European Journal of Cancer Care最新文献

Purpose. In recent years, decision-making between conventional medicine, complementary medicine (CM), and alternative medicine (AM) has been studied. The purpose of this study is to take a closer look at patients’ thoughts regarding AM and CM and, if possible, to identify differences. Patients and Methods. Ten cancer patients were recruited to participate in a guided semistructured interview. Recruitment was via verbal request during counseling sessions for complementary healing methods. The main recruiting criterion was their interest in or use of AM or CM. In the following face-to-face interviews, demographic data, previous experience with alternative medicine and conventional medicine, doctor-patient communication, role of the family, and sources of information were determined. The interviews were conducted in a semistructured manner using a guide and were recorded anonymously. The recordings were subsequently transcribed. Results. The number of patients was 10, of which eight were female and seven could show higher educational status. In most of the cases, poor communication was mentioned, both in past situations and at the time of diagnosis. Patients described a lack of emotion in the communication of their diagnosis and paternalistic discussions. They complained that they did not receive an overview of the therapy and that they were hardly involved in the decision-making process. Especially, the demanding content as well as the scarcity of conversation time played an important role for the doctor-patient relationship and the resulting trust toward the doctor. A fundamentally dismissive attitude toward CM, AM, and CAM procedures led to a more fragile trust base. Most frequently used sources were the Internet, support organizations, and books. Conclusion. The first point of contact for cancer patients is usually the conventional physician. Commonly, he is one of the most important sources. If the patient is satisfied with the atmosphere of the conversation and the information regarding CAM received, he will probably follow the doctor’s recommendations. Only in the case of dissatisfaction do patients seek advice from alternative medicine. Good training of conventional physicians in communication and complementary therapy options could, therefore, be of great importance.

Background. Family caregivers in charge of patients with advanced cancer play an essential role. The psychosocial cost of these caregiving activities has been studied, and psychosocial interventions have been developed to improve the quality of life of family caregivers. A deeper understanding of caregivers’ burden is essential in order to enhance the benefits of these interventions. The aim of this study was to explore the socioeconomic and cultural factors responsible for shaping the complex personal experience of family caregiving and to analyse the moral dimensions of the caring experience so as to understand its effects on family caregivers more clearly. Materials and Methods. A qualitative study based on in-depth interviews was conducted with patients with advanced cancer (n = 20) and their family caregivers (n = 19) from 2017 to 2020. These interviews were analysed using an inductive approach and an iterative procedure. A thematic analysis was then performed using Tronto’s “ethic of care” framework in order to identify the various levels of responsibility and the relationships and effects involved. Results. Providing patients with advanced cancer with informal care is highly valuable work requiring various moral qualities, including attentiveness, responsibility, competence, and responsiveness. The mental load resulting from the moral aspects of care results from the cumulative effects of carers’ attentiveness and the responsibilities they have taken on. Conclusion. The present findings could guide healthcare professionals to develop best practice resources and guidelines in order to alleviate the hitherto underestimated effects of caring and promote a coordinated public health approach addressing the needs of caregivers. These efforts are particularly important as contemporary health policies tend to promote the shift from inpatient to outpatient treatment, which increases the importance of informal caregiving and the burden involved.

Introduction. Prephase treatment (PP) is recommended in diffuse large B-cell lymphomas (DLBCL) to decrease therapy-related toxicities and to avoid tumour lysis syndrome. Data in the real world are limited, and no study has evaluated the impact on overall survival. We aimed to evaluate overall survival (OS), progression-free survival (PFS), and grade III-IV toxicities during the first cycle according to PP. Methods and Materials. All DLBCL diagnosed between 2014 and 2017 and aged between 18 and 80 years were identified by the Poitou-Charentes General Cancer Registry (France). PP was defined as any treatment prior to first-line, excluding anthracycline and/or Rituximab. We performed propensity score matching (PSM) to control characteristics at diagnosis, reduce bias, and approximate a randomized trial. Results. Three hundred and forty patients received first-line treatment in 17 hospital centers: 126 (37%) with prephase and 214 (63%) without prephase (NPP). After PSM, 97 patients remained in each group without significant difference in characteristics at diagnosis; matched PP patients had a 2-year OS of 71% (vs. 77%, P = 0.32), a 2-year PFS of 61% (vs. 74%, P = 0.12), and 26% grade III-IV toxicities (vs. 27%, P = 0.75). No tumour lysis syndrome was reported. PP nonsignificantly decreases grade III-IV toxicities for patients with high tumour load (P = 0.82) or elderly patients (P = 0.81). Conclusion. PP treatment does not affect survival nor does it reduce therapy-related toxicities even for patients with high tumour load or elderly patients. Further studies are needed to evaluate the efficacy and safety of PP.

Objective. Staphylococcus aureus bacteremia (SAB) in patients with solid tumors poses a dilemma between infection control and cancer treatment. We aimed to explore whether early resumption of chemotherapy yielded unfavorable outcomes in oncologic patients with SAB. Methods. We retrospectively reviewed patients who received chemotherapy within 90 days of SAB onset from 2011 to 2020. We divided patients who resumed chemotherapy into two groups by the median time from the negative blood culture to the chemotherapy resumption. We investigated the association with treatment failure, which included recurrence after completion of SAB treatment, relapse during antibiotics therapy, 90-day all-cause mortality after initiation of antibiotics, and 30-day all-cause mortality after the resumption of chemotherapy. Results. Among the 78 eligible patients, 36 patients resumed chemotherapy. The median interval to the chemotherapy resumption was 17.5 days. Two patients in the early resumption group and one in the late resumption group died within 90 days after initiating antibiotics. One patient in the early resumption group experienced SAB recurrence. None of the patients experienced SAB relapse or died within 30 days of resuming chemotherapy. Conclusion. Early resumption of chemotherapy may not be directly associated with unfavorable outcomes in oncological patients with SAB under appropriate infection management.

Objectives. Although several guidelines are available aiming for optimal chemotherapy-induced nausea and vomiting (CINV) control, there still remain critical therapeutic challenges: (i) recommendations are mainly drug-based, not protocol-based; (ii) the risk of antiemetics-related interactions is not highlighted; (iii) the emetogenicity of a regimen may vary over the cycle; and (iv) the impact of the underlying malignancy is overlooked. Apparently, the existing approach seems not to be generally efficient and puts patients at risk of insufficient use of antiemetics as well as poor emesis control. Evidence Acquisition. This study has re-evaluated the emetogenicity of chemotherapy regimens based on administered medications on each day, drug-drug interactions, combination therapy, and delayed CINV. Results. A literature review was done to re-evaluate the emetogenicity of the commonly accepted chemotherapy regimens based on administered medications on each day, drug interactions, combination therapy, and delayed CINV. Conclusion. The revised CINV prophylaxis protocols with sorted recommendations for hematologic malignancies and solid tumors have been represented, with respect to the availability of prophylactic medications.

Objective. This study aimed to develop and perform a content validation of a brief French tool for self-assessment of supportive and palliative care needs in patients with cancer, using four different approaches: issue’s importance, problem intensity, problem burden, and expressed need for help. Methods. Items, questions, and response scales were based on a literature review and discussions within a multidisciplinary scientific committee. A panel of experts evaluated the relevance, comprehensiveness, and comprehensibility of each item and question using the Delphi method. These properties were also assessed through cognitive debriefing interviews with cancer patients. Results. Eleven domains were selected from the literature review: physical, role, social, psychological, patient care and support, healthcare, information, financial, activities of daily living, spirituality, and sexuality. A scientific committee created 15 items and five questions. Two Delphi rounds were required to reach a consensus among the 29 experts on a pilot version. Twenty-three cancer patients were involved in the cognitive debriefing interviews. All items and questions were considered as relevant. Acceptability was good, and four items were reformulated based on patients’ comments. Conclusion. This brief French tool has a very good content validity and can be used in clinical practice.

The provision of psychosocial services has a substantial impact on cancer care by reducing emotional distress and improving both the quality of life and survival of patients, but the availability and utilization of such services have not been well studied in developing countries, particularly, Ethiopia. Therefore, we explored the types of psychosocial services available for breast cancer patients in Addis Ababa, Ethiopia. A mixed method study was conducted using a cross-sectional survey involving 428 breast cancer patients, followed by a qualitative study. A total of nine in-depth interviews (IDIs) were conducted with four breast cancer patients and five key informants using two separate interview guides. In addition to descriptive statistics, logistic regression was performed to identify factors associated with the provision of psychosocial services. Thematic analysis was used for the qualitative data, using NVivo 12 plus software. Only 47 (11.1%) patients received psychosocial services in the form of counselling, emotional support, or information provision. Health professionals reportedly provided such services along with their routine activities, and patients predominantly received social/emotional support from family members, friends, and colleagues. There were no well-structured counselling services, emotional support, or group discussion sessions for breast cancer patients in these health facilities. The main reasons for not providing these services were high patient flow/workload, inadequate space, lack of training, and not having qualified professionals to organise and deliver psychosocial services in these hospitals. Only one in ten breast cancer patients received psychosocial services from health professionals, and the services were not delivered in a structured way. Therefore, psychosocial services should be integrated in both private and government health facilities in Ethiopia.

Purpose. The growing choice of oral anticancer medications (OAMs) delivered in pharmacies puts the patients at the center of their own therapeutic management. Patient satisfaction regarding their pharmaceutical management is particularly important for adherence to their treatment. The aim of this study was to assess the satisfaction of patients treated with OAMs regarding their dispensing in community pharmacies. Methods. A cross-sectional study was conducted with a self-questionnaire proposed to patients in hospital centers and community pharmacies. The patient’s satisfaction regarding pharmacy dispensing was assessed with a visual analogue scale. Answers to questions about the quality of information they received from health professionals were recorded. The patient’s adherence to their medication was assessed with the 8-item Morisky Medication Adherence Scale (MMAS-8). Symptoms and quality of life were recorded with the QLQ-C30 questionnaire. Results. Ninety-one patients were included in the analysis. The median score of satisfaction was 89 (interquartile range: 68, 100), and 49.5% had a satisfaction score ≥90/100. Satisfaction scores were higher for patients reporting information from pharmacists for the method of administration, the management of adverse effects, and drug interactions than for patients reporting no information from pharmacists. Patient satisfaction was not related to MMAS-8 scores, symptoms, or quality of life. Multivariate analysis of patient satisfaction revealed a positive relationship with information on the administration method provided by pharmacists. Conclusions. The level of information provided on OAMs to patients should be the same between pharmacists and oncologists. Good medication dispensing practices by the pharmacist are important components of patient care and satisfaction. We encourage pharmacists to provide more medication information to their patients.

Objective. The association between Polycystic Kidney Disease (PKD) and susceptibility to developing oncogenicity states remains controversial, and no consensus has yet been reached. Large-scale studies on this association are also lacking. Therefore, we identified the risk of developing cancer in PKD patients. Methods. Patients diagnosed with PKD between 2000 and 2010 were enrolled in the National Health Insurance Research Database (NHIRD)-derived Longitudinal Health Insurance. Patients with antecedent cancer, end-stage renal disease, or those diagnosed with cancer within one year were excluded. Using a Standardized Incidence Ratio (SIR), we compared the patterns of cancer incidence in PKD patients and the general population. Results. The entire cohort was observed for 8,014 people, and a total of 1820 PKD patients were included, and after a median follow-up of 4.43 years, 82 patients developed cancer. Though the risk of overall cancers was comparable between PKD patients and the general population, the PKD patients exhibited a higher risk of kidney malignancy (SIR 3.72, 95% CI 1.60∼7.33). The female PKD patients were at a higher risk of lung and mediastinal cancer (SIR: 2.83, 95% CI 1.03∼6.16). The subgroup analysis revealed a significantly higher risk of kidney cancer in the patients aged <65 years (SIR 7.39, 95% CI 1.99∼18.93) than those elderly patients, especially in the females (SIR 9.81, 95%1.10∼35.41, p < 0.05). The multivariate analysis showed significant risk factors for cancer among the PKD population, including 1-year age (HR 1.04; 95% CI 1.02–1.06; p < 0.001), male gender (HR 1.85; 95% CI 1.14–3.00; p = 0.012), and chronic liver disease (HR 2.03; 95% CI 1.31–3.13; p < 0.001). Conclusion. PKD patients may be more susceptible to developing renal, lung, and mediastinal cancer than the control population, which might be attributed to PKD genetic instability.

Objective. To assess the sexual health and interest of breast cancer survivors (BCSs) in a tailored evaluation of their sexuality. Methods. A descriptive analysis on baseline sexual assessment of female BCS with genitourinary syndrome of menopause (GSM) receiving aromatase inhibitors (AIs), who have participated on an ongoing double-blinded randomized controlled trial on the efficacy and safety of laser therapy (NCT04619485), was conducted. Epidemiological and BC variables, as well as mental, vaginal, and basic sexual health assessment (self-reported sexual activity and frequency, sexual behavior, type of sexual activity and relationship status, Female Sexual Function Index (FSFI), and Body Image Scale questionnaires and 2 visual analogue scales (VASs) about sexual life disturbance and dyspareunia) were recorded. An optional specialized sexual assessment was offered. Results. Among 83 participants, 67 (80.7%) wanted sexual counseling. Half of them had a body image alteration, and 74% worsened their sexual life after receiving BC diagnosis and treatments. The sexual activity rate was 71.1%. Sexually inactive women had higher impairment of FSFI desire dimension (p = 0.0013), dyspareunia (p = 0.0114), and unsatisfaction with their sexuality (p = 0.0530) compared to sexually active women. In sexually active women, the mean FSFI and all of its dimensions showed a lower score. The most frequent sexual behavior was a combination of nonvaginal and vaginal sex, despite the high intensity of dyspareunia (mean VAS ± SD: 7.1 ± 2.1). Conclusion. Most of the BCSs with GSM receiving AI were interested in a specialized sexual consultation. Sexual activity and function were impaired, either secondary to dyspareunia or to other biopsychosocial sexual factors.