European Journal of Oncology Nursing最新文献

Purpose

This study aimed to develop and validate accessible artificial neural network and decision tree models to predict the risk of lower limb lymphedema after cervical cancer surgery.

Methods

We selected 759 patients who underwent cervical cancer surgery at the Hunan Cancer Hospital from January 2010 to January 2020, collecting demographic, behavioral, clinicopathological, and disease-related data. The artificial neural network and decision tree techniques were used to construct prediction models for lower limb lymphedema after cervical cancer surgery. Then, the models’ predictive efficacies were evaluated to select the optimal model using several methods, such as the area under the receiver operating characteristic curve and accuracy, sensitivity, and specificity tests.

Results

In the training set, the artificial neural network and decision tree model accuracies for predicting lower limb lymphedema after cervical cancer surgery were 99.80% and 88.14%, and the sensitivities 99.50% and 74.01%, respectively; the specificities were 100% and 95.20%, respectively. The area under the receiver operating characteristic curve was 1.00 for the artificial neural network and 0.92 for the decision tree model. In the test set, the artificial neural network and decision tree models’ accuracies were 86.70% and 82.02%, and the sensitivities 65.70% and 67.11%, respectively; the specificities were 96.00% and 89.47%, respectively.

Conclusion

Both models had good predictive efficacy for lower limb lymphedema after cervical cancer surgery. However, the predictive performance and stability were superior in the artificial neural network model than in the decision tree model.

Purpose

Guided by the Intersectionality Framework, we examined the differential in breast cancer care experience across population subgroups in England.

Methods

Secondary data analysis using the 2017/2018 National Cancer Patient Experience Surveys. We used disaggregated descriptive statistics (mean, standard errors, 95% confidence interval) to analyse 26,030 responses from female breast cancer patients to a question relating to overall care experience categorised by age, ethnicity, and sexual orientation in their intersection with social position. We then used logistic regression to investigate the odds (Odds Ratio (OR), 95% confidence intervals) of reporting positive care experience adjusting for patient, clinical, and Trust level factors.

Results

Poorer care experience was predominantly reported by the most deprived younger and minoritised ethnic groups. Statistically significant findings were observed in adjusted multivariable analyses. Compared to patients aged 65–74 years, younger respondents were less likely to rate their care favourably (16–34 years old OR_adj. = 0.55 (0.36–0.84). Compared to White British, Asian (OR_adj. = 0.51 (0.39–0.66)) and Black African women (OR_adj. = 0.53 (0.33–0.88)) were less likely to rate their care favourably. The least affluent respondents were less likely to rate their care favourably (OR_adj. = 0.79 (0.64–0.97)).

Conclusion

There is evidence of inequity in overall cancer care experience among female breast cancer patients in England, particularly among women living at the specific intersection of age, ethnicity, and socioeconomic position. Future research is necessary to understand the mechanisms underlying breast cancer inequities. Policymakers, commissioners, and providers should consider the existence of multiple forms of marginalisation to inform improvement initiatives targeting patients at higher risk of vulnerability.

Purpose

The purpose of this study was to develop a structural equation model (SEM) to explore the factors influencing the spiritual needs of breast cancer patients.

Methods

A cross-sectional study was conducted in the breast surgery department of a tertiary hospital in China from September 2020 to December 2020; convenience sampling and questionnaires were used to facilitate sampling and data collection. A total of 220 female breast cancer patients were included in the study. The data were analysed using multiple linear regression and structural equation modelling.

Results

Compared with patients with other diseases, patients with breast cancer have greater spiritual needs (76.16 ± 13.19). Multivariate analysis revealed that religious beliefs, education level, social support, and resilience are important factors affecting the mental health of women with cancer (p < 0.05). The structural equation model fit well (RMSEA = 0.056, χ²p = 0.002). Social support directly affected spiritual needs (β = 0.607, p < 0.001) and indirectly affected spiritual needs through resilience (β = 0.353, p < 0.001). Resilience directly affected spiritual needs (β = 0.386, p < 0.05). Education level indirectly affected spiritual needs through social support (β = 0.307, p < 0.001).

Conclusion

This study provides a theoretical basis for intervention measures to improve the spiritual needs of female breast cancer patients. Paying more attention to social support and resilience may help solve the problem of meeting the high spiritual needs of breast cancer patients. Further research is needed to develop interventions.

Purpose

Fear of cancer recurrence (FCR) is a psychological problem often faced by breast cancer patients in the rehabilitation period. The aim of this study was to identify FCR subgroups of Chinese breast cancer patients in rehabilitation and to analysis the factors affecting each subgroup. The effects of the subgroups on quality of life (QoL) were also explored.

Methods

Cross-sectional data were collected from 300 breast cancer patients in a rehabilitation setting. The researchers invited the subjects to complete questionnaires on FCR, fatigue, anxiety depression, perception of illness and QoL. The researchers conducted a latent profile analysis. The factors influencing the subgroups of FCR were identified using ANOVA and multinomial logistic regression analyses. Linear regression analyses were used to explore the effect of subgroups on QoL.

Results

There were three subgroups of FCR: profile 1 ‘Low FCR Group’ (42.3%), profile 2 ‘Moderate FCR Group’ (45.6%), and profile 3 ‘High FCR Group’ (12.1%). Cancer stage II was a protective factor for FCR patients (OR = 0.107, P < 0.01) and was more likely to be categorized among the low FCR group. Anxiety depression was a risk factor for FCR patients and was more likely to be categorized in the medium FCR group (OR = 1.764, P < 0.001) and in the high FCR group (OR = 2.911, P < 0.001). In addition, patients subjected to a high perception of illness were more likely to be considered in the medium FCR group (OR = 1.041, P < 0.05), a risk factor affecting patients with FCR. Linear regression analysis showed that subgroups with higher FCR had a stronger negative predictive effect on their QoL (all P < 0.001).

Conclusions

The FCR was identified as three subgroups among breast cancer patients in rehabilitation, which suggests that healthcare professionals should give full consideration to the impact of cancer stage, anxiety and depression, and illness perceptions on the FCR subgroups in order to improve their QoL.

Purpose

Self-management is an essential component of the curative treatment trajectory of esophageal cancer patients. The aims of this study were to explore expectations and needs of esophageal cancer patients during curative treatment regarding self-management, relevant aspects of self-management in which they need additional support, and to explore their willingness to use eHealth.

Methods

Semi-structured interviews were conducted with esophageal cancer patients, who had been treated with neoadjuvant chemo(radio)therapy followed by surgery, maximally 1 year after surgery. Based on the general model of self-management, the following themes were discussed: experience-based knowledge, contribution to care, living with the condition, and organization of care and support. A stepwise systematic text condensation guided the data analysis.

Results

All four domains of the general model of self-management were identified. All participants described a remarkable difference between the pre-operative pathway, when it felt like they were taken by the hand, and the postoperative pathway, when it felt like they were thrown into the deep end. They adjusted to their new life situation by learning new experiences, while dealing with their diminished confidence in their bodies. Patients expressed the need for support from different sources, and were open to the idea of using eHealth in addition to usual care. (digital) Self-management support should be easily accessible, person-centered, confidential, and include personal contact.

Conclusion

Differences were found among esophageal cancer patients regarding self-management, self-management support and eHealth for self-management purposes, indicating there is no one approach that will meet the needs of all patients at all times.

Purpose

Desmoid tumors are a rare and complex disease characterized by a great diversity in its forms, localizations, and prognosis. Both the disease and the treatment can have a significant impact on quality of life in patients. Given the complexity of the disease and its rarity, the literature on patients’ experience with the disease scarce. The purpose of this study is to investigate illness representations and subjective experience in participants affected with desmoid tumors.

Methods

Telephonic semi-directive interviews were used in French patients over 18 years, diagnosed with desmoid tumor. Data were analyzed through a general inductive method to identify emergent general themes in participants’ discourse.

Results

Participants (8 women, 7 men) in this study were aged between 27 and 71. The analysis revealed eight major themes relative to representations of illness and treatment, live with the illness, the impact of illness on relationships with others, the illness and medical pathways, and the identity changes caused by the illness. The two most salient themes were illness and treatment representations and life with the illness. Those themes were chosen for this study.

Conclusions

The results provide new insights on representation of and experience with desmoid tumors in patients. It brings arguments for the necessity of development wider systematic study to explore those variables in a larger sample during all the illness pathway. Indeed, this population meets particular issues appealing for the development of a specific psychosocial support.

Purpose

This meta-analysis aimed to determine how spiritual interventions affect cancer patients’ physical, emotional, and spiritual outcomes and quality of life.

Methods

Between 2012 and May 2024, the Cochrane Library, Scopus, PubMed, and Web of Science were searched considering the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Twenty-six randomized controlled trials were included, and 16 were synthesized in the meta-analysis. Bias risk was evaluated using the Cochrane risk-of-bias methodology for randomized studies. The Grading of Recommendations, Assessment, Development, and Evaluations tool was employed for evidence certainty. Heterogeneity was expressed through I² and Q statistics. Hedge's g was calculated for effect sizes. Egger's and Kendall's Tau were used for publication bias.

Results

Spiritual interventions yielded beneficial effects on fatigue (Hedges's g = 0.900, p < 0.001) and pain (Hedges's g = 0.670, p < 0.001) but not for overall symptom burden (Hedges's g = 0.208, p = 0.176). Significant effects were found for anxiety (Hedges's g = 0.301, p < 0.001), depression (Hedges's g = 0.175, p = 0.016), and psychological distress (Hedges's g = 0.178, p = 0.024), except for hopelessness (Hedges's g = 0.144, p = 0.091). Spiritual interventions enhanced faith (Hedges's g = 0.232, p = 0.035), the meaning of life (Hedges's g = 0.259, p = 0.002), spiritual well-being (Hedges's g = 0.268, p < 0.001), and quality of life (Hedges's g = 245, p < 0.001). Moderator analysis pointed out that cancer stage, total duration, delivery format, providers' qualification, content, and conceptual base of spiritual interventions significantly affect physical, emotional, and spiritual outcomes and quality of life.

Conclusion

This meta-analysis highlighted the benefits of spiritual interventions with varying effect sizes on patients’ outcomes, as well as quality of life in cancer, and shed on how to incorporate these approaches into clinical practice.

Purpose

This study aimed to explore the experiences of registered nurses in hematology departments and primary care settings regarding loss, grief, and family health in adult patients and their families during long-term cancer illnesses.

Method

A qualitative study was conducted taking a phenomenological hermeneutic approach. Data were collected between February and March 2023 through individual, semi-structured interviews with 12 nurses working in hematology departments and primary care settings in Denmark. The interviews were recorded, transcribed, and analyzed using thematic analysis.

Results

The analysis resulted in the identification of four main themes with related subthemes: (1) Patients' individual losses leading to grief reactions, (2) Nurses' experience of families grieving the loss of former daily living, (3) Supporting families with family health as an implicit concept, and (4) Overcoming barriers through nurses’ care interventions targeting family health. Results showed that nurses encountered various losses and grief reactions affecting both patients and families. Barriers such as experience levels and working conditions affected care quality. Despite challenges, nurses addressed these by utilizing communication, involving families, and directing them to additional healthcare services.

Conclusion

The study unveiled limited nurse awareness of family health, acknowledging its significance in patient and family care. The findings highlight the importance of improving nurses' comprehension of effectively supporting families as a cohesive unit in the context of long-term cancer illnesses.

Purpose

To investigate suicide mortality and the related factors among female breast cancer patients in the United States.

Methods

The SEER database was used to identify 716,422 patients diagnosed with breast cancer between 2010 and 2018 to calculate a standardized mortality rate (SMR). An analysis of risk factors for suicide death was conducted using the univariate and multivariate Cox proportional risk model. An estimation of suicide probability was performed through a nomogram model.

Results

Compared with the expected suicide cases (n = 155) in the general population of the United States at the corresponding period (a suicide death rate of 5.71 per 100,000 person-years), the suicide rate among 716,422 breast cancer patients was followed during 2010–2018 and showed a relatively higher rate of 9.02 per 100,000 person-years. The SMR was 1.58 (95%CI: 1.39–1.79). White and other races were nine and seven times more likely to complete suicide than Black race, respectively (aHR = 9.013, 95%CI: 3.335–24.36, P < 0.001; aHR = 7.129, 95%CI: 2.317–21.931, P = 0.001); unmarried or single patients were at higher risk than married patients (aHR = 1.693, 95%CI: 1.206–2.377, P = 0.002). Patients receiving radiotherapy (aHR = 0.731, 95%CI: 0.545–0.980, P = 0.036) were less likely to complete suicide than those who did not.

Conclusion

Female breast cancer patients in the United States have a higher suicide rate than the general public, and the risk factors consist of non-black ethnicity, being single or unmarried, and not being treated with radiotherapy. As a result of this study, clinicians may be able to identify female breast cancer patients who are at high risk of suicide, thus providing appropriate psychological support at the early stage.

Purpose

This study aimed to determine the effectiveness of a Phone-Based Support Program (PBSP) for newly diagnosed women with breast cancer.

Methods

A two-group repeated measures randomized controlled trial was designed. Participants included 94 patients aged 18–60 years who were newly diagnosed with breast cancer and undergoing chemotherapy in a tertiary hospital in China. They were randomly assigned to the intervention and the control groups. Participants in the intervention group were enrolled in a four-session PBSP, consisting of four interactive sections: learning, discussion, ask-the-expert, and personal stories, plus the routine care. Outcomes included patients’ self-care self-efficacy, psychological distress (including symptom distress, anxiety, and depression), and quality of life. These were assessed at three time points: pre-intervention (T1), post-intervention (T2), and follow-up (T3) by using the self-care self-efficacy scale, the M.D. Anderson Symptom Inventory, the hospital anxiety and depression scale, and the global health status scale.

Results

After completion of the intervention, participants in the intervention group had significantly (p < .001) higher self-care self-efficacy (T2: M_diff = 11.49, T3: M_diff = 22.33), better quality of life (T2: M_diff = 8.18, T3: M_diff = 17.19), lower symptom distress (T2: M_diff =

−26.68, T3: M_diff = −54.76), less anxiety (T2: M_diff = −2.52, T3: M_diff = −5.11), and less depression (T2: M_diff = −3.61, T3: M_diff = −6.71) than those in the control group.

Conclusion

These findings indicate that the PBSP is effective. Healthcare professionals, especially nurses, could utilize it to enhance self-care self-efficacy and quality of life, as well as decrease psychological distress among women newly diagnosed breast cancer.

Registration

The Thai Clinical Trial Registry #TCTR20230321010.