Pub Date : 2018-01-02DOI: 10.1080/23809000.2018.1438844
Corine Rijpkema, Margo van Hartingsveldt, M. Stuiver
Many cancer patients and cancer survivors experience physical, psychological, and social problems due to the disease and its treatment, which impact negatively on their health-related quality of li...
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Pub Date : 2018-01-01Epub Date: 2018-02-26DOI: 10.1080/23809000.2018.1444480
Elizabeth Sinatra, David S Black
Mindfulness-based interventions (MBIs) refer to the spectrum of integrative mind–body practices used to support wellness and alleviate suffering, thus enhancing the capacity for quality of life (QOL). Mindfulness practices offer tangible learning opportunities for cancer survivors to disengage from disruptive and worrisome thoughts of the past and the future and instead focus on pleasant, neutral, or uncomfortable experiences arising in the present moment [1]. Present moment awareness allows survivors to differentiate among their thoughts, emotions, and sensations arising from symptom and illness discomfort [1], offering them a greater sense of personal control, acceptance of current life circumstances, and engagement with what is most meaningful in their lives [2]. As a result, survivors often report significantly improved QOL as assessed by subjective questionnaires [3–5], suggesting MBIs as therapeutically valuable. Though the absence of a gold standard measure of QOL may inherently give rise to subjectivity regarding its assessment [6,7], current methods of reporting remain largely variable across trials. As such, disparate conceptualizations and measures of QOL may in fact limit our understanding of MBI impact on survivor health and well-being. Despite significantly improved QOL, incomplete reporting and the use of different questionnaires across MBI trials are striking limitations. Carlson et al. [3] revealed significantly improved emotional (Cohen’s d = .27) and functional wellbeing (d = .27) domains, in addition to a ‘total’ QOL score (d = .22) as evaluated by the Functional Assessment of Cancer Therapy-Breast cancer (FACT-B) questionnaire. Physical and social/family well-being were also assessed by this measure, and although statistical significance was not reached, values were reported. Johannsen et al. [5] reported significant improvement in QOL as a single score (d = .42) derived from the World Health Organization Well-Being Index (WHO-5), a psychological well-being measure[8]. Conversely, Schellekens et al. [4] reported significant improvement in QOL as a ‘global health status’ composite score (d = .60) derived from the European Organization for Research and Treatment of Cancer Quality-of-Life questionnaire (EORTC QLQ-C30). Though this measure provided physical, role, emotional, cognitive, and social functioning and cancer-specific symptomology scores, corresponding results were not reported. Incomplete reporting limits our understanding of how various QOL domains are influenced by the experience of cancer[9], whereas the assessment of varying aspects of QOL through use of different questionnaires contributes to inconsistent views of the overall conceptual breadth and operationalization of this outcome. Though reported as QOL, the questionnaires most often utilized in MBI trials are in fact assessments of ‘health-related quality of life’ (HRQOL) [10], a discrepancy frequent to oncologic literature [6]. HRQOL indicates the subjective
{"title":"Mindfulness-based interventions for cancer survivors: what do we know about the assessment of quality of life outcomes?","authors":"Elizabeth Sinatra, David S Black","doi":"10.1080/23809000.2018.1444480","DOIUrl":"https://doi.org/10.1080/23809000.2018.1444480","url":null,"abstract":"Mindfulness-based interventions (MBIs) refer to the spectrum of integrative mind–body practices used to support wellness and alleviate suffering, thus enhancing the capacity for quality of life (QOL). Mindfulness practices offer tangible learning opportunities for cancer survivors to disengage from disruptive and worrisome thoughts of the past and the future and instead focus on pleasant, neutral, or uncomfortable experiences arising in the present moment [1]. Present moment awareness allows survivors to differentiate among their thoughts, emotions, and sensations arising from symptom and illness discomfort [1], offering them a greater sense of personal control, acceptance of current life circumstances, and engagement with what is most meaningful in their lives [2]. As a result, survivors often report significantly improved QOL as assessed by subjective questionnaires [3–5], suggesting MBIs as therapeutically valuable. Though the absence of a gold standard measure of QOL may inherently give rise to subjectivity regarding its assessment [6,7], current methods of reporting remain largely variable across trials. As such, disparate conceptualizations and measures of QOL may in fact limit our understanding of MBI impact on survivor health and well-being. Despite significantly improved QOL, incomplete reporting and the use of different questionnaires across MBI trials are striking limitations. Carlson et al. [3] revealed significantly improved emotional (Cohen’s d = .27) and functional wellbeing (d = .27) domains, in addition to a ‘total’ QOL score (d = .22) as evaluated by the Functional Assessment of Cancer Therapy-Breast cancer (FACT-B) questionnaire. Physical and social/family well-being were also assessed by this measure, and although statistical significance was not reached, values were reported. Johannsen et al. [5] reported significant improvement in QOL as a single score (d = .42) derived from the World Health Organization Well-Being Index (WHO-5), a psychological well-being measure[8]. Conversely, Schellekens et al. [4] reported significant improvement in QOL as a ‘global health status’ composite score (d = .60) derived from the European Organization for Research and Treatment of Cancer Quality-of-Life questionnaire (EORTC QLQ-C30). Though this measure provided physical, role, emotional, cognitive, and social functioning and cancer-specific symptomology scores, corresponding results were not reported. Incomplete reporting limits our understanding of how various QOL domains are influenced by the experience of cancer[9], whereas the assessment of varying aspects of QOL through use of different questionnaires contributes to inconsistent views of the overall conceptual breadth and operationalization of this outcome. Though reported as QOL, the questionnaires most often utilized in MBI trials are in fact assessments of ‘health-related quality of life’ (HRQOL) [10], a discrepancy frequent to oncologic literature [6]. HRQOL indicates the subjective ","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"3 1","pages":"5-7"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2018.1444480","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36976676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01Epub Date: 2018-02-26DOI: 10.1080/23809000.2018.1443811
Diana C Pearre, Daniela A Bota
Introduction: chemotherapy-related cognitive dysfunction (CRCD) is a growing problem due to rising cancer rates and increasing numbers of cancer survivors. upwards of 70% of ovarian cancer patients report cognitive-changes following treatment for their cancer.
Areas covered: the underlying mechanisms of CRCD are a subject of active research and debate. the initial insult may start with the diagnosis of cancer itself, both in the number of peripheral cytokines it produces but also in the psychological changes caused by stress and anxiety associated with the diagnosis. chemotherapy, in its ability to alter dna in the replication cycle, has been shown to damage neurons and their stem cell precursors.
Expert commentary: based on proposed mechanisms and advancements in other neuropsychological diseases, various pharmacologic and behavioral interventions have been demonstrated to show improvements in patient's quality of life and in their perceived cognitive abilities and memory. further research is necessary to be able to determine when and how these cognitive changes occur, and if their multiple potential biological underpinnings can synergize toward deleterious cognitive effects. future therapies will include prevention strategies to avert CRCD's effects on patients.
{"title":"Chemotherapy-related cognitive dysfunction and effects on quality of life in gynecologic cancer patients.","authors":"Diana C Pearre, Daniela A Bota","doi":"10.1080/23809000.2018.1443811","DOIUrl":"https://doi.org/10.1080/23809000.2018.1443811","url":null,"abstract":"<p><strong>Introduction: </strong>chemotherapy-related cognitive dysfunction (CRCD) is a growing problem due to rising cancer rates and increasing numbers of cancer survivors. upwards of 70% of ovarian cancer patients report cognitive-changes following treatment for their cancer.</p><p><strong>Areas covered: </strong>the underlying mechanisms of CRCD are a subject of active research and debate. the initial insult may start with the diagnosis of cancer itself, both in the number of peripheral cytokines it produces but also in the psychological changes caused by stress and anxiety associated with the diagnosis. chemotherapy, in its ability to alter dna in the replication cycle, has been shown to damage neurons and their stem cell precursors.</p><p><strong>Expert commentary: </strong>based on proposed mechanisms and advancements in other neuropsychological diseases, various pharmacologic and behavioral interventions have been demonstrated to show improvements in patient's quality of life and in their perceived cognitive abilities and memory. further research is necessary to be able to determine when and how these cognitive changes occur, and if their multiple potential biological underpinnings can synergize toward deleterious cognitive effects. future therapies will include prevention strategies to avert CRCD's effects on patients.</p>","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"3 1","pages":"19-26"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2018.1443811","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36976677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01Epub Date: 2018-06-07DOI: 10.1080/23809000.2018.1483193
Laura C Bouchard, Neil Aaronson, Kathleen Gondek, David Cella
Introduction: A critical challenge in oncology is interpreting clinical trial results to inform clinical decision making. Clinical trials typically focus on overall survival (OS) and progression-free survival (PFS) as primary endpoints, which do not reflect early signs of meaningful patient benefit or harm. Cancer symptom response (CSR) can provide information about early treatment response, and studies show that CSR predicts long-term health outcomes.
Areas covered: CSR requires careful consideration of its measurement and interpretation to facilitate integration into clinical practice. We describe considerations for the evaluation, analysis, and interpretation of CSR in clinical trials. To illustrate the potential clinical value of CSR, we performed a retrospective analysis of a three-arm randomized cooperative-group clinical trial.
Expert commentary: Evaluation of CSR provides a meaningful assessment of early cancer treatment effects. It can act as an early signal of disease progression and death and thus can identify which patients with stable disease will have a more favorable prognosis. Future research will include development of methods for more accurate assessment of CSR, reduction of the number of symptoms used as signals for disease progression or survival by tumor type, and statistical methods that effectively correct for missing data and informative censoring.
{"title":"Cancer symptom response as an oncology clinical trial end point.","authors":"Laura C Bouchard, Neil Aaronson, Kathleen Gondek, David Cella","doi":"10.1080/23809000.2018.1483193","DOIUrl":"https://doi.org/10.1080/23809000.2018.1483193","url":null,"abstract":"<p><strong>Introduction: </strong>A critical challenge in oncology is interpreting clinical trial results to inform clinical decision making. Clinical trials typically focus on overall survival (OS) and progression-free survival (PFS) as primary endpoints, which do not reflect early signs of meaningful patient benefit or harm. <i>Cancer symptom response</i> (CSR) can provide information about early treatment response, and studies show that CSR predicts long-term health outcomes.</p><p><strong>Areas covered: </strong>CSR requires careful consideration of its measurement and interpretation to facilitate integration into clinical practice. We describe considerations for the evaluation, analysis, and interpretation of CSR in clinical trials. To illustrate the potential clinical value of CSR, we performed a retrospective analysis of a three-arm randomized cooperative-group clinical trial.</p><p><strong>Expert commentary: </strong>Evaluation of CSR provides a meaningful assessment of early cancer treatment effects. It can act as an early signal of disease progression and death and thus can identify which patients with stable disease will have a more favorable prognosis. Future research will include development of methods for more accurate assessment of CSR, reduction of the number of symptoms used as signals for disease progression or survival by tumor type, and statistical methods that effectively correct for missing data and informative censoring.</p>","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"3 2-3","pages":"35-46"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2018.1483193","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37180969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-02DOI: 10.1080/23809000.2017.1408412
T. Leblanc
Shared decision-making (SDM) is a best practice in personalized medicine. SDM is defined as ‘an approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences’ [1]. It reflects the ideals of person-centered care, by virtue of its inherent respect and valuation of the patient perspective as a vital component in the treatment decisionmaking process [2]. Amid a shift from the unbridled medical paternalism of the mid-twentieth century, to the other extreme of unqualified patient self-determination and medical consumerism, SDM reflects a reasonable midpoint in the pendulum swing between these more polarized approaches. Accordingly, the National Academy of Medicine has called for us all to do SDM, and has been doing so for more than a decade [3]. Unfortunately, it is not clear that this long-standing recommendation has had much impact on clinicians’ practices, despite growing evidence as to the many benefits of an SDM approach in cancer care and beyond [4–6]. Data continue to show that most patients with advanced cancer fundamentally misunderstand their prognosis [7,8], and that many Americans die each year in ways that they would not want, such as in hospital or intensive care unit settings, or receiving ineffective chemotherapies in the last 2 weeks of their life [9–11]. These gaps seem to be even worse in cases of prognostic uncertainty, such as hematologic malignancies, where cure may still be possible in those with relapsed or refractory disease (albeit less likely) [12–18]. As we grapple with this ongoing problem of poor-quality end-of-life care in oncology, SDM must be seen as an essential tool to improve these outcomes. More broadly though, SDM and the elicitation of patient preferences that must accompany it are essential to improving patients’ experiences of illness when facing a cancer diagnosis. After all, patients are the experts on their own experiences. SDM is particularly necessary in cases where reasonable people might disagree about the ‘right’ path, wherein there is truly a ‘preference-sensitive decision’ at play. A classic example is the choice of whether to pursue adjuvant chemotherapy for an early stage, colorectal, breast, or lung cancer. There is no clear ‘right answer’ in these settings, but rather a series of trade-offs to consider, the value of which might be perceived differently by people with differing value systems and priorities. While these therapies are known to reduce the risk of cancer recurrence, in many cases these reductions are relatively modest, in the order of a few percentage points. Along with such modest reductions in recurrence risk, these therapies also come with some long-term risks and short-term toxicities. For example, cardiotoxicity may result from anthracycline-containing regimens often used for breast cancer treatment. Similarly, neuropathy may result from oxa
共同决策(SDM)是个体化医疗的最佳实践。SDM被定义为“一种临床医生和患者在面临决策任务时共享最佳可用证据的方法，并支持患者考虑各种选择，以实现知情偏好”。它反映了以人为本的护理理念，因为它固有地尊重和评价患者的观点，并将其作为治疗决策过程中的重要组成部分[10]。在从20世纪中期不受约束的医疗家长式作风转变到不合格的患者自决和医疗消费主义的另一个极端的过程中，SDM反映了这些更两极分化的方法之间钟摆摆动的一个合理的中间点。因此，美国国家医学院(National Academy of Medicine)呼吁我们所有人都进行SDM，并且已经这样做了十多年。不幸的是，尽管越来越多的证据表明SDM方法在癌症治疗及其他方面有许多好处，但尚不清楚这一长期建议是否对临床医生的实践产生了很大影响[4-6]。数据继续显示，大多数晚期癌症患者从根本上误解了他们的预后[7,8]，并且每年有许多美国人以他们不希望的方式死亡，例如在医院或重症监护病房，或在生命的最后两周接受无效的化疗[9-11]。在预后不确定的情况下，这些差距似乎更大，例如血液恶性肿瘤，在这些情况下，复发或难治性疾病仍有可能治愈(尽管可能性较小)[12-18]。当我们努力解决肿瘤临终关怀质量低下的问题时，SDM必须被视为改善这些结果的重要工具。更广泛地说，SDM和必须伴随的患者偏好的引出对于改善患者在面临癌症诊断时的疾病体验至关重要。毕竟，病人才是自己经验的专家。在理性的人可能不同意“正确”道路的情况下，SDM尤其必要，因为在这种情况下，确实存在“偏好敏感决策”。一个典型的例子是选择是否对早期、结直肠癌、乳腺癌或肺癌进行辅助化疗。在这些设置中没有明确的“正确答案”，而是需要考虑一系列权衡，其价值可能被具有不同价值体系和优先级的人所感知。虽然已知这些疗法可以降低癌症复发的风险，但在许多情况下，这些降低幅度相对较小，大约只有几个百分点。随着复发风险的适度降低，这些疗法也带来了一些长期风险和短期毒性。例如，常用于乳腺癌治疗的含蒽环类药物可能导致心脏毒性。同样，神经病变也可由常用于结直肠癌辅助治疗的含有奥沙利铂的方案引起，或由用于治疗乳腺癌或肺癌的紫杉烷引起。希望我们都同意，对我们的病人来说，了解他们所考虑的任何治疗的风险和益处是很重要的，并且必须就每个人的正确途径进行诚实、开放的对话。这就是SDM的精神，那些关心癌症患者的人似乎在原则上同意它的重要性。然而，具有讽刺意味的是，我们大多数人实际上并没有接受过如何在实践中实施SDM的培训。相反，在传统的医学培训学徒模式下，我们更支持“看一个，做一个，教一个”的方法。可悲的是，这往往意味着，那些从未接受过SDM培训的人最终会以某种方式为下一代临床医生做榜样，而这些临床医生在看过一两次SDM后，可能从未亲眼见过SDM的先锋例子，然后就自己蒙混过去了。当我在实践中观察这些互动时，结果往往是我经常听到的:相对肤浅的，关于治疗途径的一次性讨论，强调风险和毒性，但缺乏任何有意义的探索和分享偏好，优先事项，目标和价值观。因此，我们没有认识到“诊断偏好”的重要性，这是真正SDM的重要组成部分[19,20]。“诊断偏好”的重要性最近对我来说变得非常清楚，因为我努力理解我们团队在2010年进行的一项研究中得出的一些令人惊讶的结果。简而言之，我们发现，即使治愈率接近50%，也有相当一部分外行人会选择以缓解为目的的化疗，而不是能够治愈他们的化疗。我们预计治愈的机会将在很大程度上推动决策，它确实在一定程度上起了作用，然而一个主要的预测因素
{"title":"‘Shared decision-making, preferences, risk-tolerance, and the cancer patient experience’","authors":"T. Leblanc","doi":"10.1080/23809000.2017.1408412","DOIUrl":"https://doi.org/10.1080/23809000.2017.1408412","url":null,"abstract":"Shared decision-making (SDM) is a best practice in personalized medicine. SDM is defined as ‘an approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences’ [1]. It reflects the ideals of person-centered care, by virtue of its inherent respect and valuation of the patient perspective as a vital component in the treatment decisionmaking process [2]. Amid a shift from the unbridled medical paternalism of the mid-twentieth century, to the other extreme of unqualified patient self-determination and medical consumerism, SDM reflects a reasonable midpoint in the pendulum swing between these more polarized approaches. Accordingly, the National Academy of Medicine has called for us all to do SDM, and has been doing so for more than a decade [3]. Unfortunately, it is not clear that this long-standing recommendation has had much impact on clinicians’ practices, despite growing evidence as to the many benefits of an SDM approach in cancer care and beyond [4–6]. Data continue to show that most patients with advanced cancer fundamentally misunderstand their prognosis [7,8], and that many Americans die each year in ways that they would not want, such as in hospital or intensive care unit settings, or receiving ineffective chemotherapies in the last 2 weeks of their life [9–11]. These gaps seem to be even worse in cases of prognostic uncertainty, such as hematologic malignancies, where cure may still be possible in those with relapsed or refractory disease (albeit less likely) [12–18]. As we grapple with this ongoing problem of poor-quality end-of-life care in oncology, SDM must be seen as an essential tool to improve these outcomes. More broadly though, SDM and the elicitation of patient preferences that must accompany it are essential to improving patients’ experiences of illness when facing a cancer diagnosis. After all, patients are the experts on their own experiences. SDM is particularly necessary in cases where reasonable people might disagree about the ‘right’ path, wherein there is truly a ‘preference-sensitive decision’ at play. A classic example is the choice of whether to pursue adjuvant chemotherapy for an early stage, colorectal, breast, or lung cancer. There is no clear ‘right answer’ in these settings, but rather a series of trade-offs to consider, the value of which might be perceived differently by people with differing value systems and priorities. While these therapies are known to reduce the risk of cancer recurrence, in many cases these reductions are relatively modest, in the order of a few percentage points. Along with such modest reductions in recurrence risk, these therapies also come with some long-term risks and short-term toxicities. For example, cardiotoxicity may result from anthracycline-containing regimens often used for breast cancer treatment. Similarly, neuropathy may result from oxa","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"2 1","pages":"275 - 277"},"PeriodicalIF":0.0,"publicationDate":"2017-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2017.1408412","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48544572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-02DOI: 10.1080/23809000.2017.1403851
E. Chung
ABSTRACT Introduction: Radical prostatectomy adversely affects patient’s sexual function and quality of life. While several preventive and treatment strategies for the preservation and recovery of sexual function are available, no widely adopted specific recommendation or consensus guidelines exist regarding the optimal rehabilitation or treatment protocol. Areas covered: This article provides a scientific review on post-prostatectomy related erectile dysfunction and explores the various treatment strategies to preserve and/or restore penile erection, as well as addresses the psychosexual issues in men who wish to remain sexually active. Expert opinion/commentary: Penile rehabilitation programs are common in clinical practice despite no definitive evidence to support their use or the best treatment strategy. The role of penile rehabilitation is evolving, and it is generally agreed that treatment should be initiated as soon as possible to protect and/or prevent corporal endothelial and smooth muscle damage. Psychological and sexual counselling is equally important in assisting the patient in maintaining and/or recovering his sexual function. The current treatment strategy should offer prostate cancer survivor a perspective that de-emphasizes the solely biomedical approach to erectile recovery but addresses sexual issues from a more holistic approach encompassing biopsychosocial perspective.
{"title":"Management of treatment-related sexual complications in cancer care: evidence for erectile function recovery and penile rehabilitation after radical prostatectomy in prostate cancer survivorship","authors":"E. Chung","doi":"10.1080/23809000.2017.1403851","DOIUrl":"https://doi.org/10.1080/23809000.2017.1403851","url":null,"abstract":"ABSTRACT Introduction: Radical prostatectomy adversely affects patient’s sexual function and quality of life. While several preventive and treatment strategies for the preservation and recovery of sexual function are available, no widely adopted specific recommendation or consensus guidelines exist regarding the optimal rehabilitation or treatment protocol. Areas covered: This article provides a scientific review on post-prostatectomy related erectile dysfunction and explores the various treatment strategies to preserve and/or restore penile erection, as well as addresses the psychosexual issues in men who wish to remain sexually active. Expert opinion/commentary: Penile rehabilitation programs are common in clinical practice despite no definitive evidence to support their use or the best treatment strategy. The role of penile rehabilitation is evolving, and it is generally agreed that treatment should be initiated as soon as possible to protect and/or prevent corporal endothelial and smooth muscle damage. Psychological and sexual counselling is equally important in assisting the patient in maintaining and/or recovering his sexual function. The current treatment strategy should offer prostate cancer survivor a perspective that de-emphasizes the solely biomedical approach to erectile recovery but addresses sexual issues from a more holistic approach encompassing biopsychosocial perspective.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"2 1","pages":"279 - 286"},"PeriodicalIF":0.0,"publicationDate":"2017-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2017.1403851","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48955828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-02DOI: 10.1080/23809000.2017.1396186
A. Jackson, J. Nangia
ABSTRACT Introduction: Chemotherapy-induced alopecia (CIA) has a significant impact on the quality of life of many cancer patients. Scalp cooling has been in use for decades for the prevention of CIA, and was first reported as effective in the 1970s. Areas covered: This review focuses on the scalp cooling as a preventative measure for CIA. It describes the recent literature on scalp cooling efficacy and safety, with a focus on recent prospective controlled trials. We performed a structured search of English language articles published from 2007 to August 2017 and selected pertinent studies reporting on scalp cooling and CIA. Expert commentary: Recent randomized and prospective trials in the United States have shown scalp cooling devices to be effective in a large percentage of patients; however, there are significant differences in rates of hair retention depending on the chemotherapy drugs and regimens used. The amassing evidence regarding scalp cooling for prevention of chemotherapy-induced alopecia has demonstrated that this is an effective, safe and well tolerated intervention which may provide an improved quality of life for patients undergoing chemotherapy for neoplastic disease.
{"title":"Scalp cooling to prevent or reduce chemotherapy-induced alopecia","authors":"A. Jackson, J. Nangia","doi":"10.1080/23809000.2017.1396186","DOIUrl":"https://doi.org/10.1080/23809000.2017.1396186","url":null,"abstract":"ABSTRACT Introduction: Chemotherapy-induced alopecia (CIA) has a significant impact on the quality of life of many cancer patients. Scalp cooling has been in use for decades for the prevention of CIA, and was first reported as effective in the 1970s. Areas covered: This review focuses on the scalp cooling as a preventative measure for CIA. It describes the recent literature on scalp cooling efficacy and safety, with a focus on recent prospective controlled trials. We performed a structured search of English language articles published from 2007 to August 2017 and selected pertinent studies reporting on scalp cooling and CIA. Expert commentary: Recent randomized and prospective trials in the United States have shown scalp cooling devices to be effective in a large percentage of patients; however, there are significant differences in rates of hair retention depending on the chemotherapy drugs and regimens used. The amassing evidence regarding scalp cooling for prevention of chemotherapy-induced alopecia has demonstrated that this is an effective, safe and well tolerated intervention which may provide an improved quality of life for patients undergoing chemotherapy for neoplastic disease.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"2 1","pages":"287 - 292"},"PeriodicalIF":0.0,"publicationDate":"2017-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2017.1396186","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46443146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-09-03DOI: 10.1080/23809000.2017.1381563
Satya Das, L. Horn
ABSTRACT Introduction: Immunotherapy has been FDA approved in several first line and many more second line settings in patients with advanced cancer. While only a subset of patients derive benefit from checkpoint blockade, the potential for durable responses and tolerable adverse effects make it an appealing option. Patient quality of life on the therapy is a particularly important consideration given its therapeutic intent is non-curative. Areas covered: The primary focus of this review is exploring studies which led to the approval of checkpoint inhibitors in a variety of tumor types, with a specific emphasis on studies looking at patient related outcomes (PRO). The latter part of the review focuses on identification and management of unique immune related toxicities. Expert commentary: PROs are improved with immunotherapy compared to chemotherapy largely by reducing functional decline and impacting global health less negatively in patients. There remain numerous questions about checkpoint inhibitors including what is the optimal duration of treatment, will they be tolerable when combined with immune stimulatory agonists or chemotherapy, and how do we increase the number of patients who derive benefit from them. We are only beginning to scratch the surface of their potential.
{"title":"Quality matters: immunotherapy and the evolving landscape of advanced cancer care","authors":"Satya Das, L. Horn","doi":"10.1080/23809000.2017.1381563","DOIUrl":"https://doi.org/10.1080/23809000.2017.1381563","url":null,"abstract":"ABSTRACT Introduction: Immunotherapy has been FDA approved in several first line and many more second line settings in patients with advanced cancer. While only a subset of patients derive benefit from checkpoint blockade, the potential for durable responses and tolerable adverse effects make it an appealing option. Patient quality of life on the therapy is a particularly important consideration given its therapeutic intent is non-curative. Areas covered: The primary focus of this review is exploring studies which led to the approval of checkpoint inhibitors in a variety of tumor types, with a specific emphasis on studies looking at patient related outcomes (PRO). The latter part of the review focuses on identification and management of unique immune related toxicities. Expert commentary: PROs are improved with immunotherapy compared to chemotherapy largely by reducing functional decline and impacting global health less negatively in patients. There remain numerous questions about checkpoint inhibitors including what is the optimal duration of treatment, will they be tolerable when combined with immune stimulatory agonists or chemotherapy, and how do we increase the number of patients who derive benefit from them. We are only beginning to scratch the surface of their potential.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"2 1","pages":"235 - 244"},"PeriodicalIF":0.0,"publicationDate":"2017-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2017.1381563","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43871838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-09-03DOI: 10.1080/23809000.2017.1378072
Laia Julià, M. Jefford
ABSTRACT Introduction: Adult cancer survivors may experience a range of consequences from their disease and its treatment. There is a need to improve the current model of post-treatment care, which is neither sufficiently effective nor sustainable in the context of a burgeoning population of cancer survivors. Areas covered: We review the current state of post-treatment care, including its strengths and limitations. Guiding principles in the design of optimal survivorship care are discussed, including longitudinal risk stratification, survivorship care plans, incorporating patient preferences and remote monitoring. Alternative models of survivorship care are reviewed which seek to address individual patient needs and preferences. Other strategies for improving survivor outcomes are reviewed. Future research priorities are outlined, including exploring the lived experience of survivors and appropriate models of care. Expert commentary: The challenge of providing optimal survivorship care is shared internationally and there is an opportunity to learn from the experiences of others. Despite high quality evidence for at least some cancer types, there has been limited adoption of alternative models of care and more work is required to translate these findings into routine practice.
{"title":"Improving care for cancer survivors","authors":"Laia Julià, M. Jefford","doi":"10.1080/23809000.2017.1378072","DOIUrl":"https://doi.org/10.1080/23809000.2017.1378072","url":null,"abstract":"ABSTRACT Introduction: Adult cancer survivors may experience a range of consequences from their disease and its treatment. There is a need to improve the current model of post-treatment care, which is neither sufficiently effective nor sustainable in the context of a burgeoning population of cancer survivors. Areas covered: We review the current state of post-treatment care, including its strengths and limitations. Guiding principles in the design of optimal survivorship care are discussed, including longitudinal risk stratification, survivorship care plans, incorporating patient preferences and remote monitoring. Alternative models of survivorship care are reviewed which seek to address individual patient needs and preferences. Other strategies for improving survivor outcomes are reviewed. Future research priorities are outlined, including exploring the lived experience of survivors and appropriate models of care. Expert commentary: The challenge of providing optimal survivorship care is shared internationally and there is an opportunity to learn from the experiences of others. Despite high quality evidence for at least some cancer types, there has been limited adoption of alternative models of care and more work is required to translate these findings into routine practice.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"2 1","pages":"251 - 262"},"PeriodicalIF":0.0,"publicationDate":"2017-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2017.1378072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60122704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-09-03DOI: 10.1080/23809000.2017.1376584
M. Tattersall
ABSTRACT Introduction and Areas covered: Misunderstanding in cancer patients receiving chemotherapy is common. 50% of cancer chemotherapy is given with palliative intent. Many patients receiving chemotherapy for incurable cancer may not understand that chemotherapy is unlikely to be curative. Cancer patients expect to share treatment decisions with their oncologist. Provision of a question prompt list (QPL) and endorsement by physicians enhances patient participation in consultations and promotes patient questions about prognosis. Audio-recordings of oncologist consultations with newly detected incurable cancer patients document that most patients were informed about the aim of cancer treatment and that their disease was incurable. Oncologists checked patient understanding in only 10% of consultations. Expert commentary: This review identifies gaps in patient understanding of palliative chemotherapy and examines incurable cancer patients expectations of treatment.
{"title":"Gaps in patients’ understanding of palliative chemotherapy. Can we better communicate that treatment is not curative?","authors":"M. Tattersall","doi":"10.1080/23809000.2017.1376584","DOIUrl":"https://doi.org/10.1080/23809000.2017.1376584","url":null,"abstract":"ABSTRACT Introduction and Areas covered: Misunderstanding in cancer patients receiving chemotherapy is common. 50% of cancer chemotherapy is given with palliative intent. Many patients receiving chemotherapy for incurable cancer may not understand that chemotherapy is unlikely to be curative. Cancer patients expect to share treatment decisions with their oncologist. Provision of a question prompt list (QPL) and endorsement by physicians enhances patient participation in consultations and promotes patient questions about prognosis. Audio-recordings of oncologist consultations with newly detected incurable cancer patients document that most patients were informed about the aim of cancer treatment and that their disease was incurable. Oncologists checked patient understanding in only 10% of consultations. Expert commentary: This review identifies gaps in patient understanding of palliative chemotherapy and examines incurable cancer patients expectations of treatment.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"2 1","pages":"245 - 249"},"PeriodicalIF":0.0,"publicationDate":"2017-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2017.1376584","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47928656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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