Social inequality in cancer survivorship: Educational differences in health-related quality of life among 27,857 cancer survivors in Denmark

The Prevalence and Factors of Dyspnea Among Advanced Cancer Survivors: A Systematic Review and Meta-analysis

BACKGROUND

Dyspnea is a significant symptom in advanced cancer patients, yet comprehensive evidence on its prevalence and related factors is lacking.

OBJECTIVE

This review aims to summarize the prevalence of dyspnea among advanced cancer survivors and identify associated factors.

METHODS

MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL Plus, and Web of Science were searched from inception to May 2024. Observational studies focusing on advanced cancer patients reporting dyspnea were included. Two reviewers performed data extraction and quality assessment independently using the Newcastle-Ottawa Scale. Prevalence estimates were pooled using a random-effects model. Subgroup analyses and metaregression were performed to explore heterogeneity.

RESULTS

A total of 67 studies involving 78 409 advanced cancer survivors were included, revealing a pooled prevalence of dyspnea of 43% (95% prediction interval, 0.07, 0.84). Significant variations were observed based on cancer types, with lung cancer showing a prevalence of 55%. Factors associated with dyspnea were categorized using the Breathing, Thinking, Functioning clinical model: (1) breathing: physical (eg, fatigue), medical (eg, lung disease), and treatment-related (eg, palliative sedation) factors; (2) thinking: psychological (eg, anxiety) factors; and (3) functioning: performance (eg, Karnofsky Performance Status) and demographic characteristics (eg, age).

CONCLUSIONS

The findings highlight a high prevalence of dyspnea among advanced cancer survivors and identify several associated factors, stressing the need for early detection and comprehensive management strategies.

IMPLICATIONS FOR PRACTICE

Health providers can improve the quality of life for patients by effectively managing dyspnea, thereby reducing symptom burden, and alleviating psychological distress, leading to better overall well-being for patients and caregivers.

Employment status among cancer survivors in a Late Effects Clinic in Denmark

PURPOSE

This study aims to investigate changes in employment status among disease-free working-age cancer survivors (CSs) with late effects from diagnosis to their first meeting in the Late Effects Clinic (LEC) and investigate associated patient-reported outcomes of reduced employment status.

METHODS

Retrospective analysis of a cohort of CSs followed in a LEC at a single institution from January, 2022, to March, 2023. Working-age CSs with no current evidence of active cancer were included in this study. CSs completed a baseline questionnaire (EORTC QLQ-SURV100) before their initial consultation. Reduced employment status was defined as transition from being in paid work at diagnosis to working fewer hours or not at all at the first visit. Multivariate linear regression analysis was used.

RESULTS

A total of 119 CSs with diverse cancer types with a mean age of 51 years (range 26 to 70) were included in this study. Eighty percent were female. Of 93 CSs in paid work at diagnosis, 66 (71%) have reduced employment status. Reduced employment status was associated with lower role functioning score (β = -12.3, p = 0.046), higher loss of income score (β = 35.1, p = 0.001), and lower Global health status score (β = - 8.3, p = 0.05).

CONCLUSIONS

This study shows that the majority of CSs seen in the LEC have reduced employment status. This is associated with impaired quality of life.

IMPLICATIONS FOR CANCER SURVIVORS

Identifying and treating late effects early in cancer survivorship are important to secure CSs' labour market attachment and, thus, their financial and social well-being.

Early, integrated palliative care for people with chronic respiratory disease: lessons learnt from lung cancer

Lung cancer and chronic non-malignant respiratory disease cause pervasive, multifactorial suffering for patients and informal carers alike. Palliative care aims to reduce suffering and improve quality of life for patients and their families. An established evidence base exists that has demonstrated the essential role of specialist palliative care for people with lung cancer. Emerging evidence supports similar benefits among people with chronic respiratory disease. Many lessons can be learnt from lung cancer care, particularly as the model of care delivery has transformed over recent decades due to major advances in the diagnostic pathway and the development of new treatments. This narrative review aims to summarize the evidence for specialist palliative care in lung cancer and chronic respiratory disease, by highlighting seven key lessons from lung cancer care that can inform the development of proactive, integrated models of palliative care among those with chronic respiratory disease. These seven lessons emphasize (1) managing challenging symptoms; (2) the efficacy of specialist palliative care; (3) the importance of providing specialist palliative care integrated with disease-directed care according to patients' needs not prognosis; (4) the need for new models of collaborative palliative care, (5) which are culturally appropriate and (6) able to evolve with changes in disease-directed care. Finally, we discuss (7) some of the critical research gaps that persist and reduce implementation in practice.

Validation of the Assessment of Rehabilitation Needs Checklist in a Swedish cancer population

BACKGROUND

Assessment of Rehabilitation Needs Checklist (ARNC), has been developed to assess rehabilitation need in cancer patients and is recommended by the Confederation of Regional Cancer Centres in Sweden, known as Hälsoskattningen. The aim of the study was to test the reliability and validity of the ARNC, mainly by comparing it with the Distress thermometer and EORTC QLQ-C30.

METHODOLOGY

A sample of 993 persons identified in the Swedish cancer register. The study participants were diagnosed with cancer in 2021 in the Mid Sweden region. The psychometric methods tested reliability and validity including factor analysis.

RESULTS

The response rate was 38%. The test-retest analysis showed that ICC was 0.80 or higher for 12 of the ARNC items. A strong or modarete correlation between ARNC and the other instruments was found in all functional scales and for most items. CFA of the 13-item two-factor model showed a RMSEA value of 0.04, CFI and TLI values of 0.97 and 0.96, and a SRMR value of 0.05, indicating a satisfactory model fit.

CONCLUSION

The evaluation of the ARNC suggests that it is an acceptable and reliable screening instrument for detecting symptoms and signs indicating a possible need of rehabilitation. The medium to strong correlations between ARNC items and the EORTC QLQ- C30 items and scales suggest that ARNC could be an alternative also for research purposes when a shorter and less comprehensive instrument is needed. The simple design could be an advantage as it lowers the burden on cancer patients.

Health-Related Quality of Life in Danish Cancer Survivors Referred to a Late Effects Clinic: A Prospective Cohort Study

PURPOSE

The Region of Southern Denmark has recently established four late effects clinics to help cancer survivors suffering from complex and severe late effects. This study aimed to capture and analyze the full range of physical, mental, and psychosocial issues using patient-reported outcomes. Moreover, we aimed to describe demographic data and the type and severity of the late effects.

METHODS

A prospective cohort study was conducted among cancer survivors referred to a late effects clinic. Before their first appointment, patients completed the European Organization for Research and Treatment of Cancer Quality of Life cancer survivorship core questionnaire (EORTC QLQ-SURV100). We compared mean scores of the EORTC QLQ-SURV100 scales that were comparable to the scales/items from the EORTC QLQ-C30 questionnaire with norm data for the Danish population and EORTC reference values.

RESULTS

All patients referred to the clinic within its first 2 years were included (n = 247). The mean age was 57 [23-85] years and 74% were females. The most common cancer diagnoses was breast cancer (39%). The five most commonly reported late effects were fatigue (66%), pain (51%), cognitive impairment (53%), sleep problems (42%), and neuropathy (40%). A total of 236 of the patients entering the clinic completed QLQ-SURV100. They reported significantly worse mean scores on all scales compared to the Danish norm population and EORTC reference values for pretreatment cancer patients, p < 0.001. Effect sizes were moderate or large for all scales.

INTERPRETATION

In this study, we collected demographic data and described the late effects presented by the patents referred to the clinic. Moreover, we captured and analyzed the full range of physical, mental, and psychosocial issues using QLQ-SURV100. Patients referred to the Late Effects Clinic (LEC) had a number of late effects and reported a significantly lower health-related quality of life compared to the general Danish population and patients who have just been diagnosed with cancer, suggesting the aim of helping patients suffering from late effects gain a better quality of life is in dire need.

Understanding the Quality of Life Among Patients With Cancer in Saudi Arabia: Insights From a Cross-Sectional Study

INTRODUCTION

Cancer patients' quality of life (QoL) significantly influences treatment response and mortality rates. Understanding QoL domains among patients with cancer and what affects it can help create interventions that improve QoL and ease patients' experience. This study measures the OoL among patients with cancer and influencing factors.

METHODS

A prospective cross-sectional questionnaire-based study included cancer patients aged >18 currently receiving treatment. The questionnaire collected social and economic data, followed by the validated Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Means and standard deviations for described numeric variables and frequencies and percentages described categorical variables. Analysis of variance, F-tests, and P-values were reported.

RESULTS

Among 182 cancer patients, 60% were female. Younger patients exhibited higher QoL in physical and role functioning (P = .016 and .03) and experienced more significant financial impact (P = .0144). Females reported more adverse effects from cancer symptoms, including fatigue, nausea, vomiting, and pain (36.7% vs 25.5%, P = .005; 20.6% vs 11.5%, P = .0186; 34.7% vs 25.1%, P = .0281). Single patients had superior QoL in physical functioning compared to others (P = .0127). Patients traveling long distances were more likely to face adverse financial consequences (P = .007). Asthmatic patients exhibited lower QoL in physical, role, and cognitive functioning (72.3 vs 37.8, P = .0147; 76.4 vs 22.2, P = .0024; 84.7 vs 44.4, P = .0038) and reported increased dyspnea and appetite loss (16 vs 55.6 and 26.1 vs 66.7, both P < .05).

CONCLUSION

Factors influencing QoL in Saudi cancer patients include age, marital status, gender, hospital distance, and chronic conditions. Thus emphasizing the necessity for personalized care strategies to enhance outcomes and alleviate the overall burden of cancer care.