Supportive Care in Cancer最新文献

Introduction: Effective communication between doctors and patients is crucial for the well-being of individuals diagnosed with cancer. This study aimed to develop and validate a cancer-specific Doctor-Patient Communication Satisfaction Scale (DPCSS-Cancer) from the patients' perspective.

Methods: Initial items were generated through literature review. Content validity was assessed via feedback from five experts, while face validity was determined through cognitive interviews with 13 patients. The revised DPCSS-Cancer was subsequently tested in a sample of 200 cancer patients to assess test-retest stability, internal consistency, factor structure, and criterion-related validity.

Results: The development process resulted in a 15-item DPCSS-Cancer across two dimensions, using a 4-point rating scale (1 = strongly disagree to 4 = strongly agree). The item-level Content Validity Index (I-CVI) ranged from 0.8 to 1.0, with a scale-level CVI of 0.96. Following expert and patient feedback, no items were eliminated, but modifications were made to item wording. In formal testing, the overall Cronbach's alpha was 0.96, with 0.89 for the first dimension and 0.95 for the second. Test-retest reliability was established at 0.82. The two-dimensional structure was partially confirmed. Criterion-related validity was supported through a significant positive correlation with a measure of trust in the physician (r = 0.86). Factors contributing to higher DPCSS-Cancer scores were identified.

Conclusion: The DPCSS-Cancer shows satisfactory reliability and validity, making it a viable patient-reported outcome measure for assessing cancer patients' satisfaction with doctor-patient communication.

Purpose: This study aimed to build a comprehensive understanding of the nutritional guidance needs of gastric cancer survivors in the primary healthcare setting that could be fulfilled by community health service centers as part of their primary healthcare services.

Methods: Gastric cancer survivors were invited to participate in a questionnaire-based survey by convenience sampling method from the community health center. Relationships between nutritional demand and potential influence factors were examined by a multivariable logistic regression model.

Results: A total of 200 gastric cancer survivors were recruited from the community health service center in Shanghai, China, from whom we obtained 194 valid questionnaires, resulting in a 97.0% response rate. Of these gastric survivor participants, 48 individuals (24.7%) expressed a need for nutritional guidance administered by community health service centers, whereas 146 participants (75.3%) held the perspective that such guidance was unnecessary. Preferences for nutritional guidance included having a dietitian as the provider (68.8%), home-based engagement (72.9%), face-to-face consultation (68.8%), individual counseling (87.5%), and beginning immediately post-discharge (89.6%). A notable reluctance (66.7%) towards financial contribution was also observed. After adjusting for confounders, participants with higher income level (odds ratio (OR) = 4.45, 95% confidence interval (CI) = 1.39-15.50), history of food intake reduction (OR = 14.96, 95% CI = 3.49-82.28), and gastrointestinal symptoms (OR = 4.40, 95% CI = 1.35-14.33) were more likely to seek nutritional guidance.

Conclusions: Gastric cancer survivors have a certain need for nutritional guidance administered by primary health service centers. Personal guidance by the primary health service center should be provided to gastric cancer survivors to support their dietary and nutritional intake needs.

Implications for cancer survivors: There is a need to develop and implement nutritional guidance programs in community health service centers as part of their primary healthcare services for gastric cancer survivors.

Objective: This study aims to evaluate the efficacy and safety of traditional acupuncture for pain relief based on rigorously designed RCTs with double-blind. The findings seek to provide valuable insights for clinical practice and inform future research.

Methods: A literature search was conducted in PubMed, Web of Science, Cochrane Library, and Embase databases for randomized controlled trials on traditional acupuncture for pain management using a double-blind design, published from database inception to November 22, 2023. The Risk of Bias 2 (RoB2) tool was used to assess potential biases in the included studies, followed by a comprehensive analysis to evaluate efficacy and safety.

Results: The findings show a significant positive effect on pain improvement, evidenced by changes in visual analog scale scores (mean difference 0.97 [95% confidence interval (CI) 0.66-1.27]). Safety analysis showed no significant differences in adverse reactions between the acupuncture and control groups (relative risk 1.40 [95% CI 0.52-3.74]), with no serious adverse effects reported.

Conclusion: Traditional acupuncture is effective and safe in pain management. This suggests that acupuncture can be a valuable approach in clinical practice. Future studies should explore optimal treatment durations and frequency, using larger sample sizes for more comprehensive insights.

Purpose: Despite growing research on financial toxicity among cancer survivors, large gaps remain in understanding how to intervene to minimize financial toxicity. Uptake and efficacy of interventions mitigating cancer financial toxicity, though promising, remain limited and inconsistent. To date, survivor preferences for financial toxicity interventions are underexplored. This study aimed to evaluate survivor preferences for timing and content of a survivor-facing intervention to address financial toxicity.

Methods: Adult survivors (N = 105) of colorectal cancer (N = 55) or Non-Hodgkin Lymphoma (N = 50) from three tertiary care centers self-reported demographic and clinical characteristics, comorbidities, mental health, financial impact of cancer (Comprehensive Score for Financial Toxicity scale), and preferences for intervention timing and content. Chi-square tests examined associations between intervention timing and content preferences with financial toxicity score. ANOVAs and correlation analyses described associations between the number of intervention components survivors endorsed and survivors' characteristics.

Results: Regarding intervention timing, 79% of survivors favored intervention before treatment. The most frequently endorsed content was understanding out-of-pocket costs and insurance (48.6%) and applying for aid (39%). Survivors experiencing higher financial toxicity reported greater interest in all intervention components. Survivors with colorectal cancer (p = .018), < 65 years (p = .019), higher financial toxicity (p < .001), greater life-altering (p < .001) and care-altering (p = .014) coping behaviors, and poorer mental health (p = .008) endorsed more intervention components.

Conclusions: Actionable insights to improve financial toxicity interventions may be to offer assistance earlier than currently provided (i.e. before treatment) and to include certain topics currently rarely offered (e.g., stress management, budget development support) in line with survivors' preferences.

Purpose: Many people with breast cancer (PwBC) experience psychological distress, including fear of cancer recurrence (FCR). Clinical levels of FCR can negatively impact quality of life. While the FCR trajectory may vary according to age, stage at diagnosis, and imminent exams, FCR levels tend to remain relatively stable over time without intervention. Understanding FCR's impact and how PwBC cope with FCR can improve care. This study aimed to explore the nature of FCR and coping mechanisms by analyzing responses to open-ended survey questions from an FCR randomized controlled trial (RCT).

Methods: This qualitative study was part of a 3-arm RCT for PwBC (N = 390) reporting clinical FCR at eligibility screening. Enrolled PwBC completed a baseline survey, including three open-ended questions regarding FCR experiences. Following thematic analysis, responses were sorted by PwBC's baseline score on the 7-item Fear of Cancer Recurrence (FCR-7) scale, identifying trends by FCR level.

Results: N ≥ 347 PwBC completed the three open-ended survey questions. FCR impacted PwBC's lives across five key domains: emotional, behavioral, cognitive, relational, and professional life. Most identified at least one coping strategy, with strategies consistent across FCR-7 score levels. Higher FCR-7 scores were associated with listing more strategies, tending toward avoidant coping. PwBC sought strategies to improve their sense of purpose, belonging, and control.

Conclusion: This study suggests many PwBC with clinical FCR are suffering without adequate means of coping. Clinicians should regularly discuss FCR with survivors. This discussion can foster education about actual risk and ways PwBC could reduce their risk of recurrence.

Purpose: Informal caregivers play a pivotal role in providing support to cancer survivors, yet have reported challenges with communicating with health providers to get all the information they need to provide optimal care. We aimed to adapt and pilot test a brief communication skills training program (COMFORT) to improve caregiver-provider communication in an Australian cancer setting.

Methods: Module adaptation was guided by the cultural adaptation model. A working group completed the module and provided feedback for adaptation. The adapted module underwent pilot testing with cancer caregivers to examine module impact on communication confidence, preparedness for caregiving, health literacy, and psychological outcomes. Semi-structured interviews and survey data provided evidence of acceptability, usability, and preliminary efficacy.

Results: Eight working group members provided mostly positive feedback on module language, content, and images. Module modifications reflected Australian services and terminology. Nineteen caregivers provided pre-post-pilot data and participated in semi-structured interviews. Following module exposure, repeated measures t-test analyses showed significant improvements in communication confidence, preparedness for caregiving, health literacy, and depressive symptoms (p < 0.05). Survey and interview data supported the acceptability and utility of the program.

Conclusion: The findings support the feasibility and preliminary efficacy of the brief module in improving communication confidence, caregiving preparedness, health literacy, and depressive symptoms in Australian cancer caregivers.

Purpose: Patients receiving treatment for solid tumours and haematological malignancies, among other acute and chronic health conditions, are highly dependent upon central venous access devices (CVADs) for administering chemotherapy and other complex therapies; thus, CVADs can meaningfully impact their health outcomes and experiences. This systematic review aimed to identify and critique patient-reported outcome measure (PROM) and patient-reported experience measure (PREM) instruments related to CVADs.

Methods: A systematic review was undertaken, commencing with an electronic search of health databases (April 2022). Studies were eligible if they used a self-reporting instrument (questionnaire) to quantitatively measure patient-reported outcomes and experiences related to CVADs (English only). Using a piloted data-extraction tool, two authors independently identified studies for full review, data extraction, and quality assessment. Data were synthesised narratively.

Results: The search yielded 875 titles, of which 41 met the inclusion and no exclusion criteria. Of these, 31 reported results of purpose-built questionnaires; a further six reported results of generic measures used for CVADs; four included both purpose-built and generic measures. Overall study quality was low; only two studies evaluated both content validity and internal consistency. In total, 155 unique PROM items (across 27 studies) were extracted which encompassed five domains (e.g., 'Instrumental activities of daily living'; 'Pain and discomfort'). Similarly, 184 unique PREMs (from 31 studies) included 13 domains (e.g., 'Shared decision-making'; 'Education').

Conclusion: Increasingly, research and quality improvement studies about CVADs are incorporating PROM and PREM. These measures are largely purpose-built, however, and their validity and reliability have not been sufficiently established for use.

Review registration: Prospectively submitted to the International prospective register of systematic reviews (PROSPERO) 05 July 2020.