Implementation of a Brief Screening Tool to Identify Needs of Breast Cancer Survivors

Survivorship concerns among posttreatment cancer survivors in South Korea: A secondary analysis of a cross-sectional survey

BACKGROUND

Cancer survivors may have a variety of survivorship concerns despite their cancer treatment having ended, with some negatively affecting their health-related quality of life. An in-depth understanding of survivorship concerns is essential for the development of survivorship care programs. However, previous findings have been limited to Western countries, and evidence from Asian countries is lacking.

OBJECTIVE

This study aimed to examine the prevalence of survivorship concerns among posttreatment cancer survivors in South Korea, identify factors associated with survivorship concerns, and explore their relationship with health-related quality of life.

DESIGN

Secondary analysis of a cross-sectional survey.

SETTING

Data were collected through an online survey of five online communities of cancer survivors in South Korea.

PARTICIPANTS

Overall, 1019 cancer survivors diagnosed with breast, colorectal, lung, stomach, and thyroid cancer (top five cancers in South Korea) who completed their cancer treatment.

METHODS

The survey collected data on demographic, disease- and treatment-related characteristics, survivorship concerns, and health-related quality of life. Survivorship concerns were measured using the checklist for survivorship concerns from the National Comprehensive Cancer Network Guidelines for Cancer Survivorship, which includes 12 survivorship concerns (e.g. cardiac toxicity, distress, cognitive dysfunction, fatigue, lymphoedema). Health-related quality of life was assessed using the Korean version of the 30-item European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire. Data were analysed using descriptive statistics, the Chi-square test, and multiple regression.

RESULTS

The prevalence of survivorship concerns ranged from 34.7 % to 78.4 %. Fatigue (78.4 %), unhealthy lifestyle (74.8 %), cognitive dysfunction (60.5 %), insomnia (58.9 %), and distress (52.9 %) were the five most frequent concerns. Survivors aged in their 50s, those diagnosed with stomach cancer, those with an elapsed time of ≥2 years but <5 years since diagnosis, and those who had received chemotherapy and/or radiotherapy were significantly more likely to report survivorship concerns. Regression analyses revealed that all survivorship concerns were significant predictors of one or more subscales of health-related quality of life. Distress was found to be a significant predictor of all six subscales of the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire.

CONCLUSIONS

This study revealed that posttreatment cancer survivors in South Korea had various survivorship concerns that decreased their health-related quality of life. To improve their health-related quality of life, systematic screening of survivorship concerns and timely appropriate interventions are critical. Our findings can thus contribute to the development of targeted survivorship care programs in Asia.

STUDY REGISTRATION

Not registered.

Validation of a Single Item Measure for Financial Toxicity Screening in Patients With Breast Cancer

PURPOSE

Financial toxicity (FT) has been linked to higher symptom burden and poorer clinical outcomes for patients with cancer. Despite the availability of validated tools to measure FT, a simple screen remains an unmet need. We evaluated item 12 ("My illness has been a financial hardship to my family and me") of the COmprehensive Score for Financial Toxicity (COST) measure as a single-item FT screening measure.

METHODS

In this secondary analysis, 711 patients with cancer (690 with breast cancer) were recruited via a web-based survey from a philanthropic organization. COST items 1-11 were scored according to Functional Assessment of Chronic Illness Therapy scoring guidelines, with lower scores indicating worse FT. Analyses focused on establishing a correlation, examining item properties, and sensitivity/specificity of item 12 relative to the total COST score.

RESULTS

Item 12 had a correlation of r = 0.53 with the COST-11 score, and an increase of one point on item 12 is associated with a decrease of approximately three total points on the full scale (b, 3.35; P < .001; adjusted R2, 0.28). Item analysis with the graded-response item in response theory modeling showed very good discrimination (a, 2.096) for item 12, indicating that it can reliably distinguish between low and high FT in patients. Sensitivity ranged between 75.6% and 95.7% on all item 12 thresholds to screen positive for FT using two COST cutoffs as criteria. Maximizing both sensitivity and specificity was to be found for higher item 12 scores.

CONCLUSION

To our knowledge, this is the first validation of a single-item screening measure for FT. Overall, these results illustrate that item 12 from the COST measure is a good candidate for a single-item screener. Clinicians can choose among item 12 screening thresholds depending on their tolerance for low specificity.

Screening for Financial Toxicity in Oncology Research and Practice: A Narrative Review

Financial toxicity (FT) is now a well-recognized issue affecting many patients with cancer and their families. The field is rapidly moving from a focus on describing this problem to efforts to optimize screening and identify management solutions. There are now multiple validated tools to study FT in the research setting. Although there is currently no standard tool for screening in the setting of routine clinical practice, many of the scales for FT were developed with clinical screening in mind, and there is emerging evidence regarding potential to screen with one or two questions to detect financial distress. This narrative review is intended to provide an update on validated scales that have been used to study FT in the research context and provide examples of tools of varying length that are being studied for implementation of screening in clinical practice. It is important for clinicians to seek to identify and assist patients who may be experiencing FT as a result of cancer or cancer therapy.

Screening for Financial Toxicity Among Patients With Cancer: A Systematic Review

OBJECTIVE

Despite the pervasiveness and adverse impacts of financial toxicity (FT) in cancer care, there are no definitive measures for FT screening that have been widely integrated into clinical practice. The aim of this review is to evaluate current methods of assessing FT among patients with cancer and confirm factors associated with higher risk of FT.

METHODS

A systematic review was performed according to PRISMA guidelines. We included peer-reviewed studies that cross-sectionally, longitudinally, or prospectively measured the self-reported financial impact of patients undergoing cancer care in the United States.

RESULTS

Out of 1,085 identified studies, 51 met final inclusion criteria. Outcomes evaluated included FT measures or tools, time and setting of screening, FT prevalence, and sociodemographic or clinical patient-level associated factors. Our findings demonstrate that there is wide variability in FT screening practices including in the timing (diagnosis versus treatment versus survivorship), setting (clinic-based, online, telephone or mail), tools used (21 unique tools, 7 previously validated), and interpretations of screening results (varying FT score cutoffs defining high versus low FT). Younger age, lower income, lower education, non-White race, employment status change, advanced cancer stage, and systemic or radiation therapy were among factors associated with worse FT across the studies.

DISCUSSION

FT screening remains heterogenous within the United States. With the ever-escalating cost of cancer care, and the strong association between FT and poor patient outcomes, universal and routine FT screening is imperative in cancer care. Further research and multifaceted interventions identifying best practices for FT screening are needed.

Patient-reported outcome measurement implementation in cancer survivors: a systematic review

PURPOSE

Patient-reported outcome measurements (PROMs) are increasingly used for cancer patients receiving active treatment, but little is known about the implementation and usefulness of PROMs in cancer survivorship care. This systematic review evaluates how cancer survivors and healthcare providers (HCPs) perceive PROM implementation in survivorship care, and how PROM implementation impacts cancer survivors' health outcomes.

METHODS

We systematically searched PubMed/MEDLINE, Embase, CINAHL, Web of Science, and Cochrane Database of Systematic Reviews from database inception to February 2022 to identify randomized and nonrandomized studies of PROM implementation in cancer survivors.

RESULTS

Based on prespecified eligibility criteria, we included 29 studies that reported on 26 unique PROMs. The studies were heterogeneous in study design, PROM instrument, patient demographics, and outcomes. Several studies found that cancer survivors and HCPs had favorable impressions of the utility of PROMs, and a few studies demonstrated that PROM implementation led to improvements in patient quality of life (QoL), with small to moderate effect sizes.

CONCLUSIONS

We found implementation of PROMs in cancer survivorship care improved health outcomes for select patient populations. Future research is needed to assess the real-world utility of PROM integration into clinical workflows and the impact of PROMs on measurable health outcomes.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors accepted PROMs. When successfully implemented, PROMs can improve health outcomes after completion of active treatment. We identify multiple avenues to strengthen PROM implementation to support cancer survivors.

Unmet supportive care needs of breast cancer survivors: a systematic scoping review

BACKGROUND

Breast cancer is the most common type of cancer in women worldwide. Though improved treatments and prolonged overall survival, breast cancer survivors (BCSs) persistently suffer from various unmet supportive care needs (USCNs) throughout the disease. This scoping review aims to synthesize current literature regarding USCNs among BCSs.

METHODS

This study followed a scoping review framework. Articles were retrieved from Cochrane Library, PubMed, Embase, Web of Science, and Medline from inception through June 2023, as well as reference lists of relevant literature. Peer-reviewed journal articles were included if USCNs among BCSs were reported. Inclusion/exclusion criteria were adopted to screen articles' titles and abstracts as well as to entirely assess any potentially pertinent records by two independent researchers. Methodological quality was independently appraised following Joanna Briggs Institute (JBI) critical appraisal tools. Content analytic approach and meta-analysis were performed for qualitative and quantitative studies respectively. Results were reported according to the PRISMA extension for scoping reviews.

RESULTS

A total of 10,574 records were retrieved and 77 studies were included finally. The overall risk of bias was low to moderate. The self-made questionnaire was the most used instrument, followed by The Short-form Supportive Care Needs Survey questionnaire (SCNS-SF34). A total of 16 domains of USCNs were finally identified. Social support (74%), daily activity (54%), sexual/intimacy (52%), fear of cancer recurrence/ spreading (50%), and information support (45%) were the top unmet supportive care needs. Information needs and psychological/emotional needs appeared most frequently. The USCNs was found to be significantly associated with demographic factors, disease factors, and psychological factors.

CONCLUSION

BCSs are experiencing a large number of USCNs in fearing of cancer recurrence, daily activity, sexual/intimacy, psychology and information, with proportions ranging from 45% to 74%. Substantial heterogeneity in study populations and assessment tools was observed. There is a need for further research to identify a standard evaluation tool targeted to USCNs on BCSs. Effective interventions based on guidelines should be formulated and conducted to decrease USCNs among BCSs in the future.

Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis

Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.