Exploring the Unmet Supportive Care Needs of Breast Cancer Survivors Experiencing Psychological Distress: Qualitative Study

The role of emotion regulation difficulties on anxiety and depressive symptoms among patients with breast cancer

The co-morbid anxiety and depressive symptoms among patients with breast cancer has been linked with adaptation problems and poor quality of life. This study investigated the effect of emotion regulation difficulties on anxiety and depressive symptoms in patients with breast cancer. The study was conducted with a cross-sectional correlational design. The study included 140 patients with breast cancer. Data were collected using the Socio-demographic Characteristics Questionnaire, Difficulties in Emotion Regulation Scale Short Form, and the Hospital Anxiety Depression Scale. Descriptive statistics, and multivariate regression analyses were used. Goals (β = 0. 294, p = 0.026) and strategies (β = 0.223, p = 0.038) were associated with anxiety, explaining 12.6% of the variance for anxiety. Regarding depressive symptoms, impulse (β = 0.250, p = 0.003), strategies (β = 0.231, p = 0.035), and goals (β = 0.222, p = 0.022) were associated with depressive symptoms. The model explained 25.2% of the variance for depressive symptoms. Patients with breast cancer who have difficulty in goal-directed behavior and limited access to emotion regulation strategies when emotionally distressed are associated with a risk of anxiety and depressive symptoms. It is recommended that emotion regulation difficulties of patients with breast cancer should be assessed in terms of anxiety and depression risk. Psychosocial interventions focused on adaptive emotion regulation strategies could be implemented in cancer care.

Systematic review of the needs and health-related quality of life domains relevant to people surviving cancer in Europe

PURPOSE

To systematically review qualitative studies on outcomes, needs, experiences, preferences, concerns and health-related quality of life (HRQoL) of people surviving cancer in Europe in the last decade.

METHODS

Protocol registered ( https://www.crd.york.ac.uk/PROSPERO , ID575065).

INCLUSION CRITERIA

studies with qualitative methods, constructs related to HRQoL, and adults surviving cancer in Europe. The search was conducted in PubMed and Scopus since 2013. Abstracts and full text were revised, data extracted and study risk of bias assessed independently by two researchers. The primary outcomes were the themes arising from each study. A thematic analysis stratified according to the study objective was undertaken by grouping themes into categories.

RESULTS

Of 18,256 articles identified, 43 fulfilled the inclusion criteria: 16 studies with a generic objective and 27 with specific objectives. Seven categories (57 themes) emerged from the studies with a generic focus: Clinical Management (n = 16), Symptoms and Physical Function (n = 5), Psychological Function (n = 21), Social Function (n = 18), HRQoL (n = 3), Life Disruption (n = 6), and Individual Factors (n = 1). The 12 studies focused on treatment and care experiences stand out among those with specific objectives, with most themes fitting into the same seven categories.

CONCLUSIONS

Results clearly showed the predominance of the social and psychological function domains over physical domains among people surviving cancer, additionally identifying specific needs in clinical management, such as information and communication, and relationship with and support from professionals. Therefore, these aspects should be incorporated into the evaluation of patient-centred initiatives for people surviving cancer.

LIMITATIONS

only two databases were searched, and most European countries were not represented.

Supportive care and information needs in relation to quality of life among patients with breast cancer and gynaecological cancer during the time of treatment

PURPOSE

Although therapy and psychosocial care for patients with breast cancer and gynaecological cancer has improved in the last years, there are still many issues that require further investigation. Unmet supportive care needs can lead to a lower adherence to treatment and a lower quality of life. Patients' needs seem to be highest during the time of treatment. Thus, this study investigated needs and quality of life.

METHODS

In this German prospective study, we enrolled 292 patients with breast cancer and gynaecological cancer during the time of treatment. Data on needs were assessed using instruments that had proven feasible in earlier studies. Data on quality of life (QoL) were assessed using the European Organization for Research and Treatment of Cancer QoL Core Questionnaire (EORTC QLQ-C30). We investigated correlations between needs and sociodemographic data as well as quality of life.

RESULTS

Among all cancer entities we observed that 150 patients (51.5%) showed unmet information needs, 221 patients (75.7%) showed at least one high supportive care need, and 91 patients (31.2%) had psychological care needs. Data showed statistically significant correlations between these needs and sociodemographic data as well as quality of life. These correlations generally showed small to medium effect sizes. Older women showed less supportive care needs (r = - 0.24; p < 0.001), (r = - 0.15; p = 0.010). Furthermore, recruitment after surgery was associated with statistically significant higher information needs (r = 0.14; p = 0.015), whereas recruitment during chemotherapy was associated with statistically significant less information needs (r = - 0.15; p = 0.013). Positive correlations were shown for the level of received information and physical functioning (r = 0.12; p = 0.047), social functioning (r = 0.16; p = 0.009) and global quality of life (r = 0.19, p = 0.002) as well as satisfaction with information and physical (r = 0.16; p = 0.006), social (r = 0.24; p < 0.001), cognitive functioning (r = 0.14; p = 0.017) as well as global quality of life (r = 0.25; p < 0.001). Negative correlations were reported for information needs and emotional functioning (r = - 0.12; p = 0.035) and global quality of life (r = - 0.15; p = 0.011). Supportive care needs also correlated negatively with physical (r = - 0.23; p < 0.001), role (r = - 0.23; p < 0.001), emotional (r = - 0.35; p < 0.001), cognitive (r = - 0.24; p < 0.001), social functioning (r = - 0.30; p < 0.001), and global quality of life (r = - 0.35; p < 0.001). Also, patients with at least one high supportive care need correlated negatively with role (r = - 0.15; p = 0.014), emotional (r = - 0.23; p < 0.001), social functioning (r = - 0.30; p = 0.001), and global quality of life (r = - 0.35; p < 0.001). There was no statistical significance concerning cancer side. Thus, both groups are reported together. Furthermore, there was no statistical significance concerning disease status.

CONCLUSION

Overall, this study highlights the importance of tailored information and supportive care interventions. Addressing these needs, particularly in terms of information provision and psychosocial support, could lead to improved quality of life and better overall patient outcomes.

Psychological-Distress Factors in Patients With Breast Cancer: A Qualitative Meta-Synthesis

AIMS

To systematically review and integrate qualitative-research results pertaining to psychological distress in patients with breast cancer and to clarify its causes and drivers.

BACKGROUND

Patients with breast cancer experience psychological distress in the stages of diagnosis, treatment, and rehabilitation, which seriously affects their quality of life. Through comprehensive qualitative research, the study comprehensively describes the experiences of patients with breast cancer to guide medical personnel in taking better care of them.

DESIGN

A systematic review and synthesis of qualitative studies.

METHODS

Qualitative studies were included if they were related to the psychological-distress experiences of patients with breast cancer. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used to appraise study quality. Data were synthesised using the Thomas and Harden method of thematic and content analysis.

DATA SOURCES

Nine electronic databases (PubMed, Embase, Cochrane Library, CINAL [via EBSCO], and PsycINFO, China Knowledge Resource Integrated Database, Wanfang, Chinese Biomedical, and Weipu) were searched from inception until February 2024.

RESULTS

Thirteen studies were included in the meta-synthesis. Four analytical themes were identified: diagnostic and therapeutic, individual, environmental, and interpersonal factors.

CONCLUSIONS

Psychological distress is a subjective feeling influenced by interactions among individual, therapeutic, environmental, and interpersonal factors, and it is commonly encountered among patients with breast cancer. Therefore, to optimise the management of psychological distress, the characteristics and external environment of patients with breast cancer should be carefully considered when delivering routine nursing care.

IMPACT

Patients experience psychological distress at different stages of breast cancer; however, the causes of psychological distress at different stages differ. Medical staff should implement targeted psychological-distress intervention measures based on factors relevant to different stages.

REPORTING METHOD

The Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement.

REGISTRATION

The protocol of this study has been registered in the database PROSPERO (registration ID: CRD42023417364).

Psychological distress in adult women of reproductive age at different stages after breast cancer diagnosis: A qualitative study

AIM

To explore the actual experience of psychological distress of adult women of reproductive age at different stages after breast cancer diagnosis.

DESIGN

Qualitative.

METHODS

Eighty-one patients with breast cancer-related distress thermometer scores >4 were selected using a purposive sampling method. Patients were divided into newly diagnosed and 1-, 3-, 6-, 9- and 12-month groups according to time since diagnosis and then interviewed. A phenomenological approach was adopted to analyse interview content, and different themes were extracted.

RESULTS

Women exhibited different levels of psychological distress depending on the time since diagnosis, with newly diagnosed patients showing the highest distress. Within 1 year post-diagnosis, different events caused patients distress. Themes extracted at new diagnosis and 1-, 3-, 6-, 9- and 12 months post-diagnosis included sadness and disbelief, loss of control, optimistic but concerned, physical and mental exhaustion, difficulties returning to society and limited sexual intimacy, respectively; all groups expressed reproductive concerns.

CONCLUSION

Clinical nurses should focus on different psychologically distressing events to provide targeted interventions at distinct phases. For women of childbearing age, clinical nurses should pay particular attention to patients' marriage and reproductive concerns.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

During the year after a breast cancer diagnosis, patients of childbearing age experience events that cause psychological distress that differ depending on time since diagnosis. Nurses should focus on core stressful events and perform specific nursing interventions.

IMPACT

To provide holistic care, nurses should consider the psychological and emotional changes patients may undergo. For women of childbearing age, clinical nurses should pay particular attention to patients' marriage and fertility concerns, and be able to provide evidence-based professional guidance on reproductive preservation techniques.

REPORTING METHOD

The study was reported using the consolidated criteria for reporting qualitative research guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Patients contributed to data collection through interviews.

The relationship between psychological distress and the nursing humanistic care demands in postoperative cancer inpatients: a cross-sectional study

PURPOSE

We aimed to investigate cancer patients' experiences of psychological distress after surgery and the factors that influence it, and to analyze the relationship between this and the nursing humanistic care demands.

METHODS

This study used a convenience sampling method to survey 432 cancer patients undergoing surgical treatment in the specialized cancer hospital in Beijing. The survey used socio-demographic information, the Distress Management Screening Measures, and the Nursing Humanistic Care Demands questionnaire. Questionnaire Star was used to collect data online. SPSS24.0 software was used to test the relationship between psychological distress and nursing humanistic care demands.

RESULTS

The mean scores for psychological distress and nursing humanistic care demands were 3.95 ± 2.71 and 147.02 ± 19.88, respectively, and showed a moderately positive correlation. The main issues that caused psychological distress in patients were: worry, financial problems, surroundings, nervousness, sleep, and pain. Regression analysis showed that gender, financial burden, personality trait, and need for humanistic care in nursing explained 24.5% of the total variance in the model and were independent predictors of psychological distress.

CONCLUSION

Cancer inpatients have significant psychological distress after surgery and exhibit high levels of nursing humanistic care demands. This study fills the research gap on humanistic care for psychological distress management, nursing humanistic care demands positively predicted psychological distress. Nursing staff should pay attention to the psychological suffering of patients and develop individualized care measures to alleviate their psychological suffering by accurately identifying their nursing humanistic care demands.