Complementary and alternative medicine in oncology: knowledge, attitude and practice among Tunisian healthcare workers

PURPOSE

Over the past years, there has been a considerable increase in complementary and alternative medicine (CAM) use among cancer patients. However, guidance from health care workers (HCWs) is not always provided. We aimed to determine the knowledge, attitude and practice of Tunisian HCWs regarding the use of CAM in cancer patients.

METHODS

We conducted a multicenter cross-sectional study over 5 months from February to June 2022 among HCWs caring for cancer patients in the Tunisian center region. Data were collected using a self-administered questionnaire developed by our investigators.

RESULTS

The level of knowledge about CAM was declared limited by 78.4% of our population. The best known CAM therapies were herbal medicine and homeopathy while chiropractic and hypnosis where the least. HCWs who had sought information on CAM represented 54.3% of our sample and the main source of information was the Internet (37.1%). A positive attitude towards the use of CAM was found in 56% of HCWs. The integration of CAM into supportive care in oncology was approved by 78% of HCWs. Concerning training on CAM, 78% declared its necessity for HCWs and 73.3% expressed a desire to have it. A personal use of CAM was found in 53% of HCWs while 38.8% had previously used CAM in the treatment of their cancer patients.

CONCLUSION

The majority of HCWs had a positive attitude towards the use of CAM in oncology despite their poor knowledge about it. Our study emphasizes the need to train HCWs dealing with cancer patients on CAM.

Effects of laughter yoga on health-related quality of life in cancer patients undergoing chemotherapy: a randomized clinical trial

BACKGROUND

Chemotherapy is associated with a wide range of physical and psychological side effects, so complementary and alternative therapies may be practiced as an independent treatment or combined with the standard ones to improve health-related quality of life of cancer patients. Laughter yoga has predominantly been used as a complementary therapy to enhance health and wellbeing of ordinary people and patients with chronic diseases. However, to date, few studies have evaluated the effects of this modern exercise on cancer patients undergoing chemotherapy in clinical settings, to the best of the authors' knowledge. the present study aimed to investigate the effects of Laughter Yoga on the health-related quality of life of cancer patients undergoing chemotherapy.

METHODS

This study was a two-group randomized clinical trial on 69 cancer patients undergoing chemotherapy at Reza Radiotherapy and Oncology Center, Iran in 2018. Patients were randomly divided into intervention and control groups. The intervention group received laughter yoga for four sessions at one-week intervals. Each session consists of one part and lasts for 20-30 min. Patients' health-related quality of life was assessed before and after the laughter yoga sessions using Quality of Life Questionnaire European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) version 3.0. SPSS Statistics (v.20 software was used to conduct Chi-square, independent t-test, Mann-Whitney, Wilcoxon and paired t-tests analyses of the data.

RESULTS

The number of participants in intervention and control groups were 34 and 35, there was no significant difference of demographic and disease related characteristics and pre-intervention HRQOL between two groups. In the intervention group, there is significant difference between pre- and post-intervention scores (Mean ± Standard Deviation) of emotional functioning (12.99 ± 10.49), physical functioning (0.78 ± 6.08), role functioning (3.43 ± 7.97), fatigue (-8.82 ± 22.01), pain (-8.33 ± 11.78), sleep disturbance (-15.68 ± 18.77), and global health and quality of life (6.37 ± 5.04) (p < 0.05). There was no significant change in the control group. Participants reported no adverse events.

CONCLUSIONS

A structured laughter yoga intervention in a hospital setting effectively improved health-related quality of life for cancer patients undergoing chemotherapy. Benefits to many patients could be expected if this would become a part of routine care.

TRIAL REGISTRATION

This study was registered in the Iranian Registry of Clinical Trials (no. IRCT20180429039463N1) on 21/08/2018.

Exploring the psychological and religious perspectives of cancer patients and their future financial planning: a Q-methodological approach

BACKGROUND

Cancer patients are often hesitant to talk about their mental health, religious beliefs regarding the disease, and financial issues that drain them physically and psychologically. But there is a need to break this taboo to understand the perceptions and behaviours of the patients. Previous studies identified many psychological factors that are bothering cancer patients. However, it still requires exploring new elements affecting their mental and physical health and introducing new coping strategies to address patients' concerns.

METHODS

The current study aims to identify cancer patients' perceived attitudes towards the severity of illness, understand their fears, tend towards religion to overcome the disease, and future financial planning by using a Q-methodological approach. Data were collected in three steps from January-June 2020, and 51 cancer patients participated in the final stage of Q-sorting.

RESULTS

The findings of the study are based on the principal component factor analysis that highlighted three essential factors: (1) feelings, (2) religious beliefs about the acceptance of death, and (3) their future personal and financial planning. Further, the analysis shows that the patients differ in their beliefs, causes and support that they received as a coping mechanism.

CONCLUSION

This study explains cancer patients' psychological discomfort and physical pain but cannot relate it to co-morbidities. Q methodology allows the contextualization of their thoughts and future planning in different sets, like acceptance of death, combating religion's help, and sharing experiences through various platforms. This study will help health professionals derive new coping strategies for treating patients and financial managers to design insurance policies that help them to share their financial burdens.

Programmable Pump for Intrathecal Morphine Delivery to Cisterna Magna: Clinical Implications in Novel Management of Refractory Pain Above Middle Thoracic Vertebrae Level Utilizing a Prospective Trial Protocol and Review

BACKGROUND

The cisterna Intrathecal Drug Delivery system (IDDS) with morphine has proven to be effective in treating refractory cancer pain above the middle thoracic vertebrae level in some countries. However, it has not been fully investigated in others. We designed the current project to investigate the efficacy and safety of cisterna IDDS for pain relief in refractory pain above the middle thoracic vertebrae level in advanced cancer patients.

METHODS

This study protocol allows for eligible cancer patients to receive the cisterna IDDS operation. Pain intensity (Visual Analogue scale, VAS), quality of life (36-Item Short-Form Health Survey, SF-36), and depression (Self-Rating Depression scale, SDS) are assessed along with side effects in the postoperative follow-up visits. Recent literature suggests a potential role for cisterna IDDS morphine delivery for refractory pain states above the middle thoracic level.

CONCLUSION

The results of this study may provide further evidence that cisterna IDDS of morphine can serve as an effective and safe pain relief strategy for refractory pain above the middle thoracic vertebrae level in advanced cancer patients.

"We are a transit station here": The role of Israeli oncology social workers in responding to mental health distress and suicidality in patients with cancer

Social workers have a prominent role in responding to cancer patients' mental health needs. Given the risk of mental health distress in cancer patients, and given that social workers are responsible for responding to these needs, the purpose of this study was to explore how social workers describe their role in responding to mental health distress and suicidality in people with cancer. The Grounded Theory method of data collection and analysis was used. Eighteen social workers were recruited and interviewed. Social workers saw themselves and acted as an interprofessional hub for their patients. This approach was based on the values of holistic care, multiple treatment modalities, interpersonal consultation, and continuity of care. From this standpoint, social workers offered their patients (and at times, their families) comprehensive services providing emotional, behavioral and practical support within the hospital setting, but also outside of it in the patient's communities. Consideration should be paid to promote systemic changes to acknowledge and compensate oncology socials workers' invisible labor that includes both emotional carryover and continuous engagement in their role as liaison and intermediaries for their patients.

Mitigating strategies and nursing response for cancer care management during the COVID-19 pandemic: an Italian experience

Aim

To describe our response to the COVID‐19 emergency in a cancer centre to enable other nursing organizations to determine which elements could be useful to manage a surge of patients in their own setting.

Background

The COVID‐19 pandemic represents one of the most challenging healthcare scenarios faced to date. Managing cancer care in such a complex situation requires a coordinated emergency action plan to guarantee the continuity of cancer treatments for patients by providing healthcare procedures for patients, caregivers and healthcare professionals in a safe environment.

Procedures

We describe the main strategies and role of nurses in implementating such procedures.

Results

Nurses at our hospital were actively involved in COVID‐19 response defined by the emergency action plan that positively contributed to correct social distancing and to the prevention of the spread of the virus.

Implications for nursing and health policies

Lessons learned from the response to phase I of COVID‐19 have several implications for future nursing and health policies in which nurses play an active role through their involvement in the frontline of such events. Key policies include a coordinated emergency action plan permitting duty of care within the context of a pandemic, and care pathway revision. This requires the rapid implementation of strategies and policies for a nursing response to the new care scenarios: personnel redistribution, nursing workflow revision, acquisition of new skills and knowledge, effective communication strategies, infection control policies, risk assessment and surveillance programmes, and continuous supplying of personal protective equipment. Finally, within a pandemic context, clear nursing policies reinforcing the role of nurses as patient and caregiver educators are needed to promote infection prevention behaviour in the general population.

Study on the Quality of Life Among the Cancer Patients at the Sari Comprehensive Cancer Center in 2017

Background:

Cancer is a disease caused by abnormal cells shape change and loss of cell variation. Cancer patients suffer from mental and physical problems, which affect their social quality of life (QOL). A cancer diagnosis and its treatment can be expensive.

Methods:

In this descriptive-analytical and cross-sectional study, 183 patients referring to the Sari Comprehensive Cancer Center were enrolled. The data on QOL of patients and the cost of diagnosis and treatment were collected in QLQ questionnaire-C30. The obtained Data were analyzed using the Kruskal-Wallis test of the correlation coefficient, the Mann–Whitney U-test, ANOVA and T-test.

Results:

The average cost of treating patients in a comprehensive cancer center was $20161801 and the average QOL was 2.43 (5 points). Therefore, the patients achieved, 2.41% of the QOL per one million rails.

Conclusions:

Considering the average QOL for cancer patients at Sari Comprehensive Cancer Center and the hospital cost, the evaluation of the patients from the view point of the hospital equipment was positive.

[Psychodynamic psychotherapy, lifestyle and prevention]

OBJECTIVES

Patients with mental disorders frequently manifest unhealthy behavior, which contributes to their increased risk for chronic mental and somatic diseases as well as excess mortality rates of 10 years and more. It also impairs their well-being and the course of mental disorders.We analyzed whether by addressing unhealthy behavior prevention can be integrated into psychodynamic psychotherapy.

METHODS

We reviewed the literature on the role of unhealthy behavior for mental disorders, on the role of lifestyle risk factors in psychodynamic theory, and on barriers to the integration of addressing lifestyle in psychodynamic psychotherapy.

RESULTS

Smoking, unhealthy dietary habits, and physical inactivity constitute dysfunctional behavior, resulting from maladaptive self-representations and an impairment of emotion-regulation capacities. In psychodynamic psychotherapy this maladaptive behavior can be addressed and treated as a kind of defensive behavior and resistance.

CONCLUSION

We believe that by addressing unhealthy behavior prevention can become a crucial task for psychodynamic psychotherapists today.

[Mindfulness, depression, quality of life, and cancer: The nonlinear, indirect effect of mindfulness on the quality of life of cancer patients]

OBJECTIVES

This study investigates the relationships between mindfulness, depression, and quality of life (QoL) in cancer patients.

METHODS

A total of 51 cancer patients were assessed with the FreiburgMindfulness Inventory (FFA;Walach et al. 2004), the Hospital Anxiety and Depression Scale (HADS-D; Herrmann et al. 1994), and the Schedule for the Evaluation of Individual Quality of Life -DW (SEI QoLDW; Browne et al. 1997). The nonlinear relationships were analyzed using the instantaneous indirect effect procedure by Hayes and Preacher (2010).

RESULTS

The relationship between mindfulness and QoL is mediated by depression. Because the relationship between mindfulness and depression is squared, the total effect of mindfulness on QoL is not constant. Increasing the level of mindfulness results in a decrease in its effect on the QoL of cancer patients.

CONCLUSIONS

Cancer patients benefit from mindfulness up to a medium level through a decrease in depression, resulting in higher QoL. Patients with very higher mindfulness show more depressive symptoms, which leads to a neutralization of the effect of mindfulness on QoL.

Promoting Factors and Barriers to Participation in Early Phase Clinical Trials: Patients Perspectives

BACKGROUND

Inclusion of minorities in clinical research is an essential step to develop novel cancer treatments, improve health care overall, understand potential differences in pharmacogenomics and address minorities' disproportionate cancer burden. However, Latinos and other minority groups continue to be critically underrepresented, particularly in early-phase clinical trials (EPCTs). The objective of the present study was to explore barriers and promoting factors influencing patients' decisions to enroll or not in early phase clinical trials (EPCTs) and identify areas for intervention to increase minority enrollment into clinical research.

METHODS

An interviewer-administered survey was conducted with 100 cancer patients in the predominantly Latino region of South Texas. Exploratory factor analysis was conducted to identify underlying dimensions, and multiple logistic regression assessed significant factors that promote or deter patients enrollment to EPCTs. In addition, a separate subgroup mean analysis assessed differences by enrollment status and race/ethnicity.

RESULTS

For one standard deviation increase in the importance given to the possibility of symptoms improvement, the predicted odds of refusing enrollment were 3.20 times greater (OR=3.20, 95% CI=1.06-9.71, p 0.040). Regarding barriers, among patients who considered fear/uncertainty of the new treatment a deterrent to enrollment, one standard deviation increase in agreement with these barriers was associated with a 3.60 increase (OR=3.60, 95% CI=1.30-9.97h, p 0.014) in the odds of not being enrolled in an EPCT. In contrast, non-enrolled patients were less likely (OR=0.14, 95% CI=0.05-0.44, p 0.001) to consider fatalistic beliefs as an important barrier.

CONCLUSION

This study, one of the first to identify South Texas patients' barriers to enroll in EPCTs, highlights potential focal areas to increase participation of both minority and non-minority patients in clinical research. Culturally tailored interventions promoting patient-centered care and bilingual, culturally competent study teams could solve common barriers and enhance Latinos' likelihood of joining clinical trials. These interventions may simultaneously increase opportunities to involve patients and physicians in clinical trials, while ensuring the benefits of participation are equitably distributed to all patients.