Exploring the problems faced by patients living with advanced cancer in Bengaluru, India

An interpretive phenomenological study on the lived experiences of allogeneic hematopoietic cell transplantation patients 'in an Islamic context'

PURPOSE

Allogeneic hematopoietic cell transplantation (allo-HCT) has serious complications despite its potential curative effects. Some of these complications can impede ongoing treatment and healing. Transplantation is a long journey that requires close follow-up and monitoring. In-depth knowledge of patient perspectives is essential to provide quality care at all levels. This study aimed to explore the lived experiences of allo-HCT patients.

METHODS

An interpretive phenomenological design was employed in this study. One-to-one virtual semistructured in-depth interviews were conducted with nine adult allo-HCT patients. Interviews were transcribed verbatim, and data were analyzed by Diekelmann's seven-stage analysis technique. The study was carried out at Princess Noorah Oncology Center (PNOC) at Jeddah city.

RESULTS

The participants were found to experience a range of physical and psychological changes as they progressed through the transplantation stages. These changes were interconnected and portrayed challenges dealing with transplantation. Overall, the findings revealed the complex and multifaceted nature of the recovery process, illustrating the delicate balance survivors are trying to reach through deep reasoning and mental adaptations. The experiences of the participants were captured in several themes: Transplantation knowledge aligned with patient preferences, transplantation course, perspective shift and transformation, family role transition, mental wellness, surrender, support system, and patience.

CONCLUSION

This study demonstrated the experiences of allo-HCT patients, how these patients transitioned from one stage to another, and the intellectual skills they embraced through this transition process. The findings reflected the coping strategies and mechanisms used by patients to overcome hardship and revealed aspects of illness and wellness concepts.

Relationship between disease perception and feelings of powerlessness in lymphoma patients: the mediating effect of social support and level of hope

Objectives

Lymphoma patients often experience significant physical and psychological stress, with feelings of powerlessness negatively impacting their health. While social support and hope are crucial for improving mood and coping with disease, their mechanisms in relation to disease perception and powerlessness remain unclear. This study aimed to examine the relationship between disease perception and feelings of powerlessness in lymphoma patients, focusing on the mediating roles of social support and hope.

Methods

For a cross-sectional design, 311 lymphoma patients were surveyed using the Brief illness perception questionnaire, Powerlessness assessment tool, Social Support Rating Scale, and Herth's Hope Scale, and were statistically analyzed using the software SPSS 27.0 and PROCESS version 4.1.

Results

A correlation was found between the disease perception, social support, hope level, and feeling of powerlessness of lymphoma patients (P < 0.01). There was a positive correlation between perceptions of illness and powerlessness (β= 0.291, P<0.001), and disease perception could influence powerlessness through three indirect pathways: the separate mediating effect of social support [β= 0.057, 95%CI (0.029~0.091)], the separate mediating effect of level of hope [β= 0.07, 95%CI (0.034~ 0.107)], and the chain mediating effect of social support and hope level [β= 0.019, 95%CI (0.008~0.033)]. Social support and level of hope played a partial medium mediating effect in the effect of perceived disease on feelings of powerlessness, accounting for 13.04% and 16.02% of the total effect, respectively, and the chained mediating effect of both accounted for 4.35% of the total effect.

Conclusions

Disease perception and powerlessness were positively correlated in lymphoma patients, and in addition, social support and level of hope mediated the relationship. This conclusion provides a theoretical basis and guidance for nursing interventions to reduce powerlessness in lymphoma patients.

Unveiling the Role of Pain Catastrophising as a Predictor of Fear of Personal Death amongst Brain Tumour Patients

Objectives

According to the National Health Portal, brain cancer is witnessing an upward curve in India. The reports by medical professionals suggest that brain tumours will become the second most common cancer by 2030. Any life-threatening illness not only impacts the physical well-being of the patient but also affects the mental well-being of the patient. As an interdisciplinary field, psychology aims to understand the psychosocial components of an illness that goes beyond the realm of medical treatments. Hence, the present study focused on two psychological constructs, namely Pain Catastrophising and Fear of Personal Death. The present research aims to evaluate the relationship between Pain Catastrophising and Fear of Personal Death as well as assess the predictive role of Pain Catastrophising for Fear of Personal Death.

Materials and Methods

A correlational design was adopted for the present study. The sample consisted of 180 patients who were diagnosed with a brain tumour and were scheduled for surgery for the removal of the tumour. A purposive sampling technique was used for the selection of the sample. Data were collected on two psychological measures, namely the Pain Catastrophising Scale and the Fear of Personal Death Scale. Pearson's product-moment method and regression analysis were employed for statistical analysis.

Results

The findings highlight that there exists a positive association between the two components of Pain Catastrophising, namely Magnification (r = 0.644, P < 0.01) and Helplessness (r = 0.456, P < 0.01) with the Fear of Personal death. Rumination (0.026, P > 0.05) component exhibited no association with Fear of Personal Death. Linear regression analysis reveals that magnification (R = 0.644, R2 = 0.414, F = 125.861, P < 0.01) and helplessness (R = 0.456, R2 = 0.208, F = 46.857, P < 0.01) are significant predictors of Fear of Personal Death for the selected sample.

Conclusion

Pain Catastrophising tendencies and feelings of Fear of Personal Death are prevalent amongst the selected cohort. Pain-catastrophising components are significantly associated with fear of personal death (FPD) and are also significant predictors of FPD amongst brain tumour patients.

Perceptions and Experiences of Informal Caregivers of Breast Cancer Patients in South India: A Qualitative Study

BACKGROUND

This study was conducted to explore the prevailing perceptions and experiences of caregiving burden among informal caregivers of women living with breast cancer in South India.

METHODS

In-depth interviews were conducted among breast cancer care-receivers (n=35) and their informal caregivers (n=39) and a thematic analysis was used to analyze the data. Informal caregiver in the context of this study was defined as one who takes up the responsibility of an informal caregiving role, and were either self-identified or acknowledged by the care-receivers.

RESULTS

Four main inductive themes in the domains of: emotional culpability, financial and workplace liability, psychosocial affliction, physical strain and health system demand were identified, that were associated with caregiver burden.

CONCLUSION

Informal caregivers form an integral part of the cancer care continuum in India. It is recommended to factor in the identified themes while developing a caregiver needs assessment model in the context of caring for breast cancer patients in the Indian setting.

Economic Perspective of Cancer Care and Its Consequences for Vulnerable Groups

Simple Summary

For cancer patients, many different reasons can cause financial burdens and economic threads. Sociodemographic factors, rural/remote location and income are known determinants for these vulnerable groups. This economic vulnerability is related to the reduced utilization of cancer care and the impact on outcome. Financial burden has been reported in many countries throughout the world and needs to be addressed as part of the sufficient quality of cancer care.

Abstract

Within healthcare systems in all countries, vulnerable groups of patients can be identified and are characterized by the reduced utilization of available healthcare. Many different reasons can be attributed to this observation, summarized as implementation barriers involving acceptance, accessibility, affordability, acceptability and quality of care. For many patients, cancer care is specifically associated with the occurrence of vulnerability due to the complex disease, very different target groups and delivery situations (from prevention to palliative care) as well as cost-intensive care. Sociodemographic factors, such as educational level, rural/remote location and income, are known determinants for these vulnerable groups. However, different forms of financial burdens likely influence this vulnerability in cancer care delivery in a distinct manner. In a narrative review, these socioeconomic challenges are summarized regarding their occurrence and consequences to current cancer care. Overall, besides direct costs such as for treatment, many facets of indirect costs including survivorship costs for the cancer patients and their social environment need to be considered regarding the impact on vulnerability, treatment compliance and abundance. In addition, individual cancer-related financial burden might also affect the society due to the loss of productivity and workforce availability. Healthcare providers are requested to address this vulnerability during the treatment of cancer patients.

Translation and Validation of COST - FACIT (Version 2) Questionnaire into Hindi and Marathi to Assess Financial Toxicity in Indian Cancer Patients

Background Cancer is one of the most expensive and exhaustive medical conditions with a huge impact on the financial condition of the patient and their family members. A lot of advancements have led to improvement in the survival of the patients but at a raised cost. Comprehensive Score for financial Toxicity - Functional Assessment of Chronic Illness Therapy (COST - FACIT Version 2) is one such validated and widely used tool. Assessing the financial burden in our country is still far more challenging as COST - FACIT is available in the English language but not in any regional language. Hence, we decided to validate this tool in Hindi and Marathi languages.

Material and Methods A single-center, cross-sectional study was conducted in the Department of Uro-Oncology at the Tata Memorial Hospital. The original version of the COST - FACIT (Version 2) was translated from English into Hindi and Marathi languages, following the FACIT translation method and tested for content validity that included two forward translations, followed by reconciliation and a backward translation. The questionnaires were then approved by the FACIT team, and pilot testing was done for 20 patients (10 for each Hindi and Marathi language). Each of these 20 patients, after filling up the questionnaire themselves, was interviewed for any difficulty encountered during answering the questionnaire. Based on the suggestions or interpretations of this pilot testing, the necessary changes were incorporated in the final Hindi and Marathi questionnaires.

Results A total of 20 patients (10 each for Hindi and Marathi) were included for pilot testing of the questionnaire. The median age of the entire cohort was 61 years (27–79). The questionnaires showed good content and face validity and demonstrated a high internal consistency (Cronbach's α: 0.85 for Hindi, 0.89 for Marathi).

Conclusion The questionnaire COST - FACIT (Version 2) has been approved and validated in Hindi and Marathi languages by the FACIT team for use in clinical practice and studies.