Psychosocial difficulties, deprivation and cancer: three questionnaire studies involving 609 cancer patients

Interventions with Social Integration Components Addressing Psychosocial Outcomes of Young- and Middle-Aged Adult Cancer Individuals: A Systematic Review

BACKGROUND

The majority of adult cancer patients/survivors encounter social challenges (e.g., obtaining social support, maintaining social relationships, feelings of social isolation). This systematic review summarizes intervention studies addressing social integration or social connectedness issues among young- and middle-aged cancer patients/survivors.

METHODS

We searched the PubMed, CINAHL, and Web of Science databases (January 2000-May 2021) to identify intervention studies that addressed social integration, social connectedness, social support, and social isolation for cancer patients/survivors in young- and middle-aged adulthood (18-64.9 years) through a randomized controlled trial (RCT). We categorized the interventions as technology-based, non-technology-based, and mixed-type (technology- and non-technology-based).

RESULTS

A total of 28 studies were identified. These interventions demonstrated improved social outcomes (e.g., increased social support, decreased loneliness), increased awareness of available cancer-related resources, and better patient-reported outcomes among patients/survivors versus controls. Specifically, the use of internet-based discussion sessions was associated with improved social cohesion and social support. Receiving social support from peers through networking sites was associated with improved physical activity. Additionally, implementing mixed-type interventions led to better social support from peer survivors, less fear of social interactions, and improved social connectedness.

CONCLUSIONS

Using existing technology- and/or non-technology-based platforms to facilitate social connectedness among cancer patients/survivors in young- or middle-aged adulthood can help them cope with stressful life circumstances and improve quality-of-life. Further interventions targeting social integration (e.g., social network interventions) are needed to improve the complex social integration challenges experienced by cancer patients and survivors.

The role of digital health in supporting cancer patients' mental health and psychological well-being for a better quality of life: A systematic literature review

BACKGROUND

This work aims to evaluate the role of digital health in supporting the mental and psychological well-being of patients with cancer and identify the associated challenges of use and implementation.

METHODS

Eligibility criteria: We included peer-reviewed studies (quantitative/qualitative) published between January 2011 and July 2022, that are written in English using technology to support cancer patients' mental health. We excluded opinion papers, editorials, and commentaries.

INFORMATION SOURCES

The systematic review was conducted across ProQuest CENTRAL, Scopus, PubMed, PsycInfo, Web Of Science, and IEEE Xplore. The study selection followed the Preferred Reporting Items for Systematic Reviews, meta-Analysis Reviews, and meta-Analysis guidelines (PRISMA). Risk of bias: All screening steps followed a consensus between the authors to minimize bias or discrepancy. Synthesis of the results: Data were extracted following the Six-factor Model of Psychological Well-being (SMPW). The technology challenges are summarized following the Systems Engineering Initiative for Patient Safety model (SEIPS), focusing on design, impact on processes, and outcomes.

RESULTS

We included 25 studies satisfying our inclusion criteria. The studies had little interest in minorities and sociodemographic factors' assessment within their results. The review showed that mental health and psychological well-being tools cover many applications. In addition to allowing personal growth, digital health can help cancer patients gain more autonomy and self-acceptance. Moreover, these health technologies can aid in mastering the environment, shaping social relationships, and pursuing life goals. Many challenges were identified related to the environment, organization, users, and tasks.

DISCUSSION

Digital health applications for cancer care cover a broad spectrum of mental health interventions. Challenges warrant analyzing the needs and usability. Lessons learned during COVID-19 may help refine technology interventions for mental health in cancer care. More interest in minorities is needed when designing technologies for patients to ensure more access to equitable care.

Measuring the Wellbeing of Cancer Patients with Generic and Disease-Specific Instruments

Different wellbeing measures have been used among cancer patients. This study aimed to first investigate the sensitivity of health state utility (HSU), capability, and subjective wellbeing (SWB) instruments in cancer. A cancer-specific instrument (QLQ-C30) was included and transferred onto the cancer-specific HSU scores. Furthermore, it examined the relative importance of key life domains explaining overall life satisfaction. Data were drawn from the Multi-instrument Comparison survey. Linear regression was used to explore the extent to which the QLQ-C30 sub-scales explain HSU and SWB. Kernel-based Regularized Least Squares (KRLS), a machine learning method, was used to explore the life domain importance of cancer patients. As expected, the QLQ-C30 sub-scales explained the vast majority of the variance in its derived cancer-specific HSU (R² = 0.96), followed by generic HSU instruments (R² of 0.65-0.73) and SWB and capability instruments (R² of 0.33-0.48). The cancer-specific measure was more closely correlated with generic HSU than SWB measures, owing to the construction of these instruments. In addition to health, life achievements, relationships, the standard of living, and future security all play an important role in explaining the overall life satisfaction of cancer patients.

Reliability, validity, and responsiveness of the Japanese version of the EORTC QLQ-ELD14 in evaluating the health-related quality of life of elderly patients with cancer

PURPOSE

This study evaluated the reliability, validity, and responsiveness of the Japanese version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-ELD14 and measured the health-related quality of life (HRQOL) of elderly Japanese patients with cancer aged ≥ 60 and ≥ 70 years.

METHODS

The study recruited elderly Japanese patients with cancer aged ≥ 60 (≥ 70) years (n = 1803 [n = 1236]). The EORTC QLQ-ELD14 was evaluated for reliability, validity, responsiveness, and correlations of changes in score between the EORTC QLQ-ELD14 and the EORTC QLQ-C30 before and after the commencement of the COVID-19 pandemic.

RESULTS

In both age groups, the proportion of missing items was low (< 3%). Cronbach's α was good at ≥ 0.70, except for two of the seven items. All the intraclass coefficient constants were good at ≥ 0.70. The concurrent validity was good but correlation with the EORTC QLQ-C30 was not strong, except for the hypothesis items. Regarding the assessment of responsiveness, only one item ("maintaining purpose") of the EORTC QLQ-ELD14 worsened (- 6.14 ± 29.20, standard response of mean > 0.2) after the commencement of the COVID-19 pandemic. The changes in score between the EORTC QLQ-ELD14 and the "global health status/QOL" and "summary score" of the EORTC QLQ-C30 had moderate-to-high negative correlations for all items, except two. Hypotheses to evaluate construct validity were accepted at 90%, while responsiveness was accepted at 80%.

CONCLUSION

The Japanese version of the EORTC QLQ-ELD14 questionnaire appears to have acceptable reliability, validity, and responsiveness to evaluate HRQOL in elderly Japanese people with cancer.

Factors associated with distress among female cancer survivors at the workplace: A cross-sectional study

OBJECTIVES

This study aimed to investigate the levels of fatigue, social support, spiritual well-being, and distress of female cancer survivors at the workplace, and identify factors associated with distress.

METHODS

One hundred and eighty-two working female cancer survivors participated from the outpatient ward in two medical institutions in South Korea and they completed questionnaires assessing their general characteristics, fatigue, social support (colleagues and superiors), and spiritual well-being distress (existential and religious well-being). The data were analyzed using descriptive statistics, T-test, one-way ANOVA, correlation, and multiple linear regression with SPSS /WIN18 version.

RESULTS

Most of the participants were breast and thyroid cancer (78.5%), married (46.2%), working periods below 10 years (62.7%) and the average age was 49.7 years. Distress positively correlated with fatigue and significant predictors of distress were "type of work" and "main source of household income" among general characteristics, fatigue, religious well-being, and existential well-being.

CONCLUSIONS

Our findings suggest that integrated program including educational and practical factors to reduce fatigue and increase spiritual well-being (i.e., peace, faith, meaning, et al.) can decrease distress. Whereas, the "ambivalence" of God accompanied by high religious well-being (i.e., punishment, abandon, blame, and so on) can rather increase distress. The development of an integrated management system of distress at work can be applied as a practical factor to improve job satisfaction, organizational performance, and quality of life.

The EORTC QLQ-ELD14 questionnaire for elderly cancer patients. Validation study for elderly Spanish breast cancer patients

BACKGROUND AND OBJECTIVES

Quality of life (QoL) is a key outcome for elderly cancer patients. The EORTC has developed QLQ-ELD14, a questionnaire that assesses important age-specific issues for older patients with cancer. This study aims to validate QLQ-ELD14 for use with elderly Spanish breast cancer patients.

MATERIALS AND METHODS

A consecutive sample of breast cancer patients with localized disease (age ≥65) who had received surgery ≥5 years earlier, were disease-free, and may have received adjuvant treatments was included. Patients completed the QLQ-ELD14, QLQ-C30 and QLQ-BR23 questionnaires. A subsample of patients completed QLQ-ELD14 six months later. Psychometric evaluation of the structure, reliability and validity of QLQ-ELD14 was conducted.

RESULTS

87 patients completed the first assessment and 30 the second. Multitrait scaling analysis showed that all items except two met the standards for convergent and divergent validity. Cronbach's coefficient met the 0.7 alpha criterion on all scales except worries about others. Areas of QLQ-ELD14 and QLQ-C30 whose contents are conceptually related correlated substantially (Spearman's Rho >0.40). Conversely, areas of QLQ-ELD14 that had less in common with those of QLQ-C30 and QLQ-BR23 had low correlations (Spearman's Rho <0.1). Differences in QLQ-ELD14 were found in groups based on age, disease duration, living arrangement, presence of limiting comorbidity, and level of performance status. Patients had a higher level of worries at the second assessment.

CONCLUSIONS

QLQ-ELD14 is a reliable and valid instrument when applied to a sample of Spanish patients. Our results are in line with those of other validation studies.

Social consequences of advanced cancer in patients and their informal caregivers: a qualitative study

PURPOSE

Cancer threatens the social well-being of patients and their informal caregivers. Social life is even more profoundly affected in advanced diseases, but research on social consequences of advanced cancer is scarce. This study aims to explore social consequences of advanced cancer as experienced by patients and their informal caregivers.

METHODS

Seven focus groups and seven in-depth semi-structured interviews with patients (n = 18) suffering from advanced cancer and their informal caregivers (n = 15) were conducted. Audiotapes were transcribed verbatim and open coded using a thematic analysis approach.

RESULTS

Social consequences were categorized in three themes: "social engagement," "social identity," and "social network." Regarding social engagement, patients and informal caregivers said that they strive for normality by continuing their life as prior to the diagnosis, but experienced barriers in doing so. Regarding social identity, patients and informal caregivers reported feelings of social isolation. The social network became more transparent, and the value of social relations had increased since the diagnosis. Many experienced positive and negative shifts in the quantity and quality of their social relations.

CONCLUSIONS

Social consequences of advanced cancer are substantial. There appears to be a great risk of social isolation in which responses from social relations play an important role. Empowering patients and informal caregivers to discuss their experienced social consequences is beneficial. Creating awareness among healthcare professionals is essential as they provide social support and anticipate on social problems. Finally, educating social relations regarding the impact of advanced cancer and effective support methods may empower social support systems and reduce feelings of isolation.

Patient-reported outcome measures of the impact of cancer on patients' everyday lives: a systematic review

Purpose

Patients with advanced disease are living longer and commonly used patient-reported outcome measures (PROMs) may miss relevant elements of the quality of extended survival. This systematic review examines the measures used to capture aspects of the quality of survival including impact on patients’ everyday lives such as finances, work and family roles.

Methods

Searches were conducted in MEDLINE, EMBASE, CINAHL and PsycINFO restricted to English language articles. Information on study characteristics, instruments and outcomes was systematically extracted and synthesised. A predefined set of criteria was used to rate the quality of studies.

Results

From 2761 potentially relevant articles, 22 met all inclusion criteria, including 10 concerning financial distress, 3 on roles and responsibilities and 9 on multiple aspects of social well-being. Generally, studies were not of high quality; many lacked bias free participant selection, had confounding factors and had not accounted for all participants. High levels of financial distress were reported and were associated with multiple demographic factors such as age and income. There were few reports concerned with impacts on patients’ roles/responsibilities in everyday life although practical and emotional struggles with parenting were identified. Social difficulties were common and associated with multiple factors including being a caregiver. Many studies were single time-point surveys and used non-validated measures. Exceptions were employment of the COST and Social Difficulties Inventory (SDI), validated measures of financial and social distress respectively.

Conclusions

Impact on some important parts of patients’ everyday lives is insufficiently and inconsistently captured. Further PROM development focussing on roles and responsibilities, including work and caring for dependents, is warranted.

Implications for Cancer Survivors

Factors such as finances, employment and responsibility for caring for dependants (e.g. children and elderly relatives) can affect the well-being of cancer survivors. There is a need to ensure that any instruments used to assess patients’ social well-being are broad enough to include these areas so that any difficulties arising can be better understood and appropriately supported.

Understanding the Attitudes of Patients with Cancer Toward Complementary and Alternative Therapies

BACKGROUND

The high prevalence of complementary and alternative medicine (CAM) use among patients with cancer can be explained by reasons such as growing scientific evidence and improved regulation. However, subjective considerations are also relevant for practicing CAM and perceiving its effectiveness. The current study aimed at qualitatively estimating patients' prior beliefs and expectations, as well as their level of satisfaction after the treatment.

PATIENTS AND METHODS

Patients with cancer who received six weekly sessions of CAM during their oncologic treatments participated in the study. They detailed their prior expectations and their level of posttreatment satisfaction. The open-ended answers were analyzed using interpretative phenomenological analysis. In addition, the contents before and after the intervention were compared.

RESULTS

Over a 2-year period, 163 patients entered the study, 135 of whom completed all six CAM sessions. The content analysis of the pretreatment expectations revealed four main categories: emotional, physical, external, and aspects related to the practice of CAM. After the intervention, patients referred to the therapeutic encounter as a significant aspect, in addition to the emotional and physical ones.

CONCLUSION

CAM sessions encouraged emotional and relational aspects in patients' perspectives, which may be highly relevant for their coping process. Encouraging personal motives may increase treatment efficacy and ensure optimal use of health care resources.

Identifying Social Distress: A Cross-Sectional Survey of Social Outcomes 12 to 36 Months After Colorectal Cancer Diagnosis

PURPOSE

To establish the prevalence and determinants of poor social outcomes after a diagnosis of colorectal cancer (CRC).

PATIENTS AND METHODS

All 12- to 36-month survivors of CRC (International Classification of Diseases [10th revision] codes C18 to C20) diagnosed in 2010 or 2011 and treated in the English National Health Service were identified and sent a questionnaire from their treating cancer hospital. This included the Social Difficulties Inventory, a 16-item scale of social distress (SD) comprising everyday living, money matters, and self and others subscales, plus five single items. Sociodemographic and clinical data were also collected. Analyses using descriptive statistics, χ(2) tests, and logistic regression models were conducted.

RESULTS

Response rate was 63.3% (21,802 of 34,467). Of the 21,802 participants, 17,830 (81.8%) completed all SD items; 2,688 (15.1%) of these 17,830 respondents were classified as experiencing SD (everyday living, 19.5%; money matters, 15.6%; self and others, 18.1%). Multivariable analysis demonstrated having ≥ three long-term conditions was the strongest predictor of SD (odds ratio [OR], 6.64; 95% CI, 5.67 to 7.77 compared with no long-term conditions), followed by unemployment (OR, 5.11; 95% CI, 4.21 to 6.20 compared with being employed), having recurrent or nontreatable disease (OR, 2.75; 95% CI, 2.49 to 3.04 compared with being in remission), and having a stoma (OR, 2.10; 95% CI, 1.86 to 2.36 compared with no stoma). Additional predictors of SD were young age (< 55 years), living in a more deprived area, nonwhite ethnicity, having advanced-stage disease, having undergone radiotherapy, and being a carer.

CONCLUSION

Although it is reassuring a majority do not experience social difficulties, a minority reported significant SD 12 to 36 months after diagnosis of CRC. The identified clinical and social risk factors are easy to establish and should be used to target support.

Impact of age-related socio-economic and clinical determinants of quality of life among long-term breast cancer survivors

OBJECTIVES

The main purpose of this study was to identify age-related socioeconomic and clinical determinants of quality of life among breast cancer survivors five years after the diagnosis. The secondary objective was to describe quality of life in the studied population according to age.

STUDY DESIGN

A cross-sectional survey in five-year breast cancer survivors was conducted in women diagnosed with breast cancer in 2007 and 2008 in Côte d'Or.

MAIN OUTCOME MEASURES

Quality of life was assessed with the SF-12, the EORTC-QLQ-C30 and the EORTC-QLQ-BR23 questionnaires. Socio-economic deprivation was assessed by the EPICES questionnaire. Social support was assessed by the Sarason questionnaire and clinical features were collected through the Côte d'Or breast cancer registry. Age-related determinants of quality of life were identified using multivariate mixed model analysis for each SF-12 dimension.

RESULTS

Overall 396 women completed the questionnaires. Women aged <65 years had a better quality of life and a greater availability of social support than did women aged ≥65 years. Body mass index, relapse and EPICES were found to be determinants of quality of life in younger women (p<0.006). For older women, comorbidities and EPICES deprivation scores were predictors of low quality of life scores (p<0.006).

CONCLUSIONS

Five years after breast cancer diagnosis, disease severity did not affect quality of life. The major determinants of quality of life in younger women were disease relapse and EPICES deprivation scores while those in older women were comorbidities and EPICES deprivation scores.

Evaluation of emotional distress in breast cancer patients

BACKGROUND

Cancer has been known as a class of dangerous diseases which cause tremendous physical and emotional problems to both patients and their families. In spite of medical advances, cancer is still considered to be equal with death and pain. This study aims to analyze the emotional distress and the causes in breast cancer patients.

METHODS

This study was a quantitative study which tries to analyze the emotional distress in 82 breast cancer patients referred to the Radiotherapy and Oncology Department of Razi Hospital in Rasht, northern Iran. In this study, the emotional distress is analyzed based on a standard questionnaire which contains demographic information, distress thermometer, and a section devoted to the probable causes.

RESULTS

Among the 82 patients that participated in this study, 32 patients (39%) suffered from severe emotional distress which had a statistically significant relationship (p<0.009) with the functional status of the patients. Taking care of children, fear, anxiety, difficulties of taking bath and wearing clothes, family problems, fever and nasal dryness are the most common issued related to emotional distress.

CONCLUSION

Emotional distress can affect the quality of life of breast cancer patients. Therefore, oncology specialists should utilize mental health services to improve their patients' mental health as well as to control the consequences of the disease.

Deaths and major biographical events: a study of all cancer deaths in Germany from 1995 to 2009

OBJECTIVE

To determine if people dying from cancer are able to prolong their own life in order to experience a certain biographical event, or whether the appearance of such an occasion leads to increased deaths before the event.

METHODS

We compared numbers of cancer deaths during a period of 1 week before and after biographically important occasions, which were birthday, Christmas and Easter. As a psychogenic postponement or hastening of death is most likely in chronic diseases (as opposed to accidents or cardiovascular events), we included cancer deaths only. We estimated relative risks (RRs) with their corresponding Bonferroni corrected CIs to assess effects of biographical events. All registered cancer deaths in Germany from 1995 to 2009 were included (3 257 520 individual deaths). Numbers of deaths were corrected for seasonality.

RESULTS

Considering all cases, there were noticeably more deaths than expected in the week preceding Christmas, leading to an RR of dying after the event of 0.987 (CI 0.978 to 0.997). Estimates indicating a hastening of death were consistent over several subgroups. Other occasions showed inconsistent results, especially there was no convincing postponement effect in our data.

CONCLUSIONS

While there is no evidence of different death numbers before and after Easter and birthdays, the appearance of Christmas seems to increase deaths.

Exploring the experience of psychological morbidity and service access in community dwelling stroke survivors: a follow-up study

PURPOSE

Post-stroke depression occurs in one-third of stroke survivors with a similar risk of development across short, intermediate and long-term recovery stages. Knowledge of factors influencing psychological morbidity beyond the first year post-stroke can inform long-term interventions and improve community service access for stroke survivors. This paper aimed to identify the physical and psycho-social functioning status of stroke survivors beyond 12 months post-stroke. Qualitative processes explored the longer term experiences of psychological morbidity and service access needs.

METHOD

A cross-sectional follow-up of participants from a prospective cohort study. In that study, patients and were followed for 12 months post-stroke. In this study, participants from that cohort study were interviewed up to five years post-stroke. Data generation and analysis were concurrent and were analysed thematically, employing a process of constant comparison.

RESULTS

Our sample included 14 participants, aged 58-89 years at an average of three years post-stroke (range 18 months to five years). Our qualitative key themes emerged as follows: physical impacts on post-stroke psychological morbidity, the experience of psychological distress, factors attenuating distress and service delivery implications.

CONCLUSIONS

The experience of psychological morbidity persists beyond 12 months post-stroke, having a profound impact on community access, and social participation. Clinical implications are a need for long-term psychological monitoring post-stroke and for ongoing rehabilitation that addresses disability, community participation and social support.

International validation of the EORTC QLQ-ELD14 questionnaire for assessment of health-related quality of life elderly patients with cancer

Background:

Older people represent the majority of cancer patients but their specific needs are often ignored in the development of health-related quality of life (HRQOL) instruments. The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-ELD15 was developed to supplement the EORTC's core questionnaire, the QLQ-C30, for measuring HRQOL in patients aged >70 years in oncology studies.

Methods:

Patients (n=518) from 10 countries completed the QLQ-C30, QLQ-ELD15 and a debriefing interview. Eighty two clinically stable patients repeated the questionnaires 1 week later (test–retest analysis) and 107 others, with an expected change in clinical status, repeated the questionnaires 3 months later (response to change analysis, RCA).

Results:

Information from the debriefing interview, factor analysis and item response theory analysis resulted in the removal of one item (QLQ-ELD15→QLQ-ELD14) and revision of the proposed scale structure to five scales (mobility, worries about others, future worries, maintaining purpose and illness burden) and two single items (joint stiffness and family support). Convergent validity was good. In known-group comparisons, the QLQ-ELD14 differentiated between patients with different disease stage, treatment intention, number of comorbidities, performance status and geriatric screening scores. Test–retest and RCA analyses were equivocal.

Conclusion:

The QLQ-ELD14 is a validated HRQOL questionnaire for cancer patients aged ⩾70 years. Changes in elderly patients' self-reported HRQOL may be related to both cancer evolution and non-clinical events.

Improvements in measuring the health-related quality of life of cancer patients

There have been considerable improvements in the collection of health-related quality of life (HRQOL) data in oncology over the past 20 years. The facility with which HRQOL information can now be collected from patients has also been associated with an improved understanding of the meaning of HRQOL and the association between HRQOL and patients' treatment and care plans. Therefore the role that HRQOL data can play in routine clinical practice is increasingly being recognized. The appearance of computer-adaptive tests will herald a new era in HRQOL where questionnaires will be individually tailored to each patient utilizing details unique to that person and linked to clinical management systems to allow a comprehensive assessment of HRQOL status.

Assessing the social impact of cancer: a review of available tools

OBJECTIVES

Taking care of oncological patients holistically--from a biological, social, and psychological point of view--also involves evaluating the social aspects of the disease. In the present study, we provide further insights on how investigations regarding the social impact of an oncological disease are conducted with specifically designed tools on patients who have personally been affected. The objective is then to understand how the social dimension is theorized and, therefore, which practical aspects of subjective experience are employed to assess the social impact.

METHOD

We performed a systematic review of the literature identified by MedLine and PsycINFO databases.

RESULTS

Of the 469 articles obtained from the search, 27 deal with 14 different measurement instruments of the social impact of the oncological experience. Of the identified tools, 71% were specifically designed for the oncological setting and were heterogeneous both in the investigated domains as well as social referrals; 64% of these had a multidimensional structure. Internal consistency was reported for all instruments, while temporal stability only for 36% of the tools. Construct validity and concurrent validity were reported for 79% of the instruments, criterion and predictive validity for one instrument only, external validity for 18% of the tools, and cross-cultural validity for one instrument only. The content was directly available for most instruments.

CONCLUSIONS

The great interest in this subject as borne out by the amount of studies published in international psycho-oncological literature confirms the importance of having a valid and reliable instrument specifically dedicated to measuring the social impact of the oncological experience. At the same time, further investigation is required to investigate the psychometric properties of the existing tools.

Home Care Clients in the Last Year of Life

Objectives: To compare demographic, social, medical, and health care characteristics of home care clients in the last year of life by quintile of deprivation and examine associations between material deprivation and service characteristics. Method: This retrospective study used administrative data for 700 clients who died while receiving home care services. Outcome measures were the receipt of supportive or palliative home care. Associations were assessed using multiple logistic regression. Result: Material deprivation was not associated with either the hours of home care received or the receipt of supportive home care services. Clients with dementia or stroke, those were older than 80 years and those who were single were less likely to receive palliative care services than other groups. Discussion: Inequalities in allocation of home care services based on age, diagnosis, and marital status, but not material deprivation, suggest the need to carefully match service with need at the end of life.

Routine assessment of social difficulties in cancer patients: are we opening Pandora's box?

GOALS OF WORK

Living with cancer impacts on the social aspects of the lives of the patient and their families, causing problems that can remain undetected. The Social Difficulties Inventory (SDI) has been shown as an effective screening tool, but concerns exist that detecting more problems may increase the workload for clinic staff and related services. The aim of this analysis is to assess the level of unmet need for social difficulties and to identify any potential increase in required interventions that may occur as a result of detailed assessment.

PATIENTS AND METHODS

A previous cross-sectional interview study was conducted to establish the clinical utility of the SDI. Adult patients were recruited from oncology, haematology and chest medicine clinics. They completed the SDI and a semi-structured interview by a social worker, who was blind to the SDI results. With participant agreement, interventions were made for the detected problems. This paper reports on a secondary descriptive analysis of intervention data, which was performed to examine the details of the interventions and referral patterns.

MAIN RESULTS

No intervention was necessary for 108 (59%) of patients, 42 (23%) received information, 33 (15%) were referred to another service and five (3%) received both information and a referral. Most information was provided about holiday insurance. The majority of referrals were made to Social Work (55% of all referrals) with the main reason being related to benefits or finances.

CONCLUSIONS

Increased referral rate was observed following a social work interview, when comparing with local audit data. However, the majority of needs could be met by increasing accessibility of information.

Benefits from membership in cancer patient associations: relations to gender and involvement

Cancer patient associations report a growing number of members and increasing possibilities to influence health care, but knowledge about the members' views on the benefit of involvement is scarce. We therefore investigated how members (n = 1742) of Swedish patient associations for breast cancer and prostate cancer rate the benefit of membership for their physical and psychological well-being and social adjustment to cancer. Using a scoring scale, 2/3 of the members reported that membership had benefit for psychological well-being, whereas half of the members reported benefit for physical well-being and social adjustment. Individuals who had been actively involved in board work and/or contact person activities within the associations reported significantly more benefit for all three parameters. Gender differences were observed with men, represented by individuals affected by prostate cancer, reporting greater benefit for all three parameters, although especially evident for psychological well-being. Individuals who obtained membership within two years of diagnosis reported greater benefit for psychological well-being and social adjustment compared to those who became members later. In conclusion, members in patient associations for cancer report benefit particularly for their psychological well-being and actively involved members and men affected by prostate cancer perceive the greatest benefit from membership.

Effects of individual housing on behavior and resistance to Ehrlich tumor growth in mice

This study analyzed in Balb/C mice the effects of individual housing on behavior, serum corticosterone and resistance to Ehrlich tumor growth. Mice (60 days old) were individually (IH) or grouped housed (G) (10-12 animals/cage) for 14-21 days. The 1st day of the housing condition was considered experimental day 1 (ED1). Results showed that on ED21, IH mice, when compared to G mice, presented no differences on corticosterone serum levels when kept undisturbed; however, an increased level of this hormone was observed in IH mice after an immobilization stress challenge. An increased time spent in the plus-maze closed arms and a decreased time in the open arms were also observed in IH mice. When compared to G animals, after inoculation with 10(5) Ehrlich tumor cells on ED1, IH mice presented an increase in volume of ascitic fluid and number of tumor cells. The survival time of IH mice was also shorter than that measured in G animals. Furthermore, IH mice injected with a different number of tumor cells on ED1 always presented increased Ehrlich tumor cells than G group. Interestingly, these effects were not observed when the tumor cells injection was done on ED4. These results suggest that individual-housing conditions induce an altered immune-endocrine response and, at the same time, decrease animals' resistance to Ehrlich tumor growth. It is proposed that the neural link between the behavioral and immunological changes observed after the stress of individual housing might involve the activation of the HPA axis.

Socioeconomic disparities in psychosocial wellbeing in cancer patients

This study tested the hypothesis that cancer patients from lower socioeconomic status (SES) backgrounds have poorer adjustment to cancer. In a longitudinal study of 352 patients with breast, prostate or colorectal cancer, SES was indexed as a composite of educational level, car and home ownership. Patients were classified as higher (3 markers: car, home and higher education) or lower (up to 2 markers) SES. Patients completed measures of depression, anxiety, quality-of-life, social difficulties and benefit-finding at 2 months (Time 1) and 10 months (Time 2) after diagnosis. Data on disease stage, treatment and co-morbid illness were also collected. At Time 1, lower SES patients were more anxious and depressed and had worse quality-of-life and more social difficulties. Psychological wellbeing improved on all measures by follow-up, and although not significant, the trend was towards diminishing, rather than increasing, differences in wellbeing between higher and lower SES groups. Acute psychosocial reactions to a cancer diagnosis appeared to be greater amongst patients with fewer educational and material resources, but longer-term adjustment did not appear to be any worse in lower SES patients.

Financial stress and strain associated with terminal cancer--a review of the evidence

Financial circumstances are a significant influence on the quality of life for older people and may be important to health and wellbeing at the end of life. The aim of this study is to review the evidence for the existence and consequences of financial stress and strain at the end of life for people dying with cancer. We conducted a systematic search of four electronic databases for studies, providing data on illness-related financial burden (stress), or perception of financial hardship (strain), from patients with terminal cancer or their caregivers. Twenty-four papers were identified from 21 studies published in English between 1980 and 2006, the majority (14) of cross-sectional design. Financial stress was reported in all 13 studies from the USA (median 33%, range 10-66%), but only four sought measures of financial strain. In the USA, specific social consequences, such as moving house or change in employment to cope with caregiving, were reported in four of these studies; one of these also noted changes in treatment choices and avoidance of care for other family members. In studies from outside the USA, there is a dearth of data on financial stresses and the consequences of this for the household, despite widespread reporting of financial strain. To fill a gap in our understanding and improve holistic palliative care, researchers need to ask the questions about the consequences of financial stresses and strain for the health and wellbeing of the household.

Measuring social difficulties in routine patient-centred assessment: a Rasch analysis of the social difficulties inventory

BACKGROUND

Social difficulties may add to the psychological burden experienced by cancer patients. Therefore identifying social difficulties in routine oncology practice may help prevent or alleviate distress. The Social Difficulties Inventory (SDI) is a short questionnaire developed for assessing social difficulties in cancer patients. Although well-validated, not enough is known about the clinical meaning and utility of the instrument or whether the items can be meaningfully summed to form a summary index of "Social Distress".

PURPOSE

To determine, using Rasch analysis, whether the SDI could be used as a summary index of social distress specifically examining three fundamental criteria: item fit, unidimensionality and item invariance.

METHODS

The Partial Credit Model was applied to a heterogeneous sample of cancer patients (n = 609) who had completed the SDI.

RESULTS

Five items were identified as misfitting (infit mean square > or = 1.3 and standardised t-statistic > or = 2) and excluded from the subsequent analysis. The remaining items formed a unidimensional interval scale with no additional factors identified in a principal components analysis of the residuals. No differential item functioning was observed for age, gender, diagnosis, extent of disease or social deprivation. The 16-item SDI can be summed to produce an overall index of social distress, facilitating routine identification of social difficulties. Subsequent work is needed to evaluate whether the instrument is able to identify patients with high levels of social distress requiring intervention.