Supportive Care Needs and the Impact of Loss of Functioning and Symptom Burden on the Quality of Life in Patients with Advanced Colorectal Cancer

A Mediating Effect of Psychological Distress in the Relationship Between Performance Status and Health-Related Quality of Life of Patients with Female Cancer

Objective: This study aimed to examine whether anxiety and depressive symptoms mediate the relationship between performance status and health-related quality of life (HRQL) in patients with female cancer. A poor performance status is known to adversely affect HRQL and psychological distress-particularly anxiety and depressive symptoms-which may play a key role in this relationship. Identifying the mediating role of these symptoms may offer valuable insights into the mechanisms linking the performance status and HRQL. Methods: In a cross-sectional, correlational study, data on the HRQL (EORTC QLQ Version 3), performance status (Eastern Cooperative Oncology Group), and anxiety and depressive symptoms (Hospital Anxiety Depression Scale) were collected between February 2019 and June 2021. Process v4.1 for SPSS was used to analyze the data. Results: Sixty-five patients with female cancer participated (breast cancer = 44; gynecologic cancer = 21; mean age = 55.03 ± 8.65 years). Anxiety (p = 0.002), but not depressive symptoms (p = 0.525), mediated the relationship between the performance status and HRQL, explaining 41% of the variance in the HRQL (R2 = 0.41, F = 14.06, p < 0.001). A better performance status was only indirectly associated with a better HROL through the effect on anxiety. The total effect of the performance status on the HRQL was 15.972 (confidence interval [CI] = 6.095, 25.849): direct effect = 7.226 (CI = -1.936, 16.389) and indirect effect = 6.878 (standardized indirect effect = 0.374) (CI = 1.195, 15.395). Conclusions: The findings of this study only supported the mediating role of anxiety in the relationship between the performance status and HRQL in patients with female cancer. To improve the HRQL in patients with female cancer, improvements in the performance status and reductions in anxiety are critical.

The mediating role of loneliness between psychological resilience and health-related quality of life among patients with nasopharyngeal carcinoma: a cross-sectional study using structural equation modeling

BACKGROUND

Cancer patients' health-related quality of life (HRQoL) has always been a hot discussion spot. Loneliness and psychological resilience are considered to be significant psychosocial factors impacting the HRQoL of the cancer population. However, there is a lack of studies on the interrelationship among loneliness, resilience, and HRQoL in patients with nasopharyngeal carcinoma (NPC). This study aims to explore the relationship between resilience and HRQoL among NPC patients and to recognize the potential mediating role of loneliness in this relationship.

METHODS

A cross-sectional study was performed in this study. A convenience sampling method was conducted to recruit participants. A total of 155 patients with nasopharyngeal carcinoma were required to complete the socio-demographic questionnaire, the Cancer Loneliness Scale (CLS), the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and the European Organization for Research and Treatment of Quality of Life Questionnaire C-30 (EORTC QLQ-C30) from April 2022 to August 2022 in a tertiary grade A hospital in Guangzhou, China. The multiple linear regression analysis was used to identify influencing factors, and structural equation modeling with the bootstrap method was performed to test the mediating role of loneliness. This study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

RESULTS

HRQoL was at a median level among NPC patients, with a mean score of 64.19 (24.38) on the Global health status/quality of life (GHS/QoL) scale. Monthly household income (B = 4.973, P < 0.001), cancer stage (B=-4.342, P = 0.004), psychological resilience (B = 0.914, P < 0.001), and loneliness (B =-1.083, P < 0.001) were independent factors related to HRQoL, explaining 36.7% of the variance of HRQoL. Psychological resilience exerted its direct negative impact on loneliness (β = -0.199, BC95%CI = -0.318/-0.089), and it also had a both direct and indirect positive impact on HRQoL (β = 0.653, BC95%CI = 0.423/0.912; β = 0.142, BC95%CI = 0.046/0.296). Loneliness exerted a partially mediating impact on the relationship between psychological resilience and HRQoL.

CONCLUSIONS

NPC patients with higher monthly household, early stages of cancer, higher resilience, and lower loneliness show a better HRQoL. Resilience has an indirect positive impact on HRQoL by influencing loneliness in NPC patients. It is suggested that healthcare staff should strive to enhancing resilience and reducing loneliness as new strategies to promote NPC patients' HRQoL further.

Supportive care needs, quality of life and social support among elderly colorectal cancer patients undergoing chemotherapy: a longitudinal study

Objective

The purpose of this study is to examine the changes in supportive care needs, quality of life and social support during different chemotherapy cycles among elderly colorectal cancer patients.

Methods

This prospective longitudinal study recruited 160 elderly colorectal cancer patients using convenience sampling at a hospital in Guangxi between August 2023 and April 2024. To assess supportive care needs, quality of life, and social support, we used a short form of the Supportive Care Needs Survey (SCNS-SF34), a Functional Assessment of Cancer Therapy-colorectal (FACT-C), and a perceived social support scale (PSSS) prior to chemotherapy, as well as after the first, third, and sixth cycles. Repeated measures analysis of variance was used to validate the changes over time in supportive care needs, quality of life, and social support.

Results

155 participants completed all questionnaire sessions across the six cycles. From pre-chemotherapy until after the sixth cycle of chemotherapy, the extent of physical and daily living requirements among all respondents fluctuated between 47.23% and 88.26%, psychological needs ranged from 60.84% to 97.67%, patient care and support needs ranged from 83.75% to 99.35%, healthcare system and information needs varied from 85.98% to 99.00%, while the level of sexual needs decreased from 1.51% to 0.65%. The mean SCNS-SF34 scores for these participants ranged between 103.81 ± 2.28 and 144.10 ± 1.08. Significant increases over time were seen for all domains of SCNS-SF34 (F=126.99, 347.41, 65.00, 72.34, 160.15, p<0.001), keeping a clear upward trend, except for sexual needs(F=0.712, p=0.546). The mean FACT-T scores dropped from 68.80 ± 1.00 to 51.24 ± 1.40, while the mean PSSS scores dropped from 55.77 ± 0.83 to 43.28 ± 1.05. The scores of FACT-T and PSSS showed statistically significant differences (F=231.21, 112.28, p<0.001), maintaining clear downward trends.

Conclusion

During chemotherapy, elderly colorectal cancer patients continue to require high levels of supportive care, while their quality of life and social support gradually decline. This study offers healthcare practitioners a foundational understanding to identify and address the supportive care needs of elderly colorectal cancer patients across various chemotherapy phases, which facilitates the development of tailored strategies aimed at enhancing patients' quality of life.

A Critical Overview of the Construct of Supportive Care Need in the Cancer Literature: Definitions, Measures, Interventions and Future Directions for Research

The growing amount of evidence about the role of supportive care in enhancing cancer patients' outcomes has made healthcare providers more sensitive to the need for support that they experience during cancer's trajectory. However, the lack of a consensus in the definition of supportive care and lack of uniformity in the theoretical paradigm and measurement tools for unmet needs does not allow for defined guidelines for evidence-based best practices that are universally accepted. Contemporary cancer literature confirms that patients continue to report high levels of unmet supportive care needs and documents the low effectiveness of most of the interventions proposed to date. The aim of this critical review is to consolidate the conceptual understanding of the need for supportive care, providing definitions, areas of expertise and a careful overview of the measurement tools and intervention proposals developed to date. The possible reasons why the currently developed interventions do not seem to be able to meet the needs, and the issues for future research were discussed.

Supportive care needs and related factors among colorectal cancer patients with stoma in the postoperative rehabilitation period from a bio-psycho-social perspective: a cross-sectional study

OBJECTIVE

This study investigated the biomedical, psychological, and social behavior factors for supportive care needs in colorectal cancer patients with a stoma, aiming to provide a theoretical basis for the development of targeted interventions.

METHODS

This cross-sectional study included 175 colorectal cancer patients with a stoma. A questionnaire was used to collect demographic and disease-related data on patients. The M.D. Anderson Symptom Inventory-Gastrointestinal Cancer (MDASI-GI), Hospital Anxiety and Depression Scale (HADS), and Perceived Social Support Scale (PSSS) were used to assess patients' symptom distress, anxiety and depression status, and social support, respectively. The Supportive Care Need Survey Short Form (SCNS-SF34) was used to evaluate supportive care needs.

RESULTS

The total score of supportive care needs of patients with colorectal cancer stoma was 87.75±17.34 points. The multivariate linear regression analysis results showed that younger age and a higher total score on symptom distress, depression, and anxiety were independent risk factors for supportive care needs.

CONCLUSIONS

Patients with colorectal cancer stoma with higher supportive care needs can be identified early from the bio-psycho-social perspective. Younger patients have more symptom distress, are depressed and anxious, have lower social support, and have higher supportive care needs. Closer monitoring of patients with symptom distress, early detection of depression and anxiety, and improving patients' social support can meet supportive care needs and improve patients' quality of life.

The supportive care needs and its influencing factors among thyroid cancer patients after surgery: A cross-sectional study

Objective

To study the supportive care needs (SCNS) of thyroid cancer (TC) patients after surgery, and to identity its influencing factors.

Methods

By convenience sampling method, total of 115 patients undergoing thyroid surgery who met the inclusion criteria from May 2021 to July 2021 were selected as the research objects. The general information questionnaire, Supportive Care Need Survey Short-Form (SCNS-SF34), functional subscale of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) were used to investigate these patients.

Results

The average score for the items of SCNS-SF34 in 102 TC patients was 2.15 ± 0.71. The domain with the highest item average score was "health system information needs" (2.48 ± 1.17). The domain with the highest unsatisfied rate was "psychological needs" (69.6%). The item with the highest average score was "fear of cancer spreading" in the psychological needs domain (2.80 ± 1.48). The scores of physical function (r = -0.431, P < 0.001), role function (r = -0.428, P < 0.001), cognitive function (r = -0.531, P < 0.001), emotional function (r = -0.388, P < 0.001), social function (r = -0.464, P < 0.001) were correlated with the total score of SCNS-SF34. The univariate analysis of SCNS-SF34 scores showed that TC patients who were women (t = 2.013, P = 0.047), older (F = 1.353, P = 0.013), and with longer hospital stays (F = 3.705, P = 0.028) had higher demand of SCNS. The results of multiple linear regression analysis showed that the significant variables that entered the regression equation were gender, age, length of stay in hospital, cognitive function and social function (P < 0.05).

Conclusion

TC patients after surgery have many SCNS in different domains. It is necessary to focus on women, older patients, patients with long hospital stays and poor functioning. The implementation of a supportive care screening tool is recommended and the individualized interventions need to be developed to provide targeted support and care.