hayashi
- Department of Biomedical Ethics, The University of Tokyo Faculty of Medicine, Tokyo, Japan
| | - Misao Fujita
- Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application Kyoto University, Kyoto, Japan
| | - Atsushi Tsuchiya
- Industrial and Social Science, Tokushima University Graduate School of Technology, Tokushima, Japan
| | - Taichi Hatta
- Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application Kyoto University, Kyoto, Japan
| | - Eisuke Nakazawa
- Department of Biomedical Ethics, The University of Tokyo Faculty of Medicine, Tokyo, Japan
| | - Yoshiyuki Takimoto
- Department of Biomedical Ethics, The University of Tokyo Faculty of Medicine, Tokyo, Japan
| | - Akira Akabayashi
- Department of Biomedical Ethics, The University of Tokyo Faculty of Medicine, Tokyo, Japan.,Division of Medical Ethics, Department of Population Health, New York University School of Medicine, New York, NY, USA
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21
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Bergqvist J, Strang P. Breast Cancer Patients' Preferences for Truth Versus Hope Are Dynamic and Change During Late Lines of Palliative Chemotherapy. J Pain Symptom Manage 2019; 57:746-752. [PMID: 30639732 DOI: 10.1016/j.jpainsymman.2018.12.336] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
CONTEXT Women with metastatic breast cancer often receive many lines of palliative chemotherapy, which might be beneficial but also harmful. Still, little is known about the patients' perception of the patient-doctor communication regarding late lines of noncurative treatment. OBJECTIVES Our aim was to explore breast cancer patients' preferences and perceptions of patient-doctor communication regarding continuous late lines of palliative chemotherapy. PATIENTS AND METHODS A qualitative study was conducted with semiguided face-to-face interviews with 20 women, 40-80 years old, on at least their second line of palliative chemotherapy (second to eighth line). We used a qualitative conventional content analysis. RESULTS All women knew they had incurable breast cancer but expressed hope for cure. Patients' definition of a good compassionate doctor was one who gives positive news and leaves room for hope. Ongoing chemotherapy, positive news from the doctors, and support from relatives encouraged hope. The women often expressed they accepted chemotherapy to please their doctor and relatives. The informants appreciated the doctor to be honest, but within positive limits. Over time, they stopped asking questions afraid of getting bad news, and left more and more treatment decisions to the doctor. CONCLUSIONS The women's preferences for truth versus hope in patient-doctor communication changed over time, which increase the risk for continuous late lines of palliative chemotherapy by common collusion. Doctors need to individualize information, help patients make sense of their life, and allow hope to endure without further chemotherapy.
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Affiliation(s)
- Jenny Bergqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Capio St Görans Sjukhus, Stockholm, Sweden.
| | - Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Research and Development, Stockholms Sjukhem Foundation, Stockholm, Sweden
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22
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Buiting HM, van Ark MAC, Dethmers O, Maats EPE, Stoker JA, Sonke GS. Complex challenges for patients with protracted incurable cancer: an ethnographic study in a comprehensive cancer centre in the Netherlands. BMJ Open 2019; 9:e024450. [PMID: 30928932 PMCID: PMC6475444 DOI: 10.1136/bmjopen-2018-024450] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Advances in oncology increasingly result in protracted disease trajectories for patients with incurable cancer. In this disease phase, patients are aware of the incurable nature of cancer although they are not yet approaching the last phase of life. We explored the challenges for patients confronted with protracted incurable cancer. DESIGN Ethnographic study (2015-2017) based on conversations with patients, observations at a day-care unit and a selection of information from the medical records of patients who died during the study period. SETTING The day-care unit of a comprehensive cancer centre in the Netherlands. PARTICIPANTS Nineteen patients with stage IV breast cancer (in remission, >1 year after diagnosis) and 11 patients with stage IV lung-cancer (in remission, >6 months after diagnosis). RESULTS In patients who had died during the study period, the treatment response often fluctuated between stable, remission and progression throughout the course of the disease. Patients reported that this fluctuation could be overwhelming. However, as patients grew accustomed to having protracted incurable cancer, the distress associated with fluctuations (perceived in scan results) slowly faded. Patients reported that cancer became part of who they were. At the day-care unit, most patients talked about their disease in an optimistic or neutral way and expressed delight in life. They often expressed gratefulness for the possible prolongation of life, expressed hope and tried to stay optimistic. This was frequently reinforced by optimistic doctors and nurses. Relatives, however, could downplay such optimism. Moreover, some patients acknowledged that hope was qualified by their personal challenges regarding their disease. CONCLUSIONS In situations where tumours remained in remission or were stable for extended periods, patients grew accustomed to having cancer. At the day-care unit, medical professionals typically encouraged an attitude of being hopeful and optimistic, which could be downplayed by relatives. More research is warranted to explore this protracted disease phase and this optimistic view among healthcare professionals.
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Affiliation(s)
- Hilde M Buiting
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marleen A C van Ark
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Clinical Psychology, Department of Behavioural and Movement Sciences, VU University, Amsterdam, The Netherlands
| | - Otto Dethmers
- Oncology day-care unit, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Emma P E Maats
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jogien A Stoker
- Medical Psychology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Centre of Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gabe S Sonke
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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23
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Cripe LD, Rand KL, Perkins SM, Tong Y, Schmidt KK, Hedrick DG, Rawl SM. Ambulatory Advanced Cancer Patients' and Oncologists' Estimates of Life Expectancy Are Associated with Patient Psychological Characteristics But Not Chemotherapy Use. J Palliat Med 2018; 21:1107-1113. [PMID: 29905496 DOI: 10.1089/jpm.2017.0686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Patients with advanced cancer often face distressing decisions about chemotherapy. There are conflicting data on the relationships among perceived prognosis, psychological characteristics, and chemotherapy use, which impair the refinement of decision support interventions. OBJECTIVE Clarify the relationships among patient and oncologist estimates of life expectancy for 6 and 12 months, chemotherapy use, and patient psychological characteristics. DESIGN Secondary analysis of data from two cross-sectional studies. SETTING/SUBJECTS One hundred sixty-six patients with advanced stage cancer recruited from ambulatory cancer clinics. MEASUREMENTS All data were obtained at study enrollment. Patients completed the Adult Hope Scale, Hospital Anxiety and Depression Scale, and Life Orientation Test-Revised. Patients and their oncologists provided estimates of surviving beyond 6 and 12 months. Chemotherapy use was determined by chart review. RESULTS There were no significant associations between life-expectancy estimates and chemotherapy use nor patient anxiety, depression, hope, or optimism and chemotherapy use. Patients' life expectancy estimates for 12 months and oncologists' for 6 months were associated with higher patient anxiety and depression. Finally, both oncologist and patient estimates of life expectancy for 6 and 12 months were associated with increased levels of trait hope. CONCLUSION Advanced cancer patients who provide less optimistic estimates of life expectancy have increased anxiety and depression, but do not use chemotherapy more often. Increased patient trait hope is associated with more favorable oncologist estimates. These findings highlight the need for interventions to support both patients and oncologists as they clarify prognostic expectations and patients cope with the psychological distress of a limited life expectancy.
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Affiliation(s)
- Larry D Cripe
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Kevin L Rand
- 2 Department of Psychology, Indiana University-Purdue University Indianapolis , Indianapolis, Indiana
| | - Susan M Perkins
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Yan Tong
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Karen Krall Schmidt
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - David G Hedrick
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Susan M Rawl
- 3 Indiana University School of Nursing , Indianapolis, Indiana
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24
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Cresswell MA, Robinson CA, Fyles G, Bottorff JL, Sudore R. Evaluation of an advance care planning web-based resource: applicability for cancer treatment patients. Support Care Cancer 2017; 26:853-860. [PMID: 28929291 DOI: 10.1007/s00520-017-3901-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 09/12/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to explore the acceptability, applicability, and understandability of a promising advance care planning (ACP) web-based resource for use with oncology patients, and determine whether revisions to the website would be necessary before implementation into oncology care. The resource is called PREPARE ( www.prepareforyourcare.org ) and it had not been tested for use within oncology, but had previously been shown to influence the readiness of older, community-dwelling adults to engage in ACP behaviors. METHODS This qualitative descriptive study included participants receiving cancer medications and one participant on watchful waiting post-chemotherapy (n = 21). Data were collected via cognitive interviewing, followed by a brief semi-structured interview to gather a meaningful account of the participants' experience with PREPARE. Content analysis resulted in a comprehensive summary of what participants liked and did not like about the resource, as well as suggestions for change. RESULTS Overall, participants agreed PREPARE was acceptable, applicable, and understandable for cancer patients. A small number of participants had difficulty with the life-limiting language found within the website and this requires follow-up to determine whether the language causes distress or disengagement from ACP. These findings extend our understanding of barriers to engagement in ACP that appear unique to cancer patients receiving active treatment. CONCLUSIONS Results indicated that PREPARE is a reflective, capacity-building ACP resource that was acceptable, applicable, and understandable for use in oncology. These findings offer direction for both research and practice.
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Affiliation(s)
- Martha A Cresswell
- BC Cancer Agency Sindi Ahluwalia Hawkins Centre for the Southern Interior, 399 Royal Avenue, Kelowna, British Columbia, V1Y 5L3, Canada
| | - Carole A Robinson
- School of Nursing, University of British Columbia Okanagan, ART 132, 1147 Research Road, Kelowna, British Columbia, V1V 1V7, Canada.
| | - Gillian Fyles
- Pain and Symptom Management Palliative Care Program, BC Cancer Agency Sindi Ahluwalia Hawkins Centre for the Southern Interior, 399 Royal Avenue, Kelowna, British Columbia, V1Y 5L3, Canada
| | - Joan L Bottorff
- Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Rebecca Sudore
- School of Medicine, San Francisco VA Medical Center, University of California San Francisco (UCSF), San Francisco, CA, USA
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25
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Kvåle K, Synnes O. Living with life-prolonging chemotherapy-control and meaning-making in the tension between life and death. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28892215 DOI: 10.1111/ecc.12770] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2017] [Indexed: 11/29/2022]
Abstract
Chemotherapy, radiotherapy, hormone therapy and immune therapy have made many cancers chronic, potential curable diseases rather than inevitably fatal, but the treatments are often both mentally and physically stressful even if the side effects varies. The right use of palliative chemotherapy is a complex issue and there are many aspects to take into consideration. The aim of the study was to gain insight into the illness narratives of cancer patients, from the day they suspected that something was wrong up to the present day where they are living with incurable cancer, undergoing life-prolonging chemotherapy. Thirteen narrators were included. They were all cancer patients on chemotherapy with the intention of prolonging life (informed by their oncologist) in an outpatient's clinic in Norway. Narrative analyse of their illness stories was applied. The main findings showed that the narrators considered their lives worth living in spite of the treatment. They seemed to take control and build a new life on "what was left after the storm," and described how they found meaning living in the tension between life and death.
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Affiliation(s)
- K Kvåle
- VID Specialized University, Bergen, Fyllingsdalen, Norway
| | - O Synnes
- Centre of Diaconia and Professional Practice, VID Specialized University, Oslo, Norway
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26
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Bergqvist J, Strang P. The will to live - breast cancer patients perceptions' of palliative chemotherapy. Acta Oncol 2017; 56:1168-1174. [PMID: 28524711 DOI: 10.1080/0284186x.2017.1327719] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND For women with metastatic breast cancer, late lines of chemotherapy might be beneficial but also harmful. Ongoing chemotherapy late in life increase the risk of late or absent discussions of palliative care and access to symptom relief by other options than chemotherapy. Our aim was, therefore, to investigate breast cancer patients' motives, perceptions, and experiences of late lines of palliative oncologic treatment. MATERIAL AND METHODS A qualitative study with semi-guided face-to-face interviews with 20 women on at least their second line of palliative chemotherapy (second-eighth line). All women had breast cancer and were 40-80 years old. The interviews were analyzed by a phenomenographical approach according to seven steps, which uses a second-order perspective, i.e., how the informants experience the world. RESULTS The categories that surrounded the decision to continue with palliative chemotherapy were: The decision, Personal motives and goals and The treatment. All women acknowledged that they knew they had incurable breast cancer and that the treatment goal was to slow down cancer growth. Fear of death was a strong motive for all women in addition to experience of new values of life, still they preferred the doctor to make the decision. Cancer symptoms, especially pain triggered death anxiety, whereas the patients patiently accepted similar side effects from the treatment. There were also external motives for treatment like wishes from family, friends, but also health care staff. CONCLUSIONS All women knew they had disseminated breast cancer, still they expressed hopes for cure, therefore, death was more of a threat than a reality of an imminent death. None of the women had perceived there was an option to stop treatment. They felt both their families and doctors expected them to continue. Death threat was their main motive for accepting treatment.
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Affiliation(s)
- Jenny Bergqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Capio St. Görans Sjukhus, Stockholm, Sweden
| | - Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Research and Development, Stockholms Sjukhem Foundation, Stockholm, Sweden
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27
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Abstract
Medical oncologists and patients with advanced cancer struggle to discuss prognosis, goals, options, and values in a timely fashion. As a consequence, many patients die receiving aggressive treatment potentially inconsistent with their fully informed preferences and experience increased symptom burden and distress. The goals of patient - oncologist communication include exchanging information, building relationship, and engaging in shared decisions. Empathy is perhaps especially essential to effective patient - oncologist communication when the end of life is approaching. We speculate that, in addition to being a skilled response to a patient’s negative emotions, empathy is an emergent property of the relationship that allows the patient and oncologist to imagine what it will be like to navigate the transition from living with to dying from cancer; and to prepare for the transition. We propose that effective empathy: 1) requires an attentive, curious and imaginative physician; 2) acknowledges the complex and shifting goals as the end of life approaches; and 3) begins with a willingness of physicians to check in and find out what she may have misunderstood or misperceived. Empathy in end of life conversations cultivates the shared experiences necessary to co-create the new goals of care that underlie excellent end of life care.
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Affiliation(s)
- Larry D Cripe
- Indiana University Simon Cancer Center Indianapolis, IN, USA
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28
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Brom L, De Snoo-Trimp JC, Onwuteaka-Philipsen BD, Widdershoven GAM, Stiggelbout AM, Pasman HRW. Challenges in shared decision making in advanced cancer care: a qualitative longitudinal observational and interview study. Health Expect 2015; 20:69-84. [PMID: 26669902 PMCID: PMC5217936 DOI: 10.1111/hex.12434] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2015] [Indexed: 02/06/2023] Open
Abstract
Background Patients' preferences and expectations should be taken into account in treatment decision making in the last phase of life. Shared decision making (SDM) is regarded as a way to give the patient a central role in decision making. Little is known about how SDM is used in clinical practice in advanced cancer care. Objective To examine whether and how the steps of SDM can be recognized in decision making about second‐ and third‐line chemotherapy. Methods Fourteen advanced cancer patients were followed over time using face‐to‐face in‐depth interviews and observations of the patients' out‐clinic visits. Interviews and outpatient clinic visits in which treatment options were discussed or decisions made were transcribed verbatim and analysed using open coding. Results Patients were satisfied with the decision‐making process, but the steps of SDM were barely seen in daily practice. The creation of awareness about available treatment options by physicians was limited and not discussed in an equal way. Patients' wishes and concerns were not explicitly assessed, which led to different expectations about improved survival from subsequent lines of chemotherapy. Conclusion To reach SDM in daily practice, physicians should create awareness of all treatment options, including forgoing treatment, and communicate the risk of benefit and harm. Open and honest communication is needed in which patients' expectations and concerns are discussed. Through this, the difficult process of decision making in the last phase of life can be facilitated and the focus on the best care for the specific patient is strengthened.
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Affiliation(s)
- Linda Brom
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Janine C De Snoo-Trimp
- Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Guy A M Widdershoven
- Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Anne M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
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29
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Patients' perspectives on information from physicians during palliative chemotherapy: A qualitative study. Palliat Support Care 2015; 14:495-502. [DOI: 10.1017/s1478951515001200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjective:During the course of their disease, patients with cancer receiving palliative chemotherapy receive extensive amounts of information from physicians. The objective of our study was to describe patients' perspectives on the information they received from physicians during palliative chemotherapy with regard to their cancer diagnosis, treatments, prognosis, and future planning.Method:A total of 15 semistructured face-to-face interviews with patients who had incurable cancer were conducted, transcribed verbatim, and analyzed with qualitative content analysis.Results:Three categories were defined during the analytical process: “having a chronic disease,” “depending on chemotherapy,” and “living with an unpredictable future.”Significance of results:Our study demonstrated that patients undergoing palliative chemotherapy perceived that their disease was incurable and chronic, that they were dependent on chemotherapy, and that their future was uncertain. Compared with other studies, the patients in our study seemed to be more aware of their prognosis and the goals of care.
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30
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Racial and geographic disparities in the patterns of care and costs at the end of life for patients with lung cancer in 2007–2010 after the 2006 introduction of bevacizumab. Lung Cancer 2015; 90:442-50. [DOI: 10.1016/j.lungcan.2015.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/14/2015] [Accepted: 09/17/2015] [Indexed: 11/22/2022]
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31
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Wijnhoven MN, Terpstra WE, van Rossem R, Haazer C, Gunnink-Boonstra N, Sonke GS, Buiting HM. Bereaved relatives' experiences during the incurable phase of cancer: a qualitative interview study. BMJ Open 2015; 5:e009009. [PMID: 26608635 PMCID: PMC4663398 DOI: 10.1136/bmjopen-2015-009009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine bereaved relatives' experiences from time of diagnosis of incurable cancer until death with specific emphasis on their role in the (end-of-life) decision-making concerning chemotherapy. DESIGN Qualitative interview study. SETTING Hospital-based. PARTICIPANTS AND METHODS In-depth interviews with 15 close relatives of patients who died from non-small cell lung cancer or pancreatic cancer, using a thematic content analysis. RESULTS All relatives reported that patients' main reason to request chemotherapy was the possibility to prolong life. Relatives reported that patients receiving chemotherapy had more difficulty to accept the incurable nature of their disease than patients who did not. They mostly followed the patients' treatment wish and only infrequently suggested ceasing chemotherapy (because of side effects) despite sometimes believing that this would be a better option. Relatives continuously tried to support the patient in either approaching the death or in attaining hope to continue life satisfactorily. Most relatives considered the chemotherapy period meaningful, since it sparked patients' hope and was what patients wanted. Cessation of chemotherapy caused a relief but coincided with physical deterioration and an increased caregivers' role; many relatives recalled this latter period as more burdensome. CONCLUSIONS Relatives tend to follow patients' wish to continue or cease chemotherapy, without expressing their own feelings, although they were more inclined to opt cessation. They experience a greater caregiver role after cessation and their feelings of responsibility associated with the disease can be exhausting. More attention is needed to reduce relatives' distress at the end of life, also to fully profit from this crucial form of (informal) healthcare.
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Affiliation(s)
- Marleen N Wijnhoven
- Department of Registry & Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Wim E Terpstra
- Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Ronald van Rossem
- Department of Pulmonology, Reinier de Graafgroep, Delft, The Netherlands
| | - Carolien Haazer
- Department of Internal Medicine, Reinier de Graafgroep, Delft, The Netherlands
| | | | - Gabe S Sonke
- Department of Registry & Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hilde M Buiting
- Department of Registry & Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
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Brooks GA, Cronin AM, Uno H, Schrag D, Keating NL, Mack JW. Intensity of Medical Interventions between Diagnosis and Death in Patients with Advanced Lung and Colorectal Cancer: A CanCORS Analysis. J Palliat Med 2015; 19:42-50. [PMID: 26600474 DOI: 10.1089/jpm.2015.0190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Medical interventions are an important component of the illness experience in advanced cancer. OBJECTIVE To describe the use of medical interventions between diagnosis and death in decedents with metastatic lung and colorectal cancer. DESIGN Retrospective analysis of a prospective cohort study. SETTING/SUBJECTS We studied 1,840 decedents from the Cancer Care Outcomes Research and Surveillance (CanCORS) study. Subjects had been diagnosed with stage IV lung or colorectal cancer between 2003 and 2005. MEASUREMENTS Hospitalizations, surgeries, radiation therapy treatments, chemotherapy treatments, and end-of-life care, reported by tertile of overall survival time. RESULTS Median survival in the bottom, middle, and top tertiles of survival was 1.2, 5.3, and 15.3 months for lung cancer, and 3.0, 18.0, and 44.4 months for colorectal cancer. Hospitalizations, chemotherapy receipt, and hospice enrollment increased with increasing survival. The median duration of chemotherapy in the top survival tertile was 149 days for lung cancer and 498 days for colorectal cancer. A minority of decedents used any hospice services, and the median duration of hospice enrollment exceeded 30 days only for enrollees in the top survival tertile (lung cancer, 35 days; colorectal cancer, 66 days). CONCLUSIONS For patients with metastatic lung and colorectal cancer, longer survival is associated with increased intensity of medical care, characterized by greater use of chemotherapy and acute hospital care. Hospice utilization was uniformly low, and most hospice enrollees were referred to hospice in the last 30 days of life.
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Affiliation(s)
- Gabriel A Brooks
- 1 Dana-Farber Cancer Institute , Boston, Massachusetts.,2 Harvard Medical School , Boston, Massachusetts
| | | | - Hajime Uno
- 1 Dana-Farber Cancer Institute , Boston, Massachusetts.,3 Harvard School of Public Health , Boston, Massachusetts
| | - Deborah Schrag
- 1 Dana-Farber Cancer Institute , Boston, Massachusetts.,2 Harvard Medical School , Boston, Massachusetts
| | - Nancy L Keating
- 2 Harvard Medical School , Boston, Massachusetts.,4 Brigham and Women's Hospital , Boston, Massachusetts
| | - Jennifer W Mack
- 1 Dana-Farber Cancer Institute , Boston, Massachusetts.,2 Harvard Medical School , Boston, Massachusetts.,5 Boston Children's Hospital , Boston, Massachusetts
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33
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Brom L, Onwuteaka-Philipsen BD, Widdershoven GAM, Pasman HRW. Mechanisms that contribute to the tendency to continue chemotherapy in patients with advanced cancer. Qualitative observations in the clinical setting. Support Care Cancer 2015; 24:1317-25. [PMID: 26329398 PMCID: PMC4729795 DOI: 10.1007/s00520-015-2910-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 08/16/2015] [Indexed: 11/25/2022]
Abstract
Purpose The study aims to describe mechanisms that contribute to the tendency towards continuing chemotherapy in patients with advanced cancer. Methods The study conducted qualitative observations of outpatient clinic visits of 28 patients with advanced cancer (glioblastoma and metastatic colorectal cancer). Results We uncovered four mechanisms in daily oncology practice that can contribute to the tendency towards continuing chemotherapy in patients with advanced cancer: (1) “presenting the full therapy sets the standard”—patients seemed to base their justification for continuing chemotherapy on the “standard” therapy with the maximum number of cycles as presented by the physician at the start of the treatment; (2) “focus on standard evaluation moments hampers evaluation of care goals”—whether or not to continue the treatment was mostly only considered at standard evaluation moments; (3) “opening question guides towards focus on symptoms”—most patients gave an update of their physical symptoms in answer to the opening question of “How are you doing?” Physicians consequently discussed how to deal with this at length, which often took up most of the visit; (4) “treatment is perceived as the only option”—patients mostly wanted to continue with chemotherapy because they felt that they had to try every available option the physician offered. Physicians also often seemed to focus on treatment as the only option. Conclusion Discussing care goals more regularly with the patient, facilitated for instance by implementing early palliative care, might help counter the mechanisms and enable a more well-considered decision. This could be either stopping or continuing chemotherapy.
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Affiliation(s)
- Linda Brom
- Department of Public and Occupational Health, EMGO Institute for Health and Care research, Expertise Center for Palliative Care, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, EMGO Institute for Health and Care research, Expertise Center for Palliative Care, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Guy A M Widdershoven
- Department of Public and Occupational Health, EMGO Institute for Health and Care research, Expertise Center for Palliative Care, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Department of Medical Humanities, EMGO Institute for Health and Care research, VU University Medical Center, Amsterdam, the Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, EMGO Institute for Health and Care research, Expertise Center for Palliative Care, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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De Snoo-Trimp JC, Brom L, Pasman HRW, Onwuteaka-Philipsen BD, Widdershoven GAM. Perspectives of Medical Specialists on Sharing Decisions in Cancer Care: A Qualitative Study Concerning Chemotherapy Decisions With Patients With Recurrent Glioblastoma. Oncologist 2015; 20:1182-8. [PMID: 26245676 DOI: 10.1634/theoncologist.2015-0095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/09/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In cancer care, difficult decisions concerning advanced treatment need to be made, weighing possible life prolongation against harmful side effects. Treatment is frequently started, showing the need to explore how decisions are made. Little is known about the perspectives of physicians on sharing decision making with patients. This qualitative study aimed to describe the perspectives of medical specialists on the decision-making process with patients with glioblastoma concerning starting new treatment. METHODS Qualitative interviews were held with medical specialists. One focus group was organized with medical professionals. Their opinions about elements of shared decision making and the applicability in the context of patients with glioblastoma were assessed. The topic list for the focus group was based on the analysis of the interviews. Qualitative analysis of the transcripts was performed by three researchers independently. RESULTS Medical specialists considered shared decision making to be important; however, they did not adhere to its elements. Stopping treatment was not considered equal to continuing treatment. Exploration of the patients' wishes was done implicitly, and shared responsibility for the decision was not highly recognized. The main barriers to shared decision making were preferences of both patients and specialists for starting or continuing treatment and assumptions of physicians about knowing what patients want. CONCLUSION Medical specialists recognized the importance of patient involvement but experienced difficulty in sharing decision making in practice. Elements of shared decision making are partly followed but do not guide decision making. To improve cancer care, education of medical specialists and adjustment to the elements are needed to involve patients.
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Affiliation(s)
- Janine C De Snoo-Trimp
- Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands
| | - Linda Brom
- Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands
| | - H Roeline W Pasman
- Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands
| | - Guy A M Widdershoven
- Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands
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Fujisawa D, Temel JS, Traeger L, Greer JA, Lennes IT, Mimura M, Pirl WF. Psychological factors at early stage of treatment as predictors of receiving chemotherapy at the end of life. Psychooncology 2015; 24:1731-7. [DOI: 10.1002/pon.3840] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/25/2015] [Accepted: 04/09/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Daisuke Fujisawa
- Massachusetts General Hospital Cancer Center; Boston MA USA
- Department of Neuropsychiatry; Keio University School of Medicine; Tokyo Japan
| | | | - Lara Traeger
- Massachusetts General Hospital Cancer Center; Boston MA USA
| | | | - Inga T. Lennes
- Massachusetts General Hospital Cancer Center; Boston MA USA
| | - Masaru Mimura
- Department of Neuropsychiatry; Keio University School of Medicine; Tokyo Japan
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Liang WL, Cao J, Xu B, Yang P, Shen F, Sun Z, Li WL, Wang Q, Liu F. miR-892a regulated PPP2R2A expression and promoted cell proliferation of human colorectal cancer cells. Biomed Pharmacother 2015; 72:119-24. [DOI: 10.1016/j.biopha.2015.04.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/14/2015] [Indexed: 01/16/2023] Open
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Garattini L, van de Vooren K, Curto A. Cost-effectiveness of trastuzumab in metastatic breast cancer: mainly a matter of price in the EU? Health Policy 2014; 119:212-6. [PMID: 25523144 DOI: 10.1016/j.healthpol.2014.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 11/19/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
Trastuzumab (TR), a monoclonal antibody approved by EMA in 2000 and one of the first examples of "targeted therapy", is indicated to treat human epidermal growth factor receptor 2 (HER2) positive breast cancer. TR, whose patent will expire in 2015 in Europe, has been judged positively for reimbursement by most public authorities in the EU. Here we critically review the existing evidence on TR in metastatic breast cancer (MBC), in line with the multidisciplinary health technology assessment (HTA) approach, to assess whether the existing evidence supports TR positive reimbursement decisions taken in MBC by EU health authorities. We did a literature search for the main HTA topics (efficacy, quality of life and ethics) on the PubMed international database (2000-2013). Then, we did a specific literature search to select the full economic evaluations (FEEs) conducted in EU countries focused on TR as first-line innovative therapy in MBC. We retrieved scant evidence in the literature to support TR reimbursement in MBC. We found only two clinical trials and their results were unclear because of the large proportion of patients who crossed over. Moreover, the quality of methods was poor in all four European FEEs selected. This example of HTA exercise on a mature monoclonal antibody in a specific indication casts doubts on how often the reimbursement decisions taken by EU health authorities in emotional pathologies like cancer are rational. These decisions should at least be reconsidered periodically on the basis of the latest evidence.
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Affiliation(s)
- Livio Garattini
- CESAV, Centre for Health Economics, IRCCS 'Mario Negri' Institute for Pharmacological Research, Via Camozzi, 3 c/o Villa Camozzi, 24020 Ranica (Bergamo), Italy.
| | - Katelijne van de Vooren
- CESAV, Centre for Health Economics, IRCCS 'Mario Negri' Institute for Pharmacological Research, Via Camozzi, 3 c/o Villa Camozzi, 24020 Ranica (Bergamo), Italy
| | - Alessandro Curto
- CESAV, Centre for Health Economics, IRCCS 'Mario Negri' Institute for Pharmacological Research, Via Camozzi, 3 c/o Villa Camozzi, 24020 Ranica (Bergamo), Italy
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Nicholson C. Research roundup. Int J Palliat Nurs 2013. [DOI: 10.12968/ijpn.2013.19.11.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
These pages provide brief synopses of a selection of recently published research articles of relevance to palliative care.
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