Un-met supportive care needs of Iranian breast cancer patients

Sociodemographic and clinical factors related to high rates of unmet supportive care needs among Polish cancer patients

Introduction

Cancer patients experience a wide range of unmet supportive care needs, which may lead to dissatisfaction with the health care system and poor quality of life. The aims of this study were to assess unmet supportive care needs in five areas: informative needs, psycho-emotional needs, relational needs, material needs and needs related to assistance/care, and to identify groups of cancer patients expressing high rates of unmet needs.

Materials and methods

The multicenter study was carried out among 1,062 cancer patients between June 2022 and May 2023. The study was performed using the validated Polish version of Needs Evaluation Questionnaire (NEQ). The total and subtotal NEQ scores were calculated.

Results

The mean total NEQ score was 0.44 ± 0.27. The highest subtotal NEQ scores were noted in the cases of informative needs and material needs. Predictive factors for a higher total NEQ score were younger age, living with a partner and a diagnosis of digestive system cancers or lung cancer.

Conclusion

Cancer patients expressed some unmet supportive care needs, especially informative needs. Identification of the groups of patients with high rates of unmet supportive care needs will be useful in clinical practice. Younger patients, living with a partner and those suffering from digestive system or lung cancer seem to require special attention.

Factors Associated with Supportive Care Needs Among Palestinian Women with Breast Cancer in the West Bank: A Cross-Sectional Study

Background: Breast cancer (BC) is the most common cancer among women in Palestine, where the need for supportive care frequently goes unmet. Therefore, this study aims to assess the supportive care services provided at the governmental hospitals in the southern area of the West Bank and to determine the factors associated with the unmet needs of these services. Methods: A cross-sectional study was conducted on 362 women with BC. Data were collected using a face-to-face questionnaire that included the Supportive Care Needs Survey (SCNS-SF34), patients' sociodemographic, economic, and clinical characteristics, as well as familial history of cancer and social support. Results: The study revealed that 61% of participants had unmet supportive care needs, with health system information, physical support, and psychological support being the most unmet needs. Factors contributing to unmet needs included age, marital status, familial support, and a family history of cancer. Chemotherapy and surgery increased the probability of physical care needs by fivefold, while hormone therapy reduced the probability of psychological needs (AOR = 0.36, p < 0.001) and patient care and support needs (AOR = 0.49, p = 0.01). Additionally, radiotherapy reduced sexual care needs by 58% and biological therapy by 60%. Conclusions: There is an urgent need for enhanced supportive care services for BC patients in the West Bank, especially regarding health system information, physical care, and psychological support. Addressing these needs through targeted interventions could significantly improve patients' quality of life.

Needs of breast cancer survivors: a systematic review of quantitative data

This systematic review aimed to update the perceived needs of individuals with breast cancer (BC). Databases were searched for studies reporting quantitative data collected through validated assessment tools. Needs of adults with BC were reported by survivorship phase. The post-diagnosis and the post-surgery phases revealed the most needs; health system and information needs represented the greatest concern, with average Supportive Care Needs Survey-Short Form (SCNS-SF34) scores ranging from 62.0 to 75.8 post-diagnosis and from 45.0 to 67.8 post-surgery. Needs then seemed to decrease or remain stable up to within one year from diagnosis, when needs in all domains increased again; health system and information needs remained a priority. Younger age, side effects, type of treatment, and advanced stage were associated with the occurrence of unmet needs. The needs of BC survivors vary over the course of their cancer experience. This knowledge can assist the planning of appropriate assessments.

Effect of WhatsApp-based BETTER model sexual counselling on sexual function and sexual quality of life in breast cancer survivors: a randomized control trial

OBJECTIVE

The aim of the study was to determine the effect of WhatsApp-based BETTER sex counselling on sexual function and sexual quality of life in breast cancer survivors in a randomized control trial.

METHODS

This is a randomized controlled trial in which a total of 90 breast cancer survivors were recruited using convenience sampling and then randomly assigned to two groups of WhatsApp-based BETTER model counselling and routine care. Data collection tools consisted of a demographic questionnaire, the Sexual Quality of Life-Female (SQOL-F) and the Sexual Function Index (FSFI-BC). Participants in the intervention group were given access to the 6-week program. The program consisted of six consultation and assignment packages covering all six steps of the BETTER model. Data were analyzed using SPSS software version 20. Chi-square test, independent samples t-test and repeated measures analysis of variance were used. The significance level (p-value) was considered to be less than 0.05.

RESULTS

In the control group, the mean score of SQL scale changed from 35.16 ± 10.71 to 35.16 ± 12.97 (P > 0.05) and in the intervention group, it significantly increased from 34.76 ± 10.13 to 68.20 ± 20.48 (P < 0.001). Similarly, the comparison of mean of FSF in the control group showed a none-significant change from 58.13 ± 7.11 to 58.35 ± 6.11 (P > 0.05), and in the intervention group, it significantly improved from 59.49 ± 6.10 to 120.73 ± 25.54 (P < 0.001). The results of rANOVA indicated that there was a significant difference in the mean scores of the SQL and SFS between the two groups from pre- to post-intervention, and then over the 1-month follow-up period in the intervention group (p < 0.001). Considering partial eta squared, the effect of the intervention had the highest interaction effect on both variables of the sexual function index (η2 = 0.73) and sexual quality of life (η2 = 0.41).

CONCLUSIONS

The intervention program was a successful model for improving female sexual quality of life and female sexual function in breast cancer survivors.

TRIAL REGISTRATION

IRCT20210926052601N1, 7-11-2021.

Supportive care needs after surgery in patients with breast cancer

PURPOSE

This study aimed to determine supportive care needs and related factors after surgery in patients with breast cancer.

METHODS

This cross-sectional study was conducted with 98 breast cancer patients in a Training and Research Hospital in Istanbul between September 2022 and November 2023. The Personal Information Form and the Supportive Care Needs Survey Short Form Turkish version were used to collect data. One-way variance analysis, post hoc (Tukey, LSD), and t-test were used to analyze the data.

RESULTS

The total scale mean score for women who underwent surgery for breast cancer in the study was 83.95 22.97. Statistically significantly higher total scale scores were observed in younger women and those who received chemotherapy and radiotherapy than in others. The mean physical and daily living subscale scores of those who received chemotherapy and radiotherapy were higher than those who did not (p < .05). The psychology subscale mean scores of those who were young and unemployed were higher than the others (p < .05). The mean sexuality scores of those who were young, those with high education levels, and those who received chemotherapy were higher than the other groups (p < .05). Age factor affects SCN scores in women with breast cancer.

CONCLUSION

Supportive care needs are higher among women with breast cancer who are younger and receive chemotherapy and radiotherapy. The physical needs of those who receive chemotherapy and radiotherapy, the psychological needs of those who are younger and unemployed, and the need for support regarding sexuality were greater among those who are younger and with higher education. Nurses should be aware of the specific needs of these disadvantaged groups and provide individualized holistic care.

Unmet Supportive Care Needs Among Cancer Patients in Sub-Saharan African Countries: A Mixed Method Systematic Review and Meta-Analysis

INTRODUCTION

Supportive cancer care is vital to reducing the current disparities in cancer outcomes in Sub-Saharan Africa (SSA), including poor survival and low quality of life, and ultimately achieving equity in cancer care. This is the first review aimed to evaluate the extent of unmet supportive care needs and identify their contributing factors among patients with cancer in SSA.

METHODS

Six electronic databases (CINAHL, Embase, Medline [Ovid], PsycINFO, PubMed, and Cochrane Library of Databases] were systematically searched. Studies that addressed one or more domains of unmet supportive cancer care needs were included. Findings were analyzed using narrative analysis and meta-analysis, as appropriate.

RESULT

Eleven articles out of 2732 were retained in the review. The pooled prevalence of perceived unmet need for cancer care in SSA was 63% (95% CI: 45, 81) for physical, 59% (95% CI: 45, 72) for health information and system, 58% (95% CI: 42, 74) for psychological, 44% (95% CI: 29, 59) for patient care and support, and 43% (95% CI: 23, 63) for sexual. Older age, female sex, rural residence, advanced cancer stage, and low access to health information were related to high rates of multiple unmet needs within supportive care domains.

CONCLUSION

In SSA, optimal cancer care provision was low, up to two-thirds of patients reported unmet needs for one or more domains. Strengthening efforts to develop comprehensive and integrated systems for supportive care services are keys to improving the clinical outcome, survival, and quality of life of cancer patients in SSA.

Sexual function index adaptation for breast cancer patients (FSFI-BC)- translation and psychometric properties of Persian version

BACKGROUND

Effective interventions to improve sexual dysfunction in breast cancer survivors need screening of these dysfunctions with a suitable instrument. The aim of present study was translation and identifying psychometric properties of Female Sexual Function Index - Adapted for Breast Cancer (FSFI-BC) which has been specifically developed for breast cancer survivors.

METHOD

This methodological study was performed between February 2017 and October 2018. 200 breast cancer survivors in stage 1 or 2 who were selected through convenience sampling method, completed the questionnaire. Reliability was assessed by Cronbach's alfa and test re-test analysis and construct validity was performed through confirmatory (CFA) and exploratory factor analysis( EFA).

RESULTS

Six factors were extracted in exploratory factor analysis (EFA). These factors explained 74.6% of the total variance in in NSA group and 0.821 in SA group. Reliability evaluation indicated high internal consistency and good test re-test reliability. Cronbach's alpha coefficient in all areas of the tool was above 0.7 (the lowest and the highest measures were 0.885 and 0.945, respectively), which is a good indicator for reliability of an instrument. Confirmatory factor analysis showed an acceptable fitness for seven factors of FSFI-BC questionnaire (Normed Fit Index or NFI = 0.9 for both groups, Comparative of Fit Index or CFI = 0.93 and 0.92, χ 2/df = 1.68 and 1.71 for SA(Sexually Active) and NSA(No Sexually Active) individuals, respectively) .

CONCLUSION

Study findings suggest that Persian version of FSFI-BC is a suitable instrument for sexual dysfunction screening in breast cancer survivors.

Validation of the Portuguese version of the supportive care needs survey short-form questionnaire (SCNS-SF34-Pt) and the breast cancer supplementary module (SCNS-BR8-Pt)

OBJECTIVE

This study aimed to test the psychometric properties of the Portuguese Supportive Care Needs Survey-Short Form-34 (SCNS-SF34-Pt) and its breast cancer-specific complementary module (SCNS-BR8-Pt). A further aim was to characterize Portuguese Breast Cancer Survivors' (BCS) unmet supportive care needs, using these measures.

METHODS

A convenient sample of BCS was recruited from five hospitals in Portugal and invited to complete SCNS-SF34-Pt and SCNS-BR8-Pt, EORTCQLQC30 and QLQBR23, the Generalized Anxiety Disorder, and the Patient Health-Questionnaire. The validity (i.e. convergent, discriminant and convergent validity) and reliability of SCNS-SF34-Pt and SCNS-BR8-Pt were statistically evaluated. BCS' unmet supportive care needs were descriptively assessed.

FINDINGS

336 BCS participated in the study. A four-factor solution was produced for SCNS-SF34-Pt. This solution included the Physical and daily living needs, Psychological needs, Sexuality needs, and Health system, information, and patient support needs dimensions (73% of the total variance; Cronbach's alpha=.82 to .97). SCNS-SF34-Pt demonstrated good convergent validity. It could also discriminate between known-groups regarding age, disease staging, treatment performed, and ECOG performance status. SCNS-BR8-Pt revealed a single-factor structure (62% of the total variance; Cronbach's alpha=.91).Portuguese BCS' most prevalent unmet supportive care needs were associated with the Psychological, and Physical and daily living domains. Fear of cancer spreading, the inability to do things as usual, and lack of energy/tiredness were perceived as issues requiring further supportive care.

CONCLUSIONS

SCNS-SF34-Pt and the SCNS-BR8-Pt are valid and reliable tools to assess Portuguese BCS' unmet supportive care needs. Fear of cancer spreading and lack of energy/tiredness concerns should be a target of supportive care services.

Unmet supportive care needs of breast cancer survivors: a systematic scoping review

BACKGROUND

Breast cancer is the most common type of cancer in women worldwide. Though improved treatments and prolonged overall survival, breast cancer survivors (BCSs) persistently suffer from various unmet supportive care needs (USCNs) throughout the disease. This scoping review aims to synthesize current literature regarding USCNs among BCSs.

METHODS

This study followed a scoping review framework. Articles were retrieved from Cochrane Library, PubMed, Embase, Web of Science, and Medline from inception through June 2023, as well as reference lists of relevant literature. Peer-reviewed journal articles were included if USCNs among BCSs were reported. Inclusion/exclusion criteria were adopted to screen articles' titles and abstracts as well as to entirely assess any potentially pertinent records by two independent researchers. Methodological quality was independently appraised following Joanna Briggs Institute (JBI) critical appraisal tools. Content analytic approach and meta-analysis were performed for qualitative and quantitative studies respectively. Results were reported according to the PRISMA extension for scoping reviews.

RESULTS

A total of 10,574 records were retrieved and 77 studies were included finally. The overall risk of bias was low to moderate. The self-made questionnaire was the most used instrument, followed by The Short-form Supportive Care Needs Survey questionnaire (SCNS-SF34). A total of 16 domains of USCNs were finally identified. Social support (74%), daily activity (54%), sexual/intimacy (52%), fear of cancer recurrence/ spreading (50%), and information support (45%) were the top unmet supportive care needs. Information needs and psychological/emotional needs appeared most frequently. The USCNs was found to be significantly associated with demographic factors, disease factors, and psychological factors.

CONCLUSION

BCSs are experiencing a large number of USCNs in fearing of cancer recurrence, daily activity, sexual/intimacy, psychology and information, with proportions ranging from 45% to 74%. Substantial heterogeneity in study populations and assessment tools was observed. There is a need for further research to identify a standard evaluation tool targeted to USCNs on BCSs. Effective interventions based on guidelines should be formulated and conducted to decrease USCNs among BCSs in the future.

Effect of traditional Chinese medicine on postoperative depression of breast cancer: a systematic review and meta-analysis

Background: Depression is one of the common complications in patients with postoperative breast cancer (BC). Conventional therapies for postoperative depression of BC always have modest treatment outcomes and undesirable side effects. Clinical practice and many studies have shown that traditional Chinese medicine (TCM) has a good effect on postoperative depression of BC. This meta-analysis aimed to assess the clinical effect of TCM as an add-on treatment for postoperative depression of BC. Methods: A systematic and thorough search was conducted on eight online electronic databases up to 20 July 2022. The control group received conventional therapies, and intervention groups received what control groups received plus TCM treatment. Review Manager 5.4.1 was used for statistical analysis. Results: Nine RCTs involved 789 participants who met the inclusion standards. The results showed the intervention group was better at decreasing the score of the Hamilton rating scale for depression (HAMD) (mean difference, MD = -4.21, 95% CI -5.54 to -2.88) and the self-rating depression scale (SDS) (MD = -12.03, 95% CI -15.94 to -8.13), improving clinical efficacy (RR = 1.25, 95% CI 1.14-1.37), increasing the levels of 5-hydroxytryptamine (5-HT) (MD = 0.27, 95% CI 0.20-0.34), dopamine (DA) (MD = 26.28, 95% CI 24.18-28.77), and norepinephrine (NE) (MD = 11.05, 95% CI 8.07-14.04), and influencing the immune index, including the levels of CD3⁺ (MD = 15.18, 95% CI 13.61-16.75), CD4⁺ (MD = 8.37, 95% CI 6.00-10.74), and CD4⁺/CD8⁺ (MD = 0.33, 95% CI 0.27-0.39). The level of CD8⁺ (MD = -4.04, 95% CI -11.98 to 3.99) had no obvious difference between the two groups. Conclusion: The meta-analysis stated that a therapeutic regimen involving TCM could better improve the depression status in postoperative BC.

Healthcare professionals' perspectives on the unmet needs of cancer patients and family caregivers: global psycho-oncology investigation

PURPOSE

This international study aimed to compare healthcare professionals' perspectives on the unmet needs of their cancer patients with those of family caregivers and to investigate the degree to which patients' age group moderates the associations.

METHODS

Healthcare professionals involved in the care for cancer patients and their family caregivers were invited to participate in the International Psycho-Oncology Society (IPOS) Survivorship Online Survey. A total of 397 healthcare professionals from 34 countries provided valid study data. The participants evaluated whether the unmet need was the same for all age groups of patients and the degree of their patients' needs not being met per patients' age group. They evaluated the same questions for family caregivers.

RESULTS

Patients' unmet needs in medical care were evaluated as greater than those of caregivers across all age groups. On the other hand, pediatric patients' unmet needs for spiritual concerns, sexuality/intimacy, and insomnia/fatigue were evaluated as greater than those of caregivers, whereas adolescent and young adult patients' unmet needs for symptom management were greater than those of caregivers. Patients' other unmet needs were evaluated as comparable with those of caregivers regardless of age groups.

CONCLUSION

The findings provide insights how best healthcare providers stratify resources to address the unmet needs of patients and caregivers by the patients' age. Development of systematic assessment of unmet needs and provision of interventions tailored for patients' lifespan to address the unmet needs of cancer patients, and caregivers are warranted.

Predictors of the relationship between the duration of cancer and care time with the supportive care needs of patients and the quality of life of their caregivers: a path analysis

BACKGROUND

Breast cancer (BC) patients face various physical and psychological challenges. The mutual impacts of patients and caregivers on each other show the need for further supportive care from the community and family. This study aimed to identify the predictors of the direct and indirect relationships of the duration of cancer (CANCERT) and care time (CARET) with the supportive care needs (SCN) of the patients and the quality of life (QOL) of their family caregivers.

METHODS

This descriptive study included 150 patients and their caregivers in Iran. Data were collected using the Supportive Care Needs Survey-Short Form (SCNS-SF34), the Caregiver Quality of Life Index-Cancer (CQOLC) scale, and a socio-demographic checklist. The data were then analyzed in SPSS-24 and Lisrel-8.8 software using descriptive statistics and path analysis.

RESULTS

The mean age of the patients and caregivers was 45.76 ± 10.44 and 43.46 ± 9.5, respectively. The majority of patients (96%) were in stages II and III of the disease. There was no statistically significant relationship between cancer stages with SCN of the patients and also caregivers' QOL (P > 0.05). Based on the test results, the CANCERT was positively correlated with the patients' care and support needs (SN) in total effect (β = 0.24). The patients' sexuality needs had the highest negative correlation with their CANCERT in the direct path (β =  - 0.27) and had the highest negative correlation with psychological needs in the indirect path (β =  - 0.174). The CARET (hours per day) had positive correlation with health systems and information needs in both the direct (β = 0.26) and indirect paths (β = 0.15). The highest positive correlation with physical needs was in the direct path (β = 0.34). The caregivers' QOL had a negative and direct relationship with the CANCERT (β =  - 0.19), and there was a positive and direct relationship between CARET and the caregivers' QOL (β = 0.18).

CONCLUSIONS

The correlations obtained from this study are not necessarily strong, yet they are important and should be noticed and tested in the future studies. The present findings reveal the need to provide comprehensive care, planning to provide supportive care, and counseling to both BC patients and their family caregivers, especially when the duration of the disease is prolonged.

The Mediating Role of Spiritual Health in Adherence to Treatment in Patients with Cancer

Background: Adherence to the treatment regimen is among the behaviors, which predict the successful control of the disease and decrease its intensity and negative consequences, which is influenced by several factors. The patient's beliefs and attitudes toward the disease are effective factors in disease management and adherence to treatment, and spiritual health is one of these influential variables. Objectives: The aim of this study was to determine the mediating role of spiritual health in adherence to treatment in patients with cancer. Methods: In this descriptive correlational study, the participants were 234 Iranian patients with cancer, who were selected through convenience sampling, admitted to the oncology wards of 9 selected teaching hospitals in the northern, southern, eastern, and western provinces of the country, as well as the capital in 2021. The research instruments included the Demographic and Clinical Information Questionnaire, Spiritual Well-Being Scale, and Morisky Medication Adherence Scale-8. The path analysis was done to determine the factors related to the degree of adherence to treatment, taking into account the mediating role of spiritual health. Results: The mean age of the participants in the study was 47.27 ± 15.36. The mean scores for spiritual health and adherence to treatment were 76.70 ± 13.75 and 6.47 ± 2.1, respectively. A positive and significant relationship was found between spiritual health and adherence to treatment (P-value < 0.05). The variables of marital status, the time of diagnosis, and being a religious person had a direct effect on spiritual health, and the time of diagnosis indirectly affected treatment adherence. Conclusions: According to the results, the level of spiritual health and adherence to the treatment in patients with cancer was moderate. In addition, the variable of diagnostic time affected adherence to treatment indirectly. Besides, in examining the factors affecting spiritual health, the findings indicated the effect of the variables “being religious”, “marital status”, and “the time of diagnosis”. In addition to strengthening spiritual health, it is necessary to highlight the need to follow therapeutic diets in these patients. Therefore, it is suggested to consider a program to meet the patients with cancer spiritual needs along with the physical care program.

Sexual health promotion interventional program for women undergoing breast cancer treatment: Protocol for a mix-methods study

BACKGROUND

Women undergoing breast cancer treatment, especially those of reproductive age, experience sexual health challenges. The aim of this study is to design an interventional program for promoting the sexual health of women undergoing breast cancer treatment.

MATERIALS AND METHODS

This is a mixed qualitative-quantitative exploratory study consisting of four phases. In the first phase, the needs and strategies for promoting sexual health of Iranian women with breast cancer in Isfahan city will be identified through a qualitative study. The patients will be selected using purposive sampling method and the data will be collected through semi-structured interviews. In the second phase of the study, the relevant literature will be reviewed. In the third phase, the initial version of the program will be designed based on the results of qualitative study and review of literature, the appropriate strategies are prioritized by the members of the panel of experts, and then, the final interventional program is prepared. In the fourth phase, the designed interventional program will be conducted as a quasi-experimental study in two groups of intervention and control and the effectiveness of the program on sexual quality of life, sexual satisfaction, and sexual function of women undergoing breast cancer treatment will be evaluated. The type of the intervention will be selected based on the results of the previous phases and the opinion of the expert panel.

CONCLUSIONS

The results of this study are expected to contribute to the design of an interventional program based on the needs of women undergoing breast cancer treatment and promote health and meet the sexual health needs of breast cancer patients.

Psychometric Properties of the Persian Version of the Short-Form Survivor Unmet Needs Survey (SF-SUNS) among Cancer Patients

Objective

Accurate identification of the unmet needs of patients with cancer and with a valid and reliable scale leads to the improvement of planning and implementation of nursing care. Thus, this study aims to translate the Short-Form Survivor Unmet Needs Survey (SF-SUNS) into Persian and to assess the psychometric properties of the Persian version among patients with cancer in Iran.

Methods

This study was conducted by methodological design. The translation of SF-SUNS was performed by translation protocol of the Quality of Life Assessment. Qualitative assessment of the face validity was conducted through cognitive interview and content validity was assessed through expert panel. This study used a convenience sampling method for 757 patients with cancer referring to Omid and Imam Reza hospitals in Mashhad, Iran. To determine the construct validity, confirmatory factor analysis and convergent validity were employed. Cronbach's alpha and intraclass correlation coefficient were calculated for reliability.

Results

Total score of unmet needs was 2.20 ​± ​0.73, which indicates the average level of unmet needs in patients with cancer. Content validity ratio and content validity index scores were 0.88 and 0.91, respectively, Cronbach's alpha coefficient was 0.89, and intraclass correlation coefficient was 0.91. Based on confirmatory factor analysis, goodness-of-fit indices confirmed the model fit (χ²/df ​= ​4.43, GFI ​= ​0.90, TLI/NNFI ​= ​0.91, CFI ​= ​0.90, RMSEA ​= ​0.067). In the subscale of unmet work and financial needs, 4 items had a factor loading lower than 0.4, which were omitted from the Persian version. The results revealed a significant difference in the unmet needs and quality of life of patients with cancer (P ​< ​0.001).

Conclusions

The Persian version of SF-SUNS has desirable psychometric properties. It can be used to design and assess interventions to improve the quality of caring, cancer management, and as well as interaction between patients and healthcare providers.

Development and evaluation of a teleoncology system for breast cancer during the COVID-19 pandemic

Background: The present study describes the steps of developing a hybrid teleoncology system to provide treatment plans for breast cancer patients. Materials & methods: This research was conducted in four stages, including developing a proposal for experts, identifying and analyzing system requirements, designing a prototype and implementing and evaluating the final version of the hybrid teleoncology system. Results: The results of the usability evaluation showed that the users evaluated the system at a good level and, in practice, the implemented system was perceived to be useful by specialists in providing treatment plans for cancer patients. Conclusion: The hybrid teleoncology system is a practical alternative to traditional methods for providing treatment plans to breast cancer patients.

The prevalence of anxiety and depression and its association with coping strategies, supportive care needs, and social support among women with breast cancer

PURPOSE

Diagnosis of breast cancer and its treatment dramatically affects women's psychological health. This study investigated the prevalence of depression and anxiety and their related factor in breast cancer women.

METHODS

We conducted a cross-sectional study with a sample of 120 women with breast cancer in Zahedan, Iran, 2020. Data were collected using instruments included: Hospital Anxiety and Depression Scale (HADS), Supportive Care Needs Survey (SCNS-SF34), Multidimensional Scale of Perceived Social Support (MSPSS), The adjustment to illness measurement inventory for Iranian women with breast cancer (AIMI-IBC). We analyzed the data using the ANOVA, independent sample t-test, Kruskal Wallis, Mann-Whitney U test, Pearson's and Spearman's correlation coefficients.

RESULTS

The prevalence of depression and anxiety in women with breast cancer was 66.6% and 60%, respectively. A significant positive correlation was found between anxiety and depression and unmet psychological needs, care/support needs, and emotional turmoil coping strategy, while reasonable efforts and avoidance coping strategies and adjusting to disease were negatively correlated with anxiety and depression. Also, linear regression results indicated unmet psychological needs, emotional turmoil coping strategy, and a high level of depression predicted a high anxiety level. A lower level of depression was indicated by reasonable efforts strategy and less level of anxiety.

CONCLUSIONS

Women with breast cancer reported a high level of depression and anxiety in Zahedan, and clinicians should pay more attention to these patients' psychological distress. Resolving the unmet need of patients, increasing social support, and using the right coping strategy have an essential role in breast cancer women's psychological distress control.

Validity and reliability of the Amharic version of supportive care needs survey - short form 34 among cancer patients in Ethiopia

OBJECTIVES

Supportive care needs survey short form has a total of 34 items that have 5 domains that measure the unmet needs of cancer patients. It is important to validate this tool since there are differences in culture, geographic areas, and clinical care service which influence patients' needs. Therefore, this study aimed to assess the construct validity and reliability of the tool.

METHODS

The study was conducted among 170 cancer patients from April 1st to 30th 2019 in Hawassa hospital, South Ethiopia. Confirmatory factor analysis was done using fit indices. Convergent and discriminant validity was evaluated using average variance extracted and maximum shared variance respectively. Known group validity was checked using the Mann-Whitney U test. The reliability of the instrument was examined using Cronbach's alpha.

RESULTS

Domains except for health system and information, and patient care and support maintained convergent and divergent validity. The remaining validity was maintained after removing items that were redundant and double loading. The average variance extracted of domains varied from 0.52-0.81. The Square of correlation between constructs was lower than the average variance extracted for the constructs. The tool had reliability r = 0.932. The root mean square error of approximation was 0.057, comparative fit index 0.954, and the other fit indices were also indicating a good fit. Known groups difference was seen by age and type of treatment taken across the different domains.

CONCLUSION

After the health system and information, and patient care, and support domain validity issues were corrected by removing 8 items, the reduced tool was found to be a valid and reliable tool. The validated tool will be valuable if included in routine cancer care in our clinical settings.

The impact of mastectomy on Iranian women sexuality and body image: a systematic review of qualitative studies

PURPOSE

Mastectomy in women is perceived as losing feminine identity and reducing sexual attraction. The aim of this review is to explore the perception and impacts of mastectomy on Iranian women with breast cancer on their sexuality and body image.

METHODS

The review used a systematic literature search that followed the guidelines of the Joanna Briggs Institute (JBI). The data sources PubMed, Scopus, Web of Science, Google Scholar, SID, ProQuest, MEDLINE, and CINAHL (via the EBSCOhost) were systematically searched. Quality appraisal, data extraction, and findings from the included studies were pooled using meta-aggregation with the Qualitative Assessment and Review Instrument (JBI-QARI).

RESULTS

Eight studies involving 163 women aged from 31 to 65 years, who had mastectomy, were included. A total of 31 findings were extracted and were aggregated into 4 categories and then further grouped into two synthesized findings: (1) fear of losing spouse's sexual monopoly and (2) overcoming the challenges of losing femininity.

CONCLUSIONS

This review found even in Muslim countries such as Iran women's breasts are perceived as sexually attractive, and changes in body shape can lead to subsequent challenges in marital relationships.

Prevalence and Correlates of Unmet Supportive Needs of Nigerian Patients With Cancer

PURPOSE

Diagnosis and treatment of cancer are associated with significant psychological distress, and patients face a broad range of challenges that create a vacuum of unmet needs felt by patients, such as a loss of personal control and frustration. The aim of the current study was to determine the magnitude, distribution, and correlates of unmet needs in Nigerian patients with cancer.

PATIENTS AND METHODS

Using a descriptive cross-sectional approach, we assessed 205 patients with cancer who attended oncology outpatient clinics at the Lagos University Teaching Hospital. Eligible patients were administered the Supportive Care Needs Survey (SCNS) –Short Form 34 with a focus on five domains of need: psychological, health system and information, physical and daily living, patient care and support, and sexuality.

RESULTS

Mean age was 47.4 ± 12.3 years and patients were predominantly female (96.6%). The most common diagnosis was breast cancer (92.2%), and mean duration since diagnosis was 20.9 ± 21.9 months for all patients. Mean SCNS score was 83.9 ± 24.8 and at least 46% of participants indicated unmet needs in 15 items of the SCNS. The most frequent unattended needs were related to the health information (53.4%), physical and daily living (49.4%), psychological (48.5%), sexuality, and patient care and support domains. None of the factors considered—age, sex marital status, family type, educational attainment, employment status, economic status, the presence of financial support, social support, and cancer type—was significantly predictive of unmet needs in these patients (P > .05).

CONCLUSION

Nigerian patients with cancer experience considerable levels of unmet needs. These needs require urgent and long-term interventions to help patients achieve increased care satisfaction and a better quality of life.

Mujeres Jóvenes con Cáncer de Mama: Necesidades de Apoyo en Atención y Resiliencia

Antecedentes: las mujeres menores de 40 años con cáncer de mama (CaMa) presentan características bio-psico-sociales únicas que ameritan ser atendidas y estudiadas. Objetivo: evaluara) la percepción de necesidades de apoyo en la atención (NAT) insatisfechas y nivel de resiliencia,b) la diferencia de NAT entre pacientes en tratamiento y sobrevivientes y c) la relación entre NAT y resiliencia, y su asociación con variables clínicas y sociodemográficas, respectivamente. Método: se estudiaron transversalmente a 150 mujeres jóvenes con CaMa en tratamiento y sobrevivientes, con una encuesta de NAT y una de resiliencia mexicanas. Resultados: la mediana de edad de las participantes fue de 36 años. Las necesidades menos satisfechas fueron las de sistema de salud e información. El grupo de tratamiento presentó más NAT comparado con las sobrevivientes (p=0,005). Se encontró que cuanto más NAT insatisfechas (globales, psicológicas, cuidado y apoyo, e información), menores valores en los dominios de resiliencia (p<0,005) en ambos grupos y por separado. Conclusiones: las condiciones externas (infraestructura, servicios de salud proporcionados y apoyo en seguridad social), habilidades propias (auto-confianza, estructura y organización) y/o recursos de apoyo externo (social y familiar) pudieron contribuir a que las pacientes percibieran pocas NAT insatisfechas. Los resultados resaltan la relevancia clínica de implementar intervenciones basadas en resiliencia.

The Information Needs of Women Who Have Undergone Breast Cancer Surgery in the West of Turkey

This descriptive study aimed to evaluate the information needs of breast cancer patients who have undergone surgery, and the level to which those information needs are met in the west of Turkey. It was conducted in 55 women who had undergone surgical intervention between March 2013 and March 2014 in a university hospital in the west of Turkey. A personal information form and the Patient Information Needs Scale were used to gather data. Descriptive statistics, the Chi-square test, and the Wilcoxon signed-rank test were used to analyze the data. It was found that the information need of the patients (3.9 +/- 0.6) was near the "very important" level, and that this need was "somewhat met" (2.4 +/- 0.9). When the information needs of the patients and the level to which those needs were fulfilled were compared, the level of fulfillment was statistically significantly lower (p < 0.001). Among the different subscales evaluated, information relating to medication was the most needed, and the information needs pertaining to this subscale were met to a greater degree (p < 0.05) than the remaining subscales. The results showed that the information needs, primarily the medication-related information needs, of the patients were high, but that the level of meeting these needs was low. It should be considered important for patients who have undergone breast cancer surgery to be kept informed and provided with information regarding their medication.

Pattern and Predictors of Unmet Supportive Care Needs in Cancer Patients

The incidence of cancers is increasing and this is associated with an increase in the burden of the disease. Patients with cancer have to deal with reduced physical functioning, emotional instability, difficulty in concentrating, and an overall diminished feeling of well-being. This creates deficits that have not been well catered for by traditional cancer care, leading to an overall dissatisfaction with care and a reduced quality of life. This review aims at assessing the pattern of unmet needs in cancer patients and to provide information as to the factors that influence the perception of unmet needs. Studies directly focused on unmet needs in cancer patients which were retrieved from Medical Literature Analysis and Retrieval System Online (MEDLINE), Public/Publisher Medline (PubMed), PsychINFO, Excerpta Medica database (EMBASE), and Google Scholar; from the earliest records till 2016. Unmet needs in cancer patients have been measured with a wide variety of tools, with the supportive care needs survey (SCNS) being the most commonly used as a result of its strong psychometric properties, ease of use, responsiveness, and its coverage of the major domains of unmet needs. The most common unmet needs were in the domains of health system and information, psychological, and physical and daily living. These needs are influenced by sociodemographic factors such as age, sex, marital status, income level; and clinical factors such as location of cancer, stage of disease, and tumor size. It is clear that cancer patients experience a wide range of unmet supportive needs, for which solutions need to be devised in order to improve the supportive care services for these patients and their overall quality of life.

The information needs of adult cancer survivors across the cancer continuum: A scoping review

OBJECTIVE

To provide an updated synthesis of the literature that investigates the self-reported information needs of people diagnosed with cancer across the cancer continuum.

METHODS

We conducted a scoping review of the literature published from August 2003 to June 2015 and expanded an existing typology summarizing the information needs of people diagnosed with cancer.

RESULTS

The majority of the included studies (n=104) focused on questions relevant to the diagnosis/active treatment phase of the cancer continuum (52.9%) and thus the most frequently identified information needs related to this phase (33.4%). Information needs varied across the continuum and the results highlight the importance of recognising this fact.

CONCLUSION

People diagnosed with cancer experience discrete information needs at different points from diagnosis to survival. Much of the research conducted in this area has focused on their information needs during the diagnosis and treatment of cancer, and literature relating to information needs following completion of treatment is sparse.

PRACTICE IMPLICATIONS

Further research is needed to discern the specific nature of the treatment concerns and identify the information needs that survivors experience during recurrence of cancer, metastasis or changes in diagnosis, and the end of life phase of the cancer continuum.

Coping Strategies and Experiences in Women with a Primary Breast Cancer Diagnosis

Background: Women with breast cancer experience problems in multiple aspects of their lives, but applying effective strategies can result in enhancing their quality of life and their psychosocial adaptation to the disease. However, there is little information about the strategies that women use to cope with complications associated with their experiences following a breast cancer diagnosis. Objectives: The aim of this study was to explore the experience of coping behavior and the main strategies that women use in dealing with a breast cancer diagnosis. Methods: This study was conducted according to a qualitative phenomenological design to investigate women’s experiences in living with breast cancer and the related complications and how they cope with these issues. Purposive sampling was used for recruiting participants with breast cancer, and data collection was conducted by semi-structured, in-depth interviews with 22 patients. The transcribed interviews were analyzed using Van Manen’s thematic approach. Results: The age range of the women was 32-68. Most were married and received adjuvant therapy (i.e., mastectomy surgery and chemo-radiation). Three dominant themes that emerged from the interviews were emotional turmoil, avoidance, and logical efforts. Conclusion: The findings highlight the importance of addressing psycho-oncology intervention programs to address the unmet pyscho-social and palliative care needs of patients suffering from breast cancer.

Cancer Patients' Informational Needs: Qualitative Content Analysis

Understanding the informational needs of cancer patients is a requirement to plan any educative care program for them. The aim of this study was to identify Iranian cancer patients' perceptions of informational needs. The study took a qualitative approach. Semi-structured interviews were held with 25 cancer patients in two teaching hospitals in Iran. Transcripts of the interviews underwent conventional content analysis, and categories were extracted. The results came under two main categories: disease-related informational needs and information needs related to daily life. Disease-related informational needs had two subcategories: obtaining information about the nature of disease and obtaining information about disease prognosis. Information needs related to daily life also had two subcategories: obtaining information about healthy lifestyle and obtaining information about regular activities of daily life. The findings provide deep understanding of cancer patients' informational needs in Iran.

Effects of Sexual Rehabilitation Using the PLISSIT Model on Quality of Sexual Life and Sexual Functioning in Post-Mastectomy Breast Cancer Survivors

Background and Objectives: As one of the most common treatments for breast cancer, mastectomy has adverse effects on the quality of sexual life and sexual functioning in the impacted women. Various strategies have therefore been proposed to resolve their sexual problems. The present study was conducted to determine the effect of sexual rehabilitation using the PLISSIT model in post-mastectomy breast cancer survivors. Materials and Methods: The present quasi-experimental study was conducted on a population of post-mastectomy breast cancer survivors and their husbands. Sample size was calculated as 50 each for intervention and non-intervention groups. The former received sexual counseling based on the PLISSIT model consisting of four levels of intervention: permission, limited information, specific suggestion and intensive therapy, presented in four 90-minute sessions. Data were collected using the Sexual Quality of Life-Female (SQOL-F) questionnaire and the Female Sexual Function Index (FSFI). Results: No significant differences were observed in the mean quality of sexual life scores between the intervention and control groups (P>0.05) before the intervention; however, a significant difference emerged between the groups after the intervention (P<0.01). Thus the mean score for sexual functioning in the intervention group was 26.3±3.76 before and30.0±4.38 after the intervention (P<0.0001). In the control group, however, the difference between the pre- and post-intervention mean scores was not statistically significant (P=0.713). Conclusion: The present study showed that nurses can use the PLISSIT model in conjunction with chemotherapy and radiotherapy to teach coping and problem-solving skills to women with breast cancer and their husbands and to encourage their participation in group programs for expressing their feelings and attitudes about their current sex life and thus help enhance quality of sexual life and sexual functioning in this group.

Cancer Care Burden among Primary Family Caregivers of Iranian Hematologic Cancer Patients

BACKGROUND

Providing care for hematologic cancer patients may lead to many negative complications in different aspects of life in their family caregivers. Based on a wide review of relevant literature, there are limited data about the burden of giving care for hematologic cancer patients on their primary family caregivers in Iran or other Middle Eastern countries. Therefore, the aim of this study was to investigate the cancer care burden on primary family caregivers of hematologic cancer patients, in terms of physical, psychological, social, spiritual, and financial aspects.

MATERIALS AND METHODS

In this descriptive study, 151 primary family caregivers of hematologic cancer patients referred to two cancer care centers in East Azerbaijan Province in northwest of Iran participated. The Financial Distress/Financial Well-being Scale, Hospital Anxiety and Depression Scale, Vaux Social Support Questionnaire, Spiritual Well-being Scale, and SF-36 were used for data collection. Data analysis was performed with SPSS software.

RESULTS

The findings of this study indicated that the primary family caregivers experience a high level of financial distress and a significant percentage of them suffered from anxiety and depression. In addition, the physical quality of life in these caregivers was moderate. On the other hand, spiritual health and social support of participants was at an acceptable level.

CONCLUSIONS

Iranian primary family caregivers of hematologic cancer patients experience many problems in physical, psychological, and financial aspects of their life. Therefore, developing care plans for reducing these problems appears necessary.

The Lived Experience of Iranian Women Confronting Breast Cancer Diagnosis

INTRODUCTION

The populations who survive from breast cancer are growing; nevertheless, they mostly encounter with many cancer related problems in their life, especially after early diagnosis and have to deal with these problems. Except for the disease entity, several socio-cultural factors may affect confronting this challenge among patients and the way they deal with. Present study was carried out to prepare clear understanding of Iranian women's lived experiences confronting breast cancer diagnosis and coping ways they applied to deal with it.

METHODS

This study was carried out by using qualitative phenomenological design. Data gathering was done through purposive sampling using semi-structured, in-depth interviews with 18 women who survived from breast cancer. The transcribed interviews were analyzed using Van Manen's thematic analysis approach.

RESULTS

Two main themes were emerged from the interviews including "emotional turbulence" and "threat control". The first, comprised three sub themes including uncertainty, perceived worries, and living with fears. The second included risk control, recurrence control, immediate seeking help, seeking support and resource to spirituality.

CONCLUSION

Emotional response was the immediate reflection to cancer diagnosis. However, during post-treatment period a variety of emotions were not uncommon findings, patients' perceptions have been changing along the time and problem-focused coping strategies have replaced. Although women may experience a degree of improvement and adjustment with illness, the emotional problems are not necessarily resolved, they may continue and gradually engender positive outcomes.

Breast Cancer Screening Barriers from the Womans Perspective: a Meta-synthesis

BACKGROUND

The principal aim of health service providers in the field of breast cancer is to detect and treat lesions at an appropriate time. Therefore, identification of barriers to screening can be very helpful. The present study aimed to systematically review the qualitative studies for extracting and reporting the barriers of screening for breast cancer from the womans perspective.

MATERIALS AND METHODS

In this systematic review; Pubmed, Google Scholar, Ovid Scopus, Cochrane Library, Iranmedex, and SID were searched using the keywords: screening barriers, cancer, qualitative studies, breast and their Persian equivalents, and the needed data were extracted and analyzed using an extraction table. To assess the quality of the studies, the Critical Appraisal Skills Programme (CASP) tool was used.

RESULTS

From 2,134 related articles that were found, 21 articles were eventually included in the study. The most important barriers from the point of view of 1,084 women were lack of knowledge, access barriers (financial, geographical, cultural), fear (of results and pain), performance of service providers, women's beliefs, procrastination of screening, embarrassment, long wait for getting an appointment, language problems, and previous negative experiences. Articles' assessment score was 68.9.

CONCLUSIONS

Increasing women's knowledge, reducing the costs of screening services, cultural promotion for screening, presenting less painful methods, changing beliefs of health service providers, provision of privacy for giving service, decreasing the waiting time, and providing high quality services in a respectful manner can be effective ways to increase breast cancer screening.

Levels of Conscience and Related Factors among Iranian Oncology Nurses

BACKGROUND

Having a conscience is one of the main pre-requisite of providing nursing care. The knowledge regarding levels of conscience among nurses in eastern countries is limited. So, the purpose of this study was to examine the level of conscience and its related factors among Iranian oncology nurses.

MATERIALS AND METHODS

This descriptive-correlational study was conducted in 3 hospitals in Tabriz, Iran. Overall, 68 nurses were selected using a non-probability sampling method. The perceptions of conscience questionnaire was used to identify the levels of conscience among nurses. The data were analyzed using SPSS version 13.0.

RESULTS

The mean nurses' level of conscience scores was 72.7. In the authority and asset sub-scales nurses acquired higher scores. The mean of nurses' scores in burden and depending on culture sub-scales were the least. Also, there were no statistical relationship between some demographic characteristics of participants and their total score on the perceptions of conscience questionnaire.

CONCLUSIONS

According to study findings Iranian nurses had high levels of conscience. However, understanding all the factors that affect nurses' perception of conscience requires further studies.

Informational Needs of Postmastectomy Patients

OBJECTIVE

The aim of this study was to determine informational needs of postmastectomy patients.

MATERIALS AND METHODS

This descriptive study was conducted in the general surgery clinics of a university health center for medical research and practice with 72 voluntary patients. For data collection, a patient identification form was used, which was prepared by the researchers in accordance with the literature.

RESULTS

The mean age of the patients was 52.66±13.39 years, 87% were married, 58% had primary school education, 76% had moderate economic status, and 53% had undergone simple mastectomy. It was determined that 83% of the patients wanted to be informed about hospital and home care interventions, 82% about symptoms and prevention of post-surgical problems, 76% regarding breast cancer and treatment options, and in the range of 54-68%, patients wanted information on the effects of surgery on the body, shoulder and arm exercises, breast self-examination, the effects of breast cancer on family and work life, lymphedema and prevention interventions.

CONCLUSION

We recommend that patients with mastectomy should be informed about topics including care interventions, breast cancer and treatment options, effects of surgery, and reducing these effects.

Post-traumatic growth: a qualitative analysis of experiences regarding positive psychological changes among Iranian women with breast cancer

INTRODUCTION

Cancer diagnosis is an extremely stressful experience that has a profound impact on a patient's life. Cancer related perceived stress and complications may lead to the experience of positive psychological changes and post-traumatic growth (PTG). Since there is lack of qualitative research assessing the experience of PTG in Iranian women with breast cancer, this study aims to investigate experiences relating to PTG of Iranian women.

METHODS

A qualitative phenomenological approach was selected to explore the experiences of Iranian women with PTG. Data were gathered using semi-structured, in-depth interviews with 18 eligible patients, which were then transcribed and analyzed using Van Manen's thematic analysis approach. Data gathering and analyses were conducted simultaneously. In addition, MAXQDA software was used for data management.

RESULTS

In this study, the participants were 18 Iranian women between the ages of 31 and 65 years. Four prominent themes were extracted from the participant's statements that demonstrated the Iranian women's experiences with breast cancer-induced psychological growth and maturity: 1) appreciate of life, 2) stability, 3) spiritual prosperity, and 4) effective interaction.

CONCLUSION

Health care professionals are strongly recommended to design robust and timely intervention programs to improving PTG among breast cancer survivors and reduce their perceived distress resulting from cancer diagnosis.

Social support and its predictors among Iranian cancer survivors

BACKGROUND

Social support is an important factor in psycho-social well-being of cancer survivors. There is little information about level of social support and its predictors among cancer survivors in Iran or other Middle Eastern countries. The aims of present study were to determine the social support and its prediction factors among Iranian cancer survivors.

MATERIALS AND METHODS

In this descriptive-correlational study 187 cancer patients in one educational center and one private oncology office in northwest of Iran participated using a convenient sampling method. The data collection tool consisted of a researcher-prepared checklist and the Multidimensional Scale of Perceived Social Support Assessment (MSPSS). Data analysis was performed using SPSS statistical software with descriptive statistics and multiple linear regression analysis.

RESULTS

The total score of MSPSS was 68 from a possible score between 7 and 84. Participants believed that they received a high level of support from their family members and significant others. Multiple linear regression analysis showed that single and depressed cancer survivors and participants with lower levels of physical activity believed that they received lower levels of social support.

CONCLUSIONS

Iranian cancer survivors receive high levels of social support and family members are the most important source of this support. In planning any supportive care program for Iranian cancer survivors this strength should be considered. Especially, single and depressed and patients with lower levels of physical activity need more attention.