Quality of life support in advanced cancer-web and technological interventions: systematic review and narrative synthesis

BACKGROUND

As treatments continue to progress, patients with advanced cancer are living longer. However, ongoing physical side-effects and psychosocial concerns can compromise quality of life (QoL). Patients and physicians increasingly look to the internet and other technologies to address diverse supportive needs encountered across this evolving cancer trajectory.

OBJECTIVES

1. To examine the features and delivery of web and technological interventions supporting patients with advanced cancer. 2. To explore their efficacy relating to QoL and psychosocial well-being.

METHODS

Relevant studies were identified through electronic database searches (MEDLINE, PsychINFO, Embase, CINAHL, CENTRAL, Web of Science and ProQuest) and handsearching. Findings were collated and explored through narrative synthesis.

RESULTS

Of 5274 identified records, 37 articles were included. Interventions were evaluated within studies targeting advanced cancer (13) or encompassing all stages (24). Five subtypes emerged: Interactive Health Communication Applications (n=12), virtual programmes of support (n=11), symptom monitoring tools (n=8), communication conduits (n=3) and information websites (n=3). Modes of delivery ranged from self-management to clinically integrated. Support largely targeted psychosocial well-being, alongside symptom management and healthy living. Most studies (78%) evidenced varying degrees of efficacy through QoL and psychosocial measures. Intervention complexity made it challenging to distinguish the most effective components. Incomplete reporting limited risk of bias assessment.

CONCLUSION

While complex and varied in their content, features and delivery, most interventions led to improvements in QoL or psychosocial well-being across the cancer trajectory. Ongoing development and evaluation of such innovations should specifically target patients requiring longer-term support for later-stage cancer.

PROSPERO REGISTRATION NUMBER

CRD42018089153.

Mindful gratitude journaling: psychological distress, quality of life and suffering in advanced cancer: a randomised controlled trial

CONTEXT

Numerous studies have shown that gratitude can reduce stress and improve quality of life.

OBJECTIVE

Our study aimed to examine the effect of mindful gratitude journaling on suffering, psychological distress and quality of life of patients with advanced cancer.

METHODS

We conducted a parallel-group, blinded, randomised controlled trial at the University of Malaya Medical Centre, Malaysia. Ninety-two adult patients with advanced cancer, and an overall suffering score ≥4/10 based on the Suffering Pictogram were recruited and randomly assigned to either a mindful gratitude journaling group (N=49) or a routine journaling group (N=43).

RESULTS

After 1 week, there were significant reductions in the overall suffering score from the baseline in both the intervention group (mean difference in overall suffering score=-2.0, 95% CI=-2.7 to -1.4, t=-6.125, p=0.000) and the control group (mean difference in overall suffering score=-1.6, 95% CI=-2.3 to -0.8, t=-4.106, p=0.037). There were also significant improvements in the total Hospital Anxiety and Depression Scale score (mean difference=-3.4, 95% CI=-5.3 to -1.5, t=-3.525, p=0.000) and the total Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being score (mean difference=7.3, 95% CI=1.5 to 13.1, t=2.460, p=0.014) in the intervention group after 7 days, but not in the control group.

CONCLUSION

The results provide evidence that 7 days of mindful gratitude journaling could positively affect the state of suffering, psychological distress and quality of life of patients with advanced cancer.

TRIAL REGISTRATION NUMBER

The trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN1261800172191) and conducted in accordance with the Declaration of Helsinki.

Platelet-to-lymphocyte, neutrophil-to-lymphocyte and lymphocyte-to-monocyte ratios are related to cancer-related fatigue and quality of life in patients with cancer: a cross-sectional study

OBJECTIVES

To explore the association of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) with cancer-related fatigue (CRF) and quality of life (QOL) in cancer patients.

DESIGN

A cross-sectional study.

SETTINGS

A grade A tertiary hospital in Wuhan, China.

PARTICIPANTS

A total of 236 participants were recruited. Participants who were diagnosed with cancer received chemotherapy and/or radiotherapy, and aged ≥18 years were included in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

The PLR, NLR and LMR were calculated based on the absolute lymphocyte count, neutrophil count, platelet count and monocyte count. The CRF and QOL of patients after the first chemotherapy/radiotherapy were evaluated.

RESULTS

The median values (IQR) of PLR, NLR and LMR were 174.51 (126.14-261.02), 2.84 (1.64-5.24) and 2.56 (1.30-3.72), respectively. Univariate analysis indicated that high PLR (≥ 174.51), high NLR (≥ 2.84) and low LMR (< 2.56) at baseline significantly correlated with CRF and poor QOL after the first chemotherapy/radiotherapy (p<0.005). Multiple linear regression analysis indicated that elevated PLR might be an independent risk factor for CRF (p<0.001) and QOL (p=0.010) in cancer patients.

CONCLUSION

PLR, NLR and LMR are associated with CRF and QOL in cancer patients. High PLR may predict severe CRF and poor QOL. Further studies are needed to validate these findings based on the expanded sample size.

Effects of an urban forest healing program on cancer-related fatigue in cancer survivors

PURPOSE

This study aimed to examine the effects of an eight-session structured urban forest healing program for cancer survivors with fatigue.

BACKGROUND

Cancer-related fatigue (CRF) is a complex and multifactorial common symptom among cancer survivors that limits quality of life (QoL). Although health benefits of forest healing on physiological, physical, and psychological aspect as well as on the immune system have been reported in many studies, there is limited evidence on the efficacy of specialized forest program for cancer survivors.

METHOD

A single-blinded, pre-test and post-test control group clinical trial was conducted with -75 cancer survivors assigned to either the forest healing group or the control group. The intervention was an eight-session structured urban forest program provided at two urban forests with easy accessibility. Each session consists of three or four major activities based on six forest healing elements such as landscape, phytoncides, anions, sounds, sunlight, and oxygen. Complete data of the treatment-adherent sample (≥ 6 sessions) was used to examine whether sociodemographic, clinical, physiological (respiratory function, muscle strength, balance, 6-min walking test) and psychological (distress, mood state, sleep quality, QoL) characteristics at baseline moderated the intervention effect on fatigue severity at 9 weeks.

RESULTS

Significant time-group interactions were observed muscle strength, balance, 6-min walking test, distress, fatigue, moods, and QoL. The mean difference in fatigue between pre- and post-forest healing program was 9.1 (95% CI 6.2 to 11.9), 11.9 (95% CI 7.6 to 16.1) in moods, and -93.9 (95% CI -123.9 to -64.0) in QoL, showing significant improvements in forest healing group, but no significant improvements in the control group.

CONCLUSION

This study suggests that a forest healing program positively impacts the lives of cancer survivors, by addressing both physical and psychological challenges associated with CRF.

TRIAL REGISTRATION NUMBER

KCT0008447 (Date of registration: May 19, 2023).

Development, Usability Testing, and Implementation Assessment of Cancer Related Infertility Score Predictor, an Online Cancer Related Infertility Risk Counseling Tool

Purpose: Oncofertility counseling of female cancer patients lacks efficient access to tailored and valid infertility risk estimates to support shared decision-making on fertility preservation treatments. The objective was to develop, conduct user-centered design, and plan clinic-based implementation of the Cancer Related Infertility Score Predictor (CRISP), a web-based tool to support infertility risk counseling. Methods: Using a mixed methods design, literature review was undertaken to abstract data on infertility, primary ovarian insufficiency, and amenorrhea risks of common cancer treatments. The CRISP website was programmed to take user input about patient ages and cancer treatments and generate a risk summary. Using user experience methodology and semistructured interviews, usability testing and implementation assessment were conducted with 12 providers recruited from 5 medical centers in Southern California. Results: The web-based CRISP tool encompasses infertility risk data for 60 treatment regimens among 10 cancer types. Usability testing demonstrated that the tool is intuitive and informed minor modifications, including adding crowd-sourced submission of additional cancer treatments. Participants rated the tool as credible, advantageous over current provider methods to ascertain infertility risks, and useful for tailoring treatment planning and counseling patients. A key barrier was lack of information on some cancer treatments. Fit within clinical workflow was feasible, particularly with electronic health record integration. Conclusions: The novel, web-based CRISP tool is a feasible, acceptable, and appropriate tool to address provider knowledge gap about cancer related infertility risks and use for patient counseling. CRISP has significant potential to support tailored oncofertility counseling in the heterogeneous young cancer patient population.

Predictors of cancer patients' utilization of psychooncological support: Examining patient´s attitude and physician´s recommendation

PURPOSE

Patients with cancer suffer from a wide range of psychological distress. Nevertheless, in the literature low utilization rates of psychooncological services are reported. Various factors may influence the utilization of professional support during inpatient care. Up to now it is unclear to what extent patients' attitude towards psychooncological support and physicians' recommendation for psychooncological care may influence the utilization.

METHODS

In a multicenter longitudinal observational study in Comprehensive Cancer Centers Germany, 1398 patients with mixed cancer diagnoses were assessed at baseline during their hospital stay with respect to psychooncological distress and the need for and use of psychooncological services.

RESULTS

Psychooncological support was used by almost 28.4% of patients up to this time. A positive attitude towards psychooncological support was reported by 41.6%. A recommendation of psychooncological support by a physician was received by 16.2%. These patients reported a significant higher level of distress compared to patients who did not received a recommendation. Multivariable logistic regression detected that the utilization rate was 3.79 times higher among patients with positive attitude towards psychooncological support (OR, 3.79; 95% CI 2.51-5.73, p < 0.001). Utilization was 4.21 times more likely among patients who received a physician´s recommendation (OR, 4.21; 95% CI 2.98-5.95, p < 0.001).

CONCLUSION

The results of the study provide evidence of the relevance of giving more attention to psychooncological distress and attitudes towards psychooncological care. To reduce reservations, patients need low-threshold information about the psychooncological services offered.

Development and initial psychometric evaluation of a COVID-related psychosocial experiences questionnaire for cancer survivors

BACKGROUND

Cancer survivors are at elevated risk of psychological problems related to COVID-19, yet no published measure adequately assesses their psychosocial experiences during the pandemic.

PURPOSE

Describe the development and factor structure of a comprehensive, self-report measure (COVID-19 Practical and Psychosocial Experiences questionnaire [COVID-PPE]) assessing the pandemic's impact on US cancer survivors.

METHODS

The sample (n = 10,584) was divided into three groups to assess COVID-PPE factor structure by conducting: (1) initial calibration/exploratory analysis of the factor structure of 37 items (n = 5070), (2) confirmatory factor analysis of the best-fitting model (36 items after item removal; n = 5140), and (3) post-hoc confirmatory analysis with an additional six items not collected in the first two groups (42 items; n = 374).

RESULTS

The final COVID-PPE was divided into two sets of subscales, conceptualized as Risk Factors and Protective Factors. The five Risk Factors subscales were labeled Anxiety Symptoms, Depression Symptoms, Health Care Disruptions, Disruptions to Daily Activities and Social Interactions, and Financial Hardship. The four Protective Factors subscales were labeled Perceived Benefits, Provider Satisfaction, Perceived Stress Management Skills, and Social Support. Internal consistency was acceptable for seven subscales (αs = 0.726-0.895; ωs = 0.802-0.895) but poor or questionable for the remaining two subscales (αs = 0.599-0.681; ωs = 0.586-0.692).

CONCLUSIONS

To our knowledge, this is the first published self-report measure comprehensively capturing psychosocial impact-both positive and negative-of the pandemic on cancer survivors. Future work should evaluate predictive utility of COVID-PPE subscales, particularly as the pandemic evolves, which may inform recommendations for cancer survivors and facilitate identification of survivors most in need of intervention.

Clinicians' perspectives on barriers and facilitators to sperm banking in adolescent males with cancer: a mixed-methods study

PURPOSE

To examine processes, barriers, and facilitators to sperm banking counseling and decision-making for adolescent males newly diagnosed with cancer from the perspective of clinicians who completed Oncofertility communication training. We also identify opportunities for improvement to inform future interventions and implementation.

METHODS

A survey (N=104) and subsequent focus groups (N=15) were conducted with non-physician clinicians practicing in pediatric oncology who completed Oncofertility communication training.

RESULTS

Most survey participants were confident in communicating about the impact of cancer on fertility (n=87, 83.7%) and fertility preservation options (n=80, 76.9%). Most participants reported never/rarely using a sperm banking decision tool (n=70, 67.3%), although 98.1% (n=102) said a decision tool with a family-centered approach would be beneficial. Primary themes in the subsequent focus groups included variable processes/workflows (inconsistent approaches to consult initiation; involvement of adolescents, caregivers, and various clinician types; assessment of puberty/sexual experience), structural and psychosocial barriers (cost and logistics, developmental, cultural, clinical acuity/prognosis), and facilitators (educational materials, alternative options for banking). Opportunities and strategies for improvement (including fertility preservation in existing research protocols; additional staffing/resources; oncologist education and buy-in; and development of decision tools) were informed by challenges identified in the other themes.

CONCLUSION

Barriers to adolescent sperm banking remain, even among clinicians who have completed Oncofertility training. Although training is one factor necessary to facilitate banking, structural and psychosocial barriers persist. Given the complexities of offering sperm banking to pediatric populations, continued efforts are needed to mitigate structural barriers and develop strategies to facilitate decision-making before childhood cancer treatment.

Effectiveness of resilience interventions among cancer patients - A systematic review, meta-analysis, and meta-regression of randomised controlled trials

PURPOSE

This systematic review, meta-analysis and meta-regression aimed to (1) evaluate the effects of resilience interventions on cancer patients' resilience and posttraumatic growth and (2) identify essential contents and features of resilience interventions.

METHODS

A systematic review, meta-analysis, and meta-regression analyses were conducted. Published and unpublished randomised controlled trials evaluating the effects of resilience interventions among cancer patients were retrieved from nine databases, trial registries, and grey literature. The mean and standard deviation scores were used to compute the effect sizes.

RESULTS

23 randomised controlled trials comprising 3287 cancer patients were included. The random effects model found that resilience interventions had beneficial impacts on patients' resilience, posttraumatic growth, quality of life, anxiety, and depressive symptoms with moderate to large effects. The subgroup analyses concluded that theoretically guided interventions that adopted synchronous communication delivered physically had greater effect sizes. Interventions comprising skills that promote patients' cognitive flexibility, self-efficacy, self-esteem, self-regulation, and coping had greater effect in comparison with interventions lacking these components. The meta-regression analyses revealed that sample size has a significant effect on posttraumatic growth scores. More well-designed trials are needed to confirm the effects of resilience interventions.

CONCLUSIONS

There is merit in utilizing resilience interventions to improve cancer patients' resilience and psychological well-being. Resilience interventions should be incorporated into the routine care for cancer patients and survivors.

What Are the Psychosocial Needs of Adolescents and Young Adults with Cancer? A Systematic Review of the Literature

Adolescents and young adults with cancer (AYACs) have become recognized as a unique group in recent years. The unique developmental context and related challenges of being a young person with a cancer diagnosis can lead to a distinct and diverse set of psychosocial issues. Existing research has attempted to explore these psychosocial needs and challenges and to develop appropriate and individualized interventions. However, the needs of this group remain unmet, with ongoing calls for individualized support. This systematic review addressed the research question, "what are the psychosocial needs of AYACs aged 15-24 years?." PubMed, PsycINFO, and CINAHL databases were searched to identify relevant studies from January 2000 to December 2022 (inclusive). Qualitative, quantitative, and mixed methods designs were included and 29 studies met inclusion criteria. Findings provide an overview of needs from the existing literature and support the idea of a changing constellation of psychosocial needs for AYACs in areas such as identity, relationships, mental health, autonomy, and occupation. The main implications for theory and future research include the importance of the developmental context and consideration of discrepancies in the age range used within the literature to define this group.

Developing a Comprehensive Adolescent and Young Adult Cancer Program: Lessons Learned from 7 Years of Growth and Progress

Purpose: Every year, nearly 100,000 adolescents and young adults (15-39 years, AYAs) are diagnosed with cancer in the United States and many have unmet physical, psychosocial, and practical needs during and after cancer treatment. In response to demands for improved cancer care delivery for this population, specialized AYA cancer programs have emerged across the country. However, cancer centers face multilevel barriers to developing and implementing AYA cancer programs and would benefit from more robust guidance on how to approach AYA program development. Methods: To contribute to this guidance, we describe the development of an AYA cancer program at the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center. Results: We summarize the evolution of UNC's AYA Cancer Program since it was established in 2015, offering pragmatic strategies for developing, implementing, and sustaining AYA cancer programs. Conclusion: The development of the UNC AYA Cancer Program since 2015 has generated many lessons learned that we hope may be informative to other cancer centers seeking to build specialized services for AYAs.

The experiences of reproductive concerns in cancer survivors: A systematic review and meta-synthesis of qualitative studies

AIM

The aim of this study was to synthesize qualitative research evidence on cancer survivors' experiences with reproductive concerns (RC).

METHODS

We conducted a systematic search of qualitative studies and utilized the meta-aggregation approach. The database searches were extended up to May 14, 2023, encompassing 12 databases, specifically MEDLINE, CINAHL, PubMed, EMBASE, Scopus, Web of Science (Core Collection), AMED, PsycINFO, The Cochrane Library, CNKI, Wan Fang Data, and VIP.

RESULTS

Three overarching themes were synthesized from the analysis of 21 studies that explored cancer patients' awareness of reproductive concerns, their perceptions, needs, and coping styles. These themes encapsulate the multifaceted aspects of cancer patients' reproductive concerns: "Gender differences in fertility concerns among cancer patients: Perspectives from men and women"; "The influence of age: Experiences with fertility issues among cancer patients at different life stages"; "The impact of treatment stages on fertility concerns: The evolution of perception and coping strategies in the course of cancer treatment".

CONCLUSION

Our study presents an in-depth exploration of the reproductive concerns experienced by cancer patients from various perspectives. We found that the internal experiences of reproductive concerns, their perceptions, needs, and coping mechanisms differ based on their roles. This comprehensive understanding of the complex emotions and needs of cancer patients when confronted with fertility issues can guide clinicians in providing more effective medical assistance, psychological counseling, and fertility-related information services.

Harmful communication behaviors in cancer care: A systematic review of patients and family caregivers perspectives

OBJECTIVE

Issues regarding clinician communication remain an important source of complaints within healthcare. This systematic review aims to determine cancer patients' and their family caregivers' views on which clinicians' communication behaviors can harm (i.e. eliciting negative feelings/consequences for patients/family caregivers).

METHODS

We searched for all types of peer-reviewed studies that determined adult (≥18 years) cancer patients' and/or family caregivers' perspectives on which clinicians' communication behaviors can harm in several databases (PubMed, Embase, Web of Science, Cochrane Library, Emcare, PsycINFO and Academic Search Premier), supplemented by expert-consultation. Studies were screened using the Artificial intelligence screening tool of ASReview and data was analyzed using Thematic Analysis. To assess the quality of the studies the Qualsyst critical appraisal tool was used.

RESULTS

A total of 47 studies were included. Four main themes of harmful communication behaviors were identified: (1) Lack of tailored information provision (e.g. giving too little or too much/specific information) (2) Lack of tailored decision making (ranging from; patient exclusion, to the patients' responsibility, and/or haste) (3) Lack of feeling seen and heard (seen as a disease, not as a human being; not listened to concerns and emotions) (4) Lack of feeling held and remembered (forgotten agreements; lack of care continuity).

CONCLUSIONS

Our results reveal an overview of patients' and family caregivers' perspectives on which clinicians' communication behaviors can harm. Harm could be prevented when information and decision involvement are tailored and patients' and family caregivers' needs to feel seen, heard, held and remembered are met.

AYA-UNITE: Lessons Learned on Intervention Development Promoting Social and Physical Health of Adolescent/Young Adult Cancer Survivors

Adolescent/young adult cancer survivors (AYACS) struggle with poor psychosocial health related to social disruptions due to cancer diagnosis, impacting long-term goal achievement and overall health. In particular, social health promotion is overlooked in AYACS' care. AYA-UNITE, a sociobehavioral exercise intervention pilot for AYACS 15-21 years of age at cancer diagnosis, was designed to foster AYACS' social and physical health. AYA-UNITE was a 12-week group-based virtual exercise program incorporating strength training and aerobic activity. In this brief report, we account AYA-UNITE's conceptual design, lessons learned through AYA-UNITE intervention development, and opportunities for improvement in implementing effective AYACS psychosocial interventions (NCT03778658).

Psychological distress and mental health care utilization among Hispanic/Latino survivors of adolescent and young adult cancer

PURPOSE

Survivors of adolescent and young adult (AYA) cancer experience psychological distress and insufficient access to mental health care. Few studies have investigated racial/ethnic disparities in psychological health outcomes in this population. This study compared psychological distress, mental health care use, and inability to afford mental health care between Hispanic/Latino survivors of AYA cancer and Hispanic/Latino controls.

METHODS

The National Health Interview Survey data (2010-2018) were analyzed to identify Hispanic/Latino survivors of AYA cancer and Hispanic/Latino age- and sex-matched non-cancer controls. Sociodemographic, chronic health, modifiable factors, and psychological outcomes were compared using chi-square tests. Logistic regression models with survey weights were used to assess the log-odds of psychological distress in relation to covariates, along with the cancer group. Interactions were evaluated between each variable and cancer group.

RESULTS

The study included 370 Hispanic/Latino survivors of AYA cancer (mean time since diagnosis = 12.34 years) and 3700 Hispanic/Latino controls. Compared to controls, survivors were more likely to report moderate/severe distress (OR = 2.23, p < 0.001), use of mental health care (OR = 2.11, p < 0.001) and inability to afford mental health care (OR = 3.05, p < 0.001). Forty-one percent of survivors reported moderate/severe distress and only 16% utilized mental health care. Among survivors, having more than two chronic health conditions and public insurance (compared to private insurance) were associated with the presence of moderate/severe distress. Among survivors experiencing moderate/severe distress, lack of insurance was associated with decreased utilization of mental health care.

CONCLUSIONS

Having cancer as an AYA may exacerbate disparities in psychological health within the Hispanic/Latino population.

Association of financial worry with substance use, mental health, and quality of life in cancer patients

PURPOSE

Financial worry is an under-appreciated negative effect of cancer. The relationship of financial worry and health behaviors in cancer is poorly characterized and has important clinical implications. This study examined the association of financial worry with substance misuse, mood, and quality of life.

METHODS

People with cancer (n = 1473; 6 to 20 months after diagnosis) were recruited from a SEER cancer registry in the Pacific Northwest. Participants completed an online survey assessing financial worry; misuse of cannabis, alcohol, and prescription drugs; tobacco smoking status; quality of life (physical and mental dimensions); anxiety; and depression. Multivariable regressions tested the association of financial worry to each health indicator and outcome.

RESULTS

In adjusted analyses, financial worry was associated with being a current vs. never smoker (odds ratio (OR) = 1.91, 95% confidence interval (CI): 1.01, 3.60), and a positive screen for an anxiety (OR = 3.01, 95% CI: 1.93, 4.68) and depressive (OR = 3.08, 95% CI: 1.89, 5.00) disorder. Financial worry was not associated with cannabis, alcohol, or prescription drug misuse (all ps > 0.05), but was associated with a decrease in physical (β =  - 2.97, 95% CI: - 4.15, - 1.79) and mental (β =  - 5.27, 95% CI: - 6.59, - 3.96) quality of life.

CONCLUSION

Financial worry among cancer survivors is associated with anxiety, depression, and worse quality of life. Of the evaluated substances, there was only an increased odds of current tobacco use with financial worry. Future longitudinal studies should inform the relationships between these factors.

IMPLICATIONS FOR CANCER SURVIVORS

Financial worry and material hardship may both need to be addressed in cancer survivorship.

A cross-sectional study of existential concerns and fear of progression in people with Rheumatoid Arthritis

OBJECTIVES

People with rheumatoid arthritis (RA) have higher levels of fear of disease progression (FOP) than cancer survivors. In cancer, FOP is inextricably linked with existential concerns. However, this has not been investigated in people with RA.

METHODS

We recruited 165 people with RA (96%F) who volunteered for a treatment trial of psychological intervention. Participants completed the Existential Concerns Questionnaire (ECQ) and questionnaires measuring constructs associated with FOP in cancer. We created groups of people with RA, with and without clinically significant levels of FOP (clinical and control groups) and compared their existential concerns. We hypothesized that existential concerns would add to the variance in FOP over and above pain, psychopathology, and disability.

RESULTS

Nearly two-thirds of people with RA scored in the clinical range for FOP. The clinical group had higher levels of all existential concerns than the control group. When subscales of the ECQ were entered into a multiple regression with FOP as the dependent variable, death anxiety, meaninglessness and guilt domains accounted for significant variance in FOP. Moreover, when added to a regression equation controlling all other variables, existential concerns continued to account for unique variance in FOP (t = 2.712, p = 0.007).

CONCLUSION

Existential concerns were strongly associated with FOP. While this cross-sectional study cannot determine whether existential concerns underlie FOP in RA, these results show robust relationships that warrant future investigation.

Effects of online-offline integrated death education on patients with advanced cancer: A before-and-after study

PURPOSE

To evaluate the effectiveness of the constructed OOIDE intervention in patients with advanced cancer.

METHOD

In this study, patients were invited to participate in a 4-week OOIDE intervention. The assessment of patients' ability to cope with death was conducted using a scale in conjunction with interviews. Additionally, patients' 'readiness to die' was assessed.

RESULTS

Thirty-two patients with advanced cancer participated in this study. Our intervention significantly enhanced their perspective on life and spirituality, while also reducing their fear of death (P < 0.01). Furthermore, it facilitated their acceptance of death, encouraged a more rational approach to their illness, and fostered an understanding of hospice care, thereby reinforcing their sense of self-worth. Additionally, the intervention improved the relationship between the patient and their families, fostering greater mutual understanding and respect for the patient's perspectives. Comparing the results to the pre-intervention period, there was a significant increase in the number of patients who discussed death with their families and contemplated the place of their passing (P < 0.05).

CONCLUSION

OOIDE improves participants' ability to confront death, while also assisting patients' families in the physical and psychological preparations for the loss of their relative.

Cancer patients' needs for volunteer services during Covid-19: a mixed-method exploratory study

INTRODUCTION

To date, there are no known studies that have investigated the new need for volunteer services among cancer patients during the Covid-19 pandemic. However, it is essential for volunteer associations to heighten such knowledge to best guide their offer in this challenging period.

AIM

The present study aims to provide a mapping of the cancer patients' needs for volunteer services followed at Istituto Nazionale dei Tumori in Milan (Italy) during the Covid-19 pandemic. Since there are no specific questionnaires for this purpose, we created an ad hoc tool for which we report the preliminary result.

METHOD

We used a mixed-method multiphase approach.

PHASE I

in April-May 2020 40 ad hoc paper questionnaires were distributed at the entrance of the aforementioned hospital, with the aim of investigating patients' needs through two open-ended questions then analyzed through thematic analysis.

PHASE II

the contents that emerged from Phase I were transformed into items and submitted to the judgment of a small group of "peers" (patients) and "experts" (professionals) in November-December 2020 to evaluate their comprehensiveness, representativeness and intrusiveness. Phase III: in January-February 2021 paper questionnaires, containing the items reviewed in Phase II, were distributed within the hospital to a representative sample of cancer patients. We applied descriptive statistics, Exploratory Factor Analysis (EFA) and Cronbach's Alpha.

RESULTS

32 patients completed Phase I, 3 "peers" and 9 "experts" participated in Phase II, 214 patients completed the questionnaire in Phase III. EFA highlights five kinds of needs during the Covid-19 pandemic, in order of priority: (1) need to be supported at the hospital; (2) need for emotional support; (3) need for daily errands; (4) need for practical support to family members; (5) need to share free time. Preliminary results on the tool are encouraging, although further studies are needed. These results will allow local volunteer associations to adapt their services during the pandemic.

Measuring and addressing health equity: an assessment of cancer center designation requirements

PURPOSE

By requiring specific measures, cancer endorsements (e.g., accreditations, designations, certifications) promote high-quality cancer care. While 'quality' is the defining feature, less is known about how these endorsements consider equity. Given the inequities in access to high-quality cancer care, we assessed the extent to which equity structures, processes, and outcomes were required for cancer center endorsements.

METHODS

We performed a content analysis of medical oncology, radiation oncology, surgical oncology, and research hospital endorsements from the American Society of Clinical Oncology (ASCO), American Society of Radiation Oncology (ASTRO), American College of Surgeons Commission on Cancer (CoC), and the National Cancer Institute (NCI), respectively. We analyzed requirements for equity-focused content and compared how each endorsing body included equity as a requirement along three axes: structures, processes, and outcomes.

RESULTS

ASCO guidelines centered on processes assessing financial, health literacy, and psychosocial barriers to care. ASTRO guidelines related to language needs and processes to address financial barriers. CoC equity-related guidelines focused on processes addressing financial and psychosocial concerns of survivors, and hospital-identified barriers to care. NCI guidelines considered equity related to cancer disparities research, inclusion of diverse groups in outreach and clinical trials, and diversification of investigators. None of the guidelines explicitly required measures of equitable care delivery or outcomes beyond clinical trial enrollment.

CONCLUSION

Overall, equity requirements were limited. Leveraging the influence and infrastructure of cancer quality endorsements could enhance progress toward achieving cancer care equity. We recommend that endorsing organizations 1) require cancer centers to implement processes for measuring and tracking health equity outcomes and 2) engage diverse community stakeholders to develop strategies for addressing discrimination.

Emotional Distress, Self-Management Skills, and Expectations Among Adolescents and Young Adult Childhood Cancer Survivors in Transition from Pediatric to Adult Care: A Brief Report

The transition from pediatric to adult care poses several emotional and personal challenges to adolescents and young adult (AYA) childhood cancer survivors (CCSs), which need attention to avoid the risk of nonadherence and medical dropout. This brief report describes the condition of AYA-CCSs at the moment of transition in terms of emotional state, personal autonomy, and expectations regarding future care. The results provide insights for clinicians dealing with survivorship care, to enhance AYA-CCSs emotional resilience and to support them in being in charge of their health, thus facilitating their transition to adulthood.

Profiling Cancer Patients Based on Their Motives for Seeking Informational and Emotional Support Online

Understanding why patients seek informational and/or emotional support online is fundamental to providing patients with accurate and reliable support that is tailored to their needs, preferences, and personal situation. Based on the stress and coping theory and uses and gratifications theory (UGT), this study aimed to identify theoretically-founded profiles of cancer patients differing in their motives for seeking informational and/or emotional support online, and to compare the profiles in terms of patients' psychological and background characteristics, and perception of health care services. Hierarchical cluster analysis was conducted, using questionnaire data from patients visiting a large Dutch health website (N = 181). This revealed three distinctive profiles, i.e., overall seekers (n = 83, 46.0%), occasional information seekers (n = 83, 46.0%), and contact exchangers (n = 15, 8.0%). Patients across these profiles differed in their eHealth literacy, with the contact exchangers being more eHealth literate than the overall seekers and occasional information seekers. The results can be used to create awareness among health care providers, web designers, and patient organizations on different types of cancer patients with different motives for seeking informational and/or emotional support online, and help them to tailor recommendations to and development of (online) sources that fit patients' needs. Future research could further investigate the integration of stress and coping theory with UGT by acknowledging the interplay of different coping strategies and different gratifications.

Smoking status among cancer patients by specialty: A U.S. nationwide representative analysis

BACKGROUND

Persistence in tobacco use among cancer survivors has been associated with a multitude of clinicodemographic factors. However, there is a paucity of understanding regarding the role the healthcare professional's specialty plays in tobacco cessation in tobacco-related cancer survivors.

METHODS

We conducted a cross-sectional analysis of data from cancer survivors with a smoking history using the Behavioral Risk Factor Surveillance System (BRFSS) database to examine differences in the proportion of patients continuing tobacco use among patients with a diagnosis of cancer segregated by cancer site specialty over the 2016-2020 period. We accounted for complex survey design and used sampling weights to obtain a nationwide representative sample. We employed modified Poisson regression adjusting for age, gender, education, income, race, marital status, and medical specialty.

RESULTS

We analyzed 19,855 cancer survivors with a current or past history of tobacco use, of whom 5222 (26,3%) self-reported to be current smokers. Patients with urological and gynecological tobacco-related malignancies had a higher relative risk (RR) of being current smokers with a RR of 1.30 (95% confidence interval, 1.12-1.51) and 1.25 (95% confidence interval, 1.12-1.39) respectively. Malignant Hematology had the lowest RR of smoking status among all other specialties RR 0.85 (95% confidence interval, 0.59-1.21).

CONCLUSIONS

Continuing smoking rates among tobacco-related cancer survivors were different between specialties. One in four cancer survivors were current smokers; this emphasizes health professionals' paramount role in tobacco cessation counseling.

Psychosocial interventions on the posttraumatic growth of adults with cancer: A systematic review and meta-analysis of clinical trials

BACKGROUND

It has been increasingly recognized that some people experience post-traumatic growth (PTG) as a result of struggling with cancer.

OBJECTIVE

This systematic review aims to identify psychosocial interventions that might facilitate PTG in adults with cancer.

METHODS

A search was conducted in PsycINFO, PubMed, Scopus, the Cochrane Library, and ProQuest up to 16 September 2022. The PRISMA guidelines were followed; all included interventional studies had to comprise 30 or more adults with cancer, using the Posttraumatic Growth Inventory, from 1994 forward.

RESULTS

A total of 2731 articles were retrieved, 1028 of those were screened and 37 unique trials were included (46 articles). A large number of studies were published since 2018 (52.4%), were randomized controlled trials (43.2%), and had group interventions (34.8%), including mainly female participants (83.8%) with a single cancer type (54.1%). Most interventions (75.7%) were moderately to highly effective in increasing PTG (d = 0.65, 95% CI 0.39-0.91) with the most effective interventions using Cognitive Behavioral Therapy (d = 1.24, 95% CI: 0.05-2.44), Mindfulness-based (d = 0.54, 95% CI = 0.14-0.94) and Education, Peer Support and Health Coaching interventions (d = 0.28, 95% CI: 0.1-0.46). Expression-based and Positive Psychology-based approaches also showed promising results. Notably, the majority of studies had a high risk of bias.

CONCLUSIONS

PTG facilitation is a promising field that should be pursued as it not only allows people with cancer to overcome their trauma but also results in them going over and above their pre-cancer state, enhancing resilience, health, and well-being.

"Clinical trials are space travel": Factors of psychological response to recurrence among oncologists enrolling patients in treatment optimization trials

BACKGROUND

Cancer recurrence after treatment is a concern for patients and oncologists alike. The movement towards treatment optimization, with trials testing less than the current standard of care (SoC), complicates this experience. Our objective was to assess oncologists' psychological response to patient recurrence on optimization-focused trials and identify factors that influence those experiences.

METHODS

Clinical oncologists participated in a semi-structured interview regarding patient enrollment in treatment optimization trials. We identified factors that influence the degree of psychological response that the oncologist may feel after patient recurrence. Residual agreement analysis was used to identify whether differences in reported psychological response was associated with alternative emphases on identified factors.

RESULTS

Thirty-six oncologists identified 20 factors spanning five major themes that affected their psychological response to patient recurrence. All oncologists expressed willingness to enroll patients in treatment optimization clinical trials; however, half indicated that they were more likely to experience a negative psychological response after a treatment optimization trial than after a traditional intensification trial, and a quarter reported that patient recurrence on an optimization trial would impact their recommendations for future trial enrollment. Oncologists who reported more negative psychological responses to patient recurrence after participation in an optimization trial were more likely to emphasize introspective factors, while those who reported no difference in response emphasized patient- and process-focused factors.

CONCLUSIONS

Although most oncologists recognize the importance of treatment optimization trials, a significant proportion indicated a greater potential for psychological distress following patient recurrence in such trials and offered insight into how trial design and the process of patient enrollment can be improved to minimize those negative psychological responses.

Interventions for financial toxicity among cancer survivors: A scoping review

INTRODUCTION

Financial toxicity impairs cancer survivors' material condition, psychological wellbeing and quality of life. This scoping review aimed to identify interventions for reducing cancer-related financial toxicity (FT), and to summarize their main findings.

METHODS

A systematic search was performed in PubMed, Web of Science, EMBASE, CINAHL, Clinical Trials, China National Knowledge Internet, Wanfang and SinoMed from January 2010 to September 2022 following the PRISMA-ScR checklist.

RESULTS

From 2842 identified articles, a total of 15 were included in this review. Existing interventions can be classified into four types: financial navigation, financial counseling, insurance education and others. Previous interventions preliminarily affirmed the feasibility, satisfaction, and improvement in financial worries and knowledge. However, the effectiveness on FT was controversial.

CONCLUSIONS

Previous interventions affirmed the feasibility and primary effect of these interventions. Studies with more rigorous design are needed to evaluate the effectiveness and generalizability of interventions on FT across diverse healthcare systems.

Effects of Music Therapy on Spiritual Well-Being among Patients with Advanced Cancer in Palliative Care: A Meta-Analysis of Randomized Controlled Trials

PURPOSE

Patients with advanced cancer in palliative care often experience physical and psychological symptoms that negatively impact their quality of life (QoL) and spiritual well-being. Music therapy can be used for symptom management in these patients. However, the effectiveness is uncertain. To determine the effectiveness of music therapy on spiritual well-being, QoL, pain, and psychological distress using randomized controlled trials (RCTs).

DATA SOURCE

A systematic search was conducted in EMBASE, PubMed, Cochrane Library, CINAHL, Web of Science, and the ClinicalTrial.gov registry up to September 2022.

CONCLUSION

The meta-analysis included seven RCTs with a total of 747 advanced cancer patients. Music therapy was found to significantly improve spiritual well-being with a mean difference of 0.43 (95% CI: 0.25 to 0.61, P < .001) in the intervention group compared to the control group. However, no significant group differences were found between the intervention and control groups for QoL (SMD: 0.53, 95% CI: -0.12 to 1.13, P = .11), pain (MD: -0.81, 95% CI: -2.06 to 0.44, P = .20), and psychological distress (SMD: -0.05, 95% CI: -0.41 to 0.32, P = .81). Music therapy can effectively improve the spiritual well-being of palliative care patients. However, its beneficial effects on QoL, pain, and psychological distress were minimal.

IMPLICATIONS FOR NURSING PRACTICE

Music therapy interventions can be introduced to help patients deal with spiritual/existential needs. Future studies should identify optimal characteristics of music therapy interventions to aid in enhancing the quality of palliative care for patients with advanced cancer.

Associations between parental depression, communication, and self-worth of siblings bereaved by cancer

A child's death from cancer may increase the risk for poor self-worth in bereaved siblings. Furthermore, bereaved parents may experience depressive symptoms and communicate differently with their surviving children. However, limited research has examined family factors associated with self-worth in bereaved siblings. Thus, we examined: (a) differences in parental depressive symptoms, parent-child communication, and sibling self-worth between bereaved and nonbereaved families and (b) indirect effects of parental depressive symptoms and communication quality on the association between bereavement and sibling self-worth. Bereaved parents and siblings were recruited 3-12 months after a child's death from cancer. Bereaved (n = 72) and nonbereaved families of classmates (n = 58) completed home-based questionnaires upon enrollment (T1), and 48 bereaved and 45 nonbereaved families completed 1-year follow-up (T2). Relative to controls at T1 and T2, bereaved mothers, but not fathers, reported more depressive symptoms. Bereaved siblings reported poorer maternal and similar paternal communication, and similar levels of self-worth compared to controls. Both cross-sectional and longitudinal serial mediation models for mothers were significant. Bereaved mothers were at greater risk for depressive symptoms, which adversely affected sibling self-worth over time through disrupted mother-child communication. The father sample was limited, but the cross-sectional model was nonsignificant. Mothers and fathers may grieve differently and may require different therapeutic approaches. Family-centered interventions should target bereaved mothers' emotional adjustment and communication to enhance sibling self-worth. Additionally, clinicians should bolster other sources of support for bereaved siblings to promote adaptive outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Beyond Medical Care: How Different National Models of Care Impact the Experience of Adolescent and Young Adult Cancer Patients

Patient experience is positively associated with clinical effectiveness, quality care, and patient safety. This study examines the experience of care of adolescents and young adult (AYA) cancer patients from Australia and the United States, allowing a comparison of patient experiences in the context of different national models of cancer care delivery. Participants (n = 190) were aged 15-29 years and received cancer treatment from 2014 to 2019. Australians (n = 118) were recruited nationally by health care professionals. U.S. participants (n = 72) were recruited nationally via social media. The survey included demographic and disease variables, and questions regarding medical treatment, information and support provision, care coordination, and satisfaction across the treatment pathway. Sensitivity analyses examined the possible contribution of age and gender. Most patients from both countries were satisfied or very satisfied with their medical treatment (chemotherapy, radiotherapy, and surgery). There were significant differences between countries in the provision of fertility preservation services, age-appropriate communication, and psychosocial support. Our findings suggest when a national system of oversight with both state and federal funding is implemented, as is the case in Australia but not in the United States, significantly more AYAs with cancer receive age-appropriate information and support services, and improved access to specialist services such as fertility care. A national approach with government funding and centralized accountability appears to be associated with substantial benefits for the well-being of AYAs undergoing cancer treatment.

What Constitutes Quality of Life? Perspectives of Adolescents and Young Adults With Advanced Cancer

BACKGROUND

Adolescents and young adults (AYAs) with advanced cancer identify maintaining a good quality of life (QoL) as a central goal of end-of-life care. QoL is a dynamic and subjective overarching concept that refers to an individual's relative satisfaction with their own life. Despite its importance to AYAs with advanced cancer, a patient-centered definition of QoL is lacking in this population.

PATIENTS AND METHODS

This qualitative secondary analysis of semistructured interviews was conducted across 3 institutions and 1 online support community among AYA patients with advanced cancer, family caregivers, and health care providers who cared for living or recently deceased AYAs. Interviewees were asked about priorities in receipt of care. Interviews were transcribed using NVivo software for primary analysis, and previously coded excerpts were screened for references to QoL. Relevant excerpts were sorted into organizing domains.

RESULTS

Participants included 23 AYA patients, 28 family caregivers, and 29 health care providers (including physicians, nurses, nurse practitioners, social workers, and psychologists). Four domains of QoL were identified: psychosocial and physical well-being, dignity, normalcy, and personal and family relationships. Within each domain there was agreement across AYAs, caregivers, and health care providers, with nuanced perspectives provided by AYAs of different ages. Personal and family relationships was the most frequently referenced domain of QoL among all participants. A common feature of each domain was that adaptation to current circumstances impacted perspectives on QoL. Patients valued active participation in the development of a care plan that supported these domains.

CONCLUSIONS

AYAs with advanced cancer, their caregivers, and health care providers agree on several broad domains of QoL in this population. To provide high-quality, patient-centered care, care plans should integrate these domains to enable AYAs to maximize their QoL throughout their advanced cancer care.

'Do you feel well or unwell?' A study on children's experience of estimating their nausea using the digital tool PicPecc

Research with childhood cancer has progressed greatly in recent years, resulting in much improved treatment that is more intensive. However, with this new treatment children often experience negative symptoms, and research shows that nausea is a symptom that most affects them. Pictorial support in person-centred care for children (PicPecc) is a digital picture-based tool for children who undergo treatment due to their cancer diagnosis and helps them more effectively communicate and self-report their symptoms and emotions. The aim of the study was to investigate children's experience of (i) using mHealth in nausea management and (ii) their acceptability of using an application (App). Semi-structured interviews were conducted with eight children aged five to fifteen years. Data were analysed with qualitative content analysis. The findings were presented in three categories: 1) Communicating feelings, 2) Playfulness generated in motivation and 3) App adaptable to children's capabilities. Using an App contributed to new opportunities for the children to participate in their care. They experienced their treatment in different ways and used different strategies to manage and distract themselves from their symptoms. Using the PicPecc App can increase healthcare staff's understanding of how children experience nausea when they undergo chemotherapy.

Establishing General Working Population Norms for the Cognitive Symptom Checklist-Work

PURPOSE

The Cognitive Symptom Checklist-Work (CSC-W) is a self-report measure to assess cognitive symptoms (i.e., memory and executive function) in working adults with cancer. To date, general working population norm data are lacking worldwide. We established CSC-W norm values in the general working population, and assessed associations of CSC-W scores with work and health-related factors.

METHODS

This cross-sectional study consisted of 1,000 Dutch working adults, of whom data was collected through an online respondent panel. The sample was stratified for sex and age, and data were weighted. Summary scores of the CSC-W total scale, and memory and executive function symptoms subscales, were determined (e.g., means, percentiles). Z- and T-scores were calculated, and analysis of (co)variance has been applied.

RESULTS

Cognitive symptom scores were relatively stable across age groups, but 18-39-year-old respondents reported lower memory and executive function than respondents in other age groups. Symptom scores of memory function (mean 29.1; SD = 16.7) were higher for all age groups and in both sexes compared to executive function (mean 22.1; SD = 16.8). No sex differences in memory and executive function were observed. Higher symptom scores were associated with performing non-manual work only, manual work only, self-reported long-term illness, and higher levels of depressive symptoms and fatigue.

CONCLUSION

The CSC-W norms may enhance the interpretation and facilitate the analysis of self-reported cognitive symptoms in patients with cancer at work. Our findings may support health care professionals in identifying working adults with cancer with cognitive symptoms and in developing personalized treatment.

Reappraising personal values in cancer: Meaning-in-life adaptation, meaningfulness, and quality of life

OBJECTIVE

This study explores the reappraisal of personal values among people with cancer post-diagnosis and its connections to meaningfulness, encompassing personal meaning and sense of meaning, and various dimensions of quality of life.

METHODS

A total of 144 patients with diverse cancer types and a control group comprising 158 healthy adults with similar demographic characteristics completed the Valued Living Questionnaire-Perceived Change, the Personal Meaning Profile-Brief, the Portrait Values Questionnaire, and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being.

RESULTS

Cancer patients displayed a substantial values reappraisal compared to healthy adults. They reported an increased significance of social areas and self-transcendental values, including close relationships (family, partner, and friends), spirituality, citizenship, and universalism, as well as an increased importance of self-care and self in general. Conversely, cancer patients assigned less importance to work and self-enhancement values such as stimulation, power, and achievement. Cluster analysis revealed that patients who reappraised their values exhibited higher meaningfulness and better indicators of quality of life, including spiritual and physical well-being, compared to patients who did not modify their value system.

CONCLUSIONS

These findings underscore the importance of assessing and promoting meaning-in-life adaptability among people with cancer, with potential applications in meaning-centered therapies and interventions aimed at enhancing psychological flexibility.

The Place of Sick Peers in Adolescents and Young Adults with Cancer: Advantage, Disadvantage, and What Makes Barriers to the Encounter

Purpose: The appreciation of peer support can vary from one country to another due to the cultural and relational differences. This study explores what perceptions French adolescents and young adults (AYAs) in post-treatment for cancer have of the place of sick peers during their treatment and what can make barriers to meet them. Methods: A semistructured interview has been proposed 6 months after the end of cancer treatments. A thematic analysis has been conducted to highlight the major themes and subthemes identified through the participants' discourses. Results: Twelve AYAs (mean age 23 y.o., standard deviation = 2.8; min = 19; max = 26) from two French cancer centers were interviewed. Five major themes were identified, but only two were presented in this article: the place of peers and the impact of coronavirus disease 2019 (COVID-19) epidemic on AYA facilities. AYA peers with cancer major theme demonstrated that meeting sick peers has benefits (e.g., identification, understanding, support, feeling of normalcy) but also has disadvantages (e.g., negative emotional influence). The benefits of peer-to-peer meetings seem to outweigh the disadvantages. Nevertheless, AYAs can face social barriers to this kind of relationship (e.g., fatigue, need to focus on oneself, confrontation to cancer and negative events, feeling of unnatural meeting). Finally, patients' encounters and the normal functioning of AYA facilities have been hampered by the COVID-19 pandemic. Conclusion: Even if AYA services systematically suggest a meeting with other sick peers, it is important to reiterate this proposal since the needs can evolve over time. It can also be interesting to propose places of life outside the hospital to make the encounters more comfortable and natural for AYAs. Clinical Trial Registration number: NCT03964116.

Perceived importance of emotional support provided by health care professionals and social networks: Should we broaden our focus for the delivery of supportive care?

INTRODUCTION

Emotional support provided by health care professionals (HCPs) for people diagnosed with cancer is associated with improved outcomes. Support via social networks may also be important.

AIMS

To report among a sample of distressed patients and caregivers, (1) the importance attributed to different sources of emotional support (HCPs and social networks) by distressed cancer patients and caregivers; (2) the proportion who indicate they did not receive sufficient levels of emotional support; and (3) potential associations between respondents' demographic and clinical characteristics and reported lack of emotional support.

METHODS

This study utilised cross-sectional data from telephone interviews collected during the usual-care phase of the Structured Triage and Referral by Telephone (START) trial. Participants completed a telephone interview 6 months after their initial call to the Cancer Council Information and Support service and included recall of importance and sufficiency of emotional support.

RESULTS

More than two-thirds of patients (n = 234) and caregivers (n = 152) reported that family and friends were very important sources of emotional support. Nurses (69% and 42%) and doctors (68% and 47%) were reported very important, while a lower proportion reported that psychologists and psychiatrists were very important (39%, and 43%). Insufficient levels of support were reported by 36% of participants. Perceptions of insufficient support were significantly associated with distress levels (p < .0001) and not having a partner (p = .0115).

CONCLUSION

Social networks, particularly family, are an important source of emotional support. Higher levels of distress, those without partners, and caregivers may require targeted interventions to increase their access to emotional support.

Psychological distress predicts quality of life in the first months of cancer diagnosis in cancer caregivers

In cancer caregivers, anxiety and depression may negatively impact quality of life. Information regarding correlations and the predictive capacity of anxiety and depression with regard to the domains of quality of life of caregivers 6 months after a patient's cancer diagnosis is sparse. Sixty-seven caregivers of cancer patients were recruited and completed the Hospital Anxiety and Depression Scale (HADS) and the Short-Form Health Survey (SF-36) 30-45 days (T1) and 180-200 days (T2) after diagnosis. Depression and anxiety (T1) correlated with quality of life in terms of general health, vitality, social functioning, as well as role limitations due to emotional problems, and mental health (T2). Depression scores at T1 predicted general health, vitality, social functioning, role limitations due to emotional problems and mental health. Although these results are interesting, it must be noted that the sample size was somewhat limited and that the patients' cancer types may have influenced the results obtained. Psychological distress, particularly depression, correlated with and acted as a predictor for changes in the different domains of quality of life, highlighting the relevance of the evaluation of psychological distress in cancer caregivers shortly after cancer diagnosis. These results underscore the importance of differentiating between the different domains in the evaluation of impairments of quality of life in cancer caregivers.

Financial toxicity among cancer patients, survivors and their families in the United Kingdom: a scoping review

BACKGROUND

The aim of this scoping review was to identify key research gaps and priorities in order to advance policy and practice for people living with cancer in the UK.

METHODS

The review adhered to PRISMA guidelines for scoping review. We searched MEDLINE, EMBASE, Scopus, Web of Science and Google Scholar on 16 July 2022. There were no restrictions in terms of study design and publication time; gray literature was included. The key words, 'financial' or 'economic', were combined with each of the following words 'hardship/stress/burden/distress/strain/toxicity/catastrophe/consequence/impact.'

RESULTS

29/629 studies/reports published during 1982-2022 were eligible to be included in the review. No study conducted a comprehensive inquiry and reported all aspects of financial toxicity (FT) or used a validated measure of FT. The most three commonly reported outcomes related to financial hardship were financial well-being (24/29), benefit/welfare (17/29) and mental health status (16/29).

CONCLUSIONS

It is evident that FT is experienced by UK cancer patients/survivors and that the issue is under-researched. There is an urgent need for further research including rigorous studies which contribute to a comprehensive understanding about the nature and extent of FT, disparities in experience, the impacts of FT on outcomes and potential solutions to alleviate FT and related problems.

Acceptance Factors and Psychological Investigation of Clinical Trials in Cancer Patients

Aim

To understand the degree of oncology patients' awareness of drug clinical trials and oncology patients' willingness to participate in drug clinical trials and the factors influencing them.

Methods

The differences in the relevant variables of patients' willingness to accept clinical trials were analyzed, and a descriptive analysis was done for the measurement data (mean and standard deviation). Pearson's correlation coefficient analysis was used to examine the correlation between willingness and the demographic variables. Stepwise regression analysis was used to explore the influencing factors of patients' willingness to accept clinical trials.

Results

There were no statistical differences in age, gender, education level, marital status, place of residence, monthly income, medical payment method, and treatment time (P > 0.05). Patients' willingness to accept drug clinical trials differed in their cognitive degree of clinical drug trials (P = 0.002). Patients' willingness to accept drug clinical trials differed in their experience in clinical trials (P < 0.001). The correlation difference was statistically significant. The willingness to accept drug clinical trials was negatively correlated with treatment time (R = -0.16, P < 0.05) and positively correlated with awareness of clinical trials and whether they had been subjects (R = 0.16 and 0.43, P < 0.05). Multiple regression analysis showed that patients' willingness was directly influenced by age, treatment time, and whether they had been subjects (F = 21.315, P < 0.001).

Conclusion

Age, treatment time, and whether they had been subjects were the direct influencing factors of patients' willingness. This study pointed out that hospitals should do a good job in the publicity of clinical trials of new drugs, expand publicity channels, increase publicity efforts, improve the awareness of clinical trials of the masses, and promote the enthusiasm of the masses to participate in clinical trials of drugs.

Experiences of the older spousal caregivers of patients with cancer during palliative chemotherapy: a qualitative descriptive study

BACKGROUND

Several studies have characterized the experiences of family members caring for patients undergoing chemotherapy; however, information about the experiences of older spousal caregivers with intensive caregiving burdens is unclear. Recently, more older patients have been diagnosed with cancer due to the aging population worldwide. Therefore, this study evaluated the patterns in the experiences of older spousal caregivers of patients undergoing palliative chemotherapy for advanced cancer.

METHODS

Qualitative research using semi-structured interviews was used in this study involving 10 older spousal caregivers of patients undergoing palliative chemotherapy at a hospital providing advanced cancer care in Japan. The data obtained were analyzed qualitatively and inductively using thematic analysis by Braun and Clarke.

RESULTS

Four themes were identified from the narratives of the participants in this study. The first theme was "getting used to living with the disease," indicating that the older spouses gradually became accustomed to living with the patient through continued caregiving. The second theme was "deepening view of life and death," indicating that the older spouses' views of life and death were deepened by being confronted with patients' quality of life until death. The third theme was "anxious about the future," indicating the fear regarding the patient's progressive diseases and anxiety pertaining to continuing care for the patient while dealing with their health problems. The final theme was "desire for a better rest of life," indicating that the couple felt their bond was strengthened through caregiving and wishes to live well for the rest of their lives.

CONCLUSIONS

The patterns in the experience of older spousal caregivers caring for patients undergoing palliative chemotherapy indicated an aspect of rebuilding their lives as they became accustomed to caregiving, while strengthening their marital bond. The caregiving process involved a mix of emotions, including anxiety about the spousal caregiver's health problems worsening. However, the caregivers recognized the value of their remaining time. Therefore, they had deep concern for the patient's comfort, concealing their feelings so that the patient would feel comfortable. This study can contribute to understanding the challenges faced and support needed by older spousal caregivers.

Grit and Health-Related Quality of Life in Adolescents and Young Adults with Cancer: Mediating Role of Health Self-Efficacy and Treatment Adherence

OBJECTIVE

Challenges with health-related quality of life (HRQOL) are common among adolescents and young adults (AYA) with cancer. Literature on HRQOL has largely been focused on individual deficits, rather than individual strengths. The present study investigated the relations between a strengths-based concept called grit (i.e., perseverance and passion for long-term goals), self-management (i.e., health self-efficacy and adherence), and HRQOL among AYA with cancer.

METHODS

Sixty-seven AYA receiving cancer treatment (Mage=17.1; 50.7% female; 25.4% Black, Hispanic, Asian, or a race other than white) and their caregivers (73.0% mothers) completed a semistructured, validated interview about adherence. AYA also completed self-report questionnaires about perceptions of their grit, health self-efficacy, and HRQOL.

RESULTS

After controlling for sex, health self-efficacy (i.e., a cognitive self-management variable) mediated the relation between grit and HRQOL (95% confidence interval = .74-6.52). When testing adherence to medications, diet, or physical activity as mediators of the relation between grit and HRQOL, mediation models were non-significant.

CONCLUSIONS

Among AYA with cancer, this study identified grit as an individual strength associated with more positive self-management beliefs, which in turn, related to better HRQOL. This adds to a growing body of literature supporting the need for resiliency-oriented, strengths-based approaches to AYA HRQOL research. Future directions include exploring the role of caregiver grit in relation to AYA cancer self-management, given that caregivers have demonstrated a high degree of involvement in AYA cancer care.

Development and psychometric evaluation of item banks for memory and attention - supplements to the EORTC CAT Core instrument

BACKGROUND

Cancer patients may experience a decrease in cognitive functioning before, during and after cancer treatment. So far, the Quality of Life Group of the European Organisation for Research and Treatment of Cancer (EORTC QLG) developed an item bank to assess self-reported memory and attention within a single, cognitive functioning scale (CF) using computerized adaptive testing (EORTC CAT Core CF item bank). However, the distinction between different cognitive functions might be important to assess the patients' functional status appropriately and to determine treatment impact. To allow for such assessment, the aim of this study was to develop and psychometrically evaluate separate item banks for memory and attention based on the EORTC CAT Core CF item bank.

METHODS

In a multistep process including an expert-based content analysis, we assigned 44 items from the EORTC CAT Core CF item bank to the memory or attention domain. Then, we conducted psychometric analyses based on a sample used within the development of the EORTC CAT Core CF item bank. The sample consisted of 1030 cancer patients from Denmark, France, Poland, and the United Kingdom. We evaluated measurement properties of the newly developed item banks using confirmatory factor analysis (CFA) and item response theory model calibration.

RESULTS

Item assignment resulted in 31 memory and 13 attention items. Conducted CFAs suggested good fit to a 1-factor model for each domain and no violations of monotonicity or indications of differential item functioning. Evaluation of CATs for both memory and attention confirmed well-functioning item banks with increased power/reduced sample size requirements (for CATs ≥ 4 items and up to 40% reduction in sample size requirements in comparison to non-CAT format).

CONCLUSION

Two well-functioning and psychometrically robust item banks for memory and attention were formed from the existing EORTC CAT Core CF item bank. These findings could support further research on self-reported cognitive functioning in cancer patients in clinical trials as well as for real-word-evidence. A more precise assessment of attention and memory deficits in cancer patients will strengthen the evidence on the effects of cancer treatment for different cancer entities, and therefore contribute to shared and informed clinical decision-making.

Evaluating fertility preservation interventions for alignment with ASCO Guidelines for reproductive aged women undergoing cancer treatment: a systematic review

PURPOSE

While cancer treatment advancements have increased the number of reproductive-aged women survivors, they can harm reproductive function. Despite national guidelines, oncofertility service uptake remains low. This review explores interventions for fertility preservation alignment with American Society of Clinical Oncology (ASCO) guidelines and consideration of a multilevel framework.

METHODS

We systematically reviewed literature from 2006 to 2022 across four databases. Identified interventions were assessed and scored for quality based on CONSORT and TREND statement checklists. Results were synthesized to assess for intervention alignment with ASCO guidelines and four multilevel intervention framework characteristics: targeted levels of influence, conceptual clarity, methodologic pragmatism, and sustainability.

RESULTS

Of 407 articles identified, this review includes nine unique interventions. The average quality score was 7.7 out of 11. No intervention was guided by theory. Per ASCO guidelines, most (n=8) interventions included provider-led discussions of treatment-impaired fertility. Fewer noted discussions on fertility preservation approaches (n=5) and specified discussion timing (n=4). Most (n=8) referred patients to reproductive specialists, and few (n=2) included psychosocial service referrals. Most (n=8) were multilevel, with five targeting three levels of influence. Despite targeting multiple levels, all analyses were conducted at the individual level. Intervention strategies included: educational components (n=5), decision aids (n=2), and nurse navigators (n=2). Five interventions considered stakeholders' views. All interventions were implemented in real-world contexts, and only three discussed sustainability.

CONCLUSIONS

This review identifies key gaps in ASCO guideline-concordant fertility preservation that could be filled by updating and adhering to standardized clinical practice guidelines and considering multilevel implementation frameworks elements.

Effects of music intervention combined with progressive muscle relaxation on anxiety, depression, stress and quality of life among women with cancer receiving chemotherapy: A pilot randomized controlled trial

Beneficial effects of music intervention and progressive muscle relaxation alone on psychological issues were reported, however, studies evaluating their combined effects are limited. This study aimed to investigate the feasibility, acceptability and preliminary effects of music intervention combined with progressive muscle relaxation on anxiety, depression, stress, and quality of life among breast and gynaecological cancer patients receiving chemotherapy.

METHODS

The study was carried out from March to May 2022 in an oncology hospital in Vietnam. A single-blinded randomized controlled trial was conducted among 24 women with breast and gynaecological cancer undergoing chemotherapy. The intervention group (n = 12) received a face-to-face training program about music listening and progressive muscle relaxation skills. They then performed the self-practice daily at home for three weeks. The control group (n = 12) received standard care, including health assessment, regular health advice and nutrition consultation. Ten participants in the intervention group were interviewed with open-ended questions to explore the acceptability of the intervention. Anxiety, depression and stress were measured using the Depression Anxiety Stress Scale, while The Functional Assessment of Cancer Therapy-General was used to evaluate the quality of life. The outcome measurements were collected at baseline (T0), post-intervention (3rd week, T1) and follow-up (6th week, T2). Appropriate descriptive statistics were used to depict the outcome measures across study time points.

RESULTS

A total of 24 patients were eligible to join, and 20 of them completed the study. Greater reductions in anxiety, depression and stress were observed in the intervention group than in the control group at T1 and T2. Greater improvements on quality of life were found in the intervention group than control group at T1 and T2 with respect to T0. The content analysis supported the acceptable intervention of participants through two themes, perceived beneficial effects on psychological and physical health and willingness to keep practising in the future.

CONCLUSIONS

Implementing music intervention combined with progressive muscle relaxation is feasible and had a trend in reducing anxiety, depression and stress levels. A larger scale randomized controlled trial is needed to confirm the effect of the intervention on outcomes.

TRIAL REGISTRATION

This trial was registered on ClinicalTrials.gov with ID: NCT05262621.

Psychological functioning of childhood cancer survivors: Longitudinal associations with the parental context

OBJECTIVE

The long-term psychological effects of childhood cancer vary, with childhood cancer survivors reporting depressive symptoms, fear of cancer recurrence, and benefit finding. As cancer is considered a family disease, investigating the parental context may provide insight into such individual differences in psychological functioning of survivors. This study examined the directionality of effects among parental sense of incompetence, parenting dimensions (responsiveness, psychological control, and overprotection), and survivor psychological functioning (depressive symptoms, fear of cancer recurrence, and benefit finding).

METHOD

This three-wave longitudinal study (covering 2 years) included 125 Dutch-speaking childhood cancer survivors (ages 14-24, 95.2% diagnosed < 18 years, and time since diagnosis 2-22 years), 114 mothers, and 91 fathers. Survivors reported (SR) about their psychological functioning and perceived parenting. Mothers reported (MR) and fathers reported (FR) about parenting and sense of incompetence. Cross-lagged panel models were estimated for each informant's perspective on parenting separately.

RESULTS

Different relations were obtained for each informant. Primarily unidirectional relations were found from parental sense of incompetence to maladaptive parenting (psychological control across informants and maternal overprotection SR) and from parenting to survivor functioning. Maternal and paternal responsiveness SR positively predicted survivors' benefit finding and negatively predicted survivors' depressive symptoms, respectively. Responsiveness MR and overprotection MR positively predicted survivors' fear of cancer recurrence and depressive symptoms, respectively. One consistent reverse pathway emerged: maternal and paternal responsiveness SR negatively predicted maternal and paternal sense of incompetence, respectively.

CONCLUSION

The results support parent-driven processes impacting survivors' psychological functioning and stress the need to focus on multiple perspectives when investigating family dynamics. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Clinical Practice Strategies to Address Sexual Health in Female Cancer Survivors

PURPOSE

The objectives of this narrative review are to describe (1) the evidence for interventions addressing four key issues affecting female sexual health in cancer populations (ie, low sexual desire, vulvovaginal symptoms, negative body image, and sexual partner relationships) that are ready or nearly ready for integration into practice and (2) the current state of patient-provider sexual health communication related to female sexual health as these findings could have implications for integrating sexual health into practice.

METHODS

A narrative review of recent intervention evidence for female cancer survivors' sexual health was conducted.

RESULTS

Strong evidence was found for behavioral interventions, such as psychosexual counseling and psychoeducation to treat concerns related to sexual health, including desire, body image, and sexual partner relationships. For partnered female survivors, couple-based psychosexual interventions have been found to be effective. There are no proven pharmacologic treatments for sexual-related concerns other than for vulvovaginal atrophy in female cancer survivors. Vaginal nonhormonal and low-dose hormonal agents are effective remedies for vulvovaginal symptoms. Laser treatment has not yet been fully evaluated. Sexual partners are a critical context for sexual health. Despite much need, discussions around this topic continue to be relatively infrequent. Recent technology-based interventions show promise in improving discussions around sexual health.

CONCLUSION

Effective interventions exist for many sexual health challenges for female survivors although more high-quality intervention research, particularly multimodal interventions, is needed. Many of the effective interventions are nonpharmacologic, and thus, evaluation of the use of digital delivery to improve access to these interventions is needed. Cancer care delivery research is urgently needed to translate existing effective interventions into practice, including strategies to improve patient-provider communication around this topic.

Communication preferences and perceptions of cancer patient during their first medical oncology appointment

BACKGROUND

The first medical oncology appointment serves as a platform for patients to comprehend their diagnosis and prognostic implications of cancer. This study aimed to determine patients' communication preferences during their first medical oncology appointment and to assess the disparities between patients' preferences and perceptions.

METHODS

A total of 169 cancer patients participated by completing the Communication in First Medical Oncology Appointment Questionnaire (C-FAQ), a two-section questionnaire designed to assess patients' preferences and perceptions regarding Content (information provided and its extent), Facilitation (timing and location of information delivery), and Support (emotional support) during their first medical oncology appointment. A comparative analysis was conducted to assess the variations between preferences and perceptions.

RESULTS

Content emerged as the most significant dimension compared to Facilitation and Support. The physician's knowledge, honesty, and ability to provide clear information were considered the most important attributes. Patients evaluated most of their preferences as "very important". Patients' perception of the communication dimensions present during their appointment was below preferences for 11 items, indicating significant discrepancies in clinical practice.

CONCLUSIONS

Patients highly valued their preferences concerning Content, Facilitation, and Support dimensions of communication. However, patient preferences were more prominently oriented towards the Content dimension. The discrepancies between preferences and perceptions should be viewed as an opportunity for enhancing communication skills through training.

Happy thus survivor? A systematic review and meta-analysis on the association between cancer survival and positive states, emotions, and traits

OBJECTIVES

Traditionally, the literature investigating patient-reported outcomes in relation to cancer survival focused on negative factors such as distress. Meta-analyses in this field have provided a clear identification of negative affect that reduce cancer survival (e.g., depression). Nevertheless, positive psychological factors and especially positive affect might be equally crucial for cancer survival but have been neglected so far. While studies in this domain have been conducted, they remain less numerous and have produced mixed results.

METHODS

A pre-registered systematic review and meta-analysis (https://osf.io/jtw7x) aimed at identifying the positive affect linked to mortality in cancers were conducted. Four databases (Pubmed, PsycINFO, Embase, and Cochrane Library) were searched to find longitudinal studies linking positive affect to survival in cancers. Two reviewers completed each stage of the study selection process, the data extraction, and the Quality in Prognosis Studies risk of bias assessments.

RESULTS

Twenty-four studies involving 822,789 patients were included based on the 2462 references identified. The meta-analysis reveals that positive affect is associated with longer survival (Hazard Ratio [HR] = 0.91; 95% CI [0.86, 0.96], z = -3.58, p < 0.001) and lower mortality (Odd Ratio [OR] = 0.59; 95% CI [0.45, 0.78], z = -3.70, p < 0.001). Sub-group analyses indicated that the main predictors of survival are emotional and physical well-being, optimism, and vitality.

CONCLUSION

This work emphasizes the need to consider the role of affective mechanisms in patients with cancer, including their levels of well-being or optimism to provide the most favorable conditions for survival. Therefore, stronger and continuous effort to improve patients' positive affect could be particularly beneficial for their life expectancy.

Aggressive end-of-life care across gradients of cognitive impairment in nursing home patients with metastatic cancer

BACKGROUND

Studies examining end-of-life (EOL) care in older cancer patients are scarce, and prior studies have not accounted for gradients of cognitive impairment (COG-I). We examine EOL care patterns across COG-I gradients, hypothesizing that greater COG-I severity is associated with lower odds of receiving aggressive EOL care.

METHODS

Using data from the linked Surveillance Epidemiology and End Results (SEER) -Medicare -Minimum Data Set (MDS) 3.0, we identified patients with nursing facility stays (NFS) and who died with metastatic cancer from 2013 to 2017. Markers of aggressive EOL care were: cancer-directed treatment, intensive care unit admission, >1 emergency department visit, or >1 hospitalization in the last 30 days of life, hospice enrollment in the last 3 days of life, and in-hospital death. In addition to descriptive analysis, we conducted multivariable logistic regression analysis to evaluate the independent association between COG-I severity and receipt of aggressive EOL care.

RESULTS

Of the 40,833 patients in our study population, 49.2% were cognitively intact; 24.4% had mild COG-I; 19.7% had moderate COG-I; and 6.7% had severe COG-I. The percent of patients who received aggressive EOL care was 62.6% and 74.2% among those who were cognitively intact and those with severe COG-I, respectively. Compared with cognitively intact patients, those with severe COG-I had 86% higher odds of receiving any type of aggressive EOL care (adjusted odds ratio (aOR): 1.86 (95% confidence interval: 1.70-2.04)), which were primarily associated with higher odds of in-hospital death. The odds of in-hospital death associated with severe COG-I were higher among those with short- than with long-term stays (aOR:2.58 (2.35-2.84) and aOR:1.40 (1.17-1.67), respectively).

CONCLUSIONS

Contrary to our hypothesis, aggressive EOL care in older metastatic cancer patients with NFS was highest among those suffering severe COG-I. These findings can inform the development of interventions to help reduce aggressive EOL care in this patient population.

Coping strategies as mediators of uncertainty and psychological distress in patients with advanced cancer

PURPOSE

Uncertainty in the context of advanced cancer diagnosis often incurs significant psychological distress. The aims were to evaluate the incidence of psychological distress upon diagnosis of advanced cancer and to analyze whether the relationship between illness uncertainty and psychological distress can be mediated by coping strategies.

METHODS

A multicenter, prospective, cross-sectional study was conducted in 15 medical oncology departments across Spain. Individuals with unresectable advanced cancer completed questionnaires on uncertainty (Michel Uncertainty of Illness Scale, coping strategies (Mental Adjustment to Cancer, M-MAC), and psychological distress (Brief Symptom Inventory, BSI-18) after the diagnostic and treatment appointment and before beginning systemic cancer treatment.

RESULTS

841 patients eligible for systemic treatment with palliative intent were included between February 2020 and April 2022. A total of 71.7% had clinically significant levels of psychological distress. Univariate analyses identified that the groups with less psychological distress were male (ηp2  = 0.016), married (ηp2  = 0.006), and had a better performance status (ηp2  = 0.007). The most widely used coping strategies were positive attitude and cognitive avoidance. A positive relationship was found between uncertainty, coping strategies, and psychological distress (p < 0.05). Participants who responded with anxious preoccupation suffered more helplessness and psychological distress, while those who responded with cognitive avoidance displayed greater positive attitude and lesser psychological distress.

CONCLUSION

Patients with newly diagnosed unresectable advanced cancer frequently experience psychological distress in the face of uncertainty, potentially influenced by coping strategies like cognitive avoidance.