Barriers to seeking psychosocial support among adult patients with hematologic neoplasms: a qualitative study

Effect of third-wave cognitive behavioural interventions on biopsychosocial outcomes in people diagnosed with advanced cancer: A systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

People with advanced cancer experience elevated psychological morbidity and poor quality of life (QoL). The role of third-wave cognitive-behavioural therapy (CBT) interventions in addressing these needs has been examined, but not synthesised in a systematic review. The aim of this review is to systematically identify, analyse and review randomised controlled trials (RCTs) which examined the effect of third-wave CBT interventions on biopsychosocial outcomes (e.g., anxiety, pain, QoL) in this population.

METHODS

A systematic search was undertaken on MEDLINE, PsycInfo, CINAHL, Embase and Cochrane CENTRAL. Studies were included if they examined the effect of third-wave CBT interventions on biopsychosocial outcomes in adults living with advanced cancer in RCTs. The Cochrane Risk of Bias tool assessed risk of bias for each study. A random-effects model was fitted to the data and the restricted maximum-likelihood estimator was applied. The standardised mean differences (SMD) between control and experimental groups at short- and long-term follow up were used.

RESULTS

Twelve RCTs with 782 participants were identified. Meta-analyses demonstrated that third-wave CBT interventions were only more effective than comparator groups in the short-term improvement of QoL (SMD = 0.19, 95 % CI [0.00, 0.37], p < 0.05). The results of the 11 other meta-analyses did not reach statistical significance. Eight studies were classified as having unclear risk, and four were classified as high risk of bias.

CONCLUSIONS

Third-wave CBT interventions may be effective in enhancing QoL in people with advanced cancer. However, more rigorous RCTs are needed to establish their efficacy in this population.

Changes in physical fitness in acute leukemia patients during chemotherapy

This study aimed to investigate the changes in physical fitness and patient-reported outcomes as well as the correlation between these two factors in adult patients with newly diagnosed acute leukemia during chemotherapy. This was a longitudinal observational study. Patients were recruited from a tertiary hospital in China with a follow-up period of less than 90 days. Physical fitness was assessed using body mass index (BMI), mean skinfold thickness, waist-to-hip ratio, spirometry, mean grip strength, and flexibility at T1 (before chemotherapy), T2 (7-14 days after initial chemotherapy), and T3 (completely relieved or after two chemotherapy courses). A repeated-measures analysis of variance was used to analyze the physical fitness changes during follow-up. Multiple linear regression was used to analyze the factors influencing patient-reported outcomes. The study analyzed 121 patients. Changes in physical fitness during chemotherapy, including BMI, mean skinfold thickness, lung capacity and flexibility were not all equal at all three time points (F = 38.477, P < 0.001; F = 44.506, P < 0.001; F = 70.948, P < 0.001; and F = 70.965, P < 0.001), and post-hoc tests showed that they all trended to be decreasing before they were elevated (T2 < T3 < T1). The waist-to-hip ratio decreased and then increased (F = 12.138, P < 0.001,T2 < T3 = T1) and the mean grip strength remained stable (F = 0.137, P = 0.718). The total patient-reported outcome scale score decreased and subsequently increased (F = 362.507, P < 0.001,T2 < T1 < T3). BMI, mean skinfold thickness, spirometry, and flexibility influenced the patient-reported outcomes (B = 1.427,P < 0.001; B=-15.340,P < 0.001; B = 0.002,P = 0.014; B = 0.249,P < 0.001). Physical fitness affects patient-reported outcomes in those with acute leukemia. During chemotherapy, especially myelosuppression, healthcare providers should monitor patients' physical fitness and implement positive patient-appropriate interventions, such as exercise interventions, to promote better outcomes.

Feasibility, acceptability, and preliminary efficacy of a self-directed online psychosocial intervention for women with metastatic breast cancer: Finding My Way-Advanced

PURPOSE

Few digital interventions target patients with advanced cancer. Hence, we feasibility-tested Finding My Way-Advanced (FMW-A), a self-guided program for women with metastatic breast cancer.

METHODS

A single-site randomised controlled pilot trial was conducted. Participants were recruited through clinicians, professional networks, and social media and randomised to intervention or usual-care control. Participants were randomly allocated to either the intervention (FMW-A; a 6-week, 6-module CBT-based online self-directed psychosocial program for women with MBC + usual care resources) or control (usual care resources: BCNA's Hope and Hurdles kit). Feasibility outcomes included rates of recruitment, uptake, engagement, and attrition. Distress, QOL, and unmet needs were evaluated for signals of efficacy, and qualitative feedback was collected to assess acceptability.

RESULTS

Due to COVID-19 and funding constraints, the target recruitment of 40 was not reached (n = 60 approached; n = 55 eligible; n = 35 consented). Uptake was high (n = 35/55; 63.6%), engagement modest (median 3/6 modules per user), and attrition acceptable (66% completed post-treatment). Efficacy signals were mixed: compared to controls, FMW-A participants experienced small improvements in fear of progression (d = 0.21) and global QOL (d = 0.22) and demonstrated a trend towards improvements in cancer-specific distress (d = 0.13) and role functioning (d = 0.18). However, FMW-A participants experienced small-to-moderate deteriorations in general distress (d = 0.23), mental QOL (d = 0.51), and social functioning (d = 0.27), whereas controls improved. Qualitatively, participants (n = 4) were satisfied with the program, perceived it as appropriate, but noted some sections could evoke transient distress.

CONCLUSION

The study demonstrated feasibility (high uptake and acceptable retention) and generated realistic recruitment estimates. While FMW-A appears promising for targeting cancer-specific distress and fear of progression, the mixed findings in quality of life and general distress warrant further revisions and testing.

Symptom experiences and self-management strategies of patients with haematological malignancy undergoing chemotherapy: A qualitative study

Objective

To explore symptom experiences and self-management strategies from the haematological malignancy patient's perspective.

Methods

A qualitative descriptive approach was used to provide a direct and comprehensive understanding of the symptoms experienced and self-management strategies during treatment among patients with haematological malignancy. Fourteen patients with haematologic malignancies who received chemotherapy at a Chinese tertiary hospital were selected using purposeful sampling. Data were collected via semi-structured interviews and one-on-one patient sessions. The collected data were analysed using the content analysis methods. Reporting adhered to the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines.

Results

The data from this study were categorized into four themes and eight subthemes: (1) the dynamics and complexity of symptom experience (nonlinear, and overloaded symptom burden); (2) strategies for coping with symptomatic change (actively responding to challenges, and facing symptoms negatively); (3) symptom affects interaction (symptoms affect family interactions, and symptoms affect social interactions); and (4) benefit from symptom management (promoting family relationships, and regaining a new role in society).

Conclusions

Patients with haematological malignancy undergoing chemotherapy still face complex and variable symptoms, and there are still considerable challenges in symptom management. The findings underscore that health care providers should provide the necessary symptom assessment to enhance the well-being of patients based on the characteristics of the patient's symptom experience and symptom management needs at different stages of the disease.

Effects of remote dignity therapy on mental health among patients with hematologic neoplasms and their significant others: A randomized controlled trial

BACKGROUND

Families of patients with hematologic neoplasms involved in dignity therapy have exhibited a remarkable improvement in psychological well-being and family functioning. However, the applicability and generalizability of family participatory dignity therapy are limited as it is influenced by factors such as intervention time, place, and participants. Whether remote support from significant others is feasible and effective remains unknown.

OBJECTIVES

This study aimed to confirm the efficacy of significant others participating in remote dignity therapy (r-DT) on hope, dignity loss, meaning of life, and sense of stigma among patients with hematologic neoplasms as well as their significant others' depression and anxiety.

DESIGN

A randomized, single-blinded, two-arm, parallel-group controlled trial.

SETTING(S) AND PARTICIPANTS

Participants included patients with hematologic neoplasms and their significant others, who were recruited from Fujian Medical University Union Hospital from May 2021 to January 2022.

METHODS

A total of 72 eligible participants (patients and significant others) agreed to participate, and were randomly assigned to an intervention group (n = 35) or a control group (n = 37). Each pair of participants in the intervention group participated in two or three conversations based on the online video function of the WeChat platform, performed by one therapist in accordance with a specific communication outline. To evaluate the effects of the intervention, we assessed the patients' degree of dignity loss, hope level, meaning of life, and sense of stigma, as well as their significant others' depression, anxiety, and intimacy at baseline (T0), 15 days (T1), 30 days (T2), and 60 days (T3), and compared the scores between the two groups after the completion of the intervention. The Generalized Estimation Equation Model (GEE) was used to examine the effects of time, group, and their interaction.

RESULTS

The intervention group statistically significantly differed in lower dignity loss (t = 2.190, p = 0.032), higher hope level (t = -2.010, p = 0.049), and higher meaning of life (t = -2.066, p = 0.043) than the control group at T1. Regarding their significant others, the results of the comparison between the two groups showed that significant others in the intervention group had reduced levels of anxiety and depression at T1 and T2 (p < 0.05). The majority of patients (84.38 %) and significant others (75.00 %) provided positive evaluations of the program.

CONCLUSIONS

The r-DT showed a short-term positive effect on decreasing patients' dignity loss and promoting patients' hope and meaning of life; among their significant others, it decreased anxiety and depression.

TRIAL REGISTRATION

Registered in the China Clinical Trial Registry on 17 March 2021(ChiCTR2100044374).

TWEETABLE ABSTRACT

Remote dignity therapy decreased patients' dignity loss and promoted their hope and meaning of life; among their significant others, it decreased anxiety and depression.

Identifying barriers to resilience from the perspective of young and middle-aged patients with lymphoma: A qualitative exploration

PURPOSE

This study aimed to understand and identify barriers to resilience in young and middle-aged patients with lymphoma in the context of Chinese culture.

METHODS

A qualitative descriptive study was employed. Face-to-face, semi-structured, and in-depth individual interviews were conducted between May and July 2022. Purposive and differential sampling was used to select eligible participants. Conventional content analysis was used to analyze qualitative data and identify categories and subcategories. This study followed the COREQ checklist.

RESULTS

Twenty patients aged 28-59 years completed the interviews. Three categories involving thirteen subcategories were identified from the interview data: (1) internal barriers-derived from individual cognitive, emotional, behavioral, spiritual, and physical distress, resulting in internal negative constructs, and reducing the motivation to overcome adversity; (2) unbalanced family functioning-families threatened by disease are incapable of maintaining normal functioning and fail to act effectively when facing crises; and (3) absent social support-insufficient or unavailable shielding protection from social support further inhibits resilience among patients with lymphoma.

CONCLUSIONS

This study identified various barriers to the resilience of young and middle-aged patients with lymphoma in the context of Chinese culture. In addition to the patient's internal barriers of resilience, specific family and socio-cultural barriers should also be emphasized by healthcare professionals. Multidisciplinary and family-centered resilience intervention should be developed to help such patients cope with, adapt to the disease, and achieve good psychosocial returns.