Breast cancer survivors’ supportive care needs 2–10 years after diagnosis

GOALS OF THE WORK: A significant proportion of breast cancer patients experience psychosocial morbidity after treatment, although their longer-term outcomes and supportive care service needs have not been comprehensively documented. The aim of this study was to identify longer-term outcomes and supportive care needs in disease-free breast cancer survivors. MATERIALS AND METHODS: One hundred seventeen patients who had been diagnosed with breast cancer 2-10 years earlier completed questionnaires to assess psychosocial outcomes including supportive care needs, psychological distress, and quality of life (QoL). MAIN RESULTS: QoL and depression scores were consistent with community rates although anxiety scores were higher. Approximately two thirds of survivors reported at least one unmet need, most frequently concerning existential survivorship issues, thereby highlighting the unique needs of survivors. Years since diagnosis was not correlated with need levels. Survivors classified as clinically anxious reported over three times as many unmet needs and survivors classified as depressed reported over two and a half times as many unmet needs. Positive outcomes were frequently reported. CONCLUSIONS: The findings have direct clinical relevance: irrespective of years since diagnosis, comprehensive and extended supportive care services are required to identify breast cancer survivors in need of supportive care interventions and remediate high levels of anxiety.     

Perceived symptoms and the supportive care needs of breast cancer survivors six months to five years post-treatment period

PurposeThis study characterized the range and levels of perceived symptoms and unmet needs reported by breast cancer survivors in the half-year to five year post-treatment period, and determined whether the symptoms can be a predictor of unmet needs.MethodsIn a cross-sectional study, 150 breast cancer survivors (mean age: 55.1 ± 8 years) at the half-year to five year post-treatment period were enrolled for analysis. The measuring scales used included the Memorial Symptom Assessment Scale (MSAS), and the Supportive Care Needs Survey Short Form (SCNS-SF34).Results88% of the survivors reported having at least one symptom, while 51% reported at least one unmet need. Lack of energy was the most prevalent symptom (47%), followed by numbness/tingling in hands/feet (41%). Most of the survivors had unmet needs in the Health care system/Information domain (37% reported at least one unmet need for help), followed by Psychological needs (29%). The mean scores for the SCNS-SF34 domains, except for sexuality, were significantly higher in the high-symptom group (mean 17.6–32.2) compared with the low-symptom group (mean 3.5–22.3) (p < 0.01). Regression of the SCNS-SF34 domain scores against the MSAS scores revealed an increase in the explained variance of from 14% to 54%.ConclusionOur results suggest that breast cancer survivors continue to experience a multitude of symptoms, and the burden of symptoms may be associated with unmet needs across a range of domains.     

Supportive care needs and quality of life of patients with gynecological cancer undergoing therapy

Objective

To identify the relationship of unmet supportive care needs with quality of life of patients with gynecological cancer undergoing therapy.

癌症患者支持性照顾需求的研究进展

阐述癌症患者支持性照顾需求的概念及国内外研究现状,分析其影响因素,提出目前癌症患者支持性照顾需求研究中存在的不足及研究展望.     

肝癌生存者支持性照顾需求和心理韧性的相关性研究

目的：调查肝癌生存者支持性照顾需求现状及心理韧性,并探讨两者间的相关性,为提高肝癌生存者照顾质量提供依据。方法：采用便利抽样法,选取120例肝癌生存者,采用自制一般资料调查表、支持性照顾需求量表（SCNS-SF34）和心理韧性量表进行问卷调查。结果：肝癌生存者支持性照顾需求总分为69.00（57.00,90.50）,其中健康信息需求得分最高24.00（17.50,32.50）;心理韧性总分为28.00（21.00,34.00）。心理韧性与支持性照顾需求成负相关（r=-0.314,P=0.001) 。结论：肝癌生存者存在不同程度的支持性照顾需求,心理韧性较差的肝癌生存者支持性照顾需求较高,提示医护人员可以通过加强对肝癌生存者支持性照顾需要的护理干预,以改善他们的心理韧性水平。     

结直肠癌患者术后支持性照顾需求调查研究

目的：全面了解结直肠癌患者术后支持性照顾需求,为护理人员开展健康指导提供依据,也为护理管理者开展培训和继续教育提供方向。方法选择2012年3-7月在山西省肿瘤医院通过病理检查确诊的结直肠癌接受手术的161例患者,在澳大利亚Bonevski设计的癌症患者支持性照顾需求调查问卷的基础上增加未保肛患者适用的造口支持需求维度进行问卷调查,观察结直肠癌患者术后支持性照顾需求各维度的需求率和得分情况。结果患者6个维度平均需求率为79．12％,平均未满足率为78．63％。患者心理需求得分为（2．71±0．56）分,照顾与支持需求得分为（2．66±0．46）分,生理及日常生活需求为（2．25±0．67）分,健康信息需求得分为（1．94±0．67）分,性需求得分为（1．88±1．25）分,造口需求得分为（0．66±1．18）分。术后支持性照顾需求各维度得分比较差异有统计学意义（F＝867．81, P＜0．05）。结论护理人员应全面了解患者的需求,及时调整护理服务内容。护理管理者应根据患者需求进行护士的继续教育工作,才能有利于护理学科的发展。     

Life after cancer: couples’ and partners’ psychological adjustment and supportive care needs

Goals of work Partners of cancer patients may experience significant distress at the time of treatment and many may experience persistent difficulties, although little research has examined their longer term psychosocial outcomes or supportive care needs. Materials and methods One hundred and fifty-four cancer survivors who were 1–11 years post diagnosis and disease-free and their partners completed mailed questionnaires. Main results A positive relationship was found between psychological distress and supportive care needs both within and between partner and survivor samples. Partners reported high levels of anxiety and supportive care needs, most frequently concerning relationships and the impact of the cancer illness. Partners within couples reported both shared and unique needs, although agreement on ratings of shared needs was low. Needs did not diminish over time although partners demonstrated psychological resilience and reported positive outcomes. Predictors of distress and unmet needs were explored: physical QOL, relationship satisfaction, and total needs contributed to variability in partners’ distress; relationship satisfaction and total needs were associated with survivors’ distress. Distress and relationship satisfaction were associated with partners’ unmet needs; only distress was associated with survivors’ unmet needs. Conclusions Partners are not merely providers of support, but need support themselves many years after a cancer diagnosis and in the context of apparently cured disease. The quality of the dyadic relationship may be critical in determining both partner and survivor distress and needs, and may prove a useful target for psychosocial interventions.     

Quality of life and most prevalent unmet needs of Chinese breast cancer survivors at one year after cancer treatment

PurposeThis study aims to examine the supportive care needs of Chinese breast cancer survivors, and investigate the relationships with participant characteristics and quality of life.MethodsA total of 163 participants were recruited from a local public hospital and completed a self-administered questionnaire: the 34-item Supportive Care Needs Survey, the supplementary module of access to healthcare and ancillary support services, and the Functional Assessment of Cancer Therapy.ResultsThe five most commonly reported unmet needs were all in the health system information domain (range: 55–63%), and the majority (84%) reported at least one unmet need in relation to information on healthcare. Stepwise multivariable regression analyses revealed that the time spent on travelling from home to hospital, receiving hormonal therapy, and physical and psychological unmet needs were independently associated with poorer quality of life among the participants.ConclusionsBreast cancer survivors perceive various unmet needs, and health system information is the most common one. Those who have more unmet needs in the physical and psychological domains were more likely to perceive a poorer quality of life.     

The contribution of wellness centres to cancer care: Patient and carer perspectives

BackgroundDedicated centres providing information and support to cancer patients and carers have recently been established in some Australian cancer centres.AimThe purpose of this research was to identify the preferences of patients and carers in relation to the environment and activities offered in a wellness centre in a regional community.MethodsA survey of current and previous patients and carers was conducted at a wellness centre in a regional area.FindingsA total of 188 people responded to the survey. The wellness centre’s environment was important to respondents, with features such as comfortable chairs, lounge and kitchen areas and the availability of hot drinks each receiving mean scores of more than 8.3 out of 10. Most respondents reported that they would be likely to read newspapers, magazines and information about cancer (mean scores greater than 7.2) and attend information sessions on topics, such as staying well with cancer and nutrition (mean scores greater than 6.5). Most preferred to visit the wellness centre around the time of an appointment (51.1%). The main barriers to visiting were parking (71.5%) and feeling unwell (35.8%). Approximately one quarter of participants reported they did not wish to attend to the wellness centre for an activity or support.DiscussionPatients and carers valued the relaxing environment of the wellness centre and more ‘traditional’ forms of supportive care, such as information sessions, rather than group activities. The wellness centre was important to carers as well as patients.ConclusionThis study outlines the preferences of regional cancer patients and their carers and could inform establishment of wellness centres in other health settings.     

肺癌病人的疼痛评估与护理

目的:减轻肺癌病人的疼痛程度,提高病人的生活质量。方法:运用自行设计问卷进行调查,并用数字分级法进行疼痛评估。结果:肺癌病人经历着不同程度的疼痛,疼痛时会对病人造成不良的影响。肺癌病人疼痛时对护理的需求是多方面的。结论:加强肺癌病人的疼痛护理,可有效减轻病人的疼痛,提高病人的生活质量。     

胃肠道肿瘤患者支持性照顾需求的现状及影响因素分析

目的:调查胃肠道肿瘤患者支持性照顾需求现状,并探究其影响因素.方法:采用一般资料调查表、支持性照顾需求量表对120例胃肠道肿瘤患者进行调查.结果:胃肠道肿瘤患者的支持性照顾需求得分为(96.05±27.98)分,条目总均分为(2.90±0.82)分.多元线性回归分析显示,文化程度、家庭人均月收入及年龄是影响胃肠道肿瘤患...     

Current practice and knowledge of oral care for cancer patients: a survey of supportive health care providers

Background The Oral Care Study Section of the Multinational Association of Supportive Care in Cancer (MASCC) and the International Society for Oral Oncology (ISOO) conducted a survey on clinical practices of oral/dental management of cancer patients among supportive health care providers. The main purpose was to evaluate the knowledge and current practice for preventing and managing oral side effects associated with intensive chemotherapy (ICT), hematopoietic cell transplant (HCT), and radiation therapy to the head and neck (H&N RT).Materials and methods A questionnaire designed and pretested was sent to 212 MASCC/ISOO members around the world with different dental and medical backgrounds.Main results Seventy-four individuals (35%) responded. The majority of respondents were aware of possible oral complications and provided patients with clinical strategies and recommendations although there was considerable variability among the respondents. Approximately 75% stated that patients were referred for oral/dental care prior to H&N RT and ICT including HCT. However, integrated dental and medical services were reported available in only about 25% of the institutions, and most patients were referred to community-based dental professionals.Main conclusions The survey represents a first review of current, international oral care practices. It suggests a need to develop evidence-based clinical guidelines to support effective oral/dental interventions and management strategies for this population. Furthermore, strategies for implementation of oral care protocols and better integration of dental and medical services should be developed. Caution in interpreting these findings is urged due to the limited response rate.For the Oral Care Study Section of the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology. Chairs: Dr. Fred K. L. Spijkervet and Dr. Philip C. Fox.     

个体化护理对肺癌患者化疗后疲乏及生活质量的影响

目的：探讨个体化护理对肺癌患者化疗后疲乏及生活质量的影响。方法选择2012年8月—2013年11月某院收治的肺癌化疗患者80例,采用简单随机抽样法分为观察组和对照组各40例,对照组给予常规护理,观察组在常规护理的基础之上,给予个体化护理干预。采用简易疲乏量表( BFI)、匹兹堡睡眠质量指数量表(PSQI)、生活质量核心量表(EORCT QLQ-C30)评价干预前后两组患者疲乏、睡眠情况及生活质量。结果干预前,两组患者的BFI、PSQI、EORCT QLQ-C30评分差异无统计学意义(P>0.05)。经过6周的护理干预,观察组中、重度疲乏患者12例,对照组20例,两组比较差异有统计学意义(Z=1.859,P<0.05);观察组PSQI评分>7分患者11例,对照组21例,两组比较差异有统计学意义(χ2=5.208,P<0.05);观察组患者EORCT QLQ-C30整体生活质量评分(17.6±5.6)分,对照组为(12.6±4.8)分,两组比较差异有统计学意义(t=4.287,P<0.01)。结论个体化护理作为一种全方位的护理,可以最大限度解决患者疲乏,改善睡眠情况,提高其生活质量。     

Significant others’ lived experiences following a lung cancer trajectory - From diagnosis through and after the death of a family member

Purpose

The purpose of this study was to illuminate the meanings of significant others’ lived experiences of their situation from diagnosis through and after the death of a family member as a consequence of inoperable lung cancer.

Methods

The data was collected through narrative interviews from eleven significant others and interpreted using a phenomenological hermeneutic approach.

Keyresults

Four themes emerged: being unbalanced, being transitional, being cared for, and moving forward.

Conclusion

The significant others’ experiences can be viewed as a transition process, beginning with a sense of dislocation in life and continuing through struggling, enduring and conquering the consequences of the altered life situation until finally approaching a point characterized by a sense of stability. Different strategies of adjustment and adaptation to the new living conditions are considered. Furthermore, the results indicate the need to develop a framework for family-centered health care in order to enhance the wellbeing for the significant others both in the anticipatory grief phase and during the bereavement phase.     

The Initial Health Assessment: an intervention to identify the supportive care needs of cancer patients

Background The first step in effective supportive care delivery is an assessment of patient needs. The Initial Health Assessment Form (IHA) was developed to aid clinicians in recognition and documentation of a patient's supportive care needs during their first visit to a comprehensive cancer centre. The purpose of this study was to determine the relative effectiveness of this instrument as compared to routine practice.Methods A before-after study was performed. Charts of consecutive patients with newly diagnosed cancer attending the Hamilton Regional Cancer Centre were selected randomly. Each chart was reviewed to determine the documentation at the initial patient assessment of 22 supportive care items under eight domains of need: physical, psychological, daily living, social, financial, informational, special needs and personal resources. The pre-intervention evaluation (T1) occurred over a 3-month period followed by the introduction of the IHA into clinical practice. Three months after its introduction, the post-intervention (T2) evaluation took place over the ensuing 3 months.Results A total of 306 charts were evaluated (153 each in T1 and T2). Patients from the two time periods were comparable with respect to background demographic variables. Introduction of the IHA increased the mean documentation of supportive care needs and resources from 26% in T1 to 49% in T2 (p=0.001). Significant improvements were found in all domains of need. Despite improvements, documentation of assessment continued to remain low for daily living, social, financial, and informational needs.Conclusions The IHA improved documentation of supportive care needs and resources. There is still room for improvement.Source of financial support: Ontario Ministry of Health and Long-Term Care, Health Systems Linked Research Unit Grant.     

Supportive care in lung cancer

OBJECTIVES: To discuss common lung cancer symptoms including prevalence, assessment, etiology, and recommended interventions. DATA SOURCES: Research studies and systematic reviews. CONCLUSION: A mandate in care of persons with lung cancer is to deliver supportive care concurrently with life-prolonging care or as the main focus of care. Most are diagnosed with advanced disease that impairs health with both physical and psychological symptoms. IMPLICATIONS FOR NURSING PRACTICE: Early assessment and comprehensive management of symptoms are main components of improving quality of life and functional status for those living with lung cancer.     

实施人文关怀对减轻肺癌患者诊断过程中心理应激的效果研究

目的 探讨实施人文关怀护理对缓解肺癌患者诊断过程中心理应激状态的效果.方法 将40例疑诊肺癌需住院确诊患者按照入院先后顺序分为实验组和对照组各20例.对照组患者入院后接受常规的治疗和护理,实验组在此基础上接受人文关怀的护理干预.采用心理行为评定量表分别对入院时和确诊后2 d内2组患者的焦虑和抑郁状况进行测试评分,并与国内常模进行比较,采用t检验.结果 入院时2组患者总体焦虑、抑郁评分均显著高于常模,但入院时2组间焦虑、抑郁评分比较差异不明显.确诊后2 d内实验组患者的焦虑、抑郁评分均显著低于对照组.结论 肺癌患者诊断过程中存在明显的焦虑抑郁心理,实施人文关怀护理可以有效减轻患者的心理应激反应.     

青年人肺癌的CT诊断

30例青年人肺癌中10例伴有胸水,CT扫描10例均显示了胸水和癌性病灶,而常规X线胸片一半只显示了胸水。此外,对隐蔽部位或小的癌灶,CT的诊断可靠性亦优于常规胸片。本组中29例(90％)都经CT检查而获确诊。选择性支气管动脉造影能清楚显示肿瘤的异常血管,对伴有胸水的肺癌亦可作出正确诊断。