Do cancer patients' psychosocial outcomes and perceptions of quality of care vary across radiation oncology treatment centres?

This study aimed to explore whether rates of depression, and anxiety and patient views about quality of patient-centred care varied across four metropolitan radiation therapy treatment centres in Sydney, Australia. Participants were radiation therapy outpatients, aged 18 or older and English-speaking. Participants completed a brief survey by touch screen computer while waiting for their radiation therapy treatment appointment. For eight indicators of patient-centred care, participants were asked to indicate whether their well-being would have been improved by better care related to the indicator. Participants also completed the Hospital Anxiety and Depression Scale. No differences between treatment centres were found for rates of anxiety and depression, or for the mean number of domains of care endorsed as needing improvement (indicated by agreeing or strongly agreeing that their well-being would have been improved by better care). The lack of variance in these outcomes may reflect that variation in treatment centre characteristics does not influence psychosocial outcomes and patient views of their care. Alternatively, it may suggest that the characteristics of the four treatment centres which participated in the present study were too similar for differences in patient outcomes to be observed.     

Patient and physician reports of the information provided about illness and treatment: what matters for patients' adaptation to cancer during treatment?

Objective: The aim of this study was to examine (a) whether illness representations mediate the relation of the amount of information provided by physicians to patients' adaptation to illness; (b) whether patient–physician agreement on the information provided impacts the aforementioned relationship. The study focused on information that, according to the Common Sense Self‐Regulation Model, is essential for adaptation to illness. Methods: The sample consisted of 93 patients undergoing chemotherapy and their physicians. Indirect (mediation) effects and conditional (moderated) indirect effects were examined using bootstrapping. Results: The more illness and treatment‐related information was provided by physicians, the more positive illness representations (specifically, illness consequences, emotional representations, and personal control) were reported by patients. In turn, these illness representations were related to better physical functioning and better adjustment to cancer. The degree of the patient–physician agreement on the information provided did not affect this relationship. Conclusions: What seems to be more crucial for patients' adaptation to cancer during treatment is the amount of information provided by physicians rather than their agreement with patients on the information provided. Also, there is a need to thoroughly examine the pathways through which information provision impacts adaptation to illness. Copyright © 2015 John Wiley & Sons, Ltd.     

Alleviating existential distress of cancer patients: can relational ethics guide clinicians?

LEUNG D. & ESPLEN M.J. (2008) European Journal of Cancer Care 19 , 30–38
Alleviating existential distress of cancer patients: can relational ethics guide clinicians? Most people have a heightened awareness of death at the moment they receive a cancer diagnosis. Medical treatment attempts to demystify and manage death, yet surprisingly, care that alleviates existential distress is the least provided psychosocial care. A review of empirical research [quantitative and qualitative studies (n = 85) and seven literature reviews] was conducted to explore the experiences of clinicians (primarily nurses) working with cancer patients who experience existential distress. This paper summarizes clinicians’ experiences with cancer patients who face the threat of mortality. Given that the majority of literature was found to be in nursing, emphasis in this paper tends to be on nurses’ experiences. However, findings are suggested to have implications for other clinicians who deal with similar concerns. A lens of relational ethics was inductively found to organize and highlight problems and gaps that originate from interpersonal concerns. This paper describes four themes requiring further research and education related to existential distress: engagement, embodiment, environment and mutual respect. Implications for oncology care are suggested at the micro‐, meso‐ and macro‐levels to encourage clinicians to ethically respond to patients’ existential distress needs.     

Iron supplementation in nephrology and oncology: what do we have in common?

Anemia is frequently seen in patients with chronic kidney disease and also in those with cancer. There are factors in the pathogenesis of anemia that are common to both clinical conditions, with iron insufficiency, inflammation, and upregulation of hepcidin activity playing a part in both chronic disease states. Diagnostic laboratory markers for detecting functional iron deficiency in renal disease and oncology are not ideal, and the most widely available tests, such as serum ferritin and transferrin saturation, have poor sensitivity and specificity. Other tests incorporating a surrogate for iron sufficiency in the RBC and reticulocyte (such as percentage hypochromic RBCs or reticulocyte hemoglobin content) have greater sensitivity/specificity, but unfortunately these tests are not widely available in many hospital laboratories. Iron supplementation may be given via the oral route, i.m., or i.v., but it is now clear that, in both the nephrology and oncology settings, i.v. iron is superior to oral iron in terms of efficacy. Oral iron is associated with a high incidence of gastrointestinal side effects, and although large epidemiological studies of i.v. iron are reassuring, the long-term safety of parenteral iron is not established in well-designed adequately powered randomized controlled trials.     

Empirically supported treatments: will this movement in the field of psychology impact the practice of psychosocial oncology?

This article discusses the likelihood of the empirically supported treatment (EST) movement impacting the practice of psychosocial oncology, with the goal of raising awareness of these issues and encouraging debate within the psychosocial oncology research and practice community. In 1993, the American Psychological Association struck a task force to develop criteria for empirically evaluating psychological interventions. The Clinical Psychology (Division 12) Task Force now evaluates psychological interventions and publishes an updated list of ESTs on a yearly basis. Concerns raised about the EST movement in psychology have included difficulties with the terminology and process of the Task Force, problems with the methodology used in psychotherapy research, and with the possible practical implications of the Task Force list of EST. A review of the literature suggests that psychosocial interventions in oncology are currently beginning to be evaluated by the EST criteria and that the reviewed interventions have yet to attain EST status. Following from this review, it is argued that researchers and practitioners in psychosocial oncology should become aware of the standards established by the Division 12 Task Force and that future psycho-oncology intervention research may need to be designed to meet those standards. The discipline of psychosocial oncology is encouraged to consider the possible implications of accepting or not accepting the EST criteria.     

Patient decision aids for prevention and treatment of cancer diseases: are they really personalised tools?

This article provides an analysis of cancer decision aids (DAs), instruments developed to support oncologic patients facing tough screening or treatment decisions, with a particular attention to their level of personalisation. As discussed in our previous works, we argue that the personalisation of medicine should regard not only the genetic and clinical aspects of diseases but also the different cognitive, psychological and social factors involved in clinical choices. According to this vision, we analysed the existing randomised controlled studies on cancer DAs concluding that only few of them take into account individual variables such as cultural level, individual risk attitudes, personal beliefs, and emotional state that are crucial to determine people's reactions and health‐related choices. For these reasons, although quality standards have been published for these interventions, we suggest the need for further research in order to make these instruments more efficient in transforming and improving the actual clinical practice, improving patient empowerment and participation in health‐related decisions.     

Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism? A cytokine-immunologic model of cancer symptoms

BACKGROUND: Cancers and cancer treatments produce multiple symptoms that collectively cause a symptom burden for patients. These symptoms include pain, wasting, fatigue, cognitive impairment, anxiety, and depression, many of which co-occur. There is growing recognition that at least some of these symptoms may share common biologic mechanisms. METHODS: In November 2001, basic and clinical scientists met to consider evidence for a cytokine-immunologic model of symptom expression along with directions for future research. RESULTS: The characteristics of cytokine-induced sickness behavior in animal models have much in common with those of symptomatic cancer patients. Sickness behavior refers to a set of physiologic and behavioral responses observed in animals after the administration of infectious or inflammatory agents or certain proinflammatory cytokines. In some cases, these responses can be prevented by cytokine antagonists. A combination of animal and human research suggests that several cancer-related symptoms may involve the actions of proinflammatory cytokines. CONCLUSIONS: Based on the similarities between cancer symptoms and sickness behavior, the authors discussed approaches to further test the implications of the relationship between inflammatory cytokines and symptoms for both symptom treatment and symptom prevention.     

Use of radiomics in the radiation oncology setting: Where do we stand and what do we need?

Radiomics is a field that has been growing rapidly for the past ten years in medical imaging and more particularly in oncology where the primary objective is to contribute to personalised and predictive medicine. This short review aimed at providing some insights regarding the potential value of radiomics for cancer patients treated with radiotherapy. Radiomics may contribute to each stage of the patients’ management: diagnosis, planning, treatment monitoring and post-treatment follow-up (toxicity and response). However, its applicability in clinical routine is currently hindered by several factors, including lack of automation, standardisation and harmonisation. A major effort must be carried out to automate the workflow, standardise radiomics good practices and carry out large-scale studies before any transfer to daily clinical practice.     

Taxanes in paediatric oncology: and now?

Taxanes are a group of anticancer agents that target microtubules, promote their assembly, and stabilize them. The resulting effects are mitotic blockage and induction of apoptosis, whose mechanism of initiation remains to be fully determined. Among adults, taxanes are one of the most powerful and most commonly used anticancer drugs. They show a wide range of activity in malignancies such as breast, ovarian, and lung cancers. In paediatric oncology, pre-clinical and clinical data are quite limited. Six phase I studies, two phase II, and rare case reports have been published. This review will focus on the paediatric pre-clinical and clinical findings with taxanes. Based on data from the literature, we will try to explain the results and foresee the possible use of taxanes in paediatric oncology. Indeed, three main advances have been made regarding taxanes: (1) Increased efficacy when used in multidrug-based chemotherapy regimen. (2) New administration schedules based on anti-angiogenic properties when given at daily very low doses. (3) Development of new taxanes with decreased recognition by Pgp, the product of the MDR1 gene. Thus, although the initial experience with taxanes in paediatric oncology has been disappointing, it may be too early to leave out taxanes and we should further investigate their use among children with cancer.     

Modulation of the blood-brain barrier in oncology: therapeutic opportunities for the treatment of brain tumours?

Systemically administered chemotherapy is not very effective in the treatment of primary or metastatic brain tumours. An important reason for this low efficacy is insufficient drug delivery to the tumour site due to the presence of the blood-brain barrier (BBB). In this review, we give an overview of strategies that were tested to bypass the BBB or to increase its permeability for anticancer drugs. Local drug administration through intracerebral implants offers only little benefit to patients with brain tumours, probably due to the limited diffusion of the drugs in brain tissue. Temporary disruption of the BBB can be achieved with intracarotid infusions of hypertonic mannitol. This method has been used with some success; however, toxic side effects and the high complexity of the surgical procedure limit its usefulness. More recently, the use of the bradykinin agonist cereport was shown to be useful in preclinical studies, but unfortunately clinical studies did not show improved efficacy. Since P-glycoprotein in the BBB restricts the brain entry of many anticancer drugs, inhibition of this drug transporter may be an option for improved drug delivery to brain tumours. Pre-clinical studies have shown the feasibility to enhance the penetration of paclitaxel into the brain by co-administration with a potent P-glycoprotein inhibitor and further clinical research is warranted.     

Ostomies in rectal cancer patients: what is their psychosocial impact?

The resection of a low‐lying rectal cancer can lead to the creation of an ostomy to discharge fecal material. In view of this reconfiguration of anatomy and life‐changing modification of daily bodily functions, it is not surprising that a rapidly growing literature has examined ostomy patients' psychosocial challenges. The current study was designed (1) to systematically review the published literature on these psychosocial challenges and (2) to explore, in a single‐institution setting, whether medical oncologists appear to acknowledge the existence of an ostomy during their post‐operative evaluations of rectal cancer patients. This systematic review identified that social isolation, sleep deprivation; financial concerns; sexual inhibition; and other such issues are common among patients. Surprisingly, however, in our review of 66 consecutive rectal cancer patients, in 17%, the ostomy was not mentioned at all in the medical record during the first medical oncology visit; and, in one patient, it was never mentioned at all during months of adjuvant chemotherapy. Even in the setting of ostomy complications, the ostomy was not always mentioned. This study underscores the major psychosocial issues cancer patients confront after an ostomy and suggests that healthcare providers of all disciplines should work to remain sensitive to such issues.