Physical activity interests and preferences in palliative cancer patients

Goals of the work

The purpose of the present study was to examine the physical activity interests and preferences of palliative cancer patients.

Patients and methods

Fifty advanced cancer patients aged 18 years or older with clinician-estimated life expectancy of less than 12 months and Palliative Performance Scale greater than 30% were recruited from an outpatient palliative care clinic and a palliative home care program. An interviewer-administered survey was used to assess physical activity behavior, interests, and preferences.

Main results

The majority of palliative cancer patients in this sample indicated that they would be interested and felt able to participate in a physical activity program. There were strong preferences for home-based physical activity programs that could be completed alone. The majority of participants in this sample reported walking as the type of physical activity in which they were most interested.

Conclusions

These findings suggest that this sample of palliative cancer patients is interested and feel able to participate in a physical activity program. Examining these unique physical activity preferences may aid in the development of an appropriate physical activity program for palliative cancer patients that can be tested in clinical research.     

Feasibility of a psychosocial and patient navigation intervention to improve access to treatment among underserved breast cancer patients

Purpose

Medically underserved women with recently diagnosed breast cancer face a number of significant obstacles that impact the timeliness and quality of their care. The Breast CARES (Cancer Advocacy, Resources Education and Support) intervention combined patient navigation with telephone counseling to guide newly diagnosed breast cancer patients in overcoming treatment barriers. The study aimed to learn more about the types of barriers encountered by the participants. The study also sought to understand the relationship between patient-reported barriers and patient-reported psychosocial distress in underserved women recently diagnosed with breast cancer.

Methods

Data were analyzed using a mixed-methods approach. Participants were assessed pre- and post-intervention. Psychosocial measures included cancer-related distress, depression, anxiety, social support, and quality of life. Case notes and responses to process evaluation questions were used to determine whether the CARES intervention adequately addressed the needs of the participants.

Results

The mean age of participants (N?=?20) was 54 years (SD?=?12.5), 40 % were Hispanic, 70 % were unemployed, 50 % were uninsured, and 20 % were mono-lingual in Spanish. Qualitative analysis revealed four categories of barriers: psychosocial, medical, logistical, and communication. Similarities and differences existed between the PN and TC regarding how barriers were addressed. Post-intervention psychosocial scores indicate a decrease in depression and cancer-related distress and an increase in social support. The participants reported that participation in the Breast CARES program helped them overcome financial barriers (73 %), transportation problems (60 %), and communication barriers with medical staff (73 %).

Conclusions

This study demonstrates the unique and complementary roles for PNs and TCs in overcoming barriers to treatment adherence faced by underserved breast cancer patients.     

Physical activity preferences of early-stage lung cancer survivors

Purpose

Engagement in physical activity can provide important benefits for cancer patients and survivors, including those diagnosed with lung cancer. Despite this, many survivors do not engage in recommended levels of physical activity and little is known about the obstacles encountered by lung cancer survivors. The current study examines the physical activity preferences of early-stage lung cancer survivors.

Method

As part of a larger survey study, 175 non-small cell lung cancer survivors who were on average 3.6 years from surgical treatment responded to questions regarding their preferences for physical activity and physical activity advice. Demographic and medical characteristics were also collected.

Results

The majority of respondents (62 %) reported a desire to receive advice regarding physical activity, predominantly before treatment (68 %), in face-to-face interactions (95 %) with a physician (80 %), and within the context of a cancer care center (92 %). Approximately half of participants indicated they would be interested in an exercise program tailored to lung cancer survivors and most individuals (73 %) reported feeling capable of engaging in an exercise program. Differences in physical activity preferences emerged based on demographic and disease characteristics.

Conclusions

The majority of participants reported a desire for physical activity advice and a willingness to engage in physical activity. Important differences were found based on demographic and medical characteristics, which may warrant consideration in the development and dissemination of physical activity interventions for this cancer survivor population.     

The Distress Thermometer in Spanish cancer patients: convergent validity and diagnostic accuracy

Purpose

International organizations such as National Comprehensive Cancer Network and NICE recommend implementation of routine screening programs for detecting and managing psychosocial distress among cancer patients. The selection of an adequate screening tool is crucial to the effectiveness of these programs. The present study examines the emotional symptomatology captured by the Distress Thermometer (DT) and its accuracy and validity as a screening tool in cancer. It also explores the possible discrepancy between patient distress and the use of psycho-oncology resources.

Methods

A heterogeneous sample of 962 adult cancer patients completed the DT, the Problem List (PL), the Brief Symptom Inventory-18 (BSI-18), and the Psychosocial Questionnaire.

Results

The DT was significantly correlated with BSI-18 symptoms and the emotional problems listed on the PL. Receiver Operating Characteristic analysis showed good diagnostic accuracy for the DT (area under the curve?=?.82, 95 %CI [.79–.85]). For a selected DT cutoff of 5, standard measures (sensitivity?=?90 %, specificity?=?64 %, predictive positive value?=?35 %, and negative predictive value?=?97 %) and Clinical Utility Indexes (utility index negative?=?.62 and utility index positive?=?.32) indicated that the DT was adequate for “screening” while it was limited for “case finding.” Finally, 81.30 % of patients with clinical distress had not sought or were not receiving professional psychosocial support at the time of the study.

Conclusion

The DT is appropriate for use as a rapid screening instrument for cancer patients in a Spanish population because it assesses a broad concept of distress including both anxiety and depression symptoms. The diagnostic accuracy of the DT could be improved with minor proposed modifications to the DT and the inclusion of nonemotional ultrashort measures.     

Exercise training in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy: a pilot study

Purpose

This pilot study aimed to investigate the feasibility of two different training programs in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy. Potential effects of training programs on the patients’ quality of life, physical performance, physical activity in daily living, and biological parameters were exploratorily evaluated.

Methods

Patients were randomly assigned to a resistance (RET) and aerobic exercise training group (AET). Both underwent supervised training sessions twice a week for 12 weeks. RET was performed at 60–80 % of the one-repetition maximum and consisted of 2–3 sets of 15–25 repetitions. The AET group performed endurance training at 60–80 % of their predetermined pulse rate (for 10 to 30 min).

Results

A total of 26 gastrointestinal cancer patients could be randomized. Twenty-one patients completed the 12 weeks of intervention. The median adherence rate to exercise training of all 26 patients was 65 %, while in patients who were able to complete 12 weeks, adherence was 75 %. The fatigue score of all patients decreased from 66 to 43 post-intervention. Sleeping duration increased in both groups and muscular strength increased in the RET group. A higher number of steps in daily living was associated with higher levels of physical and social functioning as well as lower scores for pain and fatigue.

Conclusion

RET and AET are feasible in gastrointestinal cancer patients undergoing palliative chemotherapy. Both training programs seem to improve cancer-related symptoms as well as the patient’s physical activities of daily living.     

Unmet needs in immigrant cancer survivors: a cross-sectional population-based study

Purpose

Social suffering, language difficulties, and cultural factors may all make the cancer experience more difficult for immigrants. This study aimed to document unmet needs, and variables associated with these, in a population-based sample of first-generation immigrants and Anglo-Australians who had survived cancer.

Methods

Participants were recruited via Australian cancer registries. Eligible cancer survivors had a new diagnosis 1–6 years earlier and were aged between 18 and 80 years at diagnosis. Eligible immigrant participants and parents were born in a country where Arabic, Chinese (Mandarin, Cantonese, and other dialects), or Greek is spoken, and they spoke one of these languages. A random sample of English-speaking Anglo-Australian-born controls was recruited.

Results

Five hundred ninety-six patients (277 immigrants) were recruited to the study (response rate, 26 %). Compared to Anglo-Australians, the adjusted odds ratio of Chinese immigrants for at least one unmet information/support need was 5.1 (95 % CI 3.1, 8.3) and for any unmet physical need was 3.1 (95 % CI 1.9, 5.1). For Greek, these were 2.0 (95 % CI 1.1, 4.0) and 2.7 (95 % CI 1.4, 5.2). Arabic patients had elevated, but not statistically significant, odds ratios compared to Anglo-Australians. Written information and having a specialist, support services, and other health professionals who spoke their language were in the top ten unmet needs amongst immigrants.

Conclusion

Immigrant cancer survivors, several years after initial diagnosis, are more likely to have an unmet need for information or for help with a physical problem than Anglo-Australians. They strongly desire information and support in their own language.     

Mental health-care utilization in survivors of childhood cancer and siblings: the Swiss childhood cancer survivor study

Purpose

We aimed to (1) describe the utilization of mental health-care in survivors and siblings, the association with severity of distress, and visits to other professionals in distressed survivors not utilizing mental health-care; and (2) identify factors associated with utilization of mental health-care in distressed survivors.

Methods

Within the Swiss Childhood Cancer Survivor Study, we sent postal questionnaires to all participants aged <16 years at diagnosis (1976–2003), who survived ≥5 years after diagnosis and were aged ≥16 years at study. Survivors and siblings could indicate if they utilized mental health-care in the past year. Psychological distress was assessed with the Brief Symptom Inventory-18 (BSI-18). Participants with scores T?≥?57 on two of three scales or the Global Severity Index were considered distressed.

Results

We included 1,602 survivors and 703 siblings. Overall, 160 (10 %) and 53 (8 %), utilized mental health-care and 203 (14 %) and 127 (14 %) were considered distressed. Among these, 69 (34 %) survivors and 20 (24 %) siblings had utilized mental health-care. Participants with higher distress were more likely to utilize mental health-care. Distressed survivors not utilizing mental health-care were more likely to see a medical specialist than nondistressed. In the multivariable regression, factors associated with utilizing mental health-care were higher psychological distress and reporting late effects.

Conclusions

Our results underline the importance of developing interventional programs and implementing psychological screening in follow-up of survivors. It is also important to systematically address siblings' needs. In follow-up, patients at risk should be informed about existing possibilities or advised to visit mental health professionals.     

Thromboprophylaxis for lung cancer patients—multimodality assessment of clinician practices,perceptions and decision support tools

Purpose

The purpose of this study was to report the opinions and self-reported practices of clinicians, as well as the availability of decision support tools, regarding appropriate thromboprophylaxis for patients with lung cancer to identify variation in practice and/or divergence from evidence-based clinical practice guidelines (CPG).

Methods

A computer-generated survey (SurveyMonkey software) was distributed to surgical, radiation and medical oncologists with lung cancer specialisation, via membership of the Australian Lung Cancer Trials Group (ALTG) from May to September 2013.

Results

Seventy-two clinicians, from public, private, specialist and general hospitals, completed the survey (46 % response rate). Hospital-endorsed CPG were widely available (91 %); however, these routinely lacked robust recommendations for the ambulatory care setting (98 %) and risk stratification tools (65 %). Clinicians consistently identified ambulatory care treatment modalities (chemotherapy, alone or in combination with radiotherapy) as having similar (high) thrombotic risk as surgery. Timing and duration of pharmacological thromboprophylaxis prescribing among surgical oncologists varied and were divergent from guideline recommendations. Fifty-eight percent of surveyed clinicians cited a lack of high-quality data to guide preventative strategies in lung cancer patients.

Conclusion

Clinicians consistently identified patients with lung cancer as having a high thromboembolic risk in both ambulatory and surgical settings, but with differences in recommendations and variation in practice. CPG lacked robust recommendations for the ambulatory care setting, the main arena for the multimodality lung cancer treatment paradigm.     

Comparison of physical and mental health status between cancer survivors and the general population: a Korean population-based survey (KNHANES II-IV)

Purpose

To compare the physical and mental health status of the general population with that of cancer survivors in South Korea.

Methods

We analyzed 19,035 subjects (age ≥40 years), who participated in the 2001–2009 Korea National Health and Nutrition Examination Survey II–IV. We compared metabolic syndrome components, health behaviors, and mental health outcomes between cancer survivors and non-cancer controls.

Results

Cancer survivors accounted for 1.68 % (n?=?316) of total population. Cancer survivors did not show low occurrence of hypertension and diabetes compared to the control group. Both cancer survivors and the general population had high risks of physical inactivity (75.4 % and 75.5 %, respectively) and inadequate sleep (52.5 % and 60.7 %, respectively). In the unadjusted model, depression was more common in cancer survivors (odds ratio [OR], 1.61; 95 % CI, 1.22–2.74), so was suicidal ideation (OR, 1.51; 95 % CI, 0.16–1.96) than non-cancer controls. After adjustment for attributable socioeconomic factors, the elevated adjusted odds ratios (aORs) among cancer survivors were reduced by 23 % in depression and 45 % in suicidal thought. Cancer survivors at <5 years from diagnosis showed a high occurrence of depression (aOR, 1.77; 95 % CI, 1.09–2.85) while the magnitude of aOR decreases after ≥5 years from cancer diagnosis (aOR, 1.38; 95 % confidence interval, 0.97–1.98, respectively).

Conclusions

The physical and mental health of South Korean cancer survivors was not optimal. Their control rates of modifiable risk factors were similar or even lower than those for the non-cancer groups. Depression was highly prevalent in cancer survivors which can be ascribed, at least in part, to socioeconomic environment. A better-targeted intervention to improve the health of this population may be needed.     

Survival of metastatic colorectal cancer patients treated with chemotherapy in Alberta (1995–2004)

Goals of work

Clinical trials have suggested that advances in chemotherapy significantly improve the survival of patients with metastatic colorectal cancer. Comparable evidence from clinical practice is scarce. This study aims to investigate the survival of patients with metastatic colorectal cancer treated with chemotherapy in Alberta, Canada.

Patients and methods

Trends of relative survival of patients diagnosed in 1994–2003 were assessed using Alberta Cancer Registry (ACR) data. The median overall survival (OS) of patients diagnosed in 2004 was determined by linking Cancer Registry data with Electronic Medical Records (EMR). Cox regression models were fitted to calculate the hazard ratio for patients treated with chemotherapy.

Results

The 2-year relative survival for patients with metastatic colorectal cancer who received chemotherapy increased significantly from 29% to 41% over the 10 years (1994–2003, p?<?0.015). A 69% reduction in the risk of mortality was observed in the 168 patients who received chemotherapy compared to the 87 patients who did not, after adjusting for age, gender, and number of metastases. The median OS of patients who received chemotherapy was 17.5 months. This is comparable to the 18–20 months seen in recently published clinical trials, considering the patients in this study were from the real clinical practice, nearly half of them were older than 70, and many of them might have important co-morbidities.

Conclusions

The survival of patients diagnosed with metastatic colorectal cancer in Alberta has improved in recent years; this is most likely attributable in large part to the use of chemotherapy.     

Validation of four prognostic scores in patients with cancer admitted to Brazilian intensive care units: results from a prospective multicenter study

Objective

The aim of the present study was to validate the Simplified Acute Physiology Score II (SAPS II) and 3 (SAPS 3), the Mortality Probability Models III (MPM₀-III), and the Cancer Mortality Model (CMM) in patients with cancer admitted to several intensive care units (ICU).

Design

Prospective multicenter cohort study.

Setting

Twenty-eight ICUs in Brazil.

Patients

Seven hundred and seventeen consecutive patients (solid tumors 93%; hematological malignancies 7%) included over a 2-month period.

Interventions

None.

Measurements and main results

Discrimination was assessed by area under receiver operating characteristic (AROC) curves and calibration by Hosmer–Lemeshow goodness-of-fit test. The main reasons for ICU admission were postoperative care (57%), sepsis (15%) and respiratory failure (10%). The ICU and hospital mortality rates were 21 and 30%, respectively. When all 717 patients were evaluated, discrimination was superior for both SAPS II (AROC = 0.84) and SAPS 3 (AROC = 0.84) scores compared to CMM (AROC = 0.79) and MPM₀-III (AROC = 0.71) scores (P < 0.05 in all comparisons). Calibration was better using CMM and the customized equation of SAPS 3 score for South American countries (CSA). MPM₀-III, SAPS II and standard SAPS 3 scores underestimated mortality (standardized mortality ratio, SMR > 1), while CMM tended to overestimation (SMR = 0.48). However, using the SAPS 3 for CSA resulted in more precise estimations of the probability of death [SMR = 1.02 (95% confidence interval = 0.87–1.19)]. Similar results were observed when scheduled surgical patients were excluded.

Conclusions

In this multicenter study, the customized equation of SAPS 3 score for CSA was found to be accurate in predicting outcomes in cancer patients requiring ICU admission.     

Smoking status,service use and associated factors among Japanese cancer survivors—a web-based survey

Purpose

This study aims to investigate smoking status and its associated factors among Japanese cancer survivors. We stretched our focus on association with health-related behaviors other than smoking (alcohol intake, physical exercise, and social activity) and the smoking cessation strategies used by cancer survivors.

Methods

An anonymous cross-sectional web-based survey was conducted, enrolling survivors of various types of cancer up to 10 years after diagnosis. Smoking status, socioeconomic status, health-related behaviors other than smoking, and smoking cessation resource that the participants used were evaluated. Factors associated with continuous smoking after cancer diagnosis were explored using multivariate analysis.

Results

Among 168 participants who were smoking at the time of cancer diagnosis, 96 participants (57.1 %) continued smoking. Sixty-seven survivors (69.8 %) were willing to reduce or quit smoking, however, only 39 survivors (40.6 %) were provided with counseling or intervention on smoking cessation. Male gender, shorter time after cancer diagnosis, and lack of regular physical exercise associated with continuous smoking. Higher level of fear of cancer recurrence had trend-level significance of association with smoking cessation.

Conclusions

Substantial proportions of Japanese cancer survivors continue smoking after diagnosis of cancer. The majority of them are not provided with relevant information or support, despite their willingness of reducing or quitting smoking. Smoking cessation is associated with other health behaviors (i.e., physical exercise). This suggests considerable missed opportunities for health-care providers to provide cancer survivors with counseling and evidence-based interventions. Promotion of professional support on smoking cessation and education to encourage healthy behaviors are needed.     

Chronicles of informal caregiving in cancer: using ‘The Cancer Family Caregiving Experience’ model as an explanatory framework

Background

Cancer caregiving has emerged as a dominant focus of research in recent years. A striking feature of this vast amount of literature is that it is static, examining certain points of the cancer trajectory, mostly the diagnosis and palliative care. Only The Cancer Caregiving Experience Model conceptualised the caregiving experience and explored the conceptual implications of cancer family caregiving research.

Aim

The data from this paper aim to empirically support the Cancer Caregiving Experience model, by exploring the cancer caregiving experience longitudinally.

Methods

Semi-structured interviews with 53 caregivers were carried out at patient’s diagnosis (T1), 3 months (T2), 6 months (T3) and 12 months (T4) post diagnosis.

Results

Analysis of 139 interviews generated four themes that reflected a complex and dynamic process. The themes that mapped those of the model were “Primary stressors”, “Secondary stressors”, “Appraisal”, “Cognitive-Behavioural responses” and “Health and Well Being”.

Conclusions

The study adds empirical support to The Cancer Caregiving Experience Model and confirms that different primary and secondary stressors influence how the caregivers perceive the caregiving demands, the coping mechanisms they employ and their health and well being during the cancer trajectory. Access to support services should be offered to all the caregivers from as early as the diagnosis period and take into account their specific needs.     

Assessing information and service needs of young adults with cancer at a single institution: the importance of information on cancer diagnosis, fertility preservation, diet, and exercise

Background

Young adults (YA) with cancer have unique psychosocial and medical needs. The objective of this study was to identify information and service needs important to YA cancer patients.

Methods

A supportive care needs survey was administered to ambulatory patients (<age 35 years) who were within 5 years of completing therapy at an adult hospital. Participants were asked to rate the importance of 18 sources of information or resources on a scale from 1 to 10. The relationship between gender, type of cancer, current treatment status, and marital status on the importance of these factors was explored using ANOVA.

Results

Median age of 243 respondents was 28 years (range 17–35); 61 % male. The most common diagnoses were: lymphoma (28 %), leukemia (19 %), testis (16 %), CNS (9.5 %), and sarcoma (8.6 %). Forty percent were currently receiving treatment; the majority were single/never married (67 %). Thirty-eight percent of respondents felt it was important or very important to receive care in a dedicated unit with other young people. More than 80 % rated the following items at least 8/10 in importance: information on their specific malignancy (treatment, risk of recurrence), effects of treatment on fertility, information on maintaining a healthy diet, and exercise/physical fitness during cancer treatment. Women were more likely to consider information/service needs more important than men.

Conclusions

YA’s have clear supportive care preferences and needs. Developing programs that incorporate the services identified as important should improve quality of life, psychosocial adjustment, and other outcomes during and after cancer therapy.     

Longitudinal prospective assessment of sleep quality: before, during, and after adjuvant chemotherapy for breast cancer

Purpose

Cross-sectional data suggest that many individuals with breast cancer experience significant sleep disturbance across the continuum of care. Understanding the longitudinal trajectory of sleep disturbance may help identify factors associated with its onset, severity, or influence on health-related quality of life (HRQL). Study objectives were to observe sleep quality in breast cancer patients prior to, during, and after completion of adjuvant chemotherapy, evaluate its relationship with HRQL and explore correlates over time.

Methods

Participants were administered patient-reported outcome measures including the Pittsburgh Sleep Quality Index (PSQI) and the Functional Assessment of Cancer Therapy—General (FACT-G), which assesses HRQL. Data were collected prospectively 3–14 days prior to beginning chemotherapy, cycle 4 day 1 of chemotherapy, and 6 months following initiation of chemotherapy.

Results

Participants (n?=?80) were primarily women (97.5 %) with stage II (69.0 %) breast cancer. Total FACT-G scores were negatively correlated with global PSQI scores at each time point (rho?=??0.46, ?0.41, ?0.45; all p?<?0.001). Poor sleep quality (PSQI ≥ 5) was prevalent at all time points (48.5–65.8 %); however, there were no significant changes within participants over time. Correlates with sleep quality varied across time points. Participants with poor sleep quality reported worse overall HRQL, fatigue, depression, and vasomotor/endocrine symptoms.

Conclusions

These findings suggest that early identification of sleep disturbance and ongoing assessment and treatment of contributing factors over the course of care may minimize symptom burden associated with chemotherapy and prevent chronic insomnia in survivorship.     

Does perceived control predict Complementary and Alternative Medicine (CAM) use among patients with lung cancer? A cross-sectional survey

Purpose

Scant literature exists on the use of complementary and alternative medicine (CAM) among patients with lung cancer. Preliminary data indicates that perceived control is an important factor leading patients to CAM. This study aimed to evaluate the relationship between perceived control and CAM use in patients with lung cancer.

Methods

We performed a cross-sectional survey in patients with lung cancer under active treatment and follow-up at the oncology clinic of an academic medical center. Self-reported CAM use was the primary outcome. Multivariate logistic regression was performed to determine the relationship between perceived control and CAM use, controlling for other factors.

Results

Among 296 participants, 54.4 % were female, 83.5 % were Caucasian, 57.6 % were ≤65 years old, 52.4 % were in stage IV, and 86.4 % had non-small cell lung cancer; 50.9 % of patients had used CAM, most commonly vitamins (31.5 %), herbs (19.3 %), relaxation techniques (16 %), and special diets (15.7 %). In multivariate analysis, CAM use was associated with having greater perceived control over the cause of cancer (adjusted odds ratio (AOR) 2.27, 95 % confidence interval (CI) 1.35–3.80), age?≤?65 (AOR 1.64, 95 % CI 1.01–2.67), higher education (AOR 2.17, 95 % CI 1.29–3.64), and never having smoked tobacco (AOR 2.39, 95 % CI 1.25–4.54). Nearly 60 % of patients who used CAM were receiving active treatment.

Conclusion

Over half of lung cancer patients have used CAM since diagnosis. Greater perceived control over the cause of cancer was associated with CAM use. Given the high prevalence of CAM, it is essential that oncologists caring for patients with lung cancer discuss its use.     

Prevalence of anxiety and depression and their risk factors in Chinese cancer patients

Purpose

This paper aimed to obtain information on the levels of anxiety and depression among cancer patients in China. The factors influencing these psychological problems were also analyzed.

Methods

A total of 1,217 cancer patients were interviewed, and each participant was asked to complete a self-administered questionnaire. The anxiety status, depression status, disease stage, tumor site, pain status, and performance status of the patients during the week prior to the interview were assessed.

Results

The anxiety and depression prevalence rates were 6.49 and 66.72 %, respectively. The prevalence rates of depression were 60.62 % for head and neck cancer, 77.19 % for lung cancer, 57.9 % for breast cancer, 75.81 % for esophagus cancer, 63.40 % for stomach cancer, 68.42 % for liver cancer, 54.37 % for colorectal cancer, and 71.13 % for cervix cancer. The factors influencing depression of patients were performance status (P?<?0.0001), pain (P?=?0.0003), age (P?<?0.0001), and education level (P?<?0.0001). The risk factors of anxiety were performance status (P?=?0.0007), age (P?<?0.0001), and gender (P?<?0.0001).

Conclusions

Depression was a more important psychological problem than anxiety in cancer patients. Compared with 3.8 % of the prevalence of depression in normal population, depression level was high among Chinese cancer patients. Patients with lung, esophagus, and cervix cancers were the high-risk groups for depression. Poor performance status, pain, old age, and low-level education were the predicting factors for depression.     

The symptom burden of non-small cell lung cancer in the USA: a real-world cross-sectional study

Purpose

Disease symptom management in patients with advanced non-small cell lung cancer (NSCLC) is a critical aspect of therapy. The main objective of our study was to assess patient-reported outcomes and the degree of concordance between physician and patient perceptions of symptom severity in advanced NSCLC in the USA.

Methods

Patients with advanced (stage IIIB/IV) NSCLC (N?=?450) were recruited in a nationwide (USA) lung cancer study. Patients and their oncologists completed patient and physician versions of the Lung Cancer Symptom Scale (LCSS). Patient-reported lung cancer-specific quality of life was assessed with the Functional Assessment of Cancer Therapy—Lung (FACT-L). Concordance was assessed using the kappa-statistic. Regression analysis was performed with FACT-L total score as the dependent variable and patient-reported LCSS symptom scores as predictors.

Results

A high proportion of patients experienced lung cancer symptoms: fatigue (100 %), loss of appetite (97 %), shortness of breath (95 %), cough (93 %), pain (92 %), and blood in sputum (63 %). Concordance between physician and patients was lowest for loss of appetite (kappa 0.1701) and greatest for hemoptysis (kappa 0.4586). Loss of appetite (β?=??0.204; p?<?0.001), cough (β?=??0.145; p?<?0.01), pain (β?=??0.265; p?<?0.001), and shortness of breath (β?=??0.145; p?<?0.01) were found to be significant predictors of the quality of life.

Conclusions

Symptom burden in patients with advanced NSCLC is high and has a negative impact on the quality of life. Patient-reported outcomes data could help optimize disease outcomes and therapy management in NSCLC.     

Home parenteral nutrition improves quality of life and nutritional status in patients with cancer: a French observational multicentre study

Purpose

Malnutrition is a predictor of poor outcomes in patients with cancer. Little is known about the benefit of nutritional support in these patients. The purpose of this study was to assess the impact of home parenteral nutrition (HPN) on quality of life (Qol) in cancer patients.

Methods

We performed an observational prospective study to determine the impact of HPN on Qol in a population of patients with heterogeneous cancer. Physicians, patients and family members had to complete a questionnaire before HPN administration and 28 days after the course of HPN. Qol was evaluated using the self-administered questionnaire FACT-G.

Results

We included 767 patients with cancer of whom 437 ended the study. Mean patient age was 63?±?11.4 years and 60.5 % were men. Primary gastrointestinal cancer was reported in 50 % of patients and 65.3 % were presenting metastases. Malnutrition was reported in 98.3 %. After 28 days of HPN intake, significant improvement was observed in the Qol (49.95?±?5.82 vs. 48.35?±?5.01 at baseline, p?<?0.0001). The mean weight, serum albumin and the nutrition risk index had also improved significantly. Most patients (78 %) had perceived a positive impact of the HPN. A significant improvement in patient’s well-being was perceived also by family members and physicians.

Conclusions

Our data suggest that preventing and correcting malnutrition using HPN in patients with cancer might have a significant benefit on their well-being. Randomized controlled studies are required to confirm this finding.