Validation of the Modified Thai Cancer Survivor’s Unmet Needs (T-CaSUN) for Cholangiocarcinoma Patients

Background: Cancer survivors frequently experience of unmet demands that are linked to psychological illness, anxiety, and quality of life. Cholangiocarcinoma (CCA) survivors, on the other hand, still lack of validated tool to assess their particular requirements. The aims of this study were to adjust the Cancer Survivors’ Unmet Need Scale (CaSUN) to a shorter form and to examine its psychometric scale-specific features for the Thai CCA survivors. Methods: This cross-sectional study recruited 231 CCA survivors and randomly split them into 2 groups (group 1, n =115, and group 2, n =116). Firstly, we modified and translated the CaSUN to ensure Thai cultural adaptation. Secondly, we used the statistical methods to reduce some items, then an exploratory factor analysis (EFA) using group 1 to explore the factor structure of the T-CaSUN was done. Finally, a confirmatory factor analysis (CFA) using group 2 was conducted to confirm the modified structure suggested by the EFA and to test for the construct validity of the T-CaSUN. Results: Participants consisted of 231 CCA survivors. EFA and CFA organized the four components construct T-CaSUN, which included intensive care, information, relationship, and medical care. The T-CaSUN’s internal reliability was good (Cronbach’s alpha was 0.75). Furthermore, construct validity was linked to bodily consequences, anxiety and depression, support care needs, stage of cancer, and age. For assessing unmet needs among CCA survivors in Thailand, the T-CaSUN exhibited acceptable reliability and validity. Conclusion: The T-CaSUN demonstrated acceptable reliability and validity for assessing unmet needs among CCA caregivers in Thailand. This short form measurement can assist healthcare practitioners in providing successful individualized care by focusing on the particular requirements of these survivors.     

Patient-Centered Communication in Cancer Care: The Role of the NCI’s Cancer Information Service

While patient-centered care and the reduction of suffering due to cancer are primary goals of the NCI, improvement in the delivery of patient-centered communication has been identified as a key NCI research priority. As research on patient-centered communication evolves, the potential contributions of programs such as the National Cancer Institute’s (NCI) Cancer Information Service (CIS) cannot be overlooked. The purpose of this paper is to describe how the six core functions of patient-clinician communication described in the literature (fostering healing relationships, exchanging information, responding to emotions, managing uncertainty, making decisions and enabling patient-self management) are embedded in the work of the CIS. The communication process used by the CIS to extend the patient-centered communication role of the clinician will be discussed. CIS training and quality management systems will be described. Lastly, suggestions for the role of CIS in future health information delivery and research will be explored.     

Quality Indicators in Cancer Care: Development and Implementation for Improved Health Outcomes in Non–Small-Cell Lung Cancer

Non–Small-cell lung cancer (NSCLC) care is multidisciplinary and complex in nature. However, there are few quality indicators that are widely accepted by the physicians who treat lung cancer. Quality indicators developed by the American Society of Clinical Oncology and National Comprehensive Cancer Network exist for breast and colon cancer, but not yet for lung cancer. In this article we review the current state of quality indicators in oncology care in general and for NSCLC in particular. Proposed quality metrics focus on diagnosis and staging, timeliness of care, supportive care and patient satisfaction.     

Racial-Ethnic Disparities in End-of-Life Care Quality among Lung Cancer Patients: A SEER-Medicare–Based Study

Introduction

Cancer end-of-life care and associated racial-ethnic disparities have been in focus during the last few years due to concerns regarding subjective care variations and poor quality of care. Given the high mortality rate and disease burden of lung cancer, end-of-life care quality is particularly crucial for this disease. This study uses previously validated measures and examines racial-ethnic disparities in lung cancer end-of-life care quality.

A Google Trends™ Analysis of Bladder Cancer: Determining Awareness Campaign Success,and Patients’ Needs in Clinical Management

Objective: We aimed to determine the interest and changing trends over time in the diagnosis and treatment of bladder cancer and its awareness campaign by examining the Google Trends application as an indicator of people’s interest globally. Methods: Using the Google Trends application, we determined the yearly and country-based relative search volumes of the term “bladder tumor” and of the methods used in the diagnosis and treatment of bladder cancer in the period from January 2004 to December 2019. We compared the median relative search volumes found in the period 2004-2011 (Period 1) with those found in the period 2012-2019 (Period 2). Results: We found that the median relative search volume for bladder cancer decreased in period 2 and this was parallel to the decrease in the incidence rates in North America and Australia (p<0.001). We found that the bladder cancer awareness month did not cause an increase in the online interest (p>0.05). We found that the median relative search volumes of diagnostic cystoscopy and cytology were higher than those of molecular markers and imaging methods in line with guidelines (p<0.001). Also, TURBT was the most sought-term among treatment methods with increasing popularity in the second period (p<0.001). Conclusion: People use the internet intensively to search for information about bladder cancer. We think that several types of web-based applications such as “Google Trends” can help determine the behavioural patterns and tendencies of bladder cancer patients and affect the clinical decision-making processes, as well as readily determining the impact of cancer awareness campaigns to bring about an increased awareness in the society for the recognition of the importance of an early diagnosis.     

Patient Involvement in Care and Breast Cancer Patients’ Quality of Life - a Structural Equation Modeling (SEM) Approach

In cancer patients, improving the quality of life is a basic goal of treatment, with the patient – physician relationship as a major factor. Therefore the aim of this structural equation modeling study was to analyze the influence of patient involvement in care on quality of life in 411 breast cancer patients undergoing outpatient chemotherapy and radiotherapy. Two questionnaires were used: 1-patient-physician questionnaire, 2-EORTC QLQC-30 (to measure QOL). The structural equation model exhibited an excellent data fit (Chi-Square= 31.04 / RMSEA= 0.042), T-values for all paths with the exception of that between patient satisfaction and emotional- cognitive function, were significant. According to the findings, various aspects of the physician-patient relationship are significantly and positively associated with quality of life and increasing patient involvement in care by increasing trust and satisfaction, was associated with marked improvement. The findings of this study emphasized the importance of an effective relationship between doctor and patient as a contributing factor for improving the quality of life. Therefore it is suggested that policymakers and decision-makers active in strategic planning for the health system and physicians responsible for treatment pay more attention to developing and improving relationships with patients as an approach to improving patient outcomes, particularly with reference to quality of life.     

Economic Evaluations of Medical Care Interventions for Cancer Patients: How,Why, and What Does it Mean?

While the past decade has seen the development of multiple new interventions to diagnose and treat cancer, as well as to improve the quality of life for cancer patients, many of these interventions have substantial costs. This has resulted in increased scrutiny of the costs of care for cancer, as well as the costs relative to the benefits for cancer treatments. It is important for oncologists and other members of the cancer community to consider and understand how economic evaluations of cancer interventions are performed and to be able to use and critique these evaluations. This review discusses the components, main types, and analytic issues of health economic evaluations using studies of cancer interventions as examples. We also highlight limitations of these economic evaluations and discuss why members of the cancer community should care about economic analyses.     

Adult Non Hodgkin’s Lymphoma Patients: Experience from a Tertiary Care Cancer Centre in North East India

There is paucity of data on non Hodgkin’s lymphoma (NHL) from our population in North-East India. Inthis retrospective study, patients were consecutively followed-up to see the clinic-pathological pattern of NHL,various responses, and pattern of relapses to first line treatment with chemotherapy. All patients in the presentstudy received standard regimen of cyclophosphamde, doxorubicin, vincristine, prednisolone (CHOP) with orwithout rituximab (R-CHOP) as per our institutional protocol as first line therapy. Our study has shown that,in our adult population, the majority of NHL cases present with stage II and stage III disease and extra nodalinvolvement, B-cell lymphomas and diffuse large cell lymphomas being the most common subtypes. Internationalprognostic index was a significant factor for varied responses to treatment. The majority of relapses after completeremission occurred in the first year.     

Psychometric Properties of the Farsi Version of “Spiritual Needs Questionnaire” for Cancer Patients in Iran: A Methodological Study

Background and objectives: Spiritual needs are very important requirements to cancer patients. A valid andreliable instrument is needed for evaluation. This study was conducted to psychometrically evaluate a Spiritual NeedsQuestionnaire (SpNQ) for cancer patients in Iran. Methods: In this study, the methodology and psychometric propertiesof the Farsi version of the SpNQ (Büssing et al., (2010)) were evaluated, based on the model proposed by Wilde et al.,(2005). The study population included cancer patients referred to the largest referral center in Iran. Some 400 subjectswere selected. Then, the content, face and construct validity, as well as the internal consistency and reliability of theFarsi version were assessed. Findings: In the confirmatory factor analysis, the original four-factor version with 19phrases was not confirmed. Subsequently, an exploratory factor analysis (EFA) was carried out in which phrases wereincluded in three dimensions (peace and active giving, religion, and existence) that explained 48.1% of the variance.Later, a confirmatory factor analysis (CFA) was conducted, which showed a good fit of the model (CFI=0.94, GFI=0.94,RMSEA=0.071, and AGFI=0.96). Cronbach’s alpha was α=0.91 for the whole SpNQ. Cronbach’s alpha values rangedfrom 0.76 to 0.86 for the three factors. The intra-class correlation coefficient was ICC=0.82 between two tests performedwith a two-week interval. Conclusion: The modified Farsi version of the SpNQ shows good psychometric propertiesfor patients and can be used to investigate the spiritual needs of Iranian cancer patients.     

Observational Study on Patient’s Satisfactions and Quality of Life (QoL) Among Cancer Patients Receiving Treatment with Palliative Care Intent in a Tertiary Hospital in Malaysia

The main objective of palliative treatment for cancer patients has been to maintain, if not improve, the qualityof life (QoL). There is a lack of local data on satisfaction and QoL among cancer patients receiving palliativetreatment in Malaysia. This study covers patients with incurable, progressive cancer disease receiving palliativetreatment in a teaching hospital in Kuala Lumpur, comparing the different components of QoL and correlationswith patient satisfaction. A cross-sectional survey using Malay validated SF36 QoL and PSQ-18 (Short Form)tools was carried out between July 2012 -January 2013 with 120 cancer patients receiving palliative treatment,recruited into the study after informed consent using convenient sampling. Results showed that highest satisfactionwere observed in Communication Aspect (50.6±9.07) and the least in General Satisfaction (26.4±5.90). TheMental Component Summary (44.9±6.84) scored higher when compared with the Physical Component Summary(42.2±7.91). In this study, we found that patient satisfaction was strongly associated with good quality of lifeamong cancer patients from a general satisfaction aspect (r=0.232). A poor significant negative correlation wasfound in Physical Component (technical quality, r=-0.312). The Mental Component showed there was a poornegative correlation between time spent with doctor (r=-0.192) and accessibility, (r=-0.279). We found that feelingat peace and having a sense of meaning in life were more important to patients than being active or achievinggood physical comfort. More studyis needed to investigate patients who score poorly on physical and mentalcomponent aspects to understand their needs in order to achieve better cancer care.     

Prevalence,Outcome, and Management of Risk Factors in Patients With Breast Cancer With Peripheral Arterial Disease: A Tertiary Cancer Center’s Experience

IntroductionThe risk factors of breast cancer overlap with those of peripheral arterial disease (PAD), with increasing prevalence. In addition, there is under-utilization of risk factor modification measures in patients with PAD.Materials and MethodsElectronic medical records of patients with breast cancer with International Classification of Diseases 9/10 codes for PAD spanning 10 years from June 1, 2009 to June 1, 2019 were reviewed.ResultsA total of 248 patients, 98% women, with a median age of 75 years and with a median follow-up of 76 months, were included. PAD risk factors were identified as smoking (44%), obesity (38%), hyperlipidemia (68%), hypertension (HTN) (74%), and diabetes (42%). Overall, survival was significantly impacted by smoking (P = .0301) and HTN (P = .0052). In a Cox proportion hazard ratio regression, HTN (overall death hazard ratio [HR], 3.1784; 95% CI, 1.0291-6.7490; P = .0070; cancer-related death HR, 2.6354; 95% confidence interval [CI], 1.0291-6.7490; P = .0434) and smoking (overall death HR, 1.7452; 95% CI 1.0707-2.8444; P = .0255; cancer-related death HR, 2.7432; 95% CI, 1.4190-5.3030; P = .0027) were predictors of overall death and cancer-related death. Of all patients, 48% were on statins and 54% were on antiplatelet therapies. Of the patients, 62% of current smokers were offered a smoking cessation program, 27% of obese patients were offered a nutrition consult, 42% of patients with diabetes had blood glucose controlled, and 54% of patients with HTN had blood pressure controlled.ConclusionSmoking and HTN are risk factors associated with decreased survival and predictive of overall death and cancer-related death. In this population, risk factor modification was under-utilized.     

Long-Term Morbidity Following Axillary Dissection in Breast Cancer Patients – Clinical Assessment, Significance for Life Quality and the Impact of Demographic, Oncologic and Therapeutic Factors

Objective. This study describes in detail the surgery-related symptoms following axillary lymph node dissection in breast cancer patients and considers both their significance for long term quality of life and the impact of possible influencing factors. Material and methods: Three hundred and ninety six patients were studied retrospectively using a self-report questionnaire and a clinical examination. The symptoms, numbness, pain, edema, arm strength and mobility were evaluated. The subjective assessment of the degree of symptom intensity was compared with objective measurements. The extent of surgery (number of resected nodes, level of dissection) as well as the influence of demographic, oncologic and adjuvant measures (age, time interval, number of involved nodes, chemotherapy) were evaluated. Results. Shoulder-arm morbidity and fear of cancer recurrence were the most important long-term sources of distress following breast cancer surgery in our study population. Demographic, oncologic and therapeutic measures including the extent of surgery had no influence on long-term morbidity. The intensity of all evaluated symptoms was reported to be more severe in patients' subjective statements than in the results of clinical assessment. Conclusion. Shoulder-arm morbidity following axillary dissection is a frustrating polysymptomatic disease that seems to be relatively unaffected by therapeutic measures. The surgical trauma necessary for adequate tumor staging (removal of 10 lymph nodes) seems decisive for the postsurgery syndrome following axillary dissection. For node-positive patients complete axillary clearing may improve tumor control without worsening long-term-morbidity. New techniques, such as the sentinel-node-biopsy, that selects patients with negative axillary status while preserving the integrity of axillary structures, may improve the overall morbidity.     

A Double-Blind,Placebo-Controlled Randomized Phase IIa Study: Evaluating the Effect of Curcumin for Treatment of Cancer Anorexia–Cachexia Syndrome in Solid Cancer Patients

Objective: We aim to investigate the effect of curcumin on preventing cancer anorexia–cachexia syndrome (CACS) via through mechanism of inhibition on NF-kB signal pathway. Outcome measurement for primary end point was improvement of body tissue composition, and the secondary end points were body weight and body mass index, hand grip muscle strengthening, and safety. Methods: This is randomized, double-blind, placebo-controlled phase ll a study, 33 patients with CACS in solid malignancy were enrolled and randomized in 1:1 to receive oral curcumin (at a dose of 800 mg twice daily) or placebo for 8 weeks. Results: All parameters of body compositions were not statistically significant different between two groups, which were consist body fat mass [-1.25(SEM 0.87) vs. +0.63(SEM 0.55); p=0.119], skeletal muscle mass [-0.35(SEM 0.60) vs.+0.33(SEM 0.42); p=0.408] and percent body fat [-0.47(SEM 0.95) vs. -0.29(SEM 0.82); p=0.893] including with basal metabolic rate [-13.47(SEM 21.94) vs. +15.30(13.76); p=0.336]. The average of weight loss was also not statistically significant different between two groups. [-1.4 kg(SEM 0.89) in curcumin vs-1.12 kg(SEM 0.73), p=0.810]. Notably, patient with curcumin had less reduction of hand-grip muscle strength on both hands [Rt. handed: -2.47 in curcumin vs. -5.36 in placebo; p=0.318] [Lt. handed: -1.98 vs. -5.43; p=0.317], and basal metabolic rate than placebo group. Most adverse events were grade 1 on both groups similarly. Conclusion: Curcumin was not shown to be superior to placebo with regard to increasing the body composition in cancer patients with CACS. However, curcumin might show some clinical benefits, including slow progression of hand-grip muscle strength loss, and basal metabolic rate. Further investigations should be explored.     

Prognostic Factors for Survival of Stage IB Upper Lobe Non-small Cell Lung Cancer Patients: A Retrospective Study in Shanghai,China

Objective: To identify clinical and pathologic factors that were associated with the survival of stage IB upper lobe non-small cell lung cancer (NSCLC) patients. Methods: A retrospective study of 147 subjects who had undergone curative resection for stage IB upper lobe NSCLC was performed. Patients who had received any adjuvant or neo-adjuvant chemotherapy were excluded. Survival function curves were estimated using the Kaplan-Meier procedure. Crude and adjusted hazard ratios (HRs) of potential prognostic f...     

Co-Creating a Culturally Responsive Distance Education Cancer Course with,and for,Alaska’s Community Health Workers: Motivations from a Survey of Key Stakeholders

To gain input on a proposed culturally responsive, distance-delivered cancer education course informed by empowerment theory and adult-learning principles, Alaska’s Community Health Aides/Practitioners (CHA/Ps) and CHA/P leadership were invited to take an online survey in February 2015. The proposed course will be developed as part of the “Distance Education to Engage Alaskan Community Health Aides in Cancer Control” project. The results of the survey demonstrate that respondents are both interested in taking the proposed class and engaging in course development. The results also indicate that respondents have the technological comfort and capacity to be engaged in online learning and have primarily positive experiences and perceptions of distance education. This survey is the beginning of the interactive development of the online cancer education course and part of a continuing endeavor to promote wellness with, and for, Alaska’s people by empowering Alaska’s CHA/Ps and inspiring positive behavioral change to both prevent cancer and support those who feel its burdens.     

Chemotherapy is Beneficial for Elderly Patients With Advanced Non–Small-Cell Lung Cancer: Analysis of Patients Aged 70-74, 75-79, and 80 or Older in Japan

BackgroundIt remains to be determined in elderly patients with advanced non–small-cell lung cancers (NSCLCs) if there is a benefit of chemotherapy in patients aged 80 or older.MethodsUsing a database from the Japan National Hospital Organization Study Group for Lung Cancer from 1990 to 2005, 3 cohorts based on the age of diagnosis were examined in patients with stage IIIB and IV NSCLC. Cohort 1 was for 70- to 74-year-old patients, cohort 2 for 75- to 79-year old, and cohort 3 for 80 years and older (80+). Multivariate analysis of survival for each cohort was performed using the Cox regression method using the following covariates: age, PS, histology, stage, smoking status, and chemotherapy.ResultsThere were 1617 patients in cohort 1, 1349 in cohort 2, and 1010 in cohort 3. The number of patients treated with chemotherapy were 991 (61%) in cohort 1, 648 (48%) in cohort 2, and 286 (28%) in cohort 3. Multivariate analysis for overall survival (OS) showed that chemotherapy was a significant prognostic factor among cohort 1 (hazard ratio [HR], 0.540; 95% confidence interval [CI], 0.481-0.607; P < .0001) and cohort 2 (HR, 0.715; 95% CI, 0.632-0.810; P < .0001) and showed a benefit trend among cohort 3 (HR, 0.869; 95% CI, 0.742-1.018; P = .0940).ConclusionsAfter adjustment for PS, a trend of survival benefit of chemotherapy remained in patients aged 80 or older.