Patients' experience of receiving radiation treatment for head and neck cancer: Before, during and after treatment

The psychosocial experiences of human papillomavirus (HPV) positive oropharyngeal cancer patients following (chemo)radiotherapy: A systematic review and meta-ethnography

OBJECTIVE

The UK incidence of oropharyngeal cancer has risen sharply over the last 30 years with an increase in human papillomavirus (HPV) associated diagnoses, most prevalent in younger, working age populations. This meta-ethnography explores the psychosocial needs of HPV+ve oropharyngeal cancer patients during early recovery following (chemo)radiotherapy.

METHODS

Meta-ethnography methods were used, based on the approach of Noblit and Hare. Systematic searches for relevant qualitative studies were conducted in five electronic databases (MEDLINE, PubMed, CINAHL, PsycINFO and Cochrane database) between 2010 and 2021, followed by citation searching.

RESULTS

Twenty-three papers exploring the psychosocial needs of HPV+ve oropharyngeal cancer patients after treatment were included. Findings were synthesised to develop five constructs: 'gaps in continuity of support from healthcare professionals' reflecting unmet needs; 'changes to self-identity' revealing the comprehensive disruption of this disease and treatment; 'unrealistic expectations of recovery' highlighting the difficulty of preparing for the impact of treatment; 'finding ways to cope' describing the distinct complexity of this experience; and 'adjusting to life after the end of treatment' exploring how coping strategies helped patients to regain control of their lives.

CONCLUSIONS

Completing (chemo)radiotherapy signalled a transition from hospital-based care to home-based support, challenging patients to address the constructs identified. An unexpectedly difficult and complex recovery meant that despite a favourable prognosis, poor psychosocial well-being may threaten a successful outcome. The provision of tailored support is essential to facilitate positive adjustment.

Psychoneurological Symptoms and Biomarkers of Stress and Inflammation in Newly Diagnosed Head and Neck Cancer Patients: A Network Analysis

Psychoneurological symptoms are commonly reported by newly diagnosed head and neck cancer (HNC) patients, yet there is limited research on the associations of these symptoms with biomarkers of stress and inflammation. In this article, pre-treatment data of a multi-center cohort of HNC patients were analyzed using a network analysis to examine connections between symptoms (poor sleep quality, anxiety, depression, fatigue, and oral pain), biomarkers of stress (diurnal cortisol slope), inflammation markers (c-reactive protein [CRP], interleukin [IL]-6, IL-10, and tumor necrosis factor alpha [TNF-α]), and covariates (age and body mass index [BMI]). Three centrality indices were calculated: degree (number of connections), closeness (proximity of a variable to other variables), and betweenness (based on the number of times a variable is located on the shortest path between any pair of other variables). In a sample of 264 patients, poor sleep quality and fatigue had the highest degree index; fatigue and CRP had the highest closeness index; and IL-6 had the highest betweenness index. The model yielded two clusters: a symptoms-cortisol slope-CRP cluster and a IL-6-IL-10-TNF-α-age-BMI cluster. Both clusters were connected most prominently via IL-6. Our findings provide evidence that poor sleep quality, fatigue, CRP, and IL-6 play an important role in the interconnections between psychoneurological symptoms and biomarkers of stress and inflammation in newly diagnosed HNC patients.

Exploring the cancer patients' experiences during external radiotherapy: A systematic review and thematic synthesis of qualitative and quantitative evidence

PURPOSE

To investigate the subjective experience of adult cancer patients undergoing external radiotherapy and provide evidence for better practices in radiotherapy services.

METHODS

A systematic review was performed according to the PRISMA Statement Guidelines. Qualitative and mixed studies were identified through five electronic databases (CINAHL, PsychINFO, Medline, Scopus and Web of Science), between March and April 2020, using defined criteria. Methodological quality assessment was conducted, and the data integrated into a thematic synthesis.

RESULTS

Of the 886 studies identified, 13 met our inclusion criteria. Patients experiences were described into four main themes: (1) Time, (2) Physical Environment, (3) Treatment Concerns and (4) Radiotherapy Team. Time refers to waiting time and treatment time; Physical Environment states temperature in the treatment room and equipment; Treatment Concerns included side effects, daily activities, positioning and immobilization and treatment preparation (e.g., bladder filling); radiotherapy team comprised patients support; response to patients needs and recognized team. The generating analytical phase of thematic analysis allowed us to recognize that the effectiveness of the radiotherapy team operates as a facilitator of the patients' experience. In contrast, time in the waiting room, the treatment preparation when is required, and the positioning and immobilization, specifically for the neck and head patients, act as barriers.

CONCLUSION

Four distinct themes were identified to be positively and negatively associated with patients' experience during external radiotherapy. The evidence provides valuable recommendations to improved radiotherapy services organization, as well as to the delivery of more patient-centred care adjusted to the concerns and needs of patients.

Managing the effects of cancer and cancer treatments on patients' nutritional status

Adequate nutrition is a basic requirement of the human body, supporting cell growth and optimal organ function. The nutritional requirements of patients with cancer can increase due to systemic inflammatory responses caused by cancer and cancer treatments. Nurses have an important role in providing nutritional interventions to patients undergoing treatment for cancer, through education and person-centred nutritional care. This article examines which nutritional interventions provided by nurses can relieve symptoms and side effects, improve nutritional status and enhance quality of life in patients with cancer.

The Lived Experiences of Patients with Head and Neck Cancer during Concurrent Chemoradiation Therapy Care Process

Purpose:

An exploration of concurrent chemoradiation therapy care process from the perspective of patients with head and neck cancer can provide an insight to their lived experience and the difficulties they encounter in daily life towards a deeper understanding of this phenomenon to shape nursing service delivery. The aims of this study were to explore the lived experiences of patients with head and neck cancer while receiving concurrent chemoradiation therapy.

Methods:

Data were generated from individual in-depth interviews with fifteen head and neck cancer patients, according to the semi-structured interview guidelines, at the out-patient radiation oncology department, Chulabhorn Cancer Center, Bangkok, Thailand.

Results:

By using Graneheim and Lundman’s content analysis, three categories from the data analysis of patients with head and neck cancer receiving concurrent chemoradiation therapy were isolated: 1) overwhelming information, 2) unpleasant symptom cluster, and 3) strategy for adherence to treatment regimen.

Conclusion:

The findings help to provide a better understanding of the lived experiences of patients with head and neck cancer during concurrent chemoradiation therapy, in terms of their suffering from various unpleasant side effects and how these impact their life along the treatment journey. This perspective on the care process in these patients enhances the development of a nursing care model based on patient-centered care toward positive patient outcomes.

A qualitative descriptive study of patients' experiences of a radiation skin reaction associated with treatment for a head and neck cancer

The majority of patients receiving radiation therapy will experience a radiation skin reaction, ranging from mild erythema to severe moist desquamation. The anticipated skin reaction will vary by cancer diagnosis, dose of radiation, size of treatment field, and other treatment-and patient-related factors. Recently, research has dispelled long-held myths about avoiding skin care products prior to treatment, and the use of deodorant or antiperspirant during treatment for breast cancer and any potential for an increased skin dose with the use of skin care products. Patients no longer are restricted in using these products. Most of the research regarding skin reactions due to radiation has been conducted with women with breast cancer. No research has been found on the experience of a radiation skin reaction in patients with head and neck cancer (HNC), who often get the most severe skin reactions across all patient groups. Using the qualitative interpretive descriptive approach based on the methodological work by Thorne (1997), nine participants were interviewed about their experience of having a radiation skin reaction resulting from their treatment for HNC. Three themes emerged from the interviews, including 1) the symptom experience, 2) comparison to others, and 3) the experience of support and information. Implications include recommendations for practice and patient education.

Étude qualitative descriptive sur l’expérience des patients avec réactions cutanées induites par la radiothérapie pour un cancer de la tête et du cou

La majorité des patients recevant de la radiothérapie auront une réaction cutanée radio-induite allant d’un érythème léger à une desquamation humide étendue. Les réactions cutanées attendues varieront en fonction du diagnostic de cancer, de la dose et de la taille du champ d’irradiation ainsi que d’autres facteurs liés au traitement et au patient. Récemment, la recherche a dissipé les mythes longtemps entretenus sur les produits pour le soin de la peau qui auraient été à éviter avant le traitement, tout comme le déodorant et l’antisudorifique durant les traitements contre le cancer du sein (on craignait une surdose accrue pour la peau causée par l’utilisation de ces produits). Cette limitation a été levée. Or, la plupart des recherches sur les réactions cutanées radio-induites ont été menées auprès de femmes atteintes d’un cancer du sein; aucune n’a été trouvée sur les patients atteints de cancer de la tête et du cou, alors que de tous les groupes de patients, ce sont très souvent ceux-ci qui présentent les réactions cutanées les plus graves. Nous avons fait appel à la méthode descriptive interprétative qualitative basée sur le travail méthodologique de Thorne (1997) pour interroger neuf participants sur leurs réactions cutanées par suite de radiations pour leur cancer de la tête et du cou. Trois thèmes sont ressortis des entretiens : 1) l’expérience des symptômes; 2) la comparaison avec d’autres; 3) l’expérience du soutien et de l’information. Les implications comprennent des recommandations pour la pratique et l’éducation des patients.

HPV-Positive Oropharyngeal Cancer: The Nurse's Role in Patient Management of Treatment-Related Sequelae

BACKGROUND

Patients diagnosed with oropharyngeal cancer (OPC) make up about 3% of all new cancer cases in the United States, with increasing numbers of these patients being diagnosed aged younger than 45 years and with human papillomavirus (HPV)-positive disease. Treatment effects may alter patients' physical and mental states during and after treatment.

OBJECTIVES

This article provides an overview of possible OPC treatment long-term effects to equip oncology nurses with information needed to empower patients with OPC to perform self-care.

METHODS

The OPC literature was reviewed to identify incidence, survival, risk factors, symptoms, treatment options, and treatment effects.

FINDINGS

This article provides a foundation for the plan of care for patients with OPC and strategies for patients to contribute to their self-care.

Head and neck cancer management and cancer stem cells implication

Head and neck squamous cell carcinomas (HNSCCs) arise in the mucosal linings of the upper aerodigestive tract and are heterogeneous in nature. Risk factors for HNSCCs are smoking, excessive alcohol consumption, and the human papilloma virus. Conventional treatments are surgery, radiotherapy, chemotherapy, or a combined modality; however, no international standard mode of therapy exists. In contrast to the conventional model of clonal evolution in tumor development, there is a newly proposed theory based on the activity of cancer stem cells (CSCs) as the model for carcinogenesis. This “CSC hypothesis” may explain the high mortality rate, low response to treatments, and tendency to develop multiple tumors for HNSCC patients. We review current knowledge on HNSCC etiology and treatment, with a focus on CSCs, including their origins, identifications, and effects on therapeutic options.