Patient-reported symptom distress, and most bothersome issues, before and during cancer treatment

Patient-reported sexual health outcomes of cervical cancer patients treated with definitive chemoradiation and MRI-guided brachytherapy

BACKGROUND

Sexual health is an important survivorship issue in cervical cancer. We assessed patient-reported sexual health outcomes and correlations with oncologist-assessed vaginal toxicity (VT).

METHODS

This was a prospective, cross-sectional study of stage IB-IVA cervical cancer patients treated with definitive chemoradiation, who completed a socio-demographic questionnaire and the following patient-reported-outcomes (PROs): Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Menopause Rating Scale (MRS), Hospital Anxiety and Depression Scale (HADS). VT was assessed using the CTCAE v4.0. Sociodemographic, clinical data, PROs and VT were summarized using descriptive statistics; correlations were evaluated using linear regression analyses.

RESULTS

Between August 2018 and April 2022, 73 patients were analyzed. Median age was 49 (range 25-81), 57.5% had vaginal involvement at diagnosis and 76.9% were partnered. Sexual dysfunction (FSFI score ≤ 26), sexual distress (FSDS-R ≥ 11), severe menopausal symptoms (MRS ≥ 17), anxiety (HAD-Anxiety >7) and depression (HAS-Depression >7) were reported in 86.3%, 54.5%, 36.2%, 46.6% and 24.7%, respectively. Grade 2+ VT was reported in 27.4%. No significant associations were found between PROs and VT. On multivariable analysis, non-partnered status, use of hormone replacement therapy, and International Commission on Radiation Units and Measurements - rectovaginal dose (ICRU-RV) >65Gy were associated with worse sexual health (p < 0.005).

CONCLUSION

Cervical cancer patients self-report high rates of sexual distress, dysfunction and menopause symptoms. Discordance between oncologist-assessed VT and PROs highlights the importance of evaluating the patient's experience. Proactive treatment of menopausal symptoms and attention to radiotherapy doses to the vagina should be considered.

Development and validation of the genitourinary syndrome of menopause symptoms and vaginal treatments acceptability questionnaire (GSM-SVTAQ): An electronic patient-reported outcomes measure

OBJECTIVES

To develop and validate an electronic, patient-reported outcomes measure (PROM) specific for genitourinary syndrome of menopause (GSM) patients. The PROM aimed to accurately assess the burden of GSM symptoms, their impact on health-related and sexual quality of life, and the acceptability of vaginal treatments.

METHODS

The study encompassed a comprehensive three-stage approach to the development and validation of the PROM. Initially, during the preliminary design stage, the necessity for a new PROM was recognized, an expert panel was formed, and semi-structured qualitative interviews were carried out with GSM patients. In the second stage, the study used the five-step pre-validation methodology established by Prior et al. to generate and refine the PROM items. The third and final stage encompassed the determination of scale and item content validity indexes to ensure validity. Additionally, the reliability of each construct was evaluated using Cronbach's α.

RESULTS

The resulting PROM was named GSM-SVTAQ (GSM-symptoms and vaginal treatments acceptability questionnaire). It demonstrated excellent validity in assessing symptoms burden, health-related and sexual quality of life, and vaginal treatment acceptability, with high content validity indices and strong internal consistency. The scale content validity indices and Cronbach's α coefficients for the three domains were (0.926, 0.939), (0.875, 0.947), and (0.824, 0.855), respectively.

CONCLUSION

The GSM-SVTAQ stands as the first GSM-specific, valid, and reliable PROM capable of comprehensively measuring the three components of GSM and the acceptability of vaginal treatments. Its implementation has the potential to significantly enhance patient care and outcomes in GSM management.

Involving patients in the process: Development of a constipation patient-reported outcome measure for symptoms and quality of life

Objective

Patient-reported outcome measures (PROMs) are useful standardized tools to measure current patient health status and well-being. While there are existing constipation-related PROMs, the majority of PROMs were not developed with adequate patient involvement and few examined content validity. Accordingly, the current study aimed to develop a constipation PROM with multiple phases of patient and clinician involvement.

Methods

To generate PROM items, 15 patients with chronic constipation (age range =28-79 years, 10 females) underwent a qualitative interview exploring their experiences with chronic constipation. Following that, eight clinical experts completed the content validity index (CVI) ratings of all the items generated to assess content validity. Based on results of the content validity assessment, relevant items were maintained and 12 participants with chronic constipation were re-interviewed to obtain feedback about comprehensibility, comprehensiveness and relevance.

Results

Six themes and 25 sub-themes emerged from the qualitative interview, and an initial list of 33 symptom items and 18 quality of life (QoL) items were generated. Based on the CVIs calculated, 11 symptom items and nine QoL items were maintained with the scale-content validity index indicating excellent content validity. Overall, participants indicated the PROM to be relevant, comprehensive and easy to understand however, minor amendments were made to improve the three qualities of interest.

Conclusion

The current study developed a constipation PROM that measures both symptom severity and constipation-related QoL, with supporting evidence for relevance, comprehensiveness and comprehensibility. Further prioritization should be given to validating and exploring new digital modalities of PROM administration.

Age-related differences in the occurrence, severity, and distress of symptoms in older patients at the initiation of chemotherapy

BACKGROUND

Evaluate for differences in occurrence, severity, and distress ratings for 32 symptoms between younger older adults (YOA, < 70 years) and older adults (OA, ≥ 70 years) at initiation of chemotherapy.

METHODS

Patients (n = 125) were recruited prior to the initiation of chemotherapy and completed the Memorial Symptom Assessment Scale. Differences in occurrence, severity, and distress ratings were evaluated using Independent sample t-tests and Chi-square or Fisher's exact tests.

RESULTS

On average, the older patients reported ten concurrent symptoms that equates with a moderate symptom burden. Symptoms with the highest occurrence rates were not always the most severe and/or the most distressing. Few age-related differences were found in patients' symptom experiences. When age-related differences were identified, OA reported lower occurrence, severity, and distress ratings. Nine of the ten symptoms with highest occurrence rates were common for both age groups. For severity and distress, only half of the symptoms were common. In terms of severity and distress, all of the top ten ranked symptoms were in the moderate to severe range.

CONCLUSIONS

Both YOA and OA reported a moderate symptom burden and severity and distress scores in the moderate to severe range. The symptoms with the highest occurrence rates were not always the most severe/or the most distressing. Our findings suggest that different dimensions of the symptom experience (i.e., occurrence, severity, and distress) warrant evaluation in older oncology patients.

When can cancer patient treatment nonadherence be considered intentional or unintentional? A scoping review

BACKGROUND

Treatment nonadherence in cancer patients remains high with most interventions having had limited success. Most studies omit the multi-factorial aspects of treatment adherence and refer to medication adherence. The behaviour is rarely defined as intentional or unintentional.

AIM

The aim of this Scoping Review is to increase understanding of modifiable factors in treatment nonadherence through the relationships that physicians have with their patients. This knowledge can help define when treatment nonadherence is intentional or unintentional and can assist in predicting cancer patients at risk of nonadherence and in intervention design. The scoping review provides the basis for method triangulation in two subsequent qualitative studies: 1. Sentiment analysis of online cancer support groups in relation to treatment nonadherence; 2. A qualitative validation survey to refute / or validate claims from this scoping review. Thereafter, framework development for a future (cancer patient) online peer support intervention.

METHODS

A Scoping Review was performed to identify peer reviewed studies that concern treatment / medication nonadherence in cancer patients-published between 2000 to 2021 (and partial 2022). The review was registered in the Prospero database CRD42020210340 and follows the PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Searches. The principles of meta-ethnography are used in a synthesis of qualitative findings that preserve the context of primary data. An aim of meta-ethnography is to identify common and refuted themes across studies. This is not a mixed methods study, but due to a limited qualitativevidence base and to broaden findings, the qualitative elements (author interpretations) found within relevant quantitative studies have been included.

RESULTS

Of 7510 articles identified, 240 full texts were reviewed with 35 included. These comprise 15 qualitative and 20 quantitative studies. One major theme, that embraces 6 sub themes has emerged: 'Physician factors can influence patient factors in treatment nonadherence'. The six (6) subthemes are: 1. Suboptimal Communication; 2. The concept of Information differs between Patient and Physician; 3.Inadequate time. 4. The need for Treatment Concordance is vague or missing from concepts; 5. The importance of Trust in the physician / patient relationship is understated in papers; 6. Treatment concordance as a concept is rarely defined and largely missing from studies.

LINE OF ARGUMENT WAS DRAWN

Treatment (or medication) nonadherence that is intentional or unintentional is often attributed to patient factors-with far less attention to the potential influence of physician communication factors. The differentation between intentional or unintentional nonadherence is missing from most qualitative and quantitative studies. The holistic inter-dimensional / multi-factorial concept of 'treatment adherence' receives scant attention. The main focus is on medication adherence / nonadherence in the singular context. Nonadherence that is unintentional is not necessarily passive behaviour and may overlap with intentional nonadherence. The absence of treatment concordance is a barrier to treatment adherence and is rarely articulated or defined in studies.

CONCLUSION

This review demonstrates how cancer patient treatment nonadherence is often a shared outcome. An equal focus on physican and patient factors can increase understanding of the two main types of nonadherence (intentional or unintentional). This differentation should help improve the fundamentals of intervention design.

Fatigue severity and avoidance among individuals with chronic disease: A meta-analysis

OBJECTIVE

Fatigue is a common, debilitating symptom experienced by individuals with chronic disease. Avoidance, or the act of evading unwanted experiences, is associated with fatigue across chronic disease samples. The current study sought to determine the strength of association between fatigue severity and avoidance in individuals with chronic disease.

METHODS

PubMed, PsycINFO, CINAHL, and ProQuest Dissertations and Theses databases were searched. Eligible studies measured fatigue and avoidance in chronic disease samples. Sixty-six studies were included. Data analyses were conducted in Rstudio. A random effects model was employed, and a weighted mean effect size was computed for fatigue severity and avoidance. Mixed-effects meta-regression analyses were conducted to examine moderating variables, including patient, clinical, and measurement characteristics. Publication bias was examined using funnel plot, trim-and-fill, and p-curve.

RESULTS

The meta-analysis comprised of 71 unique patient samples from 66 studies. The total number of included participants was 13,024. A small, positive association was found between fatigue severity and avoidance, r(71) = 0.22, p < .001, 95% CI [0.18-0.27], SE = 0.02. There was also significant heterogeneity, Q(70) = 349.96, p < .001. Moderator analyses examining age, sex, illness duration, avoidance type, and disease sample were all non-significant. Regarding publication bias, trim-and-fill resulted in a modified weighted mean effect size (r(83) = 0.18, p < .001) and a p-curve analysis supported the evidential value of the current analysis.

CONCLUSION

Findings support that among individuals with chronic disease, fatigue severity and avoidance are positively associated, which has implications for behavioral interventions in this population.

Occurrence and impact of pelvic floor dysfunction in women with and without breast cancer: a cross-sectional study

BACKGROUND

One of the sequalae of breast cancer treatments may be pelvic floor (PF) dysfunction such as urinary incontinence (UI), faecal incontinence (FI), and pelvic organ prolapse (POP).

OBJECTIVE

The aim of this study was to compare the occurrence and related distress and impact of PF dysfunction between women with and without breast cancer.

METHODS

Women with and without breast cancer participated in this cross-sectional study. The Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire were used to quantify the prevalence and related distress, and impact of PF dysfunction. Factors associated with PF outcomes were examined using logistic and linear regressions while controlling for known risk factors for PF dysfunction (age, body mass index, and parity).

RESULTS

120 women with breast cancer, and 170 women without breast cancer responded. The occurrence of any type of UI was higher in women with breast cancer than women without breast cancer (percentage difference=17%; 95% CI: 7, 29). Women with breast cancer experienced higher impact of urinary symptoms (mean difference=18.2; 95% CI: 8.9, 27.7) compared to those without. Multivariable analysis indicated that having breast cancer (β 0.33; 95%CI: 0.08, 0.51) was the strongest predictor of greater impact of urinary symptoms.

CONCLUSION

Women with breast cancer reported a higher occurrence and impact of urinary symptoms than women without breast cancer. While further studies are required to confirm our findings, routine screening and offering treatment for urinary symptoms may be indicated for women with breast cancer.

Evaluation of online, publicly available cancer-related educational and self-management resources for symptom management

OBJECTIVE

The aims of this study were to evaluate the readability, suitability, and quality of publicly available online self-management (SM) resources for people with cancer.

METHODS

Resources were identified using two strategies: (1) a targeted search of 20 Canadian organizations and (2) a Google search. These were evaluated using the Suitability Assessment of Materials (SAM), the DISCERN tool for quality, and readability indices. The SM skills (e.g., problem-solving) and symptom management strategies addressed by each resource were also assessed. Descriptive and hierarchical cluster analyses were performed to identify resources of the highest suitability and quality as well as resource characteristics associated with higher quality and suitability.

RESULTS

A total of 92 resources were evaluated. The mean reading grade level for English resources was 10.29 (SD = 1.64, range of 7.05 to 15.09) and 12.62 for French resources (SD = 2.27, range of 10.12 to 15.65). The mean SAM score across the sample was 50.4% (SD = 10.6%), or 'adequate', and the mean DISCERN score was 61.1% (SD = 11.8%), or 'fair'. The cluster analysis indicated that 10 resources scored highly on both the SAM and the DISCERN. In total, 91 symptom management strategies were identified. On average, resources addressed 2.73 SM skills (SD = 1.58).

CONCLUSIONS

There is a need for plain language resources for people with lower reading ability and resources that incorporate more SM skills. Study findings will help healthcare professionals, patients, and their families identify optimal resources to address cancer-related symptoms.

Building family caregiver skills using a simulation-based intervention for care of patients with cancer: protocol for a randomized controlled trial

BACKGROUND

Family caregivers of patients with cancer undergoing radiation therapy experience significant distress and challenges related to high symptom burden and complex care demands. This is particularly true for caregivers of patients with head and neck, esophageal, anal, rectal, and lung cancers, who are often receiving combined-modality treatment and may have tracheostomy tubes, gastrostomy tubes, or colostomies/ileostomies. This study aims to evaluate a simulation-based nursing intervention to provide information, support, and training to caregivers during radiation therapy.

METHODS

This randomized controlled trial will include a sample of 180 patients and their family caregivers. Caregivers assigned to the control group will receive usual care and an informational booklet from the National Cancer Institute (NCI). Those in the intervention group will receive usual care, the NCI booklet, and three meetings with a nurse interventionist during radiation treatment followed by a booster call two weeks posttreatment. Intervention sessions focus on themes consistent with the trajectory of radiation therapy: the patient experience/needs, the caregiver experience and dyad communication, and transition to survivorship. Outcomes are measured at baseline, end of treatment (T2), and 4 (T3) and 20 (T4) weeks posttreatment, with the primary outcome being caregiver anxiety at T4.

DISCUSSION

This trial is innovative in its use of simulation in a psychoeducational intervention for family caregivers. The intervention is administered at point-of-care and aimed at feasibility for integration into clinical practice. Patient quality of life and healthcare utilization measures will assess how providing support and training to the caregiver may impact patient outcomes.

TRIAL REGISTRATION

The trial was registered on 08/14/2019 at ClinicalTrials.gov (identifier NCT04055948 ).

Rectal Prolapse: Age-Related Differences in Clinical Presentation and What Bothers Women Most

BACKGROUND

Rectal prolapse has a diverse symptom profile that affects patients of all ages.

OBJECTIVE

We sought to identify bothersome symptoms and clinical presentation that motivated patients who have rectal prolapse to seek care, characterize differences in symptom severity with age, and determine factors associated with bothersome symptoms.

DESIGN

This study is a retrospective analysis of a prospectively maintained registry.

SETTINGS

This study was conducted at a tertiary referral academic center.

PATIENTS

Included were 129 consecutive women with full-thickness rectal prolapse.

MAIN OUTCOME MEASURES

The main outcomes measured were primary bothersome symptoms, 5-item Cleveland Clinic/Wexner Fecal Incontinence questionnaire, and the 5-item Obstructed Defecation Syndrome questionnaire. Patients were categorized by age <65 vs age ≥65 years.

RESULTS

Cleveland Clinic/Wexner Fecal Incontinence score >9 was more common in older patients (87% vs 60%, p = 0.002). Obstructed Defecation Syndrome score >8 was more common in younger patients (57% vs 28%, p < 0.001). Older patients were more likely than younger patients to report bothersome symptoms of pain (38% vs 19%, p = 0.021) and bleeding (12% vs 2%, p = 0.046). Mucus discharge was reported by most patients (older, 72% vs younger, 66%, p = 0.54) but was bothersome for only 18%, regardless of age. Older patients had more severe prolapse expression than younger patients (at rest, 33% vs 11%; during activity, 26% vs 19%; only with defecation, 40% vs 64%, p = 0.006). Older patients were more likely to seek care within 6 months of prolapse onset (29% vs 11%, p = 0.056). On multivariable regression, increasing age, narcotic use, and nonprotracting prolapse at rest were associated with reporting pain as a primary concern.

LIMITATIONS

This was a single-center study with a small sample size.

CONCLUSIONS

Rectal prolapse-related bothersome symptoms and health care utilization differ by age. Although rectal pain is often not commonly associated with prolapse, it bothers many women and motivates older women to undergo evaluation. Patient-reported functional questionnaires may not reflect patients' primary concerns regarding specific symptoms and could benefit from supplementation with questionnaires to elicit individualized symptom priorities. See Video Abstract at http://links.lww.com/DCR/B492.

PROLAPSO DE RECTO

INFLUENCIA DE LA EDAD EN DIFERENCIAS VINCULADAS CON LA PRESENTACIÓN CLÍNICA Y LOS SÍNTOMAS MAS DESAGRADABLES: El prolapso de recto tiene una gran variedad de síntomas que afectan a pacientes con edades diferentes.Identificar los síntomas mas molestos y la presentación clínica que motivaron a los pacientes con un prolapso de recto a consultar por atención médica, caracterizar las diferencias de gravedad de los síntomas con relación a la edad y determinar los factores asociados con los síntomas mas molestos.Análisis retrospectivo de un registro prospectivo.Centro académico de referencia terciaria.Consecutivamente 129 mujeres que presentaban un prolapso rectal completo.Síntomas y molestias primarias, cuestionario de incontinencia fecal de la Cleveland Clinic / Wexner de 5 ítems, cuestionario de síndrome de defecación obstruida de 5 ítems. Los pacientes fueron categorizados en < 65 años versus ≥ 65 años.El puntaje de incontinencia fecal de la Cleveland Clinic / Wexner > 9 fue más común en pacientes mayores (87% vs 60%, p = 0.002). La puntuación del síndrome de defecación obstructiva > 8 fue más común en pacientes más jóvenes (57% vs 28%, p <0,001). Los pacientes mayores fueron más propensos que los pacientes jóvenes a informar síntomas y molestias de dolor (38% vs 19%, p = 0.021) y sangrado (12% vs 2%, p = 0.046). La mayoría de los pacientes informaron secresión de moco (mayores, 72% frente a más jóvenes, 66%, p = 0,54), pero sólo el 18% tuvo molestias, independientemente de la edad. Los pacientes mayores tenían una exteriorización de prolapso más grave que los pacientes jóvenes (en reposo, 33% frente a 11%; durante la actividad, 26% frente a 19%; solo con defecación, 40% frente a 64%, p = 0,006). Los pacientes mayores tenían más probabilidades de buscar atención médica dentro de los 6 meses posteriores al inicio del prolapso (29% frente a 11%, p = 0.056). Tras la regresión multivariable, el aumento de la edad, el uso de narcóticos y el prolapso no prolongado en reposo se asociaron con la notificación de dolor como queja principal.Centro único; tamaño de muestra pequeño.Los síntomas y molestias relacionadas con el prolapso rectal y la solicitud de atención médica difieren según la edad. Aunque el dolor rectal a menudo no se asocia comúnmente con el prolapso, incomoda a muchas pacientes y motiva a las mujeres mayores a someterse a un examen médico. Los cuestionarios funcionales con las respuestas de las pacientes pueden no reflejar las preocupaciones principales de éstos con respecto a los síntomas específicos y podrían requerir cuestionarios complementarios para así obtener prioridades individualizadas con relación a los síntomas identificados. Consulte Video Resumen en http://links.lww.com/DCR/B492. (Traducción-Dr. Xavier Delgadillo).

The Cancer Rehabilitation Medicine Metrics Consortium: A Path to Enhanced, Multi-Site Outcome Assessment to Enhance Care and Demonstrate Value

Purpose

A primary objective stated at the Cancer Rehabilitation Symposium at the National Institutes of Health was to improve outcome measurement. The purpose of this project was for the Cancer Rehabilitation Medicine Metrics Consortium (CRMMC) to develop an assessment tool to evaluate function in cancer patients via a data-driven and methodologically sound process. There is no agreed-upon measure of physical and cognitive function for cancer patients, making it difficult to demonstrate the value of rehabilitation interventions. Cancer patients are a particularly challenging population, with many tumor- and treatment-related variables impacting function.

Methods

Investigators from nine different cancer rehabilitation programs participated in a modified-Delphi process to delineate necessary aspects of an ideal patient assessment tool, including instrument type, domains evaluated, applicability across a range of patient traits, clinical feasibility, and item response characteristics. This involved numerous meetings, data review, and analysis of items involved in patient assessment.

Results

The CRMMC developed a 21-item patient-reported outcome measure based on item response theory. The process by which the short form was developed was documented and provides a framework for other clinicians to follow.

Conclusion

This document provides a framework for rehabilitation providers to follow when developing an assessment tool. This process is described in a stepwise fashion for reproducibility even in different, non-cancer populations.

Informational Gaps, Needs, and Preferences of Adults With Chronic Health Conditions and Their Family Caregivers

The purpose of this cross-sectional, qualitative study was to determine unmet educational needs, preferences, and barriers experienced by individuals with chronic illness and their caregivers. A survey containing fixed-choice selections and open-ended questions was sent to persons with cancer and other chronic diseases who had been seen within a large national private health system. Between 20% and 25% of participants had difficulty obtaining health care information and/or felt overwhelmed with managing their condition. Coping, managing symptoms, and making treatment decisions were areas of need in both patients and caregivers. Preferences for receiving information were diverse. Existing methods of communication including secure Web sites where patients can access their medical records posed significant challenges.

Video cognitive-behavioral therapy for insomnia in cancer patients: A cost-effective alternative

OBJECTIVE

Despite its high prevalence, cancer-related insomnia typically remains untreated because of a lack of access to cognitive-behavioral therapy for insomnia (CBT-I), the treatment of choice for this condition. While face-to-face CBT-I appears to be optimal in terms of efficacy, self-administered formats may be more cost-effective. The goal of this secondary analysis of a randomized clinical trial was to compare the cost-effectiveness of a professionally-based CBT-I (PCBT-I) to that of a video-based CBT-I (VCBT-I).

METHODS

A total of 161 women with breast cancer received six weekly, individual CBT-I sessions (PCBT-I; n = 81) or a 60-minutes animated video +6 short booklets (VCBT-I; n = 80). Participants completed the Insomnia Severity Index (ISI) and provided information to calculate treatment costs.

RESULTS

Total per patient treatment costs were 5.5 times greater for PCBT-I ($1298.90) than VCBT-I ($234.36; P < .0001). Both at posttreatment and 3-month follow-up, the ISI reduction was greater in PCBT-I than VCBT-I, but these differences were not significant (P = .09 and P = .24, respectively). In contrast, the cost-effectiveness ratio was significantly more advantageous for VCBT-I than PCBT-I. Compared to VCBT-I, each reduction of 1 unit on the ISI produced by PCBT-I was associated with a treatment cost that was significantly greater at posttreatment ($186.95 CAD vs $44.87 CAD; P = .001) and follow-up ($154.76 vs $24.97, P = .005).

CONCLUSIONS

Although CBT-I is slightly less efficacious when self-administered, it constitutes a much more cost-effective alternative than face-to-face CBT-I and represents an extremely valuable option in settings where monetary and human resources required to administer CBT-I are not available or sufficient.

Screening for clinical insomnia in cancer patients with the Edmonton Symptom Assessment System-Revised: a specific sleep item is needed

OBJECTIVE

We previously investigated the capacity of the original version of the Edmonton Symptom Assessment System-Revised (ESAS-r) and the Canadian Problem Checklist (CPP) to screen for clinical levels of insomnia in cancer patients. The original ESAS-r includes an item assessing drowsiness and an "other symptom" item, both of which are rated on a scale from 0 to 10, while the CPC has a sleep item, a box which is checked when this problem is present. Because none of these items showed an optimal screening capacity, we concluded that it would be best to add a specific 0-10 sleep item to the ESAS-r. This study assessed the capacity of this ESAS-r-sleep item to screen for clinical insomnia in patients with various cancer types.

METHODS

A total of 392 patients with mixed cancer sites completed the ESAS-r as part of a routine screening procedure implemented in the radio-oncology department of L'Hôtel-Dieu de Québec (CHU de Québec-Université Laval). They also filled out the Insomnia Severity Index (ISI).

RESULTS

Using a score of 8 or greater on the ISI as the standard criterion for clinical insomnia, a score of 2 or higher on the ESAS-r-sleep item (50.8% of the patients) was the one that showed the best screening indices: sensitivity of 86.7%, specificity of 75.3%, positive predictive value of 71.9%, and negative predictive value of 88.6%. An area under the curve of 0.89 was found, which is excellent.

CONCLUSIONS

Adding a sleep item to the ESAS significantly improves screening of clinical insomnia in cancer patients.

Impact of Electronic Self-Assessment and Self-Care Technology on Adherence to Clinician Recommendations and Self-Management Activity for Cancer Treatment-Related Symptoms: Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

Patients undergoing cancer treatment experience symptoms that negatively affect their quality of life and adherence to treatment. The early identification and management of treatment-related symptoms are critical to prevent symptom distress due to unmanaged symptoms. However, the early identification and management of treatment-related symptoms are complex as most cancer treatments are delivered on an outpatient basis where patients are granted less face-to-face time with clinicians. The Electronic Symptom Assessment and Self-Care (ESRA-C) promotes participant self-management of treatment-related symptoms by providing participants with communication coaching and symptom self-report, education, and tracking features. While the ESRA-C intervention has been demonstrated to improve symptom distress significantly, little is known as to how the ESRA-C influenced participants' self-management practices and adherence to clinician recommendations for symptom/quality of life issues (SQIs).

OBJECTIVE

To compare participant adherence to clinician recommendations and additional self-management strategy use for SQIs between ESRA-C intervention and control (electronic symptom assessment and participant symptom reports alone) group participants. Secondarily, we explored the impact of participant adherence to clinician recommendations and additional self-management strategy use for SQIs on symptom control, symptom management satisfaction, and symptom distress. Lastly, we examined baseline predictors of participant adherence to clinician recommendations and additional self-management strategy use for SQIs.

METHODS

This study presents an analysis of a randomized controlled trial. Participants beginning a new chemotherapy or radiotherapy regimen were recruited from oncology outpatient centers and were randomized to receive the ESRA-C intervention or control during treatment. Patients were included in this analysis if they remained on study through the duration of treatment and self-reported at least one bothersome SQI three-to-six weeks after beginning treatment. The Symptom Distress Scale-15 and Self-Management of SQIs Questionnaire were completed two weeks later. Based on Self-Management of SQIs Questionnaire ratings, participants were placed into adherence to clinician recommendations (adhered/did not adhere/did not receive recommendations) and additional self-management strategy use (yes/no) categories.

RESULTS

Most participants were adherent to clinician recommendations (273/370, 73.8%), while fewer used additional self-management strategies for SQIs (182/370, 49.2%). There were no differences in the frequency of participant adherence to clinician recommendations (chi-square test, P=.99) or self-management strategy use (chi-square test, P=.80) between intervention (n=182) and control treatment groups (n=188). Participants who received clinician recommendations reported the highest treatment satisfaction (n=355, P<.001 by analysis of variance; ANOVA), although lowest distress was reported by participants who did not follow clinician recommendations (n=322, P=.04 by ANOVA) for top 2 SQIs. Women (n=188) reported greater additional self-management strategy use than men (n=182, P=0.03 by chi-square test).

CONCLUSIONS

ESRA-C intervention use did not improve participants' adherence to clinician recommendations or additional self-management strategy use for SQIs in comparison to the control. Future research is needed to determine which factors are important in improving patients' self-management practices and symptom distress following ESRA-C use.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00852852; https://clinicaltrials.gov/ct2/show/NCT00852852 (Archived by WebCite at http://www.webcitation.org/73rEhNWkU).

Hypnosis for Symptom Control in Cancer Patients at the End-of-Life: A Systematic Review

Hypnosis has been shown to alleviate symptoms and side effects of cancer and its treatment. However, less is known about the use of hypnosis at the end of life in individuals with cancer. Our goal was to systematically review the literature on the use of hypnosis to manage the most common symptoms of end-of-life cancer patients: fatigue, sleep disturbances, pain, appetite loss, and dyspnea. EMBASE, MEDLINE, COCHRANE, PsychINFO, and SCOPUS databases were searched from inception through November 7, 2016. No studies met the inclusion criteria. It appears that hypnosis has never been rigorously tested as a means to ameliorate the most common symptoms in individuals with cancer at the end of their lives. This finding is troubling, as it strongly implies that a population most in need has been largely neglected. However, a clear future research direction is revealed that may have significant clinical impact.