A distress thermometer with a cutoff score of ≥ 6 is the optimal point to identify highly distressed patients with advanced cancer stages in resource-limited countries without palliative care services

Characteristics and therapeutic profile of the patients with upper cervical spinal cord ependymoma from the medulla oblongata to C4: A cohort of 108 cases

BACKGROUND

Upper cervical spinal ependymomas (uCSE) is routinely identified as intramedullary ependymomas located from the oblongata medulla to C4 level. Our study aimed to report the outcomes and treatment profiles of uCSE from our cohort of uCSE patients.

METHODS

This retrospective observational study included 108 patients with upper cervical spinal ependymomas (uCSE) who underwent surgery at Huashan Hospital from 2008 to 2022. Demographic and clinical data were collected to identify risk factors may associated with post-operative spinal cord function, quality of life and respiratory function.

RESULTS

The mean age of included patients was 44.30 ± 12.71 years old. The most common uCSE was ependymoma (103 of 108, 95.37 %), followed by subependymoma (3 of 108, 2.78 %) and anaplastic Ependymoma (2 of 108, 1.85 %). Age (P = 0.003), sex (P = 0.004), duration of symptoms (P = 0.010), pre-operative bladder functions (P = 0.012), post-operative pneumonia (P = 0.013) and Carbon Dioxide Retention (CDR) (P = 0.004) could independently correlate with Iiving quality of uCSE patients. Post-operative spinal cord function was associated with pneumonia immediately after operation (P = 0.017). In addition, post-operative pneumonia correlated with tumor location (P = 0.048), pre-operative McCormick scores (P = 0.008)/ motor functions (P = 0.022)/ NRS scores (P = 0.020), and tracheotomy immediately after operation (P < 0.001). Tracheotomy immediately after operation was associated with tumor location (P = 0.023), unsteady walking (P = 0.033), pre-operative NRS scores (P = 0.029), post-operative pneumonia (P < 0.001) and CDR (P < 0.001).

CONCLUSION

Within uCSE patients, post-operative quality of life is associated with pre-operative spinal cord function and symptom duration, which emphasizing the importance of early intervention. Their post-operative respiratory dysfunctions also correlated with post-operative spinal cord function and quality of life.

The assessment of psychosocial distress in hospitalized cancer patients during radio-oncological treatment: a monocentric experience study

PURPOSE

This study investigated the prevalence and determinants of psychosocial distress among hospitalized patients undergoing radiotherapy to identify opportunities for interventions to enhance patient well-being.

METHODS

Between January 2021 and May 2023, 137 hospitalized patients received radiotherapy treatment at the Department of Radiation Oncology of the Fondazione A. Gemelli IRCCS were recruited. Participants completed a questionnaire comprising the Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS).

RESULTS

The study revealed a significant correlation among anxiety, depression, total HADS scores, and Distress Thermometer scores (p < 0.001). Female patients exhibited higher total HADS scores and anxiety levels compared to males (p < 0.004, p < 0.010, respectively). Sleep disturbances were associated with increased anxiety, depression, and overall distress (p < 0.05). Younger patients (< 65 years old) demonstrated elevated anxiety and depression levels, while no significant depressive tendency was observed among older participants (> 65 years old).

CONCLUSION

These findings underscore the intricate interplay between demographic variables, psychological distress, and treatment-related symptoms among patients during radiotherapy treatments. The study highlights the critical necessity of promptly identifying and addressing psychosocial distress in this population. It suggests that implementing a psychological therapeutic approach, particularly one focused on support, could effectively deter the onset of depression, especially among younger patients. Future research should focus on longitudinal studies to explore distress trajectories and interventions' effectiveness in mitigating distress, with collaborative efforts to translate research findings into evidence-based clinical practice for improved patient care.

Oncology nurses' lived experience of caring for patients with advanced cancer in healthcare systems without palliative care services

BACKGROUND

Caring for patients with advanced cancer is complex and challenging, requiring varied expertise, including symptom management, communication skills, care coordination and emotional resilience. Within existing literature, the lived experiences of oncology nurses are poorly articulated in countries with a lower income where formal palliative care (PC) is absent.

AIM

To explore the lived experiences of Gazan oncology nurses who provide care to patients with advanced cancer in healthcare systems, without formal palliative care infrastructure.

METHODS

A phenomenological approach was adopted. Semi-structured interviews were conducted between January and April 2022, in the Turkish Palestinian Friendship Hospital. Thematic analysis used the themes (corporeality, relationality, spatiality and temporality) to facilitate reflection on the meaning of participants' lived experiences.

RESULTS

Interviews were undertaken with 16 oncology nurses. The experience of the 'erosion of nurses' work when coping with anxious attachments to patients and families' was the overarching theme in nurses' views, characterised by five sub-themes: (1) inadequacy of PC training and resources, (2) serving humanity, (3) pride in their profession, (4) existential distress and the coping strategies used by nurses, and (5) reported stress and anxiety when caring for seriously ill patients and their families.

CONCLUSIONS

The study sheds light on the challenges and powerful emotions experienced by oncology nurses who care for patients with advanced cancer, yet lack the necessary PC training and institutional resources. The findings indicate an urgent need for PC training for nurses within the Gazan healthcare system and other lower-income settings. Assessing nurses' emotions and relationships with patients and family caregivers is imperative to enable optimum care for patients with cancer and to foster resilience among their nurses.

Distress Scores in Elderly Cancer Patients During Radiotherapy

BACKGROUND/AIM

When assigned to radiotherapy (RT), elderly patients may experience distress. We investigated distress during RT and potential risk factors in these patients.

PATIENTS AND METHODS

Six-hundred-and-nineteen patients completed pre-RT and post-RT distress thermometers. Seven characteristics were investigated including age, sex, Karnofsky performance score (KPS), grouped KPS, tumor type, intent of RT, and previous RT. Additional analyses were performed in 358 patients with pre-RT scores ≤5.

RESULTS

Mean change of distress was -0.5 (±2.7) points and associated with KPS (p=0.005) and grouped KPS (p<0.001). Male sex (p=0.035), KPS 90-100 (p=0.001), and curative intent (p=0.037) were associated with increased distress on univariable analyses, and KPS 90-100 (odds ratio=1.92, p=0.004) on multivariable analysis. In patients with baseline scores ≤5, mean change was +0.5 (±2.5) points and associated with KPS (p=0.040) and grouped KPS (p=0.025).

CONCLUSION

Psychological assistance should be considered for all patients including those with baseline scores ≤5 and KPS 90-100. Patients with risk factors for increased distress would especially benefit.