The experience of patients with cancer during diagnosis and treatment planning: a descriptive study of Canadian survey results

'How Your Spirit Is Travelling'-Understanding First Nations Peoples' Experiences of Living Well with and after Cancer

As the number of people living with cancer increases, it is important to understand how people can live well with and after cancer. First Nations people diagnosed with cancer in Australia experience survival disparities relating to health service accessibility and a lack of understanding of cultural needs and lived experiences. This study aimed to amplify the voices of First Nations individuals impacted by cancer and advance the development of a culturally informed care pathway. Indigenist research methodology guided the relational and transformative approach of this study. Participants included varied cancer experts, including First Nations people living well with and after cancer, health professionals, researchers, and policy makers. Data were collected through online Yarning circles and analysed according to an inductive thematic approach. The experience of First Nations people living well with and after cancer is inextricably connected with family. The overall themes encompass hope, family, and culture and the four priority areas included the following: strength-based understanding of cancer, cancer information, access to healthcare and support, and holistic cancer services. Respect for culture is interwoven throughout. Models of survivorship care need to integrate family-centred cancer care to holistically support First Nations people throughout and beyond their cancer journey.

Hopelessness and Social Support among Cancer Patients in Saudi Arabia

BACKGROUND

Receiving a cancer diagnosis can be extremely stressful for patients, as it is a life-threatening disease. However, when this topic is discussed or researched, the psychological state of cancer patients is often ignored or forgotten. The study aimed to measure the levels of hopelessness and social support among cancer patients. It also aimed to assess the relationship between different demographic variables, hopelessness, and social support of these patients.

METHODS

The study followed a cross-sectional quantitative design. The setting included Princess Norah Oncology Center, at King Abdul-Aziz Medical City, Jeddah.   A convenience sampling technique including 300 cancer patients was followed. Data collection included a demographic questionnaire, the Beck Hopelessness Scale (BHS), and the Multidimensional Scale of Perceived Social Support (MSPSS).  Ethical principles of anonymity and confidentiality were followed.

RESULTS

The total number of respondents was 300, with 50% being male and 50% being female. The mean age of patients was 52.6±14.83 years. The most prevalent types of cancer were breast cancer (21.4%), colorectal (15.2%), and lymphoma (12.1%) respectively. Most of the patients were married (71.3%). The mean value of the BHS was 4.5, whereas the mean value of the MSPSS was 67.7. Moreover, the type of cancer showed a significant association between family support and total social support. In colorectal cancer patients, the total social support (71.2 ± 20.1) and family support (26.2 ± 5.0) provided was the highest followed by leukemia (70.3 ± 15.5 and 25.2 ± 5.1) and breast cancer (68.3-± 20.3. and 24.3 ± 6.8).

CONCLUSION

The findings of the present study suggest that the levels of hopelessness in cancer patients are moderate, and the levels of social support received by participants are high. In addition, the relationship between the levels of hopelessness and the levels of social support received is inversely proportional.

A Retrospective Age Analysis of the Ambulatory Oncology Patient Satisfaction Survey: Differences in Satisfaction across Dimensions of Person-Centred Care and Unmet Needs among Older Adults Receiving Cancer Treatment

Over half of all new cancer cases in Alberta are diagnosed among people aged 65+ years, a group that encompasses vast variation. Patient-reported experience measures are routinely collected within Cancer Care Alberta; however, the specific consideration of the needs and concerns of older Albertans with cancer is lacking. In 2021, 2204 adults who had received treatment at a cancer centre in Alberta completed the Ambulatory Oncology Patient Satisfaction Survey (AOPSS). In this study, we explored the age differences in satisfaction across six dimensions of person-centred care and in the proportions of unmet needs across eight types of issues, with specific attention to older adults. Using three age groups (18-39, 40-64, 65+), only the physical comfort dimension showed significantly lower satisfaction among those aged 65+ years. Using five age groups (18-39, 40-64, 65-74, 75-84, 85+), significantly lower levels of satisfaction were found related to 'physical comfort' for those aged 65-74 and 75-84, 'coordination and continuity of care' for those aged 75-84 and 85+, and 'information, communication, and education' for those aged 85+. Therefore, grouping together all older adults aged 65+ years obscured lower levels of satisfaction with some dimensions of person-centred care among those aged 75-84 and 85+ years. Unmet needs generally increased with age for all types of issues, with significant differences across age groups for emotional, financial, social/family, and sexual health issues. The lower levels of satisfaction and higher proportions of unmet needs call for tailored interventions to promote optimal care experiences and outcomes among older adults receiving cancer care in Alberta and their families.

The effect of two different types of music played to cancer patients during chemotherapy on anxiety, nausea, and satisfaction levels

PURPOSE

To investigate the effect of two different types of music on anxiety, nausea, and satisfaction levels in cancer patients receiving chemotherapy (CT) for the first time.

METHODS

The study was conducted as a single-blind, pre-test, post-test, three-group randomized controlled trial in an outpatient CT unit between August 2022 and February 2023. A simple (computer-based) and stratified (age and gender) randomization method was used to assign 75 patients to the relaxing music group (RMG), Turkish classical music group (TCMG), and control group (CG) (n = 25 each). The primary outcome was the change in anxiety levels measured by Spielberger's State Anxiety Inventory before (T0) and after (T1) CT session. Secondary outcomes were the change in the severity of nausea from T0 to T1 and the level of satisfaction at T1.

RESULTS

The groups were similar in terms of baseline sociodemographic and health-related characteristics. Anxiety levels were lower than the baseline in RMG and TCMG in comparison to CG, and repeated measures analysis showed a significant group × time interaction (p = 0.001, F = 210.221, η2 = 0.745). Nausea severity increased from T0 to T1 for CG but decreased for RMG and TCMG with a significant group × time interaction (p = 0.001, F = 100.785, η2 = 0.583). The satisfaction level was significantly higher in TCMG than in CG and RMG (8.64 ± 0.95 vs. 7.88 ± 0.72, and 7.00 ± 0.70, respectively).

CONCLUSION

Music may be an effective non-pharmacologic option to relieve patients' anxiety and nausea during first-time CT. Larger, multicenter studies evaluating the long-term effect of music are needed to confirm these findings.

TRIAL REGISTRATION

clinicaltrials.gov (NCT05687838)/2022-13/18.

Patient perspectives of 'Watch and Wait' for chronic haematological cancers: Findings from a qualitative study

PURPOSE

Chronic blood cancers are incurable, and characterised by unpredictable, remitting-relapsing pathways. Management often involves periods of observation prior to treatment (if required), and post-treatment, in an approach known as 'Watch and Wait'. This study aimed to explore patient experiences of 'Watch and Wait'.

METHODS

In-depth interviews with 35 patients (10 accompanied by relatives) with chronic lymphocytic leukaemia, follicular lymphoma, marginal zone lymphoma or myeloma. Data were analysed using descriptive qualitative techniques.

RESULTS

Patient views of Watch and Wait ranged along a continuum, from immediate acceptance, to concern about treatment deferral. Significant ongoing anxiety and distress were described by some, due to the uncertain pathways associated with Watch and Wait. Infrequent contact with clinical staff was said to exacerbate this, as there was limited opportunity to ask questions and seek reassurance. Patients indicated that the impact of their malignancy could be underestimated by clinicians; possibly due to them comparing chronic and acute subtypes. Most patients lacked knowledge of blood cancers. Support from clinicians was considered greater among treated patients, possibly due to increased contact, and many drew on relatives for aid. Most patients were satisfied with their time-allocation with haematology staff, although experiences could be improved by greater access to clinical nurse specialists, counselling services, and community-based facilities.

CONCLUSION

Experiences varied. Anxiety about unpredictable futures could be more distressing than any physical symptoms and have a greater impact on quality of life. Ongoing assessment could facilitate identification of difficulties, and is particularly important among individuals without supportive networks.

The Patient's perspective: A review of the results from a radiotherapy patient experience survey in the North-West of England

INTRODUCTION

A patient experience survey was undertaken for patients completing radiotherapy at the three Northwest of England Radiotherapy Providers.

METHODS

A previously reported National Radiotherapy Patient Experience Survey was adapted and undertaken in the Northwest of England. Quantitative data was analysed to establish trends. Frequency distribution was applied to appraise the number of participants selecting each of the pre-determined responses. Thematic analysis of free text responses was conducted.

RESULTS

The questionnaire received 653 responses from the 3 providers across seven departments. Thematic analysis revealed 3 themes; logistics, information and operational.

CONCLUSION

The results indicate that the majority of patients are satisfied with their treatment and care. Patients' responses indicate areas for improvements. Expectancy theory states that an individual's satisfaction is related to the difference between expected service and the service received. Consequently, when reviewing services and developing improvement it is important to understand patients' expectations^. This regional survey starts to capture what people receiving radiotherapy expect from the service and the professionals delivering their treatment.

IMPLICATIONS FOR PRACTICE

This survey responses make a case for reviewing the information provision pre and post radiotherapy. This includes clarifying the understanding of consent for treatment including the intended benefits and potential late effects. There is an argument to offer information sessions prior to radiotherapy to achieve more relaxed and informed patients. A recommendation from this work is for the radiotherapy community undertake a national radiotherapy patient experience survey, facilitated via the 11 Radiotherapy ODNs. A national radiotherapy survey has multiple benefits to inform improvements in practice. This includes benchmarking services against national averages. This approach is aligned with the principles of the service specification in terms of reducing variation and increasing quality.

Quantifying the Impact of Family Doctors on the Care Experiences of Patients with Cancer: Exploring Evidence from the 2021 Ambulatory Oncology Patient Satisfaction Survey in Alberta, Canada

Oncology programs across Canada are reaching capacity as more Canadians are diagnosed with and treated for cancer each year. There is an increasing need to share care with family doctors, however it is unclear how this type of care impacts patient experiences, particularly while receiving active treatment. Retrospective data from the 2021 Ambulatory Oncology Patient Satisfaction Survey (AOPSS) in Alberta, Canada was used in this study. A unique question on the Alberta survey asks patients about their family doctor's involvement during their cancer care. Patient satisfaction across the six domains of person-centred care on the AOPSS was analyzed based on how involved a patient's family doctor was. Compared to patients who indicated their family doctor was "Not involved", patients with "Very involved" family doctors had significantly higher satisfaction scores in all six domains of care. The three domains which showed the largest positive impact of family doctor involvement were: Coordination & Integration of Care, Emotional Concerns, and Information, Communication & Education. The results demonstrate that involving family doctors in cancer care can be beneficial for patients. Based on the observed satisfaction increases in this study, shared care models may be preferred by many patients. These models of care can also help alleviate strain and capacity issues within cancer programs. The results could be used to support recommendations for cancer care teams to regularly involve and communicate with family doctors, to ensure that patients receive comprehensive and tailored care from all their health care providers.

Perception of Survivorship Needs Among Breast Cancer Patients in Trinidad and Tobago

The perception of survivorship among the cancer communities of the Caribbean is largely unknown. This study focused on determining the perception and interest in cancer survivorship among breast cancer (BC) patients in Trinidad and Tobago, as a preliminary, to introducing a pilot survivorship program and evaluating its impact on this patient population. Participants were given a questionnaire to determine needs, expectations and interest in survivorship care. Baseline measurable outcomes reported in this article include the following: 1. Participants' satisfaction with their medical care follow-up plan (if any), 2. Participants' satisfaction with the amount of information provided by healthcare providers, and 3. Participants' satisfaction with their physician's overall concern about their well-being, ranked on a 5-point Likert scale. Participants also reported on the advice/ guidelines provided by their physicians, after surgery and/or on completion of treatment, what they did to cope with BC, and their expectations of what could have been done to improve the quality of care received. A second questionnaire was then used to measure the level of interest in participating in a Cancer Survivorship Program (CSP) with components such as: nutrition, psychosocial development, spiritual well-being, and yoga and mindfulness. The level of interest was ranked by participants on a 5-point Likert scale. Fifteen themes emerged from participants' responses to the first questionnaire. Nutrition stood out as the module of highest interest, followed by psychosocial development among BC patients.

Patients' experiences with cancer care in Switzerland: Results of a multicentre cross-sectional survey

OBJECTIVES

The objectives were to describe patients' experiences of cancer care in Switzerland and explore the variation of these experiences by type of cancer.

METHODS

The Swiss Cancer Patient Experiences (SCAPE) study was a cross-sectional, multicentre survey conducted in 2018. Adult patients (n = 7145) with breast, prostate, lung, colorectal, skin or haematological cancer from four large hospitals in French-speaking Switzerland were invited to complete a survey. Logistic regressions were used to assess whether experiences varied according to cancer type, adjusting for confounders.

RESULTS

Of the 3121 persons who returned the survey (44% response rate), 2755 reporting an eligible cancer were included in the analyses. Participants' average score for overall care was 8.5 out of a maximum score of 10. Higher rates of positive experiences were found for nurse consultations (94%), diagnostic tests (85%) and inpatient care (82%). Lower positive responses were reported for support for people with cancer (70%), treatment decisions (66%), diagnosis (65%) and home care (55%). We observed non-systematic differences in experiences of care by cancer type.

CONCLUSIONS

This large study identified that cancer patient experiences can be improved in relation to communication, information and supportive care aspects. Improvement efforts should target these areas of care to enhance responsiveness of cancer care.

Factors influencing cancer survivors' experiences with follow-up cancer care: results from the pan-Canadian Experiences of Cancer Patients in Transition Study survey

PURPOSE

The purpose of this study was to examine the influence of individual and structural factors on cancer survivors' experiences with follow-up cancer care.

METHODS

In 2016, the Canadian Partnership Against Cancer collected survey responses from cancer survivors about their experiences with follow-up cancer care. We included respondents from this survey if they were diagnosed with non-metastatic breast, hematologic, colon, melanoma, and prostate cancer. Our primary outcome was cancer survivors' self-reported overall experience with follow-up cancer care. We used multivariable logistic regression to examine the influence of individual and structural factors on cancer survivors' experiences with follow-up cancer care.

RESULTS

Of the 8402 cancer survivors included in our study, 81.8% (n = 6,875) reported a positive experience with their follow-up cancer care. The individual factors associated with positive overall experiences were more commonly those associated with self-perceptions of respondents' personal health and well-being rather than baseline sociodemographic factors, such as sex, income, or education. For example, respondents were more likely to report a positive experience if they perceived their quality of life as good (OR 1.9, 95% CI 1.0-3.5, p < 0.01) or reported not having an unmet practical concern (OR 1.3, 95% CI 1.1-1.6, p < 0.01). The structural factors most strongly associated with positive overall experiences included respondents perceiving their oncology specialist was in charge of their follow-up cancer care (OR 5.2, 95% CI 3.6-7.5, p < 0.01) and reporting the coordination of their follow-up cancer care among healthcare providers was good or very good (OR 8.4, 95% CI 6.7-10.6, p < 0.01).

CONCLUSION

While real-world experiences with follow-up cancer care in Canada are reported to be positive by most cancer survivors included in this study, we found differences exist based on individual and structural factors. A better understanding of the reasons for these differences is required to guide the provision of high-quality follow-up care that is adapted to the needs and resources of individuals and contexts.

Experiences of cancer survivors in Europe: Has anything changed? Can artificial intelligence offer a solution?

Introduction

Cancer is a major global health issue. Despite technological advancements in oncology, challenges remain in many aspects related to cancer management. This study constitutes one part of the user requirement definition of INCISIVE EU H2020 project, which has been designed to explore the full potential of artificial intelligence (AI) based technologies in cancer imaging. The study aimed to explore cancer survivors’ experiences of cancer care in five European countries.

Methods

A qualitative study employing semi-structured interviews was conducted. A purposive sampling strategy was used to recruit participants across the five validation countries of INCISIVE project: Greece, Cyprus, Spain, Italy, and Serbia. Forty cancer survivors were interviewed between November 2020 and March 2021. Data was analysed thematically using the framework approach and coded using NVivo12 software.

Results

The analysis yielded several gaps within the cancer care pathway which reflected on the participants experiences. Five key themes were revealed; (1) perceived challenges during the cancer journey, (2) the importance of accurate and prompt diagnosis, (3) perceived need for improving cancer diagnosis, (4) absence of well-established/designated support services within the pathway and (5) suggestions to improve cancer care pathway.

Conclusion

Cancer survivors experienced significant burdens pertaining to cancer diagnosis and treatment. Our findings underscored some main gaps within the cancer care pathway which contributed to the challenges articulated by the participants including lack of resources and delays in diagnostic and treatment intervals. Additionally, several suggestions were provided by the cancer survivors which could be considered towards the improvement of the current state of care, some of which can be optimised using new technologies involving AI such as the one proposed by INCISIVE.

Croatian National Cancer Patient Experience Survey

Background: Cancer patients’ experiences of the healthcare system, care, and treatment are increasingly viewed as important in order to inform and improve quality of care, patient safety, and treatment efficacy. Understanding patient experience is a key step in moving toward patient-centred care. The aims of this study were to determine the experience of cancer patients in Central and Eastern European countries and to identify the needs and perspectives of oncological patients during the cancer treatment. In this paper, results from Croatia are presented. Methods: A sixty-nine item online survey was translated by native-language participating countries. Only registered members (subjects with confirmed cancer diagnosis) of the national patient oncology associations in each participating country were allowed to access and complete the online questionnaire (n = 16,458). Data were collected between October 2018 to February 2019. The Croatian Coalition of Health Associations enabled the authors of this paper to use the collected data from a sample of the Croatian participants (n = 2460) for the purposes of publication. Results: Two-thirds (67.3%) of the respondents reported satisfaction with the length of time needed for getting tests done. Bad news was delivered sensitively to 52.97% of the participants, and 52.76% received a cancer treatment plan. During the hospitalisation, 45.93% responded that they did not find someone from the hospital staff whom they could talk to about their worries and fears, and 57.48% were not given any contact information in case of concerns about their condition or treatment following the discharge. Regarding the patients’ preferences, needs, and values, 60.81% of the respondents felt that the greatest improvement would be to perform all services in one place, and 55.28% felt that improvement would be achieved through a multidisciplinary team coordinated by one person. Conclusions: The study reveals domains that need to be addressed in the overall Croatian healthcare system for oncology patients. Based on the obtained data, we can conclude that there is a large need for improvement in patient experience on the oncology pathway.

Factors influencing cancer patients' experiences of care in the USA, United Kingdom, and Canada: A systematic review

The extent to which individual and structural factors influence cancer patients' reports of their experiences are not yet well understood. We sought to identify which groups of patients consistently report poorer experiences and whether structural care factors might also be associated with better or worse reports. We conducted a systematic review of literature in PubMed and Web of Science with the date of last search as 27th of February 2022 following PRISMA guidelines. We focused on studies from three established population-based surveys datasets and instruments. After screening 303 references, 54 studies met the inclusion criteria. Overall, being from an ethnic minority group, having a more deprived socioeconomic status, poorer general or mental health status, being diagnosed with poor prognosis cancers, presenting to care through an emergency route, and having delayed treatment were consistently associated with poorer cancer care experiences. Conversely being diagnosed with earlier stage disease, perceiving communication as effective, positive patient-provider relationships, and receiving treatment with respect were overall associated with better reports of cancer care experiences. Improvement efforts aimed at delivering better experiences of patient-centred care need to take account much more explicitly patients' differing characteristics, prognoses, and trajectories they take through their care journeys.

Comparison of Patient-Reported Experience of Patients Receiving Radiotherapy Measured by Two Validated Surveys

Patient-reported experience is associated with improved patient safety and clinical outcomes. Quality improvement programs rely on validated patient-reported experience measures (PREMs) to design projects. This descriptive study compares the experience of cancer patients treated with radiation as recorded through the Ambulatory Oncology Patient Satisfaction Survey (AOPSS) or as recorded through Your Voice Matters (YVM) between February and August 2019. Six questions were compared (“overall experience with care”, “discussion of worries”, “involvement in decisions”, “trusting providers with confidential information”, “providing family with information”, and “knowing who to contact”). Positive experience scores were calculated by cohort and by tumor groups. Multivariable logistic regression models evaluated factors associated with positive experience. Two cohorts (220 and 200 patients) met the eligibility criteria for the AOPSS and YVM, respectively. Positive experience was reported similarly between the two PREMs for “overall experience with care”, “discussion of worries”, and “trusting providers with confidential information” with a score difference of 1–4% at the cohort level. Positive experience score difference ranged from 5% to 44% across questions at the tumor group level. Different experience gaps were identified with the two measures, mainly at the tumor group level. Programs interested in using these PREMS might consider this when designing projects.

Investigating the experiences, thoughts, and feelings underlying and influencing prehabilitation among cancer patients: a qualitative perspective on the what, when, where, who, and why

Purpose: To investigate the experiences, thoughts, and feelings that underlie and influence prehabilitation among cancer patients due to undergo major abdominal surgery.Materials and methods: Prior to their surgery, sixteen patients with peritoneal carcinomatosis of colorectal or ovarian origin due to undergo major surgery received oral information and a leaflet with preoperative recommendations. They subsequently participated in individual, semi-structured interviews. Malterud's principles of systematic text condensation were used to analyse the interviews, and the concept of action competence inspired and framed the discussion.Results: Although the patients found themselves in an unpredictable and uncontrollable situation, they nevertheless knew what was important to them. These factors were contextualised in five themes that reflected the experiences, thoughts, and feelings that underlay and influenced their actions: "Perception of preparation," "The two-sided preoperative period," "Home or facility-based prehabilitation," "Stakeholders in prehabilitation," and "Reasons for taking action".Conclusions: The patients demonstrated action competence in relation to their preoperative preparation. However, in relation to the kind of prehabilitation that required lifestyle changes, their action competence needed to be developed and supported. To do so, it is necessary to ask questions that cover the patients' perspectives of the what, when, where, who, and why of prehabilitation.IMPLICATIONS FOR REHABILITATIONPatients undergoing major, abdominal cancer surgery have very clear opinions about what are important to them during the preoperative period, and this is not only limited to prehabilitation-related actions.In order to develop patients' action competence in relation to prehabilitation, patients need more support and supervision from health professionals.Qualitative in-depth knowledge concerning the what, when, where, who, and why of prehabilitation should be taken into account in the development of future prehabilitation programmes.

The patient experience of ambulatory cancer treatment: a descriptive study

Background

Patient experience is often measured quantitatively, but that approach has limitations for understanding the entire experience. Qualitative methods can help to understand more complex issues most important to patients and their families. The purpose of the present work was to use a qualitative analysis examining the patient experience of ambulatory cancer care in Ontario to generate a deeper understanding of the patient experience and to lead to solutions for improvement.

Methods

Data from the Ambulatory Oncology Patient Satisfaction Survey (aopss) for 2013-2015 were used to conduct a qualitative content analysis. The aopss is a retrospective paper-based survey, mailed to patients who are currently receiving cancer treatment or who have received cancer treatment within the preceding 6 months, that is designed to capture their experiences. Patients who were surveyed were asked, "Is there anything else you would like to tell us about your cancer care services?" The National Research Corporation Canada's patient-centred care framework was used to guide the analysis.

Results

From the 5391 patients who responded, 7328 coded responses were generated, of which 3658 (49.9%) were related to the patient-centred care framework. New subthemes were identified: diagnosis sensitivity; emotional support resources; care delivery with care, compassion, and comfort; continuity of care between departments and in the community; access to cancer centre personnel; patient-health care provider communication; confidence in the health care provider; wait times; health care provider and treatment coordination; and parking.

Conclusions

The results identify facilitators and barriers to the patient experience in the ambulatory cancer treatment setting from the patient perspective and identify opportunities to improve the patient experience.

Psychological issues in cancer survivorship

Thankfully, many more women are now surviving cancer due to advances in awareness, surveillance, and treatment. In fact, many oncology clinicians now consider cancer a chronic illness. This has meant that a growing number are living with the physical and psychological consequences of the disease. The psychological impact and emotions experienced by survivors are varied. Some reactions are more common than others, including the onset of depression, anxiety, and sexual dysfunction and feelings of abandonment, isolation, grief, and fear of recurrence. Body image and sexuality are also commonly impacted by cancer, particularly by women who experience treatment-induced menopause. Existential and spiritual concerns can also cause psychological consequences. In time, however, many women adjust to life as a cancer patient and find new meaning and purpose in their lives. The aim of this article is to highlight the key psychological issues faced by women who are in the chronic or survivorship phase of their cancer experience. The article also aims to emphasize the need for ongoing evaluation of the psychological status of these women during regular follow-up appointments. This will ensure that patient-centered supportive care is optimized.