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Kelmendi N, Nilsson M, Taloyan M, Sundberg K, Langius-Eklöf A, Craftman ÅG. Preferences for Tailored Support - Patients' and Health Care Professionals' Experiences Regarding Symptoms and Self-Management Strategies During the First Year After Curatively Intended Prostate Cancer Treatment. Patient Prefer Adherence 2024; 18:275-288. [PMID: 38333642 PMCID: PMC10850763 DOI: 10.2147/ppa.s440689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/06/2024] [Indexed: 02/10/2024] Open
Abstract
Purpose There is an increase in the number of men undergoing screening for prostate cancer, and advancements in treatments, which implies current knowledge about symptoms and self-management. This study aims to explore experiences of symptom distress, and self-management strategies during the first year after curatively intended treatment for prostate cancer, as identified by patients and health care professionals. Methods A qualitative design was used, including data triangulation from individual interviews with patients (n =17) and one focus group interview with healthcare professionals (n =5). Thematic analysis was used. Results The two main themes were identified: living with the consequences of treatment and navigating a new situation. Living with the consequences of treatment illustrated how losing control of bodily functions such as bladder, bowel, and sexual functions interfered with daily life. A stigma around the disease was described, and a life living in an unfamiliar body challenged ideas of masculinity. The first months after treatment ended was a distressing period related to the abruption in frequent contact with healthcare providers, and concerns about the future. The second theme, navigating a new situation, illustrates that self-management strategies varied, due to individual factors as did the need for tailored information and support provided from healthcare professionals and family, which was highly valued. Information and support were described as complex topics and healthcare professionals emphasized the need for appropriate education for staff to provide proper support to men after ended treatment. Conclusion Lingering symptoms and concerns were evident during the first year after treatment. Self-management strategies varied, and timely and tailored information and support during the first year were considered highly valued, important, and preferred by patients. Our results indicate that support should be offered immediately after curatively intended treatment.
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Affiliation(s)
- Nazmije Kelmendi
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| | - Marie Nilsson
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | - Marina Taloyan
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | - Kay Sundberg
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Ann Langius-Eklöf
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Åsa G Craftman
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
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Al Hussein Al Awamlh B, Wallis CJD, Diehl C, Barocas DA, Beskow LM. The lived experience of prostate cancer: 10-year survivor perspectives following contemporary treatment of localized prostate cancer. J Cancer Surviv 2023:10.1007/s11764-023-01381-6. [PMID: 37171717 DOI: 10.1007/s11764-023-01381-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/10/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Studies relying on standardized instruments to measure patient-centered harms and benefits of cancer treatment may fail to capture important elements of the lived experience of cancer patients. Further, qualitative studies on the survivorship experience of men with localized prostate cancer (PCa) are limited. We sought to explore the early experience, long-term experience, and advice provided for others among long-term survivors of localized PCa. METHODS Semi-structured qualitative interviews with a subset (n = 66) of respondents to a survey of 10-year PCa survivors who underwent active surveillance, radical prostatectomy, or radiotherapy. Topics included early and long-term experiences and advice to other men and physicians. RESULTS Immediately after treatment, men were mostly satisfied with radiation and active surveillance due to remaining whole and avoiding surgical removal of the prostate. Meanwhile, men treated with surgery felt relieved by the removal of cancer. Some early negative perception was related to short-term anxiety, particularly among men who underwent active surveillance. Long-term experiences included accepting the trade-offs of urinary and sexual side effects with survival. Most men fared well financially, some had strengthened relationships, and many reported greater appreciation and compassion. Men provided essential advice to other men and physicians on the importance of gathering detailed information on treatments and establishing a strong relationship with physicians. CONCLUSIONS Long-term survivors of localized PCa generally do well by accepting the long-term effects of contemporary treatments, experiencing strengthened relationships, and developing a better overall life approach. IMPLICATIONS FOR CANCER SURVIVORS We provide useful perspectives and insights for men opting to use current-day treatments for localized PCa.
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Affiliation(s)
- Bashir Al Hussein Al Awamlh
- Department of Urology, Medical Center North, Vanderbilt University Medical Center, 1161 21st Avenue South, A-1302, Nashville, TN, 37232, USA.
| | | | - Carolyn Diehl
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel A Barocas
- Department of Urology, Medical Center North, Vanderbilt University Medical Center, 1161 21st Avenue South, A-1302, Nashville, TN, 37232, USA
| | - Laura M Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
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Yoder AK, Lakomy DS, Wu J, Andring LM, Fellman B, Colbert LE, Jhingran A, Klopp AH, Soliman P, Peterson SK, Lin LL. Impact of Treatment Modality on Quality of Life Among Uterine Cancer Survivors. Clin Oncol (R Coll Radiol) 2023; 35:e215-e226. [PMID: 36494250 PMCID: PMC9904419 DOI: 10.1016/j.clon.2022.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
AIMS Our understanding of the impact of adjuvant therapy on longitudinal quality of life (QoL) following surgery for patients with uterine cancer is limited. The purpose of this study was to compare QoL in patients who have undergone surgery with or without radiation therapy for uterine cancer. MATERIALS AND METHODS This was a cross-sectional cohort study that examined women treated for uterine cancer at MD Anderson Cancer Center from 2006 to 2017. Participants included those who underwent hysterectomy/bilateral salphingo-oophorectomy alone, with brachytherapy or external beam radiation therapy (EBRT). A non-cancer cohort of women who underwent a hysterectomy/bilateral salphingo-oophorectomy for benign indications was also identified (non-CA). To compare QoL we used the Functional Assessment of Cancer Therapy - Endometrial survey (FACT-En), a validated survey used to assess QoL. The survey has five subscales: physical, social, emotional, functional and an endometrial cancer-specific subscale. Cohorts were compared using ANOVA tests. RESULTS In total, 309 women responded to the questionnaire (hysterectomy/bilateral salphingo-oophorectomy 64, brachytherapy 77, EBRT 96, non-CA 72). The median time from surgery to survey completion was 6.7 years. The mean total FACT-En score for the entire cohort was 144 [standard deviation 22]. Overall QoL was different between cohorts, with the EBRT cohort reporting the lowest QoL (mean 139.4 [21.6]) and the brachytherapy cohort the highest (150.6 [18.2], P = 0.006). Among patients who had undergone cancer treatment, the EBRT cohort reported the worst endometrial-specific QoL (53.5 [8.6]), while again the brachytherapy group reported the highest score (57.5 [6.1], P = 0.007). CONCLUSIONS QoL differences in women who have undergone different treatments for uterine cancer may persist years after treatment. In women with endometrial cancer who require adjuvant therapy, brachytherapy does not appear to have any long-term detriments on QoL.
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Affiliation(s)
- A K Yoder
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D S Lakomy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Dartmouth College Geisel School of Medicine, Hanover, NH, USA
| | - J Wu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; The University of Texas School of Public Health, Houston, TX, USA
| | - L M Andring
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L E Colbert
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P Soliman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L L Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Whiteside L, Nelder C, Pitt E, Hodgson C, Choudhury A, Eccles CL. Comparing patient acceptability of MR-guided radiotherapy to conventional CBCT on two Elekta systems: a questionnaire-based survey. J Radiother Pract 2022. [DOI: 10.1017/s1460396922000206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background and Purpose:
The magnetic resonance linear accelerator system (MR Linac) is a novel piece of radiotherapy (RT) equipment allowing the routine application of daily MR-guided treatment adaptation. The hardware design required for such technical capabilities and the increased complexity of the treatment workflow entails a notable departure from cone beam computed tomography (CBCT)-based RT. Patient tolerability of treatment is paramount to RT practice where high compliance is required. Presented is a comparative analysis of how such modality specific characteristics may ultimately impact the patient experience of treatment.
Materials and Methods:
Forty patients undergoing RT for prostate cancer (PCa) on either the MR Linac (n = 20) or a CBCT-based linac (n = 20) were provided with a validated patient reported outcomes measures (PROM’s) questionnaire at fraction 1 and fraction 20. The 18-item questionnaire provided patient responses recorded using a 4-point Likert scale, 0 denoting a response of ‘Not at all’, 1 ‘Slightly’, 2 ‘Moderately’ and 3 signifying ‘Very’. The analysis provided insight into both comparisons between modalities at singular time points (fractions 1 and 20), as well as a temporal analysis within a single modality, denoting changing patient experience.
Results:
Patients generally found the MR Linac treatment couch more comfortable, however, found the increase in treatment duration harder to tolerate. Responses for all items remained stable between first and last fraction across both cohorts, indicating minimal temporal variation within a single modality. None of the responses were statistically significant at the 0·01 level.
Conclusion:
Whether radiotherapy for PCa is delivered on a CBCT linac or the MR Linac, there is little difference in patient experience with minimal experiential variation within a single modality.
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Corrigan KL, De B, Rooney MK, Ludmir EB, Das P, Smith GL, Taniguchi CM, Minsky BD, Koay EJ, Koong AC, Holliday EB. Patient-Reported Outcomes Following Chemoradiation in Patients with Anal Cancer: A Qualitative Analysis. Adv Radiat Oncol 2022; 7:100986. [PMID: 35662810 PMCID: PMC9157211 DOI: 10.1016/j.adro.2022.100986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022] Open
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Zhao Y, Ebert MA, Waterhouse D, Goodall S, Rowshanfarzad P, Fattahi S. Deriving optimal planning organ at risk volume margins in prostate external beam radiotherapy. Phys Eng Sci Med 2021; 44:1071-1080. [PMID: 34410627 DOI: 10.1007/s13246-021-01044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/30/2021] [Indexed: 11/30/2022]
Abstract
Planning organ-at-risk volume (PRV) margins can be applied to the bladder and rectum in prostate external beam radiation therapy (EBRT), in order to incorporate the uncertainties resulting from their inter-fraction motion. For each of a total of 16 patients, the bladder and rectum were delineated on CBCT images for five treatment fractions in addition to the planning CT image set. The bladder and rectum boundary displacements across the images were measured and the frequency and size of organ boundary displacements were evaluated. Subsequently, PRV margins were created to cover a specific percentage of organ boundary motion for a specified percentage of the population. In this investigation, two bladder PRV margins were generated to deal with two bladder conditions of low and high-volume variation among fractions. A combined PRV margin was also generated for the rectum by separating the rectum into three parts and deriving independent PRV margins for each segment. Outward coverage and effectiveness metrics allowed evaluation of the margins.
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Affiliation(s)
- Yutong Zhao
- School of Physics, Mathematics and Computing, The University of Western Australia, Nedlands, WA, Australia.
| | - Martin A Ebert
- School of Physics, Mathematics and Computing, The University of Western Australia, Nedlands, WA, Australia.,Department of Radiation Oncology, Sir Charles Gairdner Hospital (SCGH), Nedlands, WA, Australia.,5D Clinics, Claremont, WA, Australia
| | | | - Simon Goodall
- School of Physics, Mathematics and Computing, The University of Western Australia, Nedlands, WA, Australia.,Genesis Cancer Care, Perth, WA, Australia
| | - Pejman Rowshanfarzad
- School of Physics, Mathematics and Computing, The University of Western Australia, Nedlands, WA, Australia
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