It's not over when it's over: long-term symptoms in cancer survivors--a systematic review

Lived experiences and quality of life after gynaecological cancer-An integrative review

Aim and objectives

To review the literature on Nordic women's lived experiences and quality of life (QoL) after gynaecological cancer treatment.

Background

While incidence and survival are increasing in all groups of gynaecological cancers in the Nordic countries, inpatient hospitalisation has become shorter in relation to treatment. This has increased the need for follow‐up and rehabilitation.

Design

Integrative literature review using the Equator PRISMA guidelines.

Methods

The review was selected, allowing inclusion of both experimental and nonexperimental research. The search included peer‐reviewed articles published 1995–2017. To frame the search strategy, we applied the concept of rehabilitation, which holds a holistic perspective on health.

Results

Fifty‐five articles were included and were contextualised within three themes. Physicalwell-being in a changed body encompasses bodily changes comprising menopausal symptoms, a changed sexual life, complications in bowels, urinary tract, lymphoedema and pain, bodily‐based preparedness and fear of recurrence. Mental well-being as a woman deals with questioned womanliness, the experience of revitalised values in life, and challenges of how to come to terms with oneself after cancer treatment. Psychosocial well-being and interaction deals with the importance of having a partner or close person in the process of coming to terms with oneself after cancer. Furthermore, the women needed conversations with health professionals around the process of coping with changes and late effects, including intimate and sensitive issues.

Conclusion

Years after gynaecological cancer, women have to deal with fundamental changes and challenges concerning their physical, mental and psychosocial well‐being. Future research should focus on how follow‐up programmes can be organised to target the multidimensional aspects of women's QoL. Research collaboration across Nordic countries on rehabilitation needs and intervention is timely and welcomed.

Relevance to clinical practice

To ensure that all aspects of cancer rehabilitation are being addressed, we suggest that the individual woman is offered an active role in her follow‐up.

Effect of an Inpatient Rehabilitation Program for Recovery of Deconditioning in Hematologic Cancer Patients After Chemotherapy

OBJECTIVE

To investigate the effect of a rehabilitation program in terms of De Morton Mobility Index (DEMMI) score, in hematologic cancer patients after chemotherapy.

METHODS

Hematologic cancer patients admitted for chemotherapy were reviewed. They received a rehabilitation program during their hospital stay. DEMMI score measurement was performed, before and after rehabilitation. Demographics, diagnosis, chemotherapy information, rehabilitation program duration, mortality, body mass index (BMI), and laboratory test results were collected. For analysis, patients were classified according to diagnosis (multiple myeloma, leukemia, and others), mortality, and additional chemotherapy.

RESULTS

There was statistically significant improvement in DEMMI score of 10.1 points (95% confidence interval, 5.9-14.3) after rehabilitation. It was more evident in the multiple myeloma group, and they revealed less mortality. When patients were divided according to mortality, survivors received the program earlier, and in a shorter period than in mortality cases. Although survivors revealed higher initial DEMMI score, improvement after rehabilitation did not differ significantly.

CONCLUSION

In hematologic cancer patients, rehabilitation program was effective for recovery from deconditioning, revealing significant increase in DEMMI score. Multiple myeloma patients may be good candidates for rehabilitation. Rehabilitation could be sustained during chemotherapy and for high-risk patients.

Unemployment following breast cancer diagnosis: A population-based study

OBJECTIVES

The population of breast cancer survivors is growing. In Western societies, many of these women are working age, and therefore, potentially desire to return to the work force. We aimed to evaluate the unemployment risk for up to 8 years following a breast cancer diagnosis and identify contributing socio-economic factors.

METHODS

This historical prospective study included baseline measurements from the Israeli Central Bureau of Statistics 1995 National Census, with follow-up to 2011. We retrieved data on employment from the Israeli Tax Authority database and cancer status from the National Cancer Registry. A control group without cancer was selected to match the patients. Analyses were controlled for socio-economic factors and the baseline employment status 2 years prior to diagnosis.

RESULTS

We retrieved data for 2341 patients with breast cancer and 6837 age-matched women without cancer. We found an elevated risk of unemployment during the 8 years after breast cancer diagnosis (2-year OR 1.82, 95%CI: 1.59-2.075; 8-year OR 1.26, 95%CI: 1.07-1.47). Age and all examined socio-economic variables were correlated to increased risk of unemployment. The strongest predictor was pre-diagnosis unemployment (2-year OR 18.95, 95%CI: 16.68-21.52; 8-year OR 4.92, 95%CI: 4.07-5.96). Surprisingly, patients with axillary involvement were associated with less risk of unemployment than other patients.

CONCLUSIONS

Breast cancer survivorship was associated with long-term risk of unemployment. Older patients and patients with lower socio-economic status were at increased risk of unemployment.

A comparison of psychosocial care preferences of breast cancer women in Mainland China and Hong Kong

PURPOSE

Despite shared cultural values, Mainland China's health care system differs from that of Hong Kong. We compared preferences for psychosocial care in Mainland breast cancer women with their Hong Kong counterparts to determine core preferences for, and correlates of, clinical psychosocial care implementation.

METHODS

Two hundred eighty breast cancer patients from 23 hospitals located in 15 provinces across Mainland China were recruited to complete the 55-item Chinese version of the Australian National Health and Medical Research Council's National Breast Cancer Centre assessment. Items ranked by proportions of women endorsing them as "essential" for care were compared with similar rankings by Hong Kong Chinese women with breast cancer.

RESULTS

Valid response rate was 83% (231/280). Among 231 breast cancer patients, greater than 40% endorsed 15/55 items as essential for effective psychosocial care. Of the top 10 ranked "repeatable" items, seven items were common to both Chinese and Hong Kong breast cancer women, while of the top 10 ranked "once-only" items, nine were common. Mainland breast cancer women ranked help with anxiety and social roles higher than did their Hong Kong counterparts. Demographic factors significantly associated with psychosocial care needs included ethnicity, age, income source and level, religious beliefs, education level, marital status, residential status, and current therapies.

CONCLUSIONS

Chinese breast cancer patients prioritize both disease and treatment information and psychosocially sensitive care, making these core items in comprehensive psychosocial care implementation by clinicians and nurses.

Automating Treatment Summary Development Using Electronic Billing Information: A Pilot Study of Survivors of Head and Neck Cancer

PURPOSE

Although the provision of a treatment summary (TS) is a quality indicator in oncology, routine delivery of TSs remains challenging. Automatic TS generation could facilitate use, but data on accuracy are lacking in complex cancers such as head and neck cancer (HNC). We developed and evaluated an electronic platform to automate TS generation for HNC.

METHODS

The algorithms autopopulated TSs using data from billing records and an institutional cancer registry. A nurse practitioner used the medical record to verify the accuracy of the information and made corrections electronically. Inaccurate and missing data were considered errors. We described and investigated reasons for errors in the automatically generated TSs.

RESULTS

We enrolled a heterogeneous population of 43 survivors of HNC. Using billing data, the information on primary site, lymph node status, radiation, and chemotherapy use was accurate in 93%, 95%, 93%, and 95% of patients, respectively. Billing data captured surgery accurately in 77% of patients; once an omitted billing code was identified, accuracy increased to 98%. Chemotherapies were captured in 90% of patients. Using the cancer registry, month and year of diagnosis were accurate in 91% of cases; stage was accurate in 28% of cases. Reprogramming the algorithm to ascertain clinical stage when pathologic stage was unavailable resulted in 100% accuracy. The algorithms inconsistently identified radiation receipt and treating physicians from billing data.

CONCLUSION

It is feasible to automatically and accurately generate most components of TSs for HNC using billing and cancer registry data, although clinical review is necessary in some cases.

Post-Treatment Symptoms of Pain, Anxiety, Sleep Disturbance, and Fatigue in Breast Cancer Survivors

BACKGROUND

In part because of improvements in early detection and treatment, the number of breast cancer survivors is increasing. After treatment, however, breast cancer survivors often experience distressing symptoms, including pain, sleep disturbance, anxiety, and fatigue; at the same time, they have less frequent contact with health care providers. Pain commonly co-occurs with other symptoms and the combination of symptoms contribute to the amount of distress experienced by survivors. Previous studies of post-treatment symptoms include primarily urban and white women.

AIMS

The purpose of this study was to describe the post-treatment cluster of symptoms, to examine the correlations among these symptoms, and to examine the role pain intensity may play in understanding the variation in sleep disturbance, fatigue, and anxiety in a racially diverse sample of rural breast cancer survivors.

DESIGN

The theoretical framework for this descriptive correlational study was the theory of unpleasant symptoms.

SETTINGS

Outpatient university-affiliated cancer clinic.

PARTICIPANTS/SUBJECTS

Forty women who were between 6 months and 5 years post breast cancer diagnosis.

METHODS

Participants completed the following self-report instruments: Patient Reported Outcomes Measurement Information System of pain intensity, pain interference, anxiety, and sleep disturbance and the Piper Fatigue Short Form 12.

RESULTS

The average age of participants was 58 years, and 57.5% were black. Most women reported sleep disturbance (78%), pain interference (68%), and pain intensity (63%) above the national average for an American adult. Black women reported higher pain intensity than whites. There were moderate to strong correlations among the symptoms (range r = 0.35-0.89).

CONCLUSIONS

Nurses and health care providers in primary care settings need to screen for symptoms, and nursing interventions are needed to assist breast cancer survivors to manage distressing symptoms.

Salivary secretory immunoglobulin A reactivity: a comparison to cortisol and α-amylase patterns in the same breast cancer survivors

Introduction

One way to examine the extent to which the stress associated with a breast cancer experience (BC) impacts stress-related physiological mechanisms is to study the secretion patterns of associated biomarkers. Unlike cortisol and α-amylase (sAA), biomarkers of immune functioning such as secretory immunoglobulin A (SIgA) have rarely been examined in BC survivors.

Aim of the study

This study had two principal aims: the first was to evaluate the basal secretion profiles of SIgA as well as its response to an acute stressor as a marker of immune health in BC survivors and women with no history of BC, and the second was to determine how SIgA stress-related patterns compare to published cortisol and sAA patterns in the same women.

Results

Overall, the findings indicate that BC survivors exhibit a blunted cortisol reaction to an acute stressor, a generally elevated diurnal sAA concentration pattern, and normal SIgA profiles, compared to women with no history of cancer. This study serves as a foundation for future research to elucidate the relationships between BC experience variables, stress biomarkers, and health outcomes in BC survivors.

Burden of cancer pain in developing countries: a narrative literature review

Cancer pain is one of the most common, feared, debilitating, and often undertreated symptoms among cancer patients. It needs attention since it has a significant impact on the quality of life (QoL) of the patients. Also, since cancer has emerged as a major health problem in developing countries, there is a need to strengthen preventive strategies for effective cancer pain management and provide comfort to cancer patients. Nonetheless, various barriers limit developing countries toward optimal cancer pain management. To bridge the gap between adequate pain management and burden of cancer pain in developing countries, a comprehensive understanding of the limitations faced and the prevalence of cancer pain should be addressed. The aim of this literature review is to provide a deeper understanding on the factors associated with cancer pain as well as barriers toward optimal cancer pain management in developing countries. Some of the barriers addressed were administrative, judicial, economic, and professional barriers. Also, estimates on the prevalence of cancer pain and detrimental effects of pain on the QoL of cancer patients have been addressed. In summary, pain, which is one of the most debilitating symptoms of cancer, remains uncontrolled and undertreated in developing countries. It has a profound impact on the patient’s QoL and can have physical, psychological, and social consequences; therefore, it needs to be managed urgently and appropriately. Most importantly, optimal treatment of cancer pain should be highlighted as a priority in developing countries and concerted efforts should be made to eliminate different barriers discussed in this review for effective and humane care.

Nasal administration of mesenchymal stem cells restores cisplatin-induced cognitive impairment and brain damage in mice

Cognitive impairments are a common side effect of chemotherapy that often persists long after treatment completion. There are no FDA-approved interventions to treat these cognitive deficits also called ‘chemobrain’. We hypothesized that nasal administration of mesenchymal stem cells (MSC) reverses chemobrain. To test this hypothesis, we used a mouse model of cognitive deficits induced by cisplatin that we recently developed. Mice were treated with two cycles of cisplatin followed by nasal administration of MSC. Cisplatin treatment induced deficits in the puzzle box, novel object/place recognition and Y-maze tests, indicating cognitive impairment. Nasal MSC treatment fully reversed these cognitive deficits in males and females. MSC also reversed the cisplatin-induced damage to cortical myelin. Resting state functional MRI and connectome analysis revealed a decrease in characteristic path length after cisplatin, while MSC treatment increased path length in cisplatin-treated mice. MSCs enter the brain but did not survive longer than 12-72 hrs, indicating that they do not replace damaged tissue. RNA-sequencing analysis identified mitochondrial oxidative phosphorylation as a top pathway activated by MSC administration to cisplatin-treated mice. Consistently, MSC treatment restored the cisplatin-induced mitochondrial dysfunction and structural abnormalities in brain synaptosomes. Nasal administration of MSC did not interfere with the peripheral anti-tumor effect of cisplatin. In conclusion, nasal administration of MSC may represent a powerful, non-invasive, and safe regenerative treatment for resolution of chemobrain.

Predicting Engagement With Online Walking Promotion Among Metropolitan and Rural Cancer Survivors

BACKGROUND

Physical activity has numerous associated benefits for cancer survivors. Compared with their urban counterparts, rural Australians experience a health disadvantage, including poorer survival rate after diagnosis of cancer.

OBJECTIVE

The aims of this study were to test the effectiveness of an online 12-week walking intervention designed for cancer survivors and explore region-specific psychological predictors of behavior change.

METHODS

This was a quasi-randomized controlled trial of an online resource designed according to Social Cognitive Theory and Self-determination Theory, based on individualized goal setting. Measures of habitual walking, motivation, and self-efficacy were taken at baseline, postintervention, and 3-month follow-up in an intervention group (n = 46) and active control group (n = 45). The control group was provided a pedometer but did not have access to the online program.

RESULTS

An increase in steps/day at 12 weeks was observed in both groups, with a larger increase in the intervention group; these increases were not sustained at the 3-month follow-up. Psychological predictors of maintained change in steps per day (motivation, barrier self-efficacy, and relapse self-efficacy) did not differ between metropolitan and rural participants. Changes in steps per day among intervention participants were predicted by changes in relapse self-efficacy and barrier self-efficacy.

CONCLUSIONS

The intervention was successful in increasing physical activity postintervention; however, changes were not maintained at follow-up. There were no region-specific predictors of engagement in the intervention.

IMPLICATIONS FOR PRACTICE

Nurses are seamlessly positioned to promote health interventions like walking. Nurses should reframe physical activity with patients so that relapse is seen as common and possibly inevitable when adopting a regular physical activity habit.

Motivational interviewing added to oncology rehabilitation did not improve moderate-intensity physical activity in cancer survivors: a randomised trial

QUESTION

Does adding weekly, physiotherapist-delivered motivational interviewing to outpatient oncology rehabilitation for cancer survivors increase physical activity levels and improve physical and psychosocial outcomes that are typically impaired in this cohort?

DESIGN

Randomised controlled trial with blinded outcome assessment, concealed allocation and intention-to-treat analysis.

PARTICIPANTS

A heterogeneous sample of 46 cancer survivors (n=29 female; mean age 59 years) participating in a public outpatient oncology rehabilitation program.

INTERVENTION

Participants were randomly allocated to receive oncology rehabilitation (n=24) or oncology rehabilitation with motivational interviewing delivered once weekly for 7 weeks via telephone by a physiotherapist (n=22).

OUTCOME MEASURES

The primary outcome was amount of physical activity of at least moderate intensity completed in 10-minute bouts, measured by an accelerometer worn continuously for 1 week. Secondary outcomes included other measures of physical activity, sedentary behaviour, physical function, psychosocial function, and quality of life.

RESULTS

When added to oncology rehabilitation, motivational interviewing caused no appreciable increase in the amount of moderate-intensity physical activity (MD -1.2 minutes/day, 95% CI -2.5 to 0.02). Among many secondary outcomes, the only statistically significant result was a small effect on nausea, which probably represents a Type I error. However, several secondary outcomes related to lower-intensity physical activity had non-significant confidence intervals that included large effects such as: sedentary time (SMD -0.67, 95% CI -1.32 to 0.02), light-intensity physical activity (SMD 0.56, 95% CI -0.12 to 1.21) and daily step count (SMD 0.37, 95% CI -0.30 to 1.02).

CONCLUSION

Adding motivational interviewing to oncology rehabilitation did not increase moderate-intensity physical activity. Favourable trends on measures of lower-intensity physical activity suggest that motivational interviewing should be further investigated for its effects on reducing sedentary time and improving light-intensity physical activity for cancer survivors participating in rehabilitation.

TRIAL REGISTRATION

ANZCTR 12616001079437. [Dennett AM, Shields N, Peiris CL, Prendergast LA, O'Halloran PD, Parente P, Taylor NF (2018) Motivational interviewing added to oncology rehabilitation did not improve moderate-intensity physical activity in cancer survivors: a randomised trial. Journal of Physiotherapy 64: 255-263].

The mediating role of coping between self-reported health complaints and functional limitations, self-assessed work ability and work status of long-term sick-listed cancer survivors

Our purpose was to investigate the possible mediating role of active coping and passive coping between self-reported health complaints and functional limitations, as assessed by an insurance physician (IP), self-assessed work ability and work status in cancer survivors on long-term sick leave. Validated questionnaires were used for self-reported health complaints, work ability and work status. The functional limitations of the respondents were transformed into scales for mental and physical limitations and limitations in working hours. Using LISREL, we constructed a model with coping in a mediating role. Active coping mediated between fewer self-reported physical limitations, more depressive symptoms, better cognitive functioning and more fatigue on the one hand, and more physical limitations and limitations in working hours on the other hand. Passive coping played no mediating role and was associated with more self-reported depressive symptoms only. More functional limitations were associated with lower self-assessed work ability of cancer survivors, and with not being at work, whereas higher self-assessed work ability was associated with being at work. Regarding the role of active and passive coping strategies in cancer survivors on long-term sick leave, more longitudinal research is needed to confirm causality.

Gaps in communication between cancer patients and healthcare providers: symptom distress and patients' intentions to disclose

PURPOSE

Good communication between patients and healthcare professionals (HCPs) is an important contributor to patient well-being. Few studies have focused on the gaps in communication between patients and HCPs about symptoms. This study examined patients' perspectives on symptom distress, intention to discuss symptoms, and actual symptom discussion in medical oncology visits.

METHODS

This was a cross-sectional descriptive study. Ninety-four patients provided demographic and clinical information and completed the Memorial Symptom Assessment Scale. Patients also answered questions about their plans for communication-and after the visit, their actual communication-with their medical team about their symptoms.

RESULTS

Patients reported many symptoms by questionnaire; however, they did not plan to discuss-nor actually discussed-most of their symptoms with their HCPs. For all symptoms, fewer than 42% of patients with the symptom intended to discuss it (except for lack of energy and pain) and less than 50% actually discussed the symptom. For bothersome symptoms, less than 42% of those with the symptom intended to discuss it (except for lack of energy) and less than 40% actually discussed the symptom. Psychological symptoms were endorsed by 24-41% of patients, depending on the symptom; however, of those endorsing a symptom, most did not discuss it with an HCP.

CONCLUSIONS

Results of this study support the perception of communication gaps between patients and HCPs about symptoms. Better understanding of these gaps is needed to ensure that patient-centered care is delivered and that patients' symptoms can be appropriately managed in oncology clinics.

Survivorship care planning in gynecologic oncology-perspectives from patients, caregivers, and health care providers

Purpose

This qualitative study sought to describe the challenges following treatment and the preferences regarding survivorship care among patients treated for gynecological cancer, their caregivers, and health care providers.

Methods

Between July and August 2017, in-depth semi-structured interviews regarding survivorship were conducted at a large academic hospital in the USA among patients who recently completed treatment (< 12 months) for a gynecological cancer (ovarian, endometrial, cervical, and vulvar) and their primary caregivers. A focus group was conducted among health care providers (oncologists, nurses, and fellows). Main themes were identified using descriptive content analysis.

Results

A total of 30 individuals participated in this study (13 patients, 9 caregivers, 8 health care providers). Almost all participants reported a desire for more information on how to address survivorship needs, specifically as they related to side effects, follow-up schedule, and psychological assistance. Despite this uniformly identified need for more information, preferences for survivorship care planning differed across cancer types and individuals, with respect to content, timing, and mode of delivery. Health care providers expressed challenges in communicating with patients about survivorship, a desire to shift post-treatment conversations to the goal of improving quality of life as opposed to focusing on disease recurrence, and an unmet need for disease specific and individualized survivorship care planning.

Conclusions

Patients, caregivers, and health care providers each expressed a need for gynecologic cancer-tailored survivorship care resources.

Implications for Cancer Survivors

The variation of disease types and patient and caregiver needs may require multi-faceted, individualized survivorship care planning.

Electronic supplementary material

The online version of this article (10.1007/s11764-018-0713-9) contains supplementary material, which is available to authorized users.

Processing fluency effect of a leaflet for breast and cervical cancer screening: a randomized controlled study in Japan

Processing fluency (the inferred subjective ease with which people process information) has been a topic of increasing research attention in the field of psychology over the past decade. We examined the effect of improving written materials in terms of processing fluency with regard to encouragement for obtaining breast and cervical cancer screening. We randomly assigned 670 women to intervention or control conditions; the 215 who mailed back distributed questionnaires were the study participants. A standard leaflet for cancer screening was mailed to the control group, while the materials mailed to the intervention group were improved in terms of perceptual fluency (e.g., legibility), linguistic fluency (e.g., readability), retrieval fluency (e.g., reducing amount of information) and imagery fluency (having recipients imagine future behavior and events). The screening rate of the intervention group was significantly higher than that of the control group (29.4% vs. 14.2%, χ² = 7.275, df = 1, p = .007, φ = .184). Improving the processing fluency of written materials may be useful for encouraging individuals to obtain breast and cervical cancer screening.

Non-participation in breast cancer screening among previous cancer patients

Purpose

Breast cancer can be detected at early stages through organised screening. This study explored reasons for non-participation in breast cancer screening among previous cancer patients, who have high risk of developing a new primary cancer.

Method

We conducted a population-based historical cohort study, including all women invited to the first organised screening round in 2008–2009 in the Central Denmark Region (n = 149,234). All data were based on national registers.

Results

Among women with previous cancer (n = 6638), 25.3% did not participate in breast cancer screening compared to 20.9% of women with no registrations of previous cancer, thus previous cancer patients were 21% less likely not to participate in breast cancer screening (PRR 1.21, 95% CI 1.16–1.27). Further analysis showed that this association was due to women receiving current cancer treatment or being in palliative care in the time leading up to screening. Women with previous malignant melanoma or colorectal cancer were more likely to participate in breast cancer screening, whereas women with previous gynaecological or “other” cancer types were less likely to participate.

Conclusion

Screening for breast cancer may help diagnose breast cancer at an early stage. Women with previous cancer who are not undergoing current treatment or in palliative care have the same propensity to participate as other women invited to breast cancer screening. Women with previous gynaecological cancer were less likely to participate in breast cancer screening than women with other cancer types. These results may only be generalised to similar health care systems.

Comorbid conditions and health-related quality of life in long-term cancer survivors-associations with demographic and medical characteristics

PURPOSE

Our study provides a detailed overview of comorbid conditions and health-related quality of life of long-term cancer survivors and analyses the impact of demographic, disease- and treatment-related characteristics.

METHODS

We present data obtained from 1000 survivors across mixed tumour entities 5 and 10 years after cancer diagnosis in a cross-sectional study. We analyse the prevalence of physical symptoms and health conditions via self-report and health-related quality of life using the EORTC QLQ-C30 in comparison to gender- and age-matched reference values of the general population.

RESULTS

Cancer survivors reported on average 5 comorbidities; 23% had 7 or more comorbid conditions. Cancer survivors reported higher physical symptom burden than the population-especially fatigue, insomnia and pain. Type and prevalence of long-term and late effects differ with disease-related factors (e.g. cancer type, treatment) and characteristics of the patient. Cancer survivors also reported lower quality of life than the population, especially in everyday activities, social life, psychological well-being and financial difficulties. There was a positive association between high quality of life and a low level of morbidity.

CONCLUSIONS

The specific knowledge about physical long-term consequences for the individual types of cancer could raise awareness in health care professionals for high-risk patients and help to develop adequate prevention and survivorship-programs.

IMPLICATIONS FOR CANCER SURVIVORS

Limitations in the mental health area underlines the importance of psycho-oncological survivorship-care-plans, which go beyond the time of rehabilitation. Special attention should be given to the financial situation of patients in long-term follow-up care.

Work-specific cognitive symptoms and the role of work characteristics, fatigue, and depressive symptoms in cancer patients during 18 months post return to work

OBJECTIVE

Cancer patients can experience work-specific cognitive symptoms post return to work. The study aims to (1) describe the course of work-specific cognitive symptoms in the first 18 months post return to work and (2) examine the associations of work characteristics, fatigue and depressive symptoms with work-specific cognitive symptoms over time.

METHODS

This study used data from the 18-month longitudinal "Work Life after Cancer" cohort. The Cognitive Symptom Checklist-Work Dutch Version (CSC-W DV) was used to measure work-specific cognitive symptoms. Linear mixed models were performed to examine the course of work-specific cognitive symptoms during 18-month follow-up; linear regression analyses with generalized estimating equations were used to examine associations over time.

RESULTS

Working cancer patients examined with different cancer types were included (n = 378). Work-specific cognitive symptoms were stable over 18 months. At baseline, cancer patients reported more working memory symptoms (M = 32.0; CI, 30.0-34.0) compared with executive function symptoms (M = 19.3; CI, 17.6-20.9). Cancer patients holding a job with both manual and nonmanual tasks reported less work-specific cognitive symptoms (unstandardized regression coefficient b = -4.80; CI, -7.76 to -1.83) over time, compared with cancer patients with a nonmanual job. Over time, higher depressive symptoms were related to experiencing more overall work-specific cognitive symptoms (b = 1.27; CI, 1.00-1.55) and a higher fatigue score was related to more working memory symptoms (b = 0.13; CI, 0.04-0.23).

CONCLUSIONS

Job type should be considered when looking at work-specific cognitive symptoms over time in working cancer patients. To reduce work-specific cognitive symptoms, interventions targeted at fatigue and depressive symptoms might be promising.

Healthcare Professionals' Attitudes to Rehabilitation Programming for Male Cancer Survivors

PURPOSE

The purpose of this study is to describe and interpret the attitudes and conduct of hospital healthcare professionals (HCPs) in association with male cancer survivors and their municipal rehabilitation participation.

DESIGN

Ethnographic fieldwork was conducted, consisting of participant observation and nine semistructured focus group interviews with 58 hospital HCPs.

METHODS

Using interpretive description methodology with symbolic interaction as a theoretical framework, data were collected through fieldwork in three oncology wards in Denmark.

FINDINGS

Attitudes about both gender and rehabilitation were identified as overarching obstructions within hospital HCP conduct toward promoting men's participation in cancer rehabilitation.

CONCLUSIONS

Gender and rehabilitation perceptions formed barriers in this context, suggesting that male cancer survivors' rehabilitation outcomes may be compromised by HCP attitudes and conduct.

CLINICAL RELEVANCE

These findings provide insight into approaches to guide HCPs to take responsibility for rehabilitation and to take gender into account in their work.

The cancer may come back: experiencing and managing worries of relapse in a North Norwegian village after treatment. Anthropol Med 2018;26:296-310. [PMID: 29913070 DOI: 10.1080/13648470.2017.1391172]

Little is known about how people living in the aftermath of cancer treatment experience and manage worries about possible signs of cancer relapse, not as an individual enterprise but as socially embedded management. One-year ethnographic fieldwork was conducted in a coastal village of under 3000 inhabitants in northern Norway. Ten villagers who had undergone cancer treatment from six months to five years earlier were the main informants. During fieldwork, the first author conducted qualitative, semi-structured monthly interviews with them, and participated in their everyday activities and relationships, including families, friends and co-villagers. In this article, we contemplate human emotions as arising in contexts of transactions, capable of creating social realities. By including this perspective, we highlight how people who recover from cancer construct and experience worry about possible relapse in relation to close family members, friends and co-villagers in the socially closely-knit and relatively isolated village. These emotional experiences emerge through relationships with others have communicative characteristics and take place in interaction with the social environment of their village. While informants attempt to protect family members by avoiding sharing worries with them, they express the need to share their worries within friendships. However, they experience both comfort and challenges in managing their worries in relation to acquaintances in the village. Overall, the study enhances understanding of the social embeddedness of emotions in everyday life, by revealing how worries of relapse of cancer configure and relate to various social contexts.

Effect of psychosocial interventions on the quality of life of patients with colorectal cancer: a systematic review and meta-analysis

Background

We conducted a systematic review and meta-analysis of randomized controlled trials examining the effect of psychosocial interventions on the quality of life of patients with colorectal cancer.

Methods

We searched the main health-related databases for relevant papers. Then, we examined the titles and abstracts of the retrieved papers, applying exclusion criteria to filter out irrelevant papers; a more in-depth filtering process was then conducted by reading the full texts. Eight studies remained at the end of this process. Next, we performed data extraction and assessed the methodological quality of the selected studies. This was followed by computation of effect sizes and the heterogeneity of the results, and then an assessment of the potential bias.

Results

The systematic review found that most of the interventions in these eight studies did not have a significant effect on quality of life. Meanwhile, the meta-analysis, the overall effect of psychosocial interventions at the post-intervention period was found to be statistically significant but small.

Conclusions

This meta-analysis provides evidence for the beneficial effect of face-to-face psychosocial interventions on the quality of life of colorectal cancer patients. It is, however, suggested that further studies be conducted on this topic to assess the roles of physical functioning and severity of symptoms before utilizing such face-to-face interventions.

Electronic supplementary material

The online version of this article (10.1186/s12955-018-0943-6) contains supplementary material, which is available to authorized users.

Predictors of falls in older survivors of breast and prostate cancer: A retrospective cohort study of surveillance, epidemiology and end results-Medicare health outcomes survey linkage

OBJECTIVES

To identify predictors of falls in older breast and prostate cancer survivors.

METHODS

This retrospective cohort study analyzed population-based Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey (SEER-MHOS) linkage. Inclusion criteria were age >65 years at cancer diagnosis, first primary female breast or prostate cancer, cancer staging information available, completion of baseline MHOS during years 2-3 and follow-up MHOS during years 4-5 post-diagnosis, and falls information available. Data from 437 breast and 660 prostate cancer survivors were analyzed. Multivariable logistic regression was constructed to evaluate variables from baseline MHOS with relation to falls from follow-up MHOS. Model accuracy was assessed using area under receiver-operating-characteristic curve (AUC).

RESULTS

At follow-up MHOS, 26% of breast and 22% of prostate cancer survivors reported falls in the past 12 months. In breast cancer, a history of falls (odds ratio (OR) = 4.95, 95% confidence interval (CI) = 2.44-10.04) and sensory impairment in feet (OR = 3.33, 95%CI = 1.51-7.32) were significant predictors of falls. In prostate cancer, a history of falls (OR = 3.04, 95%CI = 1.79-5.15), unmarried (OR = 1.82, 95%CI = 1.12-2.95), lower physical summary score of quality-of-life(OR = 0.96, 95%CI = 0.94-0.98), urinary incontinence (OR = 1.69, 95%CI = 1.08-2.65), older age at diagnosis (OR = 1.05, 95%CI = 1.01-1.09), and shorter time post-diagnosis (OR = 0.96, 95%CI = 0.93-0.99) were significant predictors of falls. AUC was 0.67 and 0.77 for breast and prostate cancer, respectively, indicating moderate accuracy of models in detecting fallers.

CONCLUSIONS

Asking older breast and prostate cancer survivors about falls in the past 12 months is imperative in fall prevention. Further examination of deficits specific to each cancer is necessary to assess fall risks.

Healthcare experience among older cancer survivors: Analysis of the SEER-CAHPS dataset

OBJECTIVE

Little is known about factors affecting medical care experiences of cancer survivors. This study examined experience of care among cancer survivors and assessed associations of survivors' characteristics with their experience.

MATERIALS AND METHODS

We used a newly-developed, unique data resource, SEER-CAHPS (NCI's Surveillance Epidemiology and End Results [SEER] data linked to Medicare Consumer Assessment of Healthcare Providers and Systems [CAHPS] survey responses), to examine experiences of care among breast, colorectal, lung, and prostate cancer survivors age >66years who completed CAHPS >1year after cancer diagnosis and survived ≥1year after survey completion. Experience of care was assessed by survivor-provided scores for overall care, health plan, physicians, customer service, doctor communication, and aspects of care. Multivariable logistic regression models assessed associations of survivors' sociodemographic and clinical characteristics with care experience.

RESULTS

Among 19,455 cancer survivors with SEER-CAHPS data, higher self-reported general-health status was significantly associated with better care experiences for breast, colorectal, and prostate cancer survivors. In contrast, better mental-health status was associated with better care experience for lung cancer survivors. College-educated and Asian survivors were less likely to indicate high scores for care experiences. Few differences in survivors' experiences were observed by sex or years since diagnosis.

CONCLUSIONS

The SEER-CAHPS data resources allows assessment of factors influencing experience of cancer among U.S. cancer survivors. Higher self-reported health status was associated with better experiences of care; other survivors' characteristics also predicted care experience. Interventions to improve cancer survivors' health status, such as increased access to supportive care services, may improve experience of care.

Association between operative technique and intrusive thoughts on health-related Quality of Life 3 years after APE/ELAPE for rectal cancer: results from a national Swedish cohort with comparison with normative Swedish data

The aim of this prospective registry‐based population study was to investigate the association between QoL 3 years after surgery for rectal cancer and intrusive thoughts and to assess the association with the type of surgery (i.e., APE or ELAPE) in a population‐based national cohort. ELAPE has been proposed as a superior surgical technique for distal rectal cancer, but long‐term effects on QoL are not known. There are also no studies on the association of negative intrusive thoughts on patients′ self‐reported Quality of Life following surgery for distal rectal cancer. Negative intrusive thoughts are regarded as a marker of incomplete cognitive processing of the psychological trauma caused by, for example, a cancer diagnosis. Intrusive thoughts have been recognized as an important factor associated Quality of Life outcome following surgery for other malignancies. All Swedish patients operated with any kind of abdominoperineal resection in the years 2007–2009 were identified through the Swedish ColoRectal Cancer Registry (SCRCR)—the APER population. All patients alive 3 years after surgery and willing to participate were included. Data were collected from three different sources: the registry, the original operative notes, and a study‐specific questionnaire regarding health‐related QoL answered by the patients. Questions on QoL from a normative reference population were also collected for comparison. Fifty‐six percent of the APER population reported a low overall Quality of Life. There was no significant difference between the sexes. Among men, there was a difference in overall QoL, with a higher level in the normative population (48%) compared with the male APER population (39%). Overall QoL was compared to a normative Swedish population. Almost half of the patients experienced negative intrusive thoughts, which was associated with a lower overall Quality of Life. The frequency and severity of negative intrusive thoughts were significantly associated with a low overall QoL. There was no difference in overall QoL after standard, compared with extralevator abdominoperineal excision. A large proportion of survivors after abdominoperineal excision for rectal cancer has a Quality of Life compared with a normative population, but many suffer from negative intrusive thoughts, a symptom of stress, which significantly decrease overall Quality of Life.

Mindfulness-Based Interventions and Sleep Among Cancer Survivors: a Critical Analysis of Randomized Controlled Trials

PURPOSE OF REVIEW

The purpose of our critical examination is to present results and provide a synthesis of this body of work.

RECENT FINDINGS

Sleep problems among cancer survivors are gaining research attention. To our knowledge, there have been six randomized control trials published from 2013 to 2015 that test the effects of mindfulness-based interventions (MBIs) on sleep as a primary or secondary outcome. Our examination of the literature highlights important methodological issues and variability among trials. We conclude our review by offering solutions to facilitate more scientific rigor in future studies.

Concordance networks and application to clustering cancer symptomology

Symptoms of complex illnesses such as cancer often present with a high degree of heterogeneity between patients. At the same time, there are often core symptoms that act as common drivers for other symptoms, such as fatigue leading to depression and cognitive dysfunction. These symptoms are termed bridge symptoms and when combined with heterogeneity in symptom presentation, are difficult to detect using traditional unsupervised clustering techniques. This article develops a method for identifying patient communities based on bridge symptoms termed concordance network clustering. An empirical study of breast cancer symptomatology is presented, and demonstrates the applicability of this method for identifying bridge symptoms.

Implementation and Preliminary Analysis of FACT-G Quality of Life Questionnaire within an Oncology Survivorship Clinic

Purpose: To conduct a descriptive analysis of the results from the Functional Assessment of Cancer Therapy-General (FACT-G) quality of life (QOL) questionnaire, describe the outcomes from the FACT-G to drive treatment recommendations within the breast survivorship clinic and to quantify the severity of QOL issues experienced.

Methods: A retrospective analysis utilizing medical records of participants in a breast cancer survivorship clinic. Measurement data included demographics and FACT-G results. Descriptive analysis of demographics and trends in referral recommendations and FACT-G scores was completed.

Results: All 30 participants were females diagnosed with breast cancer of various stages, ages 28 to 81 years. Approximately 1.5 years elapsed between cancer diagnosis and completion of the FACT-G. Participants received surgery (100%), radiation (76%), and chemotherapy and/or hormonal therapy (43%). Results demonstrated that participants reported having a lack of energy (24%) and were bothered by side effects of their treatment (20%). The greatest impact on functional well-being was difficulty sleeping (50%).

Limitations: Decreased ability to generalize the data to breast cancer survivors due to small sample size from one institution and potential referral bias.

Conclusions: Cancer survivors experience QOL issues throughout the continuum of their care, which can result in long-term effects on their physical, functional, social and emotional well-being. QOL is a major focus for cancer survivors and many times determines a survivor’s healthcare decisions. QOL measurements can be utilized at multiple points during survivorship to identify the need for referrals and to guide interventions.

High-Intensity Focused Ultrasound for Pain Management in Patients with Cancer

Cancer-related pain affects up to 80% of patients with malignancies. Pain is an important distressing symptom that diminishes the quality of life and negatively affects the survival of patients. Opioid analgesics are generally the primary therapy for cancer-related pain, with surgery, radiation therapy, chemotherapy, and other interventions used in cases of treatment-resistant pain. These treatments, which can be associated with substantial side effects and systemic toxicity, may not be effective. High-intensity focused ultrasound is an entirely noninvasive technique that is approved for treatment of uterine fibroids, bone metastases, and essential tremors. With magnetic resonance imaging or ultrasonographic guidance, high-intensity ultrasound waves are focused on a small well-demarcated region to result in precise localized ablation. This treatment may represent a multimodality approach to treating patients with malignant diseases-facilitating pain palliation, enhanced local drug delivery and radiation therapy effects, and stimulation of anticancer specific immune responses, and potentially facilitating local tumor control. Focused ultrasound can be used to achieve pain palliation by producing several effects, including tissue denervation, tumor mass reduction, and neuromodulation, that can influence different pathways at the origin of the pain. This technology has several key advantages compared with other analgesic therapies: It is completely noninvasive, might be used to achieve rapid pain control, can be safely repeated, and can be used in combination with chemotherapy and radiation therapy to enhance their effects. Online supplemental material is available for this article. ^©RSNA, 2018.

Disparities in women's cancer-related quality of life by Southern Appalachian residence

PURPOSE

The purpose was to determine whether Appalachian residence alone or in combination with violence was linked to poorer quality of life (QOL).

METHODS

Women recently diagnosed and included in either the Kentucky or North Carolina Cancer Registries were interviewed by phone between 2009 and 2015 (n = 3320; mean age = 56.74). Response rates were similar by state (40.1 in Kentucky and 40.9% in North Carolina). Appalachian (N = 990) versus non-Appalachian residents (N = 2330) were hypothesized to have poorer QOL defined as (a) lower Functional Assessment of Cancer Therapy-General (FACT-G) scores and (b) more symptoms of depression, stress, or comorbid physical conditions. Lifetime intimate partner or sexual violence was first investigated as a moderator then mediator of regional differences. Multiple analyses of covariance (MANCOVA) models were used.

RESULTS

Violence modified the effect of Appalachian residence on poorer QOL outcomes; FACT-G total scores (p = .02) were lowest for women living in Appalachia who had additionally experienced violence. Socioeconomic indicators appeared to mediate or explain differences in QOL outcomes by Appalachian residence such that when adjusting for income, education and insurance, Appalachian residence remained associated only with poorer physical QOL outcomes (p < .05).

CONCLUSIONS

While violence rates did not differ by residence, the combined effect of living in Appalachia and experiencing violence resulted in significantly greater impact on poorer QOL among women recently diagnosed with cancer. Clinical consideration of patients' residence, socioeconomic status and violence experienced may help identify and mitigate the longer-term impact of these identifiable factors associated with poorer QOL.

Evaluation of the psychological and biological changes of patients diagnosed with benign and malignant breast tumors

Purpose

Posttraumatic stress disorder (PTSD) is a severe anxiety disorder developed by exposure to any incident or circumstance that results in psychological trauma. In this study we compared the psychological and physiological changes between patients with malignant and benign breast tumors.

Methods

We selected 150 Chinese women with a breast mass, aged 20 to 45 years, from the Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital between 2009 and 2011 for this study; 30 healthy participants were enrolled into the control group. All subjects were examined and had their tumor mass aspirated for diagnosis. Equal numbers of patients with benign and malignant tumors were recruited. Patients with malignant tumors presented with low grade, minimal tumor invasion and non-involved lymph nodes. Questionnaires regarding anxiety, depression and PTSD were conducted 2 hours before getting the diagnostic result and 1 month after the diagnosis. Serum levels of IL-6, TNF-, cortisol and high-sensitivity C-reactive protein before and after diagnosis were investigated and compared. The number of occurrences of oral ulcerative mucositis was also recorded.

Results

All patients experienced a certain degree of anxiety and their biomarkers were elevated compared with the normal reference range before the pathological report was disclosed. However, 1 month after the operation, the benign tumor group showed significantly lower levels of biomarkers and anxiety scores than patients with a malignant breast tumor. The results were consistent throughout 12 months of study.

Conclusion

Study subjects with a benign tumor returned to their normal condition after being diagnosed, while patients with a malignant tumor suffered from a certain degree of PTSD or depression.

A qualitative study on the attitudes of patients with gastrointestinal cancer toward being informed of the truth

OBJECTIVE

The aim of this study is to investigate the attitudes of hospitalized patients with gastrointestinal cancer toward being informed of the truth and to provide references for informing patients of their gastrointestinal cancer diagnosis.

METHODS

Nine patients with gastrointestinal cancer were selected for this study by using a purposive sampling technique from a general surgery ward in a tertiary-level general hospital in Zhejiang Province from June 2016 to October 2016. Semi-structured, in-depth interviews were conducted, and the descriptive phenomenological method (developed by Amedeo Giorgi) was used to analyze the interview data.

RESULTS

Five themes were developed through reading, analysis, reflection, and classification of the data: Theme 1, guessing the diagnosis of gastrointestinal cancer before being informed of the truth; Theme 2, eagerness to know the diagnosis results; Theme 3, expectations related to beginning treatment for cancer; Theme 4, stress and anxiety during treatment; and Theme 5, providing patients with hope and optimism at the early diagnosis stage.

CONCLUSION

Patients have a strong desire to survive and can confidently confront their gastrointestinal cancer diagnosis. Medical staff should carefully select the appropriate time to inform patients of their diagnosis by evaluating their attitudes toward being informed, thereby actively meeting patients' needs for information and treatment.

The significance of cultural norms and clinical logics for the perception of possible relapse in rural Northern Norway – sensing symptoms of cancer

Little is known about the process from experiencing indeterminate bodily sensations to perceiving them as possible symptoms of cancer relapse. We explore how such processes are related to local values and to clinical practice in rural Northern Norway. One-year ethnographic fieldwork was conducted in a coastal village involving ten key participants residing in the village who had undergone cancer treatment from six months to five years earlier. The village has instability in primary health care staffing, which influences how and when indeterminate bodily sensations are presented to shifting GPs. The participants feel that they have to present clear symptoms, so they hesitate to see the doctor for such bodily sensations. Moreover, the personal evaluation of bodily sensations is embedded in local values in the village. Core values are to contribute to the common good, not be a burden, be positive and avoid focusing on difficult things. Participants’ inner dialogues with co-villagers and health personnel lead to not sharing concerns about bodily sensations, even though they might be symptoms of relapse. We suggest a rethinking and relocation of Hay’s analysis of social legitimation in sense-tosymptom processes in order to grasp the experiences of cancer in rural Northern Norway.

Evidence-based recommendations on care for breast cancer survivors for primary care providers: a review of evidence-based breast cancer guidelines

OBJECTIVE

To review evidence-based (EB) recommendations on survivorship care for primary care providers (PCPs) in EB breast cancer guidelines.

DESIGN AND SETTING

Guidelines were collected via experts and via literature database, guideline database and cancer agency websites searches.

METHOD

EB guidelines in any language published between 2012 and 2017 were collected. EB recommendations on survivorship care relevant for PCPs were extracted and grouped into three categories (recurrence detection, long-term effects and recurrence prevention). The content of the recommendations was analysed and summarised in the number and type of clinical topics addressed. The Appraisal of Guidelines for Research and Evaluation II instrument was used to evaluate the methodological quality of the guidelines.

RESULTS

Six guidelines, of which two were of acceptable methodological quality, were included. One was specifically made for general practitioners. Fifteen clinical topics were identified. Guidelines differed in the clinical topics addressed and for some identical topics in the content of the recommendations. Many recommendations were based on low-quality evidence. Recurrence detection received most attention, physical examination and mammography were often highlighted. Potential complications largely varied in number and type. Intimacy concerns, vaginal dryness, dyspareunia, fatigue, menopausal symptoms, peripheral neuropathy and lymphedema were reported in more than one guideline. Recurrence prevention was mentioned in four guidelines; all recommended physical activity.

CONCLUSION

The number of EB recommendations in guidelines is limited. Moreover, recommendations differ between guidelines and most are based on low-quality evidence. More high-quality research is needed to develop and adapt guidelines to support PCPs in providing optimal breast cancer survivorship care.

Management of work through the seasons of cancer survivorship

PURPOSE OF REVIEW

Survival from cancer has expanded enormously over the past decades. It is estimated that 40-50% of all cancer survivors are of working age at time of diagnosis and thus potentially part of the labor force. The seasons of survivorship can be used as a steppingstone to describe issues regarding employability survivors are dealing with.

RECENT FINDINGS

The acute survival stage begins at the point of diagnosis. Disclosure of diagnosis, and flexibility of both employers and (occupational) healthcare professionals are important factors in this stage. Extended survival starts when the survivor has completed the basic course of treatment. Survivors become aware that the old normality at work will be difficult to achieve. Problems like fear of recurrence, cognitive, and physical limitations might intensify during this stage and affect work ability. Permanent survival can be called long-term remission. Prospective studies on work-related outcomes and work-related interventions in this stage are rare.

SUMMARY

It is important to improve our understanding of the seasons of survival and to explore concepts, such as employability, against the background of these seasons. This perspective may help both survivors and (occupational) healthcare professionals to develop better strategies for dealing with the difficult life event cancer represents in each specific stage.

Cancer-related loneliness mediates the relationships between social constraints and symptoms among cancer patients

Cancer patients have high rates of persistent and disabling symptoms. Evidence suggests that social constraints (e.g., avoidance and criticism) negatively impact symptoms, but pathways linking these variables have yet to be identified. This study examined whether cancer-related loneliness (i.e., feeling socially disconnected related to having cancer) mediated the relationships between social constraints and symptoms (i.e., pain interference, fatigue, sleep disturbance, and cognitive complaints) in patients with various cancers (N = 182). Patients (51% female, mean age = 59) were recruited from the Indiana Cancer Registry and completed questionnaires assessing social constraints, cancer-related loneliness, and symptoms. Structural equation modeling was used to evaluate the hypothesized relationships among variables. The model demonstrated good fit. Consistent with our hypothesis, cancer-related loneliness mediated the relationships between social constraints and each symptom. Findings suggest that addressing cancer-related loneliness in symptom management interventions may mitigate the negative impact of social constraints on outcomes.

Long-term quality of life profile in oncology: a comparison between cancer survivors and the general population

PURPOSE

Understanding the quality of life (QoL) of cancer survivors is relevant to both clinical practice and health care policy. The current study compared the QoL profile in this specific population with that of a normative sample for the general population, as well as with those of both healthy and oncological patients normative sub-samples. In addition, associations between the obtained QoL profile and the main socio-demographic and clinical characteristics of the sample were examined.

METHODS

Three hundred and ninety-two adult long-term cancer survivors (i.e., people 5 + years from their cancer diagnosis who were free from it and its treatments) were enrolled during follow-up visits and compiled the Short Form 36 Health Survey.

RESULTS

In comparison with the normative data for the adult general population, the present sample showed lower scores in Physical functioning, Role-physical limitation, and Role-emotional limitations (all differences were both statistically and clinically significant); the difference in Vitality was only statistically significant. In all eight SF-36 scales, scores of the present sample were clinically and statistically lower than those of the normative healthy subsample, whereas they were statistically and clinically higher than those of normative subsample which had experienced cancer, except for Role-physical limitation. The QoL profile was associated with gender (p = 0.002), age (p = 0.001), education (p < 0.001), occupational status (p < 0.001), and the presence of other health issues (p < 0.001).

CONCLUSION

These data support the utility of rehabilitative programs which integrate both healthcare and social interventions. In addition, they encourage the monitoring of the health status of this specific population, within a broad frame which simultaneously takes into consideration health and QoL.

Psychological factors and psychosocial interventions for cancer related pain

The present paper is aimed at briefly presenting psychological factors involved in cancer related pain and what psychosocial interventions are efficient in reducing it. Cancer related pain is a complex experience and the most integrative and recommended approach is the biopsychosocial model. It has been proved that chronic pain is more strongly related to psychological factors than to treatment or illness related factors. Psychological factors influencing pain experience can be intuitively grouped starting with awareness of pain (i.e., attentional factor), then with evaluation of pain (i.e., cognitive factors) which is leading to feelings (i.e., emotional factors), and behaviours (i.e., coping strategies) regarding pain. Psychosocial interventions (i.e., skill based and education based interventions) have strong evidence that is effective in reducing cancer related pain.