Comparison of the sensitivities of pharmacotherapy-related and disease-specific quality of life measures in response to pharmacist-led pharmaceutical care for cancer outpatients: a randomised controlled trial

BACKGROUND

No data were previously available regarding the sensitivities of pharmacotherapy-related and disease-specific quality of life measures to pharmacist-led pharmaceutical care (PC).

AIM

The aim was to compare the sensitivities of two health-related quality of life (HRQoL) measures, i.e. the Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) versus the Functional Assessment of Cancer Therapy-General (FACT-G), in response to pharmacist-led PC for cancer outpatients.

METHOD

A randomised controlled trial was conducted on cancer outpatients of a tertiary Thai hospital. Eligible patients were randomly allocated to a PC group receiving PC interventions or a usual care (UC) group receiving pharmacist's standard care. The HRQoL of both groups was assessed using the PROMPT-QoL and the FACT-G before and after intervention. The sensitivities of the two measures were determined using standardised mean differences (SMDs).

RESULTS

A total of 237 patients in two arms (120 PC vs. 117 UC patients) completed the trial. With PC interventions, all eight PROMPT-QoL domains and 3 out of 4 FACT-G domains were significantly improved. The PROMPT-QoL yielded SMDs ranging from 0.24 to 1.68 that were considered moderate-to-high sensitivity, while the FACT-G provided moderate sensitivity with SMDs of 0.31-0.64. The average SMDs of four FACT-G domains was 0.50 and SMD of the total score was 0.80. Eight PROMPT-QoL domains had the average SMD of 0.60 and the total score SMD was 1.40.

CONCLUSION

The PROMPT-QoL is more sensitive to detect HRQoL when delivering pharmacist-led pharmaceutical care to cancer outpatients.

TRIAL REGISTRATION

TCTR20210809008.

Stigma, risks, and benefits of medicinal cannabis use among Australians with cancer

PURPOSE

People with cancer who use medicinal cannabis do so despite risks associated with limited clinical evidence, legalities, and stigma. This study investigated how Australians with cancer rationalise their medicinal cannabis use despite its risks.

METHODS

Ten adults (5 males and 5 females; mean age of 53.3) who used cannabis medicinally for their cancer were interviewed in 2021-2022 about how they used and accessed the substance, attitudes and beliefs underpinning their use, and conversations with others about medicinal cannabis.

RESULTS

Participants had cancer of the bowel, skin, oesophagus, stomach, thyroid, breast, and Hodgkin lymphoma for which they were receiving treatment (n = 5) or under surveillance (n = 5), with most (n = 6) encountering metastatic disease. Cannabis was used to treat a variety of cancer-related symptoms such as pain, poor sleep, and low mood. Cannabis was perceived as natural and thus less risky than pharmaceuticals. Participants legitimised their medicinal cannabis use by emphasising its natural qualities and distancing themselves from problematic users or riskier substances. Cost barriers and a lack of healthcare professional communication impeded prescription access. Similarly, participants navigated medicinal cannabis use independently due to a lack of guidance from healthcare professionals.

CONCLUSION

Findings highlight the need for robust data regarding the harms and efficacy of medicinal cannabis and dissemination of such information among healthcare professionals and to patients who choose to use the substance. Ensuring healthcare professionals are equipped to provide non-judgmental and evidence-based guidance may mitigate potential safety and legal risks.

The intersection of oncology and oral health: exploring nurses' insights and practices - a systematic review

PURPOSE

Oral health care for cancer patients is essential but often overlooked. Nurses play a critical role in assessing and managing oral health in this population. This systematic review aims to examine nurses' knowledge, attitudes, and practices regarding oral healthcare in cancer patients.

METHODS

A systematic review was conducted following the Joanna Briggs Institute methodology. Qualitative and quantitative studies focused on nurses' knowledge, attitudes, and practices in oral healthcare for cancer patients. Seven databases were searched for studies published between January 2000 and January 2023. The primary outcomes of interest were patient satisfaction, quality of life, and nurses' knowledge, attitudes, and practices related to oral healthcare.

RESULTS

The review identified gaps in nurses' knowledge and training in oral healthcare for cancer patients. Insufficient understanding of oral diagnoses, treatment protocols, and pediatric oral care was noted. Lack of knowledge and skills posed barriers to implementation. Some healthcare providers demonstrated low awareness of oral health recommendations, including the use of fluoridated toothpaste and the need for dental referrals. Referrals to dental services and regular oral assessments were infrequent. Attitudes towards oral healthcare varied, with providers feeling more comfortable in certain areas than others.

CONCLUSION

Enhancing nurses' knowledge, attitudes, and practices in oral healthcare for cancer patients is crucial. Targeted educational initiatives and interventions are needed to address these gaps. By improving nurses' understanding of oral complications and management approaches, patient outcomes and quality of life can be improved.

REGISTRATION

 PROSPERO International prospective register of systematic reviews, ID: CRD42022368053.

The relationship between psychological distress and the nursing humanistic care demands in postoperative cancer inpatients: a cross-sectional study

PURPOSE

We aimed to investigate cancer patients' experiences of psychological distress after surgery and the factors that influence it, and to analyze the relationship between this and the nursing humanistic care demands.

METHODS

This study used a convenience sampling method to survey 432 cancer patients undergoing surgical treatment in the specialized cancer hospital in Beijing. The survey used socio-demographic information, the Distress Management Screening Measures, and the Nursing Humanistic Care Demands questionnaire. Questionnaire Star was used to collect data online. SPSS24.0 software was used to test the relationship between psychological distress and nursing humanistic care demands.

RESULTS

The mean scores for psychological distress and nursing humanistic care demands were 3.95 ± 2.71 and 147.02 ± 19.88, respectively, and showed a moderately positive correlation. The main issues that caused psychological distress in patients were: worry, financial problems, surroundings, nervousness, sleep, and pain. Regression analysis showed that gender, financial burden, personality trait, and need for humanistic care in nursing explained 24.5% of the total variance in the model and were independent predictors of psychological distress.

CONCLUSION

Cancer inpatients have significant psychological distress after surgery and exhibit high levels of nursing humanistic care demands. This study fills the research gap on humanistic care for psychological distress management, nursing humanistic care demands positively predicted psychological distress. Nursing staff should pay attention to the psychological suffering of patients and develop individualized care measures to alleviate their psychological suffering by accurately identifying their nursing humanistic care demands.

Quality of life among family caregivers of cancer patients: an investigation of SF-36 domains

BACKGROUND

With improving survival rates, cancer has become more of a chronic disease with long-term palliative care requirements. Thus, it is even more than ever necessary to pay careful attention to the well-being of family caregivers of cancer patients, as cancer trajectory is a challenging path for both patients and their caregivers. This study focusses on ascertaining the level of quality of life (QoL) domains and their attributable significant factors among a population of cancer family caregivers.

METHODS

This was a cross-sectional study. The study population consist of caregivers of adult cancer patients in Zanjan, Iran between 2019 and 2020. Medical Outcomes General Health Survey Short Form 36 (SF-36) was the instrument to measure outcome variables. Clinical and basic characteristics of the caregivers and their patients were also collected using a questionnaire designed for this purpose. Data were analyzed using Independent samples t-test, Analysis of Variance, and stepwise linear regression in SPSS v.26.

RESULTS

Of the caregivers 167 were male and 133 were female. The mean age of the participants was 40.77 ± 12.56, most of whom were offspring of the patients (148, 49.3%), married (239, 79.7%), and self-employed (81, 27.0%). both domains of bodily pain (76.50 ± 16.67) and physical functioning (74.88 ± 20.27) showed the highest scores among caregivers. Age and gender of caregivers, duration of caregiving, Eastern Cooperative Oncology Group (ECOG) performance status scale as well as type and stage of cancer, and type of treatment were among the significant predictors of QoL domains (All, p < 0.001).

CONCLUSION

Findings of the present study substantiated various significant predictors for QoL along with low levels of QoL domains among the caregivers of cancer patients. Securing such findings proves the magnitude of probable unmet needs and psychological challenges in this population and provides the health policy makers with some valuable clues to draw effective strategies to address such issues.

Effects of routine collection of patient-reported outcomes on patient health outcomes in oncology settings: A systematic review

Objective

This study aims to investigate the potential benefits of integrating patient-reported outcomes (PROs) into routine clinical practice for patients undergoing active anticancer treatment.

Methods

We conducted a comprehensive systematic review of randomized controlled trials involving cancer patients undergoing active anticancer treatment, spanning various cancer types and stages. The review covered four electronic databases (Medline, EMBASE, Cochrane Library, and CINAHL) up to September 2022. Key inclusion criteria focused on the incorporation of PROs as a routine intervention. Bias assessment followed the Cochrane collaboration's criteria, while the synthesis of results utilized effect size measurements (Cohen's d). The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results

Out of 1549 initially screened records, 16 published randomized controlled trials encompassing 5300 patients met the inclusion criteria. The interventions involved 18 different PROs measurements, with prominent tools being EORTC QLQ-C30 (utilized in four trials) and PRO-CTCAE (utilized in four trials). Measured endpoints included overall quality of life (12 trials), physical health (11 trials), mental health (7 trials), and social health (5 trials). Overall, the study revealed a limited number of statistically significant findings, with predominantly small to moderate effect sizes associated with the interventions.

Conclusions

The findings suggest that the routine integration of PROs into clinical practice does not yield definitive advantages in terms of PROs. It is apparent that further efforts are necessary to ascertain the impact of these interventions on patient health.

Systematic review registration

The review protocol was registered on PROSPERO (ID: CRD42022365456).

First report of Central-line-associated bloodstream infection (CLAB- SI) due to Enterococcus raffinosus (ER) in a cancer patient

Abstract

Despite the advances made by therapeutic technologies, healthcare-associated infections (HAIs) are currently still a worldwide problem. Central-line-associated bloodstream infections (CLABSIs) are one of the most common causes of HAIs. The cost of CLABSIs is considerable, both for the increase in morbidity and financial resources expenses. Coagulase-negative staphylococci are the common pathogens responsible for CLABSIs, followed by Staphylococcus aureus, Enterococci, and Candida spp. The Enterococcus genus comprises of more than 50 species but E. faecalis and E. faecium are the most common causes of infections in humans. Enterococcus Raffinosus (ER) is a non-faecalis and non-faecium enterococcus even if ER has rarely been proven to be a human pathogen, recent reports of infections caused by enterococci that are relatively resistant to beta-lactam antibiotics by non-p-lactamase mechanisms have included strains of ER. Here we describe a first report of CLABSI due to Enterococcus Raffinosus in a cancer patient.

Status and influential factors of spiritual well-being in cancer patients with drug clinical trials: a cross-sectional study

PURPOSE

The purpose of this study was to investigate the spiritual well-being status of cancer patients in drug clinical trials and its influencing factors, and to provide theoretical support for the spiritual health intervention of clinical trial cancer patients.

METHODS

This cross-section study was conducted among 244 cancer patients in clinical trials. The Memorial Symptom Assessment Scale Short Form (MSAS-SF), Connor-Davidson Resilience Scale 10 (CD-RISC 10), and Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-SP-12) were used to measure symptom burden, psychological resilience, and spiritual well-being. The Multiple Linear Regression Model was used to determine the influencing factors of patients' spiritual health.

RESULTS

The overall spiritual health level of cancer patients with clinical trials was high (36.87 ± 11.0), and the spiritual health level was positively correlated with psychological resilience (r = 0.872, P < 0.001). Religious belief, nationality, treatment regimen, and resilience were independent risk factors for the spiritual health of cancer patients in clinical trials. Patients with religious beliefs (β = 0.097, P = 0.012), ethnic minorities (β = 0.087, P = 0.023), and high resilience scores (β = 0.874, P < 0.001) had higher levels of spiritual health. Patients who received single antineoplastic therapy (β =  - 0.079, P = 0.028) had lower levels of spiritual health.

CONCLUSION

Our study found that the spiritual health of cancer patients in clinical trials was at a high level, superior to cancer patients receiving conventional anti-tumor therapy. Religious belief, nationality, treatment regimen, and psychological resilience were the influential factors of spiritual health.

Hope and its associated factors in cancer patients undergoing drug therapy: a systematic review

OBJECTIVE

This study seeks to clarify the hope of cancer patients undergoing drug therapy and related factors through a systematic review.

METHODS

References were searched and selected in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses.

RESULTS

Thirteen articles were selected. A meta-analysis found that the overall Herth Hope Index score for cancer patients undergoing drug therapy averaged 35.64 points. The hope of cancer patients was associated with anxiety/depression and quality of life (QOL). It was also associated with personal attributes such as age, family structure, economic situation, educational level, social support, internal factors such as coping, self-esteem, optimism, self-confidence, locus of control, etc., as well as disease/treatment-related factors such as the purpose of treatment, general condition, presence or absence of metastasis, symptoms, survival period, and estimated life expectancy.

CONCLUSION

Anxiety/depression, QOL, and other factors were found to be related to cancer patients' hope. In the future, studies that clarify the overall structure of various factors related to hope and longitudinal studies will be necessary.

Improving Access to Patient Education: an Audit of Extant Educational Materials

Health information exchange between provider and patient, along with patient participation in their care (self-management), can lead to improved health outcomes. A step towards achieving better outcomes is the systematic provision of education materials to patients and caregivers throughout the cancer trajectory. An audit of patient education (PE) materials was conducted at a cancer center to identify content gaps and determine areas for future development. The PE audit was conducted in all outpatient clinics (13) and clinic-specific PE materials were identified, reviewed, and categorized by cancer type and under the following topics: About Cancer/Disease, Medical Tests and Imaging, Treatment, Symptom Management, Rehabilitation/Survivorship, General Wellbeing, Medical Device Care, Practical and Other. Four hundred forty-seven PE materials were included in the audit. Totals for each topic were summed and analyzed for education development opportunities. Results varied based on clinic and cancer type. Majority of the materials were found in the following clinics: Hematology (75), Genitourinary (74), and Gastrointestinal (57). The most common information topics were treatment (277), about cancer/disease (134), and symptom management (120). When broken down by cancer type, it was clear that while the collection of PE materials is well established for some diagnoses (e.g., 28 prostate cancer materials), there is a significant dearth in materials for others (e.g., 0 penile cancer materials). Audit results will be used to identify opportunities for future education material development. Determining cancer-specific information gaps is important in achieving equal information access for patients and caregivers, regardless of cancer diagnosis.

Molecularly imprinted electrochemical sensor for the selective and sensitive determination of octreotide in cancer patient plasma sample

In this study, a molecularly imprinted polymer film (P (ANI)@MIP) on the electrode surface was fabricated using aniline as a functional monomer and octreotide (OC) as a template molecule. The developed P (ANI)@MIP was electrochemically electropolymerized on a glassy carbon electrode (GCE) surface. Each step of MIP production was evaluated by viewing the [Fe (CN)₆]^3-/4- signal obtained using cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). The P (ANI)@MIP film layer was studied with a scanning electron microscope (SEM), Raman, and contact angle measurements. The parameters consisting of monomer, template ratio, cycle number, removal solution, removal time, and rebinding time were optimized to obtain the best electrochemical sensor. The developed method was validated in line with ICH guidelines. The linear range, LOD, and LOQ were found as 10-80 fM, 0.801 fM, and 2.670 fM, respectively. The selectivity of the method was tested with the response of somatostatin and lanreotide from the same growth hormone family by comparing the OC response. The developed P (ANI)@MIP/GCE sensor is the first reported method for electrochemical analysis of OC. The P (ANI)@MIP/GCE sensor exhibited high sensitivity and selectivity for OC. The novel MIP sensor was used to determine OC in cancer patient plasma samples. The concentration of OC in cancer patients varied between 8.98 ng/mL and 10.10 ng/mL.

Quality of care in the oncological outpatient setting: Individual interviews with people receiving cancer treatment

PURPOSE

To describe how patients receiving cancer treatment perceive quality of care in the oncological outpatient settings.

METHOD

A strategic sample of 20 adult patients with cancer treated in four oncological outpatient settings in four hospitals in Sweden participated in the study. Participants were interviewed using a semi-structured interview guide with open-ended questions. The interviews were audio-recorded, and the transcripts were analysed using a phenomenographic approach.

RESULTS

Three descriptive categories emerged from the data: The patient's care is designed to meet individual needs, The patient's dignity is respected, and The patient feels safe and secure with the care. Overall, quality of care in the oncological outpatient setting is perceived as something positive and described in normative terms by the participants.

CONCLUSION

The results emphasises that in order to achieve quality of care it is important to the patients that they are able to meet with the same well-educated, professional, caring and sensible health care professionals every time.

Cancer-Associated Thrombosis: Enhanced awareness and pathophysiologic complexity

Thrombosis, both venous and arterial, is a leading cause of morbidity and mortality in patients with cancer. Studies on the molecular basis of cancer-associated thrombophilia have a long story starting from the first observation of the presence of tumor cells in circulating microthrombi two centuries ago. The profound link between pathways of blood coagulation and tumor biology has been more and more unraveled, and new actors in this complex interaction have been identified. The unfavorable impact of thrombosis in a cancer patient, on which also hangs a high bleeding risk as compared to the non-cancer population, has led during years to the production of large clinical studies to adopt the best prophylaxis and treatment strategies of venous thromboembolism in different medical and surgical settings, now incorporated in dedicated international guidelines. This field, however, still represents an open challenge due to the intrinsic variability of the cancer patient with his/her personal medical history and cardiovascular risk factors, as well as the type, site and stage of the tumor, and the use of a wide array of new sophisticated anticancer drugs. This review aims to highlight some of the many key observations in the field of cancer and thrombosis, spanning the scope from fundamental tumor biology to advanced clinical trials of new anticoagulants. We hope that some of the examples we have included will inspire readers to explore and discuss these topics, thereby increasing awareness of cancer-related thrombosis in both physicians and patients.

Identifying risk factors for opioid-induced neurotoxicity in cancer patients receiving oxycodone

PURPOSE

The aim of this study was to determine the frequency of opioid-induced neurotoxicity (OIN) in cancer patients receiving oral controlled-release oxycodone and to define risk factors for OIN.

METHODS

This was a single-center, retrospective study of hospitalized adult cancer patients receiving oral controlled-release oxycodone between April 1, 2013, and April, 30, 2020. The onset of OIN within 30 days after oxycodone initiation in the study patients was investigated. OIN was defined as any of the following: delirium, hallucinations (visual or auditory), seizure, myoclonus, hyperesthesia, and excessive somnolence. Multivariate logistic regression analysis was performed to identify risk factors for OIN in patients receiving oxycodone.

RESULTS

In total, 520 patients were included in this study. The number of patients with OIN was 65 (12.5%). The median time until onset of OIN after oxycodone initiation was 7.5 days. Multivariate logistic regression analysis revealed that age ≥ 65 years (OR = 2.74, 95% CI [1.30-5.78], p = 0.008), total bilirubin ≥ 1.3 mg/dL (OR = 4.85, 95% CI [2.13-11.0], p < 0.001), and concomitant use of pregabalin or mirogabalin (OR = 3.11, 95% CI [1.47-6.61], p = 0.003) were significant independent risk factors for OIN.

CONCLUSION

Age ≥ 65 years, liver dysfunction, and concomitant use of pregabalin or mirogabalin were independent risk factors for OIN in patients receiving oxycodone. Patients with these risk factors who are receiving oxycodone should be monitored for OIN, especially early in the administration of oxycodone.

Cancer literacy - Informing patients and implementing shared decision making

In order to tailor treatment to their needs, cancer patients are encouraged to be more active and engaged in their care decisions and to be autonomous yet collaborative with their healthcare professionals when it comes to aspects of their treatment in order to get better results. However, this can only happen after providing them with accurate information about cancer and the different treatment alternatives and their potential side effects. However, sharing robust data-based information is often hindered by exposure to misleading information through different media and online platform, where patients might come across unscientifically founded health practices. Increasing health literacy and cancer-specific literacy is essential to fight this negative trend. The idea is that more knowledgeable patients will be able to debunk more easily misinformation they encounter. This is also related to inequalities among cancer patients. Not only levels of cancer literacy within Europe are uneven across and within countries, but there are social groups that, due to specific social determinants, are systematically less informed and skilled regarding cancer care. In this paper an overview of gaps in addressing literacy issues, and the importance of health literacy to empower patients in their journey through treatment is delineated, concluding with some recommendations to improve cancer literacy in Europe.

Glucocorticoid Effect in Cancer Patients

The use of glucocorticoids is very varied in the context of cancer patients and includes the treatment of symptoms related to cancer, but also the management of the most common side effects of antitumor treatments or adverse events related to the immune system. There is a quantity of experimental evidence demonstrating that cancer cells are immunogenic. However, the effective activation of anticancer T cell responses closely depends on an efficient antigen presentation carried out by professional antigen-presenting cells such as dendritic cells (DCs). The classic strategies to improve the medical management of inflammation are aimed at exacerbating the host's immune response. Although successful in treating a number of diseases, these drugs have limited efficacy and variable responses can lead to unpredictable results. The ideal therapy should reduce inflammation without inducing immunosuppression and remains a challenge for healthcare personnel.

Molecular detection and genotype identification of Acanthamoeba species from bronchoalveolar lavage of patients with pulmonary symptoms suspected of cancer

Acanthamoeba spp. are the most common free-living amoeba worldwide, inducing life-threatening diseases such as Granulomatous Amoebic Encephalitis, pulmonary infection, and amoebic keratitis. This study aimed to identify the FLA and Acanthamoeba genotypes in patients with pulmonary symptoms suspected of cancer in Kashan's hospitals, Kashan, Iran. This cross-sectional study was conducted on 97 bronchoalveolar lavage samples of patients with respiratory symptoms suspected of lung cancer, who were admitted to the Shahid Beheshti Hospital of Kashan from 2019 to 2020. The samples were cultured onto 1.5% non-nutrient agar enriched with killed Escherichia coli and examined for the presence of FLA. Following amoeba isolation and DNA extraction, Acanthamoeba spp. were determined by Polymerase Chain Reaction using JDP1 and JDP2 primers, which amplified a 490 bp fragment from the 18 S rDNA gene. Eighteen Acanthamoeba isolates were sequenced, and the genotypes were identified. The prevalence of FLA and Acanthamoeba and the relationship between symptoms and demographic variables were analyzed with SPSS Software version 16. The prevalence rates of FLA and Acanthamoeba in the BAL samples was 86.6% and 73.2%, respectively. All Acanthamoeba isolates belonged to the T4 genotype. The most symptoms among Acanthamoeba-positive patients were dyspnea and cough; however, their difference was not statistically significant. The findings indicated the high prevalence of FLA and Acanthamoeba in BAL in the population suspected of cancer in Kashan. Since the T4 genotype is a pathogenic genotype of Acanthamoeba, training health and improving sanitation levels would help to prevent infection.

The effect of amino acid-oral rehydration solution (Enterade®) on chemotherapy related diarrhea and quality of life in solid tumor cancer patients: A non-randomized experimental study

PURPOSE

The purpose of this study was to evaluate use of a proprietary amino acid-oral rehydration solution (AA-ORS) known as Enterade® to reduce the severity of chemotherapy related diarrhea (CRD), to improve patient reported Quality of Life (QOL), and to reduce treatment holds, delays, dose modifications, prevention of weight loss, and subjective improvement of associated gastrointestinal mucositis physical symptoms.

METHODS

An experimental pilot study without randomization in a single population with two separate measurements over time was performed in a National Cancer Institute (NCI) designated cancer center in the South-Central United States. The variables included sociodemographic data, cancer diagnosis, chemotherapy treatment regimens, Common Terminology Criteria for Adverse Events (CTCAE) v5.0 grade of diarrhea, stool consistency using the Bristol Stool Scale, use of antidiarrheals, associated gastrointestinal mucositis symptoms affecting QOL, and QOL measured with the Functional Assessment of Chronic Illness Therapy-Diarrhea survey.

RESULTS

A total of 22 participants enrolled in the study. Sixteen completed both the pre-survey and post survey. A statistically significant difference was not found between the patient's subjective report of quality of life when comparing pre and post survey responses. There was a statistically significant improvement from baseline in the QOL questions specific to bowel concerns due to diarrhea with a mean pre-survey response score of 35.3 versus a post survey score of 29.2 (p = .003). There was a reduction in the CTCACE grade of diarrhea demonstrating a reduction in the frequency of stools per day (p = .001) and a change in the consistency of stools moving from watery to more formed stools using the Bristol Stool Scale (p = .049).

CONCLUSION

Use of AA-ORS in this study was found to be useful in the reduction of CRD in patients receiving systemic oncology therapies. This study needs to be replicated with a larger, more inclusive sample size to further support the use of AA-ORS in the reduction of CRD and QOL.

Lessons learned from an outbreak of COVID-19 in the head and neck surgery ward of a Japanese cancer center during the sixth wave by Omicron

Introduction

We describe a coronavirus disease (COVID-19) outbreak in a cancer center's head and neck surgery ward and the interventions to halt ongoing exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers and patients with cancer.

Methods

Case definition included all healthcare workers and all patients associated to the ward from January 27 to January 31, 2022 with a positive SARS-COV-2 antigen test. This retrospective descriptive study was conducted between January 27, 2022, and February 14, 2022.

Results

From January 28, 2022, to February 9, 2022, 84 cases (36 healthcare workers, 48 patients) were screened, and 26 (12 healthcare workers, 14 patients) were identified as SARS-CoV-2-positive. The proportion of healthcare providers who performed aerosol generating procedures on positive patients was 91% for positive cases and 49% for non-cases. Room sharing with patients with COVID-19 was 64% for positive cases and 21% for non-cases (57% vs. 21% with positive tracheostomy patients; 43% vs. 9% with positive cases using a nebulizer; 50% vs. 15% with positive cases requiring sputum suctioning, respectively). Compliance with the universal masking policy for patients was 36% of positive cases and 79% of non-cases.

Conclusions

This is the first report of a nosocomial outbreak of COVID-19 in a head and neck surgery ward during the Omicron pandemic. Notably, there were a high number of positive cases among healthcare workers who performed aerosol generating procedures for positive patients and patients who shared the room with a patient with COVID-19 with the potential to generate aerosols.

'Nobody can take the stress away from me': a qualitative study on experiences of partners of patients with cancer regarding their work and health

PURPOSE

To explore experienced health- and work-related problems of partners of patients with cancer, and their needs for support.

MATERIALS AND METHODS

Semi-structured interviews were conducted with Dutch partners of patients with cancer. Interviews were transcribed verbatim. Data were analysed thematically, following the six steps of Braun & Clarke.

RESULTS

Of 20 included partners (mean age: 50 years [31-63]), 60% was female. Five themes consistently emerged from the data: 1) overwhelming chaos calls for taking control; 2) impact of prolonged stress; 3) flexibility and support of the employer are crucial; 4) coping with family and friends is a delicate matter; and 5) support from healthcare professionals is needed, but not a given.

CONCLUSIONS

Findings from this study show that the burden on partners of patients with cancer is substantial and cannot be overlooked. The state of survival mode that partners get into during the diagnosis, treatment and follow-up of their loved ones can have various implications on their physical and mental health, and work situation. Given this high burden and as legislation for care leave from work and (health care) support for partners appear to be insufficiently in place in the Dutch context, there is a need for better-targeted support for partners of patients with cancer. Implications for RehabilitationThe survival mode that partners of patients with cancer get into during the diagnosis, treatment and follow-up of their loved ones can have various implications on their physical and mental health, and work situation.This study showed that the burden on partners of patients with cancer is substantial and cannot be overlooked.Given this high burden and because legislation for care leave from work and (health care) support for partners appears to be insufficiently in place in the Dutch context, there is a need for better-targeted support for partners of patients with cancer.

Correlation of self-efficacy and symptom control in cancer patients

OBJECTIVE

This cross-sectional study was planned to evaluate the self-efficacy and symptom control of cancer patients and to determine the factors affecting them.

METHODS

The sample of the study consisted of 329 cancer patients who were treated in the Medical Oncology Clinic of a university hospital between April and June 2019 and accepted to participate in the study. Data were collected using the Patient Characteristics Information Form, Cancer Behavior Inventory-Short Version (CBI-SV), and Edmonton Symptom Assessment Scale (ESAS). Percentage, mean, Mann-Whitney U test, and Kruskal-Wallis analysis of variance were used in the analysis of the data.

RESULTS

The mean CBI-SV score of the patients was 79.10 ± 17.55. It was determined that the highest mean score of ESAS of the patients was in the symptom of fatigue (3.53 ± 2.81). Some symptoms were statistically lower in patients with good income, who are working, and who are non-smokers. Also it was determined that the self-efficacy levels of the patients with good income and quitting smoking were higher (p < 0.05). At the same time, as the patients' self-efficacy scores increased, the severity of the symptoms they experienced decreased statistically (p < 0.05).

CONCLUSION

It was found that the patients' self-efficacy score was above the moderate level, the most intense symptom experienced by the patients was fatigue, and the severity of the symptoms decreased as the patients' self-efficacy level increased. In line with these results; the symptoms, self-efficacy perceptions, and affecting factors of cancer patients should be evaluated by nurses at regular intervals, and care and consultancy services should be provided.

Health-related quality of life among cancer patients and survivors and its relationship with current employment status

INTRODUCTION

Health-related quality of life (HRQoL) is an important end point to measure in cancer patients and survivors. This study investigated whether differences in HRQOL exist between cancer patients, cancer survivors, and the general population, in addition to how employment status interplays in this relationship.

METHODS

Data were from the 2019 Korea National Health & Nutrition Examination. HRQoL was measured using the HRQoL Instrument with 8 Items (HINT-8) index, which encompasses physical, mental, social, and health-related aspects. All variables were entered simultaneously into the fully adjusted model. Multiple regression analysis was used to evaluate the association between HRQoL in cancer patients and cancer survivors compared to the general population. An interaction analysis was conducted based on current employment status.

RESULTS

A total of 3805 cancer patients, 109 cancer survivors, and 3609 individuals of the general population were included in this study. The HRQoL scores of cancer patients (β: - 0.0221, p-value: 0.0218) were poorer compared to the general population with statistical significance. In contrast, the HRQoL scores of cancer survivors did not show statistically significant differences. The interaction term between cancer status and economic activity status was statistically significant for cancer patients * unemployed (β: - 0.0557, p-value: 0.0020).

CONCLUSION

Cancer patients had lower HRQoL than the general population. Additionally, the interaction analysis reveals that unemployed cancer patients have poorer HRQoL scores than the employed general population. The results reveal that cancer patients are vulnerable to decreases in HRQoL, in particular those who are currently unemployed.

Development and validation of a Modified Patient-Generated Subjective Global Assessment as a nutritional assessment tool in cancer patients

BACKGROUND

Completing Patient-Generated Subjective Global Assessment (PG-SGA) questionnaires is time consuming. This study aimed to develop and validate an easy-to-use modified PG-SGA (mPG-SGA) for cancer patients.

METHODS

Seventy professionals assessed the content validity, comprehensibility, and difficulty of the full PG-SGA. A survey including the PG-SGA and other questionnaires was completed by 34 071 adult hospitalized cancer patients with first cancer diagnosis or recurrent disease with any tumour comorbidities from the INSCOC study. Among them, 1558 patients were followed for 5 years after admission. Reliability and rank correlation were estimated to assess the consistency between PG-SGA items and to select mPG-SGA items. The external and internal validity, test-retest reliability, and predictive validity were tested for the mPG-SGA via comparison with both the PG-SGA and abridged PG-SGA (abPG-SGA).

RESULTS

After deleting items that more than 50% of professionals considered difficult to evaluate (Worksheet 4) and items with an item-total correlation <0.1, the mPG-SGA was constructed. Nutritional status was categorized using mPG-SGA scores as well-nourished (0 points) or mildly (1-2 points), moderately (3-6 points), or severely malnourished (≥7 points) based on the area under curve (0.962, 0.989, and 0.985) and maximal sensitivity (0.924, 0.918, and 0.945) and specificity (1.000, 1.000, and 0.938) of the cut-off scores. The external and internal validity and test-retest reliability were good. Significant median overall survival differences were found among nutritional status groups categorized by the mPG-SGA: 24, 18, 14, and 10 months for well-nourished, mildly malnourished, moderately malnourished, and severely malnourished, respectively (all Ps < 0.05). Neither the PG-SGA nor the abridged PG-SGA could discriminate the median overall survival differences between the well-nourished and mildly malnourished groups.

CONCLUSIONS

We systematically developed and validated the mPG-SGA as an easier-to-use nutritional assessment tool for cancer patients. The mPG-SGA appears to have better predictive validity for survival than the PG-SGA and abridged PG-SGA.

Patients' perspectives on the effect of the COVID-19 pandemic on access to cancer care and social contacts in Sweden and the UK: a cross-sectional study

PURPOSE

We aimed to determine whether there was a difference in access to cancer-related healthcare between people living in Sweden and the United Kingdom (UK) during the COVID-19 pandemic. We also describe how the pandemic affected social contact of patients undergoing treatment.

METHODS

This cross-sectional study used survey data collected through the War on Cancer mobile phone application between September 5, 2020, and January 6, 2021. We included individuals with cancer diagnoses living in Sweden or the UK. The association between difficulty accessing cancer-related healthcare and country was examined using logistic regression. Frequencies were used to describe the effect of the pandemic on social contact.

RESULTS

Of 491 individuals included in the study, 183 were living in the UK and 308 in Sweden. Living in the UK was associated with greater difficulty accessing cancer-related healthcare (n = 99/183, 54.1%) than living in Sweden (n = 100/308, 32.5%) (odds ratio 2.12, 95% CI 1.39-3.23, p < 0.001). The pandemic affected social contact for almost all patients (n = 218/238, 91.6%) undergoing treatment.

CONCLUSION

This study highlights the differential impact that the pandemic may have had on patients' access to cancer-related care in the UK and Sweden. In both countries, the pandemic overwhelmingly affected social contact of individuals undergoing cancer treatment. New ways must be found to improve access to cancer-related care and reduce social isolation for patients with cancer during a pandemic.

COVID-19 and Access to Cancer Care in Kenya: Patient Perspective

COVID‐19 disruptions severely impacted access to health services for noncommunicable diseases, including cancer, but few studies have examined patient perspectives of COVID‐19‐induced barriers to care in low/middle‐income countries. Data come from a survey completed online, over the phone or in person of 284 adult people with cancer in Kenya. One‐third (36%) of participants had primary or no education and 34% had some or complete secondary education. Half of the participants (49%) were aged 40 to 59, 21% were 18 to 39 and 23% were 60 or older. Two‐thirds were female (65%) and most visited a national referral hospital in Nairobi to receive care (84%). Mean travel time to Nairobi from the respondent county of residence was 2.47 hours (±2.73). Most participants reported decreased household income (88%) and were worried about their ability to afford cancer treatment due to COVID‐19 (79%). After covariate adjustment, participants who lost access to hospitals due to COVID‐19 travel restrictions were 15 times more likely to experience a cancer care delay (OR = 14.90, 95% CI: 7.44‐29.85) compared to those with continued access to hospitals. Every additional hour of travel time to Nairobi from their county of residence resulted in a 20% increase in the odds of a cancer care delay (OR = 1.20, 95% CI: 1.06‐1.36). Transportation needs and uninterrupted access to cancer care and medicines should be accounted for in COVID‐19 mitigation strategies. These strategies include permits for cancer patients and caregivers to travel past curfew time or through block posts to receive care during lockdowns, cash assistance and involving patient navigators to improve patient communication.

Value of influenza vaccines in cancer patients during the coronavirus (COVID-19) pandemic: a cross-sectional study

BACKGROUND

According to the recommendation of the Centers for Disease Control and Prevention (CDC), getting influenza vaccines during the coronavirus (COVID-19) pandemics is especially important for people with certain underlying medical conditions, like cancer. Due to the similarities between the symptoms of influenza and COVID-19, receiving the flu vaccine in suspicious cases can be helpful because it will make it easier to request a medical test and diagnosis. In this study, the value of influenza vaccination in the cancer population was investigated.

METHODS

In a cross-sectional study, all cancer patients who were referred to our clinic and had eligibility to receive the flu vaccine were included in our study for following up clinical signs every week for one month. All patients who were vaccinated from October 1 to November 15, 2020 were investigated. The most side effects that were followed were fever, runny nose, bone pain, and life-threatening or persistent adverse effects.

RESULTS

From a total of 288 patients (median age: 52 years (range 18-79), 112 (38.9%) males and 176 (61.1%) female) with different types of cancers, only two patients had an adverse effect of vaccination (including bone pain, runny nose, and fatigue), and one had COVID-19 ten days after vaccination. The rest of the patients did not show any side effects due to flu vaccination after one month of follow-up. Cancer patients are recommended to receive the flu vaccine annually during the pandemic and after the end of this pandemic, usually during the flu epidemic season to reduce mortality.

Perceptions of homeopathy in supportive cancer care among oncologists and general practitioners in France

OBJECTIVES

In France, homeopathy is the most frequently used complementary therapy in supportive care in oncology (SCO); its use is steadily increasing. However, data is limited about the perception and relevance of homeopathy by oncologists and general practitioners (GPs) both with and without homeopathic training (HGPs and NHGPs, respectively). Our aim was to evaluate French physicians' perceptions of homeopathy to clarify its place in SCO through two original observation survey-based studies.

MATERIALS AND METHODS

Two cross-sectional surveys of French physicians were conducted involving (1) 150 specialist oncologists; (2) 97 HGPs and 100 NHGPs. Questions evaluated physician attitudes to homeopathy and patterns of use of homeopathic therapies in patients requiring SCO. Survey responses were described and analyzed on the basis of physician status.

RESULTS

Ten percent of oncologists stated they prescribe homeopathy; 36% recommend it; 54% think that homeopathy is potentially helpful in SCO. Two-thirds of the NHGPs sometimes prescribe homeopathy in the context of SCO and 58% regularly refer their patients to homeopathic doctors. HGPs have a positive perception of homeopathy in SCO.

CONCLUSIONS

Homeopathy is viewed favorably as an integrated SCO therapy by the majority of French physicians involved with cancer patients-oncologists and GPs. Symptoms of particular relevance include fatigue, anxiety, peripheral neuropathy, sleep disturbance, and hot flashes. In such clinical situations, response to conventional therapies may be suboptimal and homeopathy is considered a reliable therapeutic option. These two studies highlight the fact that homeopathy has gained legitimacy as the first complementary therapy in SCO in France.

Incidence and risk factor for infection of totally implantable venous access port

BACKGROUND

Totally implantable venous access ports (TIVAP) have been widely used in cancer patients for many years. The early infection (within 30 days after TIVAP implantation) rate of TIVAP accounts for about one-third of all TIVAP infections, and early infection often causes port removal and affects subsequent cancer treatment. This study investigated the incidence and risk factors for early and late infection after TIVAP implantation.

METHODS

From January 2013 to December 2018, all adult cancer patients who received TIVAP implantation in Taipei Medical University Shuang-Ho Hospital were reviewed. We evaluated the incidence of TIVAP-related infection, patient characteristics, and bacteriologic data. Univariable analysis and multiple logistic regression analysis were used to evaluate the risk factors of TIVAP-related infection.

RESULTS

A total of 3001 TIVAPs were implanted in 2897 patients, and the median follow-up time was 424 days (range: 1-2492 days), achieving a combined total of 1,648,731 catheter days. Thirty-one patients (1.0%) had early infection and 167 (5.6%) patients had late infection. In multivariate analysis, TIVAP combined with other surgeries (p = 0.03) and inpatient setting (p < 0.001) was the risk factor of early infection, and TIVAP combined with other surgeries (p = 0.007), hematological cancer (p = 0.03), and inpatient setting (p < 0.001) was the risk factor of late infection.

CONCLUSION

Inpatient TIVAP implantation and TIVAP implantation combined with other surgeries are associated with high rates of TIVAP-related early and late infections.

Palliative care and quality of life in patients with cancer during the terminal phase. A family/patient perspective

OBJECTIVE

To explore the meaning of palliative care as perceived by the family caregiver and the patient with advanced cancer.

METHOD

Information was collected through in-depth interviews and field diaries to conduct this qualitative research study, with an interpretative phenomenological approach. We adopted Heidegger's perspective for the development of hermeneutic interpretation, and therefore followed the stages of intentionality, reduction, and constitution. We used Bardin's constructs of pre-analysis, coding, categorisation, and interpretation for the discourse analysis.

RESULTS

Seventeen patient-family caregiver dyads were considered. The perceptions of palliative nursing care focused on transpersonal relationships and the discourses referred to a lack of closeness between nursing staff and the patient. This was mainly expressed as a lack of emotional understanding and unmet needs. Themes were drawn from these findings based on developing a transpersonal relationship as a priority, including meeting needs and providing the empathic accompaniment that is fundamental for emotional well-being.

CONCLUSION

From the perspective of the dyads, palliative care covers intangible aspects of care. This requires nursing staff to work collaboratively with colleagues, with other health professionals and interprofessionally, including the institutions involved in care. Further work is required to implement these actions.

Exercise intervention in cancer patients with sleep disturbances scheduled for elective surgery: Systematic review

BACKGROUND & OBJECTIVES

Sleep disturbance is one of the patients' major complaints after major surgery and can impair postoperative recovery. Pre-operative exercise has been shown to increase functional capacity and resilience in cancer patients; scarce knowledge is available on the effects of pre-operative exercise on sleep disturbances. This systematic review aims to determine the impact of pre-operative exercise training alone or as part of multimodal prehabilitation on sleep disturbances and sleep quality in cancer patients.

METHODS

A systematic search including Biosis, Cochrane Library and CENTRAL, EMBASE, MEDLINE, and clinical trial registries (clinicaltrials.gov, International Clinical Trials Registry Platform) was performed to identify studies involving a pre-operative exercise intervention in cancer patients awaiting surgery. Trials had to contain at least one sleep measure, assessed subjectively and objectively were included in the systematic review. The quality of the included trials was assessed using the Cochrane Risk of Bias Tool for assessing the risk of bias in randomized trials tool and the ROBINS-I tool for evaluating the risk of bias in non-randomized studies.

RESULTS

Seven studies were included (1 RCT, 2 non-RCTs and 4 single-arm design). Due to substantial heterogeneity in the interventions across studies, a meta-analysis was not conducted. The available empirical evidence on the presurgical effect of exercise on sleep outcomes is scarce and, overall, suggests that it has a limited effect. Besides, non-significant improvement of the pre-operative exercise on sleep was unique to the studies that used subjective measures to assess sleep disturbances changes during cancer treatment.

CONCLUSION

There are conflicting results and a lack of quality data proving the pre-operative exercise on sleep quality and disturbances. More research is needed in the pre-operative period using clinical sleep disturbances such as insomnia as an inclusion criterion, subjectively and objectively assessed.

Pre-loss grief and preparedness for death among caregivers of terminally ill cancer patients: A systematic review

BACKGROUND

Cancer is one of the most common causes of death. The period of time between receiving a terminal diagnosis of cancer and the death of a loved one has been operationalized as pre-loss grief and, more recently, as preparedness for death. Originally, grief before loss was thought to have positive effects on the bereavement outcome, but some studies have revealed contradictory findings. This systematic review investigates definitions and measurement tools of pre-loss grief and preparedness for death, as well as the associations of both constructs with caregiver characteristics, pre-loss psychological aspects and post-loss adjustment among caregivers of people living with terminal cancer.

METHODS

PubMed/Medline, PsycINFO and Web of Science were searched for studies published up until October 2020. Quantitative empirical studies from peer reviewed journals were included if a measurement tool for pre-loss grief or preparedness for death was used and if they focused on adult caregivers of adult people with cancer in an end-of-life trajectory and were excluded when they were not written in English or were descriptive/qualitative studies. Quality assessment of all studies was performed.

RESULTS

Most studies used convenience samples and had a mean number of 725 participants. Overall, 16,326 participants in 35 articles were included and narratively synthesized. High levels of pre-loss grief, as well as low levels of perceived preparedness for death, were associated with poor post-loss adjustment (e.g., prolonged grief, depressive symptoms, etc.).

CONCLUSIONS

Caregivers with high levels of pre-loss grief and low levels of preparedness for the death of their loved one would benefit from targeted support for post-loss adjustment. Results are limited by an inconsistent operationalization of both constructs.

Antimicrobial photodynamic therapy to oral candidiasis not responsive to micafungin in a patient undergoing hematopoietic cell transplantation

In hematopoietic cell transplants (HCT) patients, opportunistic fungal infections - especially candidiasis - are typical and, due to the immunosuppressed condition, severe and fatal clinical conditions may occur. Many antifungal agents are used for treating candidiasis; however, there are non-responsive, drug-resistant cases in which alternative antimicrobial therapies are strongly needed. The present study aimed to report a clinical case in which antimicrobial photodynamic therapy (aPDT) was used for extensive oral pseudomembranous candidiasis not responsive to micafungin in a patient undergoing HCT. Thus, 0.01 % methylene blue solution was applied for 3 min onto the infected area, followed by 660-nm laser irradiation. Within 72 h, there was neither a symptom nor a sign of the fungal infection. According to the current case report, aPDT seems to be highly effective for HCT patients presenting oral candidiasis not responsive to micafungin; however, further studies are necessary.

Choice of access route for artificial nutrition in cancer patients: 30 y of activity in a home palliative care setting

OBJECTIVES

Malnutrition negatively affects the quality of life, survival, and clinical outcome of patients with cancer. Home artificial nutrition (HAN) is an appropriate nutritional therapy to prevent death from cachexia and to improve quality of life, and it can be integrated into a home palliative care program. The choice to start home enteral nutrition (HEN) or home parenteral nutrition (HPN) is based on patient-specific indications and contraindications. The aim of this observational study was to analyze the changes that occurred in the criteria for choosing the access route to artificial nutrition during 30 y of activity of a nutritional service team (NST) in a palliative home care setting, as well as to compare indications, clinical nutritional outcomes, and complications between HEN and HPN.

METHODS

The following parameters were analyzed and compared for HEN and HPN: tumor site and metastases; nutritional status (body mass index, weight loss in the past 6 mo); basal energy expenditure and oral food intake; Karnofsky performance status; access routes to HEN (feeding tubes) and HPN (central venous catheters); water and protein-calorie support; and survival and complications of HAN.

RESULTS

From 1990 to 2020, HAN was started in 1014 patients with cancer (592 men, 422 women; 65.6 ± 12.7 y of age); HPN was started in 666 patients (66%); and HEN was started in 348 patients (34%). At the end of the study, 921 patients had died, 77 had suspended HAN for oral refeeding and 16 were in the progress of HAN. The oral caloric intake was <50% basal energy expenditure in all patients: 721 (71.1%) were unable to eat at all (HEN 270, HPN 451), whereas in 293 patients (28.9%), artificial nutrition was supplementary to oral intake. From 2010 to 2020, the number of central venous catheters for HPN, especially peripherally inserted central catheters, doubled compared with that in the previous 20 y, with a decrease of 71.6% in feeding tubes for HEN. At the beginning, patients on HEN and HPN had comparable nutrition and performance status, and there was no difference in nutritional outcome after 1 mo of HAN. In 215 patients who started supplemental parenteral nutrition to oral feeding, total protein-calorie intake allowed a significant increase in body mass index and Karnofsky performance status. The duration of HEN was longer than that of HPN but was similar to that of supplemental parenteral nutrition.

CONCLUSIONS

Over 30 y of nutritional service team activity, the choice of central venous catheters as an access route to HAN increased progressively and significantly due to personalized patient decision-making choices. Nutritional efficacy was comparable between HEN and HPN. In patients who maintained food oral intake, supplemental parenteral nutrition improved weight, performance status, and survival better than other types of HAN.

Quality of life, self-compassion and mindfulness in cancer patients undergoing chemotherapy: A cross-sectional study

PURPOSE

We investigated whether self-compassion and mindfulness are associated with quality of life in patients undergoing antineoplastic chemotherapy.

METHODS

A cross-sectional survey of 183 patients (100% response rate) undergoing chemotherapy was conducted at a Brazilian hospital between August and December 2019. A questionnaire was administered by the research team, collecting clinical and demographic data as well as responses to the Self-compassion scale, Mindful Attention Awareness Scale, and the Functional Assessment of Cancer Therapy-General instrument. Data analysis comprised descriptive and inferential statistics, with multiple regression and Spearman's rank-order correlation testing for associations between quality of life, self-compassion and mindfulness.

RESULTS

Mean scores for the study variables were 4.23 (SD = 0.63) for self-compassion, 69.05 (SD = 13.27) for mindfulness, and 80.25 (SD = 12.62) for quality of life. Significant positive correlations were observed between quality of life and self-compassion (r = 0.466, p < 0.001), as well as for quality of life and mindfulness (r = 0.325, p < 0.001). Higher levels of self-compassion and mindfulness were associated with better quality of life.

CONCLUSIONS

This research suggests merit in further studies of self-compassion and mindfulness either as predictor variables or for direct causal effect on quality of life in cancer patients undergoing antineoplastic chemotherapy. We recommend that future studies incorporate an intervention and experimental design.

Effects of art-based mandala intervention on distress and anxiety in cancer patients

OBJECTIVE

This study was planned to determine the effect of art-based mandala intervention on the distress and anxiety experienced by cancer patients.

METHODS

This semi-experimental study with a single group pretest-posttest design was performed with 12 breast cancer survival patients. The data were collected through "Patient Diagnostic Form", "Distress Thermometer", "Trait Anxiety Inventory". Patients participated in the "Art-Based Mandala Interventıon" for eight weeks, one day a week, 2 h each. The distress and anxiety levels of the patients were measured before starting the program and at the end of the program.

RESULTS

Cancer patients experienced moderate level of anxiety (50.66 ± 6.91) and clinically significant distress (4.08 ± 2.74). Anxiety scores of cancer patients decreased significantly after the program compared to before the program (p < 0.05). The distress scores of cancer patients increased after the program compared to before the program (p > 0.05).

CONCLUSION

After the art-based mandala intervention program, anxiety scores of breast cancer survival patients decreased, and distress scores increased.

Scored-GLIM as an effective tool to assess nutrition status and predict survival in patients with cancer

BACKGROUND & AIMS

The Global Leadership Initiative on Malnutrition (GLIM) released new universal criteria for diagnosing and grading malnutrition, and calls for further investigations not only in different clinical setting but also in GLIM itself including reference value, combination and weight of different GLIM criteria. This study aimed to weigh the GLIM criteria and develop a scored-GLIM system, and then validate as well as evaluate its application in nutritional assessment and survival prediction for patients with cancer.

DESIGN

A total of 3547 patients in the primary cohort and 415 patients in the validation cohort were included in the study. Patients' nutritional status were retrospectively assessed using the GLIM criteria. Kaplan-Meier survival curves and multivariate Cox regression analyses were performed to analyze the association between nutritional status and overall survival (OS). A nomogram was produced to quantify the GLIM criteria and develop the scored-GLIM system. C-index, receiver operating characteristic (ROC) curve and calibration curve analyses were performed to validate the predictive accuracy and discriminatory capacity of the scored-GLIM. Finally, a decision curve was applied to assess the clinical utility of the scored-GLIM system.

RESULTS

In the primary cohort, 70.3% of patients were diagnosed as malnutrition. The malnutrition severity grading according to the GLIM criteria were associated with the prognosis of patients with cancer (HR 1.42, 1.23 to 1.65 for moderate malnutrition; HR 1.80,1.84 to 2.09 for severe malnutrition). The weight of each GLIM criteria was calculated, and unintentional weight loss was the most determining factor acting upon mortality (HR 1.82, 1.64 to 2.10 for stage II and HR 1.50, 1.31 to 1.73 for stage I). A nomogram was constructed by four factors of GLIM to weigh the GLIM criteria. The areas under the ROC curve were 65.3 (1-year ROC) and 65.5 (3-year ROC), and the C-index was 0.62, and the calibration curves fitted well. Decision curve analysis demonstrated the clinical usefulness of the scored-GLIM system.

CONCLUSION

The accuracy and net clinical benefit of scored-GLIM system were similar to scored-PG-SGA but higher than GLIM both in nutrition assessment and in survival prediction for patients with cancer. These findings, along with its time-savings advantages over scored-PG-SGA, suggest scored-GLIM be a better nutritional assessment tool.

Moderating effect of sense of coherence on the relationship between symptom distress and health-related quality of life in patients receiving cancer chemotherapy

PURPOSE

This study is aimed at examining the buffering effect of sense of coherence (SOC) on symptom distress during cancer drug therapy, which thereby affects health-related quality of life (QoL), and obtaining suggestions for promoting supportive care.

METHODS

We investigated health-related QoL (SF-8), symptom distress (using the Symptom Distress Scale (SDS)), and SOC (the SOC 13-item Scale) in 66 patients receiving adjuvant chemotherapy for non-small cell lung cancer. We employed descriptive statistics to seek the correlation of each variable; then, a hierarchical multiple regression analysis was conducted with SF-8 score as the dependent variable.

RESULTS

Results showed that significant changes in bodily pain showed a buffering effect on the SDS and sense of comprehensibility (β = - 0.658, p < 0.01, β = - 0.319, p < 0.05), sense of manageability (β = - 0.658, p < 0.01, β = 0.398, p < 0.01), and meaningfulness (β = - 0.658, p < 0.01, β = - 0.257, p < 0.05). Significant changes in general health perception showed a buffering effect on the SDS and sense of manageability (β = - 0.406, p < 0.01, β = 0.329, p < 0.05). As a result of the simple inclination test, SOC proved to be effective under high levels of symptom distress; the buffering effect of sense of manageability was reversed regarding bodily pain; and when meaningfulness was lower, it had a positive effect on QoL.

CONCLUSION

This study revealed that SOC exerts a buffering effect in situations where symptoms are highly painful. It also revealed that the effect of SOC was reversed for bodily pain and that a high SOC had a negative effect on QoL.

Unmet supportive care needs and associated factors among young adult cancer patients in Japan

Background

Young adult cancer patients often face unique challenges and have potential unmet needs. This study aimed (1) to describe unmet supportive care needs among young adults with cancer in Japan, and (2) to identify its associated factors.

Methods

In a cross-sectional web-based survey, 206 young adults with cancer were assessed for supportive care needs. Multiple regression analysis examined whether demographics, clinical variables and social support were associated with unmet supportive care needs.

Results

A total of 206 patients (180 female) with a mean age of 33.7 years (SD = 4.3, range: 22–39) participated. One hundred and fifty-eight participants (76.7%) reported at least one unmet supportive care needs. The top 20 unmet needs included 9 of the 10 psychological needs, 3 of the 5 physical and daily living needs, 8 of the 11 health system and information needs and 1 of the 5 sexuality needs. Multiple regression analysis revealed that perceived poorer PS, experience of change in work/school after a cancer diagnosis and poor social support were significantly associated with higher supportive care needs. The total score of supportive care needs was significantly associated with both psychological distress and QOL.

Conclusions

More than 70% of young adult cancer patients reported unmet supportive care needs and most of those were psychological needs. The findings suggest potential opportunities for intervention in addressing psychological needs rather than physical and information needs.

Factors Associated with the Quality of Life of Patients with Cancer Undergoing Radiotherapy

OBJECTIVE

Approximately half of patients with cancer have comorbidities, such as adjustment disorder, major depressive disorder, and delirium. Radiotherapy can cause psychological problems, e.g., the fear of treatment and its side effects, anxiety, depression, and social isolation. Health-related quality of life (QoL) must be determined to evaluate the effectiveness of cancer treatment. We analyzed the clinical, psychological, and sociodemographic factors influencing the QoL of patients with cancer who were undergoing radiotherapy.

METHODS

Twenty-six patients undergoing radiotherapy (10 male, 16 female) were included. Sociodemographic and clinical data were collected prior to radiotherapy. Psychosocial factors were assessed by self-reported questionnaires before, immediately after, and 3 months after radiotherapy. A multivariate regression analysis identified factors affecting QoL at each time point.

RESULTS

Patients' diagnoses were breast, cervical, prostate, endometrial, rectal, hypopharyngeal, laryngeal, liver, gallbladder, esophageal, ovarian, lung, and skin cancers. Before radiotherapy, better resilience was significantly associated with a higher QoL score (R2=0.199, p=0.033). Immediately after radiotherapy, financial difficulty was significantly associated with a lower QoL score (R2=0.274, p=0.010). Three months after radiotherapy, the presence of chronic disease (R2=0.398, p=0.002) and the severity of nausea and vomiting were significantly associated with a lower QoL score (R2=0.278, p=0.014).

CONCLUSION

Resilience, financial difficulty, the presence of chronic diseases, and the severity of nausea and vomiting significantly influenced the QoL of patients with cancer who were undergoing radiotherapy. Factors affecting QoL varied at each time point. Thus, patients with cancer should undergo regular mental health assessments, including assessments of QoL. Multidimensional (physical, psychological, and social) approaches and individualized time-based interventions are needed to improve the QoL of cancer patients undergoing radiotherapy.

Psychotropic medication utilisation in adult cancer patients in China: A cross-sectional study based on national health insurance database

Background

Psychotropic medications are useful to treat psychiatric disorders which are frequently underdiagnosed and undertreated in cancer patients. Evidence on utilisation of psychotropic medications in cancer patients was absent in China. This study aimed to analyse the prevalence and the potential predictors of psychotropic medication use in adult cancer patients in China.

Methods

We analysed cross-sectional data from the China Health Insurance Association database in 2015-2017, which contained health care utilisation information for a national representative sample of basic medical insurance beneficiaries. Cancer patients aged above 18 were identified by International Classification of Disease 10th revision code C00-C97. Psychotropic medications were defined following the Anatomical Therapeutic Chemical codes: antipsychotics (N05A), anxiolytics (N05B), hypnotics and sedatives (N05C), and antidepressants (N06A, N06CA). We calculated the prevalence of psychotropic medication use in cancer patients, and applied multivariable logistic regression to identify its potential predictors.

Findings

A total of 260,364 adults with cancer were identified in the database, of which 48,111 (18•5%) were prescribed at least one psychotropic medication comprising antipsychotics (3763, 1•4%), anxiolytics (15,902, 6•1%), hypnotics and sedatives (37,040, 14•2%), and antidepressants (2379, 0•9%). Patients with solid tumours had higher prevalence of psychotropic medication use than patients with lymphoid and hematopoietic malignancies (e.g. female genital organs, adjusted odds ratio (OR)=2•25, 95%CI=2•09-2•44). The prevalence of psychotropic medication use in cancer patients in the Eastern region was significantly higher than those of cancer patients in the Western regions (OR=2•33, 95%CI=2•27-2•40). Compared with the Urban Rural Resident Basic Medical Insurance beneficiaries, cancer patients covered by the Urban Employee Basic Medical Insurance were more likely to use psychotropic medications (OR=1•18, 95%CI=1•15-1•20). Midazolam was the most frequently used psychotropic (21,728, 45•2%), and flupentixol-melitracen was the most commonly used antidepressant (1176, 2•4%) among all psychotropic medication users in the sample.

Interpretation

The prevalence of psychotropic medication use in Chinese adult cancer patients was inequitable. Further attention will be needed to be paid to the mental health of cancer patients in China.

Funding

No funding.

Factors related to satisfaction of cancer patients with transfer arrangements made by university hospitals at the end-of-life in Japan: a cross-sectional questionnaire survey of bereaved family members

PURPOSE

Cancer patients in university hospitals often face a difficult decision regarding transfer to other care settings at the end-of-life. Arrangements for a satisfying transfer are important for reducing the psychosocial impact of the transition, but few studies have evaluated this aspect. This study aimed to identify factors related to the satisfying arrangement of transfers to other care settings from university hospitals.

METHODS

A total of 400 bereaved family members of cancer patients in Japan participated in this cross-sectional web-based questionnaire survey. Statistical methods including decision tree analysis were conducted to identify factors significantly associated with satisfying transfer arrangements.

RESULTS

More than 60% of cancer patients were satisfied with the transfer arrangements made by university hospitals. Decision tree analysis revealed that the factor most significantly associated with satisfaction with transfer arrangements was "satisfaction with contents of the explanation about transfer." The following significant factors were also extracted: "timing of being informed of transfer," "presence of primary care physician," and "presence of trustworthy staff." "Satisfaction with overall care from university hospital staff" and "involvement of palliative care team" were identified as factors contributing to a high degree of satisfaction with transfer arrangements.

CONCLUSION

In order to make satisfying transfer arrangements from university hospitals for cancer patients at the end-of-life, healthcare professionals should provide satisfactory explanations about the transfer process in order to meet the information needs of patients. To be effective, healthcare professionals should initiate transfer arrangements prior to cancer treatment, while simultaneously building trusting relationships with patients.

The effect of applying Spiritual Care Model on well-being and quality of care in cancer patients

PURPOSE

The study was an attempt to explore the effect of applying spiritual model of nursing care on spiritual well-being and quality of spiritual care in cancer patients.

METHOD

A quasi-experimental study, the present inquiry was carried out with control and intervention groups with participation of 72 patients and 63 nurses in an advanced center in Iran. The Spiritual Care Model (SCM) was designed by the researchers in this study and was performed on the intervention group by nurses after they received proper training. The data were collected using Demographic Information Questionnaire, Spiritual Well-Being Scale (SWBS), and Spiritual Care Delivery Rating Scale (SCDRS) in pre-intervention and post-intervention stages and were analyzed with SPSS v.16.

RESULTS

Before the intervention, the means for spiritual well-being and the quality of spiritual care were not significantly different for the intervention and control groups (p < 0.05). After the intervention, i.e., upon discharge from the hospital, the mean of spiritual well-being in the intervention group was significantly higher than that of the control group (p < 0.001). Based on the opinions of both nurses and patients, the mean of the spiritual care quality was significantly higher in the intervention group in comparison to that in the control group once the intervention was over (p < 0.001).

CONCLUSION

Given the positive effect of the SCM on enhancing the spiritual care quality and improving the patients' spiritual well-being, it is recommended that the SCM be used as a proper guideline and as a model for boosting nurses' professional performance in spiritual care.

Psychological reactions and interventions to help Cancer patients cope during the COVID-19 pandemic in China

During COVID-19 pandemic, how can cancer patients adjust their psychological status? In this article, some questions and suggestions are given to share. I listed some of negative emotions could happen on cancer patients and showed their harm and gave suggestions accordingly, especially in how to keep cancer patients in a healthy attitude during the difficult time.

Spiritual care experiences by cancer patients, their family caregivers and healthcare team members in oncology practice settings: A qualitative study

PURPOSE

Integrating spirituality into the patient care within a healthcare team, increases the ability to provide "holistic care" for cancer patients. The spiritual care experiences of different involved persons can be a guide for future planning. Therefore, this study aimed to explore the spiritual care experiences of hospitalized cancer patients, their family caregivers and healthcare team members in oncology settings.

METHODS

This is a descriptive qualitative study which was conducted with 21 participants, who were selected by purposive sampling. Semi-structured interviews were used to collect the data. The data were analyzed with conventional content analysis method.

RESULTS

Two themes of "systematic care" and "caring with paradoxical results" were extracted from the spiritual care experiences of our participants.

CONCLUSIONS

Spiritual care as professional, comprehensive, collaborative and artistic care should be provided in a multidisciplinary healthcare team for cancer patients. Otherwise, patients may experience deprivation of spiritual services and consequently, spiritual distress.

Demand for weekend outpatient chemotherapy among patients with cancer in Japan

BACKGROUND

Advanced cancer therapeutics have improved patient survival, leading to an increase in the number of patients who require long-term outpatient chemotherapy. However, the available schedule options for chemotherapy are generally limited to traditional business hours.

METHOD

In 2017, we surveyed 721 patients with cancer in Okayama, Japan, regarding their preferences for evening and weekend (Friday evening, Saturday, and Sunday) chemotherapy appointments.

RESULTS

A preference for evening and weekend appointment options was indicated by 37% of the respondents. Patients who requested weekend chemotherapy were younger, female, with no spouse or partner, living alone, employed, and currently receiving treatment. Among these factors, age and employment status were significantly associated with a preference for weekend chemotherapy, according to multivariate analysis.

CONCLUSION

Our findings reveal a demand for evening and weekend outpatient chemotherapy, especially among young, employed patients.

Development and validation of bioanalytical methods for LNA-i-miR-221 quantification in human plasma and urine by LC-MS/MS

LNA-i-miR-221, a 13-mer oligonucleotide, has proved favorable efficacy and safety profiles in the preclinical studies, leading to being approved for use in clinical trials by regulatory authorities. The objective of this study was to develop and validate LC-MS/MS methods to quantify LNA-i-miR-221 in human plasma and urine. Chromatographic separation was performed with a gradient system on HALO C18 column using hexafluoro-2-propanol/triethylamine buffer and methanol as mobile phase. LNA-i-miR-221 was detected on tandem mass spectrometer with electrospray ionization source in negative ion mode. The methods showed good linearity within the calibration range of 50-25000 ng/mL and 50-50000 ng/mL for human plasma and urine, respectively. The methods proved to be accurate, precise and selective in both human matrices. These validated methods are reliable and are currently in use to support a first-in-human clinical trial of LNA-i-miR-221 in patients affected by refractory multiple myeloma and advanced solid tumors.

Effectiveness of palliative care consultation service on caregiver burden over time between terminally ill cancer and non-cancer family caregivers

PURPOSE

The responsibility of taking care of terminal patients is accepted as a role of family members in Taiwan. Only a few studies have focused on the effect of palliative care consultation service (PCCS) on caregiver burden between terminal cancer family caregivers (CFCs) and non-cancer family caregivers (NCFCs). Therefore, the purpose of this study is to address the effect of PCCS on caregiver burden between CFC and NCFC over time.

METHODS

A prospective longitudinal study was conducted in a medical center in northern Taiwan from July to November 2017. The participants were both terminally ill cancer and non-cancer patients who were prepared to receive PCCS, as well as their family caregivers. Characteristics including family caregivers and terminal patients and Family Caregiver Burden Scale (FCBS) were recorded pre-, 7, and 14 days following PCCS. A generalized estimating equation model was used to analyze the change in the level of family caregiver burden (FCB) between CFC and NCFC.

RESULTS

The study revealed that there were no statistically significant differences in FCB between CFC and NCFC 7 days and 14 days after PCCS (p > 0.05). However, FCB significantly decreased in both CFC and NCFC from pre-PCCS to 14 days after PCCS (β = - 12.67, p = 0.013). PPI of patients was the key predictor of FCB over time following PCCS (β = 1.14, p = 0.013).

CONCLUSIONS

This study showed that PCCS can improve FCB in not only CFC but also NCFC. We suggest that PCCS should be used more widely in supporting family caregivers of terminally ill patients to reduce caregiver burden.

Preservation of Childbearing Potential in Cancer Survivors: a Survey of Gynecologists' and Embryologists' Current Knowledge, Attitude, and Practice

Cancer is one of the life-threatening diseases, and cancer therapy may produce severe side effects such as impaired fertility. Saving childbearing potential after cancer treatment is of high importance to cancer survivors. This study assessed gynecologists' and embryologists' current practice, knowledge, and attitude concerning fertility preservation (FP) in cancer survivors. This current survey was performed on a convenience sample of 277 gynecologists and embryologists who attended large international congresses held across Iran. A 23-item self-administered questionnaire that included questions on knowledge, attitudes, and practice was used. Questions had either yes/no responses, or were answered based on a 4-point (1 to 4) Likert scored scale. Total mean score for knowledge of all FP options was 2.97 ± 0.62. Total mean scores for knowledge of all FP options in gynecologists and embryologists were 3.03 ± 0.65 and 2.95 ± 0.61, respectively (p = 0.33). These scores were above the median value of 2.5 obtained using the 4-point Likert scale. Participants regarded the patient age as the most important reason for discussing FP with patients (mean scores 3.74 ± 0.71 and 3.73 ± 0.52 for gynecologists and embryologists, respectively; p = 0.93). The majority of the participants (i.e., 95.2% (79 gynecologists) and 92.2% (166 embryologists)) referred cancer patients to centers providing FP services (p = 0.15). This sample of Iranian gynecologists and embryologists had considerable information on FP methods to develop appropriate attitudes and practices in relation to FP for cancer patients in order to prevent loss of fertility.

Recommendations for spiritual care in cancer patients: a clinical practice guideline for oncology nurses in Iran

BACKGROUND

In spite of the necessity of implementing spiritual care practices for cancer patients, there is no clear process in this regard in palliative care programs of the health system of countries. The present study was designed with the aim of developing a clinical practice guideline of spiritual care in cancer patients for oncology nurses in the current context.

METHODS

This is a multi-method study which was conducted in five stages within the framework of the National Institute for Health and Care Excellence (NICE) guideline. A research committee consisting of four focal and 16 secondary members was formed. The stages included determining the scope of the study, developing guideline (a qualitative study and a systematic review, triangulation of the data, and producing a preliminary draft), consultation stage (validation of the guideline in three rounds of the Delphi study), as well as revision and publication stages.

RESULTS

The clinical guideline of spiritual care with 84 evidence-based recommendations was developed in three main areas, including the human resources, care settings, and the process of spiritual care.

CONCLUSIONS

We are hoping by applying this clinical guideline in oncology settings to move towards an integrated spiritual care plan for cancer patients in the context of our health system. Healthcare organizations should support to form spiritual care teams under supervision of the oncology nurses with qualified healthcare providers and a trained clergy. Through holistic care, they can constantly examine the spiritual needs of cancer patients alongside their other needs by focusing on the phases of the nursing process.

Breaking bad news about cancer in China: Concerns and conflicts faced by doctors deciding whether to inform patients

OBJECTIVES

We aimed to explore how doctors in China decide whether to inform cancer patients about diagnosis and prognosis.

METHODS

We conducted in-depth, semi-structured interviews with 24 doctors and residents from a leading hospital in Hunan, China. Data were analyzed by content analysis.

RESULTS

Doctors routinely told the family about cancer first, then withheld information from patients if the family did not want to tell the patient. Three main themes emerged in relation to hiding bad news from patients: 1) fear that most patients lack resilience to cope with bad news; 2) fear of direct or legal conflict with the family, and 3) a value conflict between respecting the patient's "right to know" and respecting the family's interest in protecting the patient.

CONCLUSIONS

Doctors consider decisions to withhold information from cancer patients to be a non-ideal but necessary compromise of the patient's "right to know." Culturally adjusted training and guidelines could help with including the patient in information disclosure while still respecting China's cultural value of family decision-making.

PRACTICE IMPLICATIONS

Future training and guidelines should help doctors mediate between patient and family interests and understand changing laws and regulations. Other important elements include reflection, senior mentorship, self-awareness, and building trust.