How badly did it hit? Self-assessed emotional shock upon prostate cancer diagnosis and psychological well-being: a follow-up at 3, 12, and 24 months after surgery

Knowledge, attitude, and practice towards thyroid nodules and cancer among patients: a cross-sectional study

Aim

This study aimed to explore the knowledge, attitude, and practice (KAP) towards thyroid nodules (TN) and thyroid cancer (TC) among patients.

Subject and methods

This cross-sectional study enrolled patients with TN or TC at the Second Affiliated Hospital of the University of South China between September 2022 and February 2023. A self-administered questionnaire was developed to collect demographic information of the participants, and their knowledge, attitude and practice (KAP) towards TN and TC.

Results

A total of 510 valid questionnaires were collected. Among the participants, 102 (20.00%) were male, and 197 (38.63%) had the diagnosis of TC. The knowledge, attitude and practice scores were 5.76 ± 3.09 (possible range: 0-12), 31.07 ± 2.73 (possible range: 9-45), and 18.97 ± 2.92 (possible range: 5-25), respectively. Multivariate logistic regression showed that age of above 50 years old (OR = 0.27, 95%CI: 0.12-0.64, p = 0.003), junior college or bachelor's degree and above (OR = 4.97, 95%CI: 1.74-14.20, p = 0.003), monthly income of 5,000-10,000 CNY (OR = 2.02, 95%CI: 1.09-3.74, p = 0.025) and > 10,000 CNY (OR = 5.67, 95%CI: 2.49-12.94, p < 0.001) were independently associated with knowledge. The good knowledge (OR = 3.87, 95%CI: 1.89-7.95, p < 0.001), high school or technical secondary school (OR = 0.52, 95%CI: 0.30-0.88, p = 0.016), and monthly income of 5,000-10,000 CNY (OR = 2.02, 95%CI: 1.13-3.63, p = 0.018) were independently associated with practice.

Conclusion

Patients demonstrated poor knowledge, moderate attitude, and proactive practice towards TN and TC.

Determinants of poor quality of life in older patients with cancer: A longitudinal mixed methods study (PROGNOSIS-Q)

INTRODUCTION

Patient-reported outcomes are becoming more employed in oncologic research because many older patients with cancer prioritize preserved health-related quality of life (HRQoL) over prolonged survival. However, few studies have examined the determinants of poor HRQoL in older patients with cancer. This study aims to determine whether HRQoL findings are truly reflective of cancer disease and treatment, as opposed to external factors.

MATERIALS AND METHODS

This longitudinal, mixed-methods study included outpatients, age 70 years or more, with a solid cancer, who reported poor HRQoL (EORTC QLQ-C30 Global health status/QoL (GHS) score ≤ 33.3), at treatment initiation. A convergent design was employed, in which HRQoL survey data and telephone interview data was collected in parallel at baseline and three-months follow-up. Survey and interview data was analyzed separately and subsequently compared. Thematic analysis of interview data was conducted according to Braun & Clarke, and changes in patients GHS score were calculated using mixed model regression.

RESULTS

Twenty-one patients with a mean age of 74.7 years were included (12 men and 9 women) and data saturation was achieved at both time intervals. Baseline interviews (n = 21) showed that poor HRQoL at cancer treatment initiation was primarily reflective of participants' initial shock upon receiving their cancer diagnosis and their change in circumstance and sudden functional independence. At three months, three participants were lost to follow-up and two provided only partial data. Most participants experienced an increase in HRQoL, with 60% showing a clinically significant improvement in GHS scores. Interviews showed that this was due to lessening functional dependency and disease acceptance achieved by mental and physical adjustment. HRQoL measures were less reflective of cancer disease and treatment in older patients with preexisting highly disabling comorbidity.

DISCUSSION

This study showed good alignment between survey responses and in-depth interviews, demonstrating that both methodologies are highly relevant measures during oncologic treatment. However, for patients with severe comorbidity, HRQoL findings are often more reflective of the steady state of their disabling comorbidity. Response shift may play a part in how participants adjusted to their new circumstances. Promoting caregiver involvement from the time of diagnosis may increase patients´ coping strategies.

Patients' Reaction to Diagnosis with Thyroid Cancer or an Indeterminate Thyroid Nodule

Introduction: Little is known about the experiences and concerns of patients recently diagnosed with thyroid cancer or an indeterminate thyroid nodule. This study sought to explore patients' reactions to diagnosis with papillary thyroid cancer (PTC) or indeterminate cytology on fine needle aspiration. Methods: We conducted semistructured interviews with 85 patients with recently diagnosed PTC or an indeterminate thyroid nodule before undergoing thyroidectomy. We included adults with nodules ≥1 cm and Bethesda III, IV, V, and VI cytology. The analysis utilized grounded theory methodology to create a conceptual model of patient reactions. Results: After diagnosis, participants experienced shock, anxiety, fear, and a strong need to "get it out" because "it's cancer!" This response was frequently followed by a sense of urgency to "get it done," which made waiting for surgery difficult. These reactions occurred regardless of whether participants had confirmed PTC or indeterminate cytology. Participants described the wait between diagnosis and surgery as difficult, because the cancer or nodule was "still sitting there" and "could be spreading." Participants often viewed surgery and getting the cancer out as a "fix" that would resolve their fears and worries, returning them to normalcy. The need to "get it out" also led some participants to minimize the risk of complications or adverse outcomes. Education about the slow-growing nature of PTC reassured some, but not all patients. Conclusions: After diagnosis with PTC or an indeterminate thyroid nodule, many patients have strong emotional reactions and an impulse to "get it out" elicited by the word "cancer." This reaction can persist even after receiving education about the excellent prognosis. Understanding patients' response to diagnosis is critical, because their emotional reactions likely pose a barrier to implementing guidelines recommending less extensive management for PTC.

"I Will Not Be Defined by This. I'm Not Going to Live Like a Victim; It Is Not Going to Define My Life": Exploring Breast Cancer Survivors' Experiences and Sense of Self

A life-threatening disease such as breast cancer with its pervasive nature of uncertainty can lead to feelings of disempowerment. Nonetheless, survivors may reconstruct their identity within optimism and a celebration of a new self. In this qualitative constructionist study, we explored survivors' experiences, meaning-making, and identity transformation. Semi-structured interviews were undertaken with 11 women who identified as breast cancer survivors. Participants were aged 35 years old or above and were in post-diagnosis for at least 3 years. Interview data were collected and analyzed using thematic techniques. We identified three master themes: Diseased Self, focused on emotional distress and the presentation of a façade; Coping Self, explored resilience and post-traumatic growth; and Transformed Self, engaged in presentations of self-image, meaning-making, and psychological ownership addressing survivorship and empowerment. The findings may be used to inform guidelines and support for cancer survivors considering the impact of diagnosis, treatment, and post-treatment experiences on self-identity.

Mood outcomes of a behavioral treatment for urinary incontinence in prostate cancer survivors

PURPOSE

This study aimed to assess whether prostate cancer survivors who received a behavioral intervention to urinary incontinence had experienced a significant mood improvement.

METHODS

One hundred fifty-three prostate cancer survivors with persistent incontinence were included in this secondary data analysis. They were randomly assigned to usual care or interventions that provided pelvic floor muscle exercises and self-management skills. All subjects had measures of anxiety, depression, and anger at baseline, 3 months (post-intervention), and 6 months (follow-up). Negative binomial regression analysis was performed to examine the group status, daily leakage frequency at 3 months, and their interactions at 3 months as predictors for mood outcomes at 6 months, controlling for demographic and medical variables.

RESULTS

The main effect of daily leakage frequency at 3 months significantly predicted anxiety at 6 months (p < .01). The group main effect on any mood outcomes at 6 months was not statistically significant. The interaction between the group and 3-month leakage had a significant effect on anxiety; intervention subjects achieving a significant leakage reduction at 3 months exhibited significantly less anxiety at 6 months than other subjects (p = .04). Age, employment status, and receiving surgery at baseline were significantly associated with less anxiety, depression, and anger at 6 months.

CONCLUSIONS

Reduced urinary incontinence significantly predicted less anxiety, especially among the intervention subjects. The findings suggest a significant association between a behavioral therapy of urinary incontinence and anxiety reduction in prostate cancer survivors.

" The Worst Thing Was…": Prostate Cancer Patients' Evaluations of Their Diagnosis and Treatment Experiences

The objective of the current study was to identify the patient-perceived "worst aspects" of their diagnostic and treatment processes for prostate cancer (PCa) so as to inform targeted interventions aimed at reducing patient anxiety and depression. Two hundred and fifty-two patients who had received their diagnoses less than 8 years ago answered a postal survey about (a) background information, (b) their own descriptions of the worst aspects of their diagnosis and treatment, and (c) their ratings of 13 aspects of that process for (i) how these aspects made them feel stressed, anxious, and depressed and (ii) how they affected their relationships with significant others. They also answered standardized scales of anxiety and depression. The worst aspects reported by patients were receiving the initial diagnosis of PCa, plus the unknown outcome of that diagnosis, because of the possibility of death, loss of quality of life and/or partner, and the shock of the diagnosis. The most common coping strategy was to "just deal with it," but participants also thought that more information would help. Principal contributors to feeling stressed, anxious, and depressed were also the diagnosis itself, followed by surgery treatment effects. The aspects that most affected relationships were receiving the diagnosis and the side effects of hormone therapy. The identification of these specific worst aspects of the PCa experience provides a set of potential treatment and prevention "targets" for psychosocial care in PCa patients.