Feasibility, acceptability, and efficacy of online supportive care for individuals living with and beyond lung cancer: a systematic review

Co-designing a web-based intervention (RESTORE) to support self-management of cancer-related fatigue in people living with a brain tumour

PURPOSE

Cancer-related fatigue (CRF) is a debilitating symptom commonly reported by people with a brain tumour (BT). Many interventions have been developed to reduce CRF; however, few have been evaluated in people with BT despite the unique functional deficits experienced by this population. We aimed to explore the appropriateness of a web-based intervention (RESTORE) to support self-management of fatigue for people with a BT and identify recommended modifications.

METHODS

Semi-structured interviews were conducted with people with BT, their caregivers and healthcare professionals (HCPs) who treat them. Interviews explored the appropriateness of RESTORE for this population, and suggested modifications to improve relevance and suitability. Interviews were transcribed and analysed thematically using interpretive description to devise recommendations.

RESULTS

Forty participants were interviewed (24 people with BT, 5 caregivers, 11 HCPs). Four themes were identified: feedback on content; feedback on format; feedback on use; and, barriers to engagement. These themes were linked by an overarching need for flexible and responsive tailoring to the unique needs of people with BT. Thirty-two recommended modifications were derived from feedback to optimise RESTORE for this population.

CONCLUSION

Results suggest a BT-specific version of RESTORE would be acceptable to address fatigue in this population. Recommended adaptations include greater flexibility and tailoring of content and format for effective use among people with BT. Barriers to engagement including digital access and literacy and awareness of the resource should be addressed in the implementation of a BT-specific version of RESTORE.

Barriers and facilitators of supportive care access and use among men with cancer: a qualitative study

PURPOSE

Men diagnosed with cancer are underrepresented in existing supportive care programming and related research, with preliminary indications that men face unique challenges in accessing and engaging with such services. This study aims to identify barriers and facilitators related to the supportive care service access and use among men diagnosed with cancer.

METHODS

From March to May 2021, thirty-one Quebec men (Mage = 52.7, range:(26-82 years) diagnosed with various cancer types were recruited to take part in individual telephone interviews (n = 14) or online focus groups (n = 17) addressing experiences of cancer supportive care services. Content analysis of qualitative data was performed.

RESULTS

Barriers and facilitators to men's supportive care access and use were grouped into four categories: (1) alignment between services and men's needs and preferences; (2) delivery of services in an accessible, inclusive, and responsive way; (3) communication and promotion of services in ways that are acceptable, appealing, and attractive to men; and (4) social norms and perceptions of gender and masculinity affecting men's perceptions of and engagement with services.

CONCLUSIONS

Barriers and facilitators influencing access and use of supportive care services in men are numerous and diverse. These findings may inform the development of new and the adaptation of current supportive care strategies to better address men's needs and preferences after a cancer diagnosis.

IMPLICATIONS FOR CANCER SURVIVORS

Increased adequacy of services tailored to men's needs and preferences, with an emphasis on supporting men to take an active role in their recovery, could improve access and adherence to care. Services adopting a more integrated, patient-centered, and holistic approach to service delivery could positively impact the cancer care trajectory and health outcomes of men. Larger systemic changes may be needed to support men in engaging in currently existing activities and services.

Exploring the symptoms and psychological experiences among lung cancer convalescence patients after radical lobectomy: A qualitative study

OBJECTIVE

This study aims to explore the symptom experiences and psychological feelings of lung cancer patients after radical lobectomy in China.

METHODS

A qualitative study was conducted using face-to-face semistructured interviews with lung cancer patients who had a radical lobectomy for treatment of their cancer during the convalescence period. Participants (n = 18) were recruited from a general hospital in China, and patients were selected using purposive sampling from September 2021 to February 2022. Interviews were recorded and transcribed verbatim, and Colaizzi's seven-step method of phenomenology was used. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was conducted to report the study.

RESULTS

Four themes were extracted from the interview data: physiological dimensions (fatigue, cough or sputum, chest tightness and shortness of breath, daily activities affected, sleep disturbance, lack of appetite); psychological dimensions (negative emotion, fear of cancer recurrence, learning to accept reality, strengthened faith and hope); family dimensions (heavy economic burden, perceived family care, improved health management behavior); and social dimensions (perceived support of medical staff, decreased sense of social value and self-identity, changes in social and working style).

CONCLUSION

Lung cancer patients are still troubled by many problems during the postoperative recovery period. Medical staff should design and implement effective evaluations and targeted interventions for patients' physical and mental health as soon as possible to improve patients' physical and mental health, as well as their quality of life.

Cancer Patients' Perspectives and Requirements of Digital Health Technologies: A Scoping Literature Review

Digital health technologies have the potential to alleviate the increasing cancer burden. Incorporating patients' perspectives on digital health tools has been identified as a critical determinant for their successful uptake in cancer care. The main objective of this scoping review was to provide an overview of the existing evidence on cancer patients' perspectives and requirements for patient-facing digital health technologies. Three databases (CINAHL, MEDLINE, Science Direct) were searched and 128 studies were identified as eligible for inclusion. Web-based software/platforms, mobile or smartphone devices/applications, and remote sensing/wearable technologies employed for the delivery of interventions and patient monitoring were the most frequently employed technologies in cancer care. The abilities of digital tools to enable care management, user-friendliness, and facilitate patient-clinician interactions were the technological requirements predominantly considered as important by cancer patients. The findings from this review provide evidence that could inform future research on technology-associated parameters influencing cancer patients' decisions regarding the uptake and adoption of patient-facing digital health technologies.

Development of an App for Symptom Management in Women With Breast Cancer Receiving Maintenance Aromatase Inhibitors: Protocol for a Mixed Methods Feasibility Study

BACKGROUND

Patients with postmenopausal nonmetastatic estrogen receptor-positive breast cancer often experience a reduced quality of life after primary treatment. The disease and treatment trajectory consists of surgery followed by chemotherapy or radiation therapy. Upon this, maintenance hormone therapy with an aromatase inhibitor can result in several physical and psychosocial symptoms. Optimal symptom control during maintenance therapy is central to maintaining the patient's quality of life.

OBJECTIVE

This study aims to (1) develop an electronic symptom management tool for patients with postmenopausal early breast cancer receiving maintenance aromatase inhibitors with an endocrine aspect and (2) assess the feasibility, acceptability, and usability of the pilot version of the Bone@BC app. Furthermore, longitudinally, symptom prevalence and quality of life for patients with postmenopausal nonmetastatic estrogen receptor-positive breast cancer will be explored.

METHODS

This study follows a multistage research plan. In stage 1, a systematic literature review to establish an overview of aromatase inhibitor-related symptoms reported by postmenopausal women with nonmetastatic estrogen receptor-positive breast cancer will be completed. In stage 2, a comprehensive overview of symptoms related to aromatase inhibitors (letrozole, exemestane, and anastrozole) will be performed (eg, by reviewing medical leaflets and guidelines). In stage 3, an electronic app with a user-friendly Patient Concern Inventory list to comprise symptoms and concerns will be developed. Last, in stage 4, a convergent mixed methods feasibility study of the pilot version of the Bone@BC app will be conducted. A total of 45 patients with postmenopausal nonmetastatic estrogen receptor-positive breast cancer will use the app daily for symptom identification and respond to 6 serial patient-reported outcome measurements for 12 weeks. Finally, semistructured interviews will be performed. The primary outcome includes consent rate, attrition rate, retention rates, technical issues, and adherence, assessed using preestablished criteria on feasibility and a mixed methods approach for exploring acceptability. A patient advisory board consisting of 5 women with breast cancer is recruited to include their perspectives and experiences in the planning, organization, implementation, and dissemination of the research throughout the project.

RESULTS

At the time of submitting this paper (January 2024), a total of 23 patients have been included in the stage 2 medical audit over the recruitment period of 3 months (November 2022 to February 2023), and 19 patients have been enrolled in stage 2, the semistructured patient interviews.

CONCLUSIONS

This protocol describes a study investigating the feasibility, acceptability, and usability of the symptom management tool Bone@BC developed for patients with breast cancer with an endocrine aspect.

TRIAL REGISTRATION

ClinicalTrails.gov NCT05367830; https://clinicaltrials.gov/ct2/show/NCT05367830.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/49549.

Feasibility of Microlearning for Improving the Self-Efficacy of Cancer Patients Managing Side Effects of Chemotherapy

Lung cancer patients have a high symptom burden that negatively affects their quality of life. Increasing patient self-efficacy to deal with treatment side effects can ameliorate their symptom burden. Education programs can help enhance patient self-efficacy by giving patients more control over their condition through increased disease literacy. This study aimed to evaluate the feasibility of microlearning for delivering lung cancer patients' information on side effects of chemotherapy. Secondary objectives of the program are to understand the acceptability of microlearning for delivery this type of education to lung cancer patients and the potential impact of microlearning on patient self-efficacy, knowledge and confidence managing side effects of chemotherapy. A mixed-methods prepost test (or quasi-experimental) study design was used to better enable patients to identify and manage the side effects of their condition and chemotherapy. Participants were patients diagnosed with stage II to stage IV lung cancer, who had a life expectancy of greater than 3 months and were aged 18 years or older. Multiple validated scales were used to assess patient self-efficacy pre- and post-intervention. The online program was evaluated using quantitative data of completion rates extracted from the online platform. Semi-structured interviews were used to explore the impact of the online program on perceived self-efficacy and quality of life. Twenty-three participants agreed to participate in the study and five agreed to complete a semi-structured interview. Participants found the content comprehensive, relevant and engaging. The program improved perceived disease literacy and helped participants develop coping strategies to manage side effects. Participants also found the platform easy to use and navigate. Additional courses and features were requested. Patients with a diagnosis of cancer receive a large amount of information about the side effects of chemotherapy and how to manage them. This information is often provided soon after diagnosis or upon commencement of therapy, which can be overwhelming for some patients. Microlearning, a method of online learning that spaces distributing of content over several weeks, may be a useful tool for supporting delivering of health information to this group of patients.

Digital health and telehealth in cancer care: a scoping review of reviews

The COVID-19 pandemic necessitated remote cancer care delivery via the internet and telephone, rapidly accelerating an already growing care delivery model and associated research. This scoping review of reviews characterised the peer-reviewed literature reviews on digital health and telehealth interventions in cancer published from database inception up to May 1, 2022, from PubMed, Cumulated Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Reviews, and Web of Science. Eligible reviews conducted a systematic literature search. Data were extracted in duplicate via a pre-defined online survey. Following screening, 134 reviews met the eligibility criteria. 77 of those reviews were published since 2020. 128 reviews summarised interventions intended for patients, 18 addressed family caregivers, and five addressed health-care providers. 56 reviews did not target a specific phase of the cancer continuum, whereas 48 reviews tended to address the active treatment phase. 29 reviews included a meta-analysis, with results showing positive effects on quality of life, psychological outcomes, and screening behaviours. 83 reviews did not report intervention implementation outcomes but when reported, 36 reported acceptability, 32 feasibility, and 29 fidelity outcomes. Several notable gaps were identified in these literature reviews on digital health and telehealth in cancer care. No reviews specifically addressed older adults, bereavement, or sustainability of interventions and only two reviews focused on comparing telehealth to in-person interventions. Addressing these gaps with rigorous systematic reviews might help guide continued innovation in remote cancer care, particularly for older adults and bereaved families, and integrate and sustain these interventions within oncology.

Continuous care needs in patients with cancer receiving chemotherapy during the recent omicron wave of COVID-19 in Shanghai: A qualitative study

Aims

This study aimed to investigate the care needs, to clarify the factors affecting the quality of homecare, and to provide reference for constructing a homecare system for patients with cancer receiving chemotherapy during the recent omicron wave of COVID-19 in Shanghai.

Methods

From March to May 2022 when the omicron wave emerged in Shanghai, 50 consecutive patients who received chemotherapy at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, were enrolled, and underwent face-to-face or telephone-based semi-structured interviews regarding continuous care needs. Some of their homecare-givers, caring nurses, and physicians were also interviewed. The Colaizzi method was used for data analysis.

Results

Fifty patients, 4 homecare-givers, 4 nurses, and 4 physicians were interviewed. Three themes and six subthemes emerged from analysis of the interviews: The first theme was "Disease management needs," including needs for knowledge of managing adverse events associated with chemotherapy, and needs for treatment-related information. Patients expressed most concern about not being able to go to the hospital for blood review and disease evaluation in time due to the outbreak. With the COVID-19 pandemic being ongoing, factors such as pandemic panic, inconvenient medical treatment, and worry about hospital cross-infection might reduce disease management for patients with cancer. The second theme was "Medical needs," including needs for mobile healthcare and needs for medical resources. All interviewees emphasized the importance of mobile healthcare during the COVID-19 pandemic, as access to hospitals was difficult. The third theme was "Spiritual needs," including demands for psychological counseling and intervention, and needs for spiritual care. Patients and homecare-givers commonly lacked a feeling of security and needed communication, encouragement, and reassurance that medical care could be delivered to them, and patients reported that they very much wanted psychological advice.

Conclusion

For patients with cancer receiving chemotherapy during the COVID-19 pandemic, continuous care is greatly needed. Medical personnel should strengthen the healthcare education for patients and their caregivers during hospitalization, and further improve the patients' information intake rate through Internet-based digital healthcare methods during homecare, to further meet the information needs of patients after discharge from hospital.

M-Health in lung cancer: A literature review

The internet and digital technology have become an important resource for patients with cancer. Mobile health strategies permit patients and clinicians to interact via different tools to enrich the supplements to routine hospital visits or out-patient attendance. In this work, we have reviewed different mobile health platforms to support lung cancer patients in different areas: pre-surgery; post-surgery and on systemic treatment. We have also reviewed different digital tools used by long-term lung cancer survivors as well as the impact of these tools on the quality of life, and we tried to analyse according to literature the potential efficiency of these platforms in health system administration.

Developing and testing the ExerciseGuide UK website for people with lung cancer: reflections on the added value of patient and public involvement within a doctoral degree

BACKGROUND

Lung cancer has one of the highest incidence and mortality rates worldwide. Physical activity can provide those diagnosed with lung cancer with several physical and psychological benefits. However, the examination of digitally delivered physical activity to those with lung cancer is not as researched as other common cancers. Often, those diagnosed with lung cancer are older adults (65 years or older). Older adults are often wrongly assumed to lack digital skills, interest, and not engage with digital technology regularly. Although individuals are interested, would involving older people in designing of websites and apps result in better engagement?

MAIN BODY

In this article, the authors discuss the process of adapting a digital platform with a patient and public involvement group to provide those who have received a lung cancer diagnosis with a tailored physical activity program and health educational modules. We discuss the influence of recurrent patient and public involvement on the study, the patient and public involvement members, and the doctoral researcher.

CONCLUSION

Working with a patient and public involvement group over several months, especially potential users of a digital intervention, may enhance its relevance, accessibility, and usability. By engaging with patients, family, or caregivers for someone with lung cancer, the doctoral student gained insight into the needs of the study population and what to consider during development. All group members expressed their interest and enjoyment in their involvement, and several are now active members of a wider patient and public involvement network.

Effectiveness of telenursing for people with lung cancer at home: A systematic review and meta-analysis

AIM

To evaluate the effectiveness of telenursing involving nurses on the health outcomes of adults with lung cancer at home.

METHODS

We conducted literature searches on PubMed, CINAHL, EMBASE, CENTRAL, and the Japan Medical Abstracts Society up to December 2021. Articles eligible for inclusion were (i) reporting on randomized controlled trials involving telenursing, (ii) focusing on health consultations provided by healthcare providers involving nurses, and (iii) targeting adults with lung cancer at home. Two researchers independently screened eligible studies and assessed the risk of bias using the Cochrane risk-of-bias tool 2. We performed meta-analyses of symptom distress and quality of life. This study was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The quality of evidence was assessed applying the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

Four studies with 508 participants were included, of which three were finally evaluated by meta-analysis. Telemonitoring and education by nursing professionals in collaboration with other healthcare professionals were confirmed. Symptom distress was significantly lower in the intervention group (mean difference = -0.54, 95% confidence interval: -1.06, -0.02). There was no significant effect on other outcomes. The GRADE assessment revealed serious risk of bias, inconsistency, and imprecision.

CONCLUSIONS

The findings suggest that telenursing brought about low symptom distress in adults with lung cancer compared with the absence of telenursing. However, the certainty of the evidence was low owing to the high risk of bias. Further accumulation of high-quality studies is needed to establish definitive evidence.

Successful wayfinding in age: A scoping review on spatial navigation training in healthy older adults

Introduction

Spatial navigation is a complex cognitive function that declines in older age. Finding one's way around in familiar and new environments is crucial to live and function independently. However, the current literature illustrates the efficacy of spatial navigation interventions in rehabilitative contexts such as pathological aging and traumatic injury, but an overview of existing training studies for healthy older adults is missing. This scoping review aims to identify current evidence on existing spatial navigation interventions in healthy older adults and analyze their efficacy.

Methods

To identify spatial navigation interventions and assessments and investigate their effectiveness, four electronic databases were searched (Pubmed, Web of Science, CINAHL and EMBASE). Two independent reviewers conducted a screening of title, abstract and full-texts and performed a quality assessment. Studies were eligible if (1) published in English, (2) the full text was accessible, (3) at least one group of healthy older adults was included with (4) mean age of 65 years or older, (5) three or more spatial navigation-related training sessions were conducted and (6) at least one spatial ability outcome was reported.

Results

Ten studies were included (N = 1,003, age-range 20-95 years, 51.5% female), only healthy older adults (n = 368, mean age ≥ 65) were assessed further. Studies differed in sample size (n = 22-401), type of training, total intervention duration (100 min-50 h), and intervention period (1-16 weeks).

Conclusion

The spatial navigation abilities addressed and the measures applied to elicit intervention effects varied in quantity and methodology. Significant improvements were found for at least one spatial ability-related outcome in six of 10 interventions. Two interventions achieved a non-significant positive trend, another revealed no measurable post-training improvement, and one study did not report pre-post-differences. The results indicate that different types of spatial navigation interventions improve components of spatial abilities in healthy older adults. The existing body of research does not allow conclusions on transferability of the trained components on everyday life spatial navigation performance. Future research should focus on reproducing and extending the promising approaches of available evidence. From this, valuable insights on healthy aging could emerge.

Trial Registration

This scoping review was preregistered at Open Science Framework (https://osf.io/m9ab6).

Evaluating a web-based computer-tailored physical activity intervention for those living with and beyond lung cancer (ExerciseGuide UK): protocol for a single group feasibility and acceptability study

BACKGROUND

Lung cancer is the leading cause of cancer-related death globally. Physical activity and exercise provide unequivocal benefits to those living with and beyond lung cancer. However, few of those living with and beyond cancer meet the national physical activity guidelines. Various barriers exist for this population's engagement in physical activity and exercise, such as the lack of knowledge and lack of tailored information, little access to exercise specialists, fatigue, and mobility challenges. Digitally delivered programmes have the potential to address several of these barriers, with techniques like "computer-tailoring" available to enable the delivery of tailored content at a time and place that is convenient. However, evaluation of such programmes is needed prior to implementation. This protocol describes a single group study that will examine the feasibility and acceptability of an online tool (ExerciseGuide UK) that provides those living with and beyond lung cancer web-based computer-tailored physical activity prescription and modules underpinned by behaviour change theories.

METHODS

Thirty-five individuals diagnosed with lung cancer, or cancer affecting the lung (e.g. pleural mesothelioma), will be recruited into a single-intervention arm. The platform will provide tailored resources and a personalised physical activity programme using IF-THEN algorithms. Exercise prescription will be tailored on factors such as self-reported specific pain location, exercise history, and current physical fitness. In addition, modules grounded in behaviour change will supplement the physical activity programme and will focus on topics such as exercise benefits, safety, goal setting, and tracking. The primary outcome will be assessed using pre-established criteria on feasibility and mixed-methods approach for acceptability. Secondary outcomes will explore changes in the physical activity, quality of life, anxiety, and depression.

DISCUSSION

This manuscript describes the protocol for a study examining the feasibility and acceptability of a web-based computer-tailored physical activity intervention for those living with and beyond lung cancer. The publication of this protocol aims to increase the transparency of the methods, report pre-determined criteria, and aid replication of the study and associated materials. If feasible and acceptable, this intervention will inform future studies of digital-based interventions.

TRAIL REGISTRATION

ClinicalTrails.gov , NCT05121259. Registered on November 16, 2021.

Investigating the Challenges and Benefits of Engaging in Peer Support via Videoconferencing for People with Spinal Cord Injury

BACKGROUND

One of the greatest challenges faced by people following a spinal cord injury is reintegrating into the community. Peer mentors are people who have had shared experiences of disadvantage and distress and have successfully navigated their way through the associated challenges to lead meaningful lives. Historically, peer mentoring services have been predominantly delivered via face-to-face interactions. Little is known about the experience of people with spinal cord injury engaging in online peer support services, and what the challenges and benefits are of this mode of delivery.

METHODS

An anonymous online survey consisting of closed and open response questions was used to collect data. Quantitative data were analysed descriptively and qualitative data were analysed using inductive content analysis.

RESULTS

Positive benefits of engaging in peer support via videoconferencing included convenience and social connectedness. The main barriers were problems with Wi-Fi and internet connections, inconsistencies between platforms and having to learn new platforms. Even though responses were mixed when comparing videoconferencing to face-to-face peer support, most participants felt socially connected.

CONCLUSIONS

Addressing barriers through the provision of appropriate technology, and targeted and individualised assistance, is important to facilitate uptake of online peer support for people with spinal cord injury.