Psycho-Oncology

Nghiên cứu này nhắm đến việc kiểm tra hiệu quả của hai can thiệp được cung cấp qua điện thoại trong việc cải thiện chất lượng cuộc sống (QOL) (tâm lý, thể chất, xã hội và tinh thần) của phụ nữ Latinas bị ung thư vú và gia đình hoặc bạn bè của họ (được gọi là đối tác hỗ trợ trong nghiên cứu này).

Phụ nữ Latinas bị ung thư vú và đối tác hỗ trợ (SPs) được phân ngẫu nhiên vào một trong hai can thiệp 8 tuần qua điện thoại: (i) tư vấn liên kết qua điện thoại (TIP-C) hoặc (ii) giáo dục sức khỏe qua điện thoại (THE). Đánh giá QOL được thực hiện tại điểm xuất phát, ngay sau khi kết thúc can thiệp 8 tuần, và sau đó 8 tuần. Bảy mươi phụ nữ Latinas và 70 SPs đã hoàn tất tất cả các đánh giá (36 người tham gia giáo dục sức khỏe và 34 người tham gia tư vấn) và được bao gồm trong phân tích cuối cùng.

Cả phụ nữ Latinas bị ung thư vú và SPs của họ đã có những cải thiện đáng kể trong hầu hết các khía cạnh của QOL trong suốt 16 tuần điều tra. Tuy nhiên, không có bằng chứng nào cho thấy sự vượt trội của bất kỳ phương pháp can thiệp nào trong cải thiện QOL. Phân tích chi phí sơ bộ cho thấy can thiệp tư vấn có chi phí khoảng 164,68 đô la cho một cặp so với 107,03 đô la cho giáo dục sức khỏe. Phần lớn người tham gia báo cáo rằng họ nhận thấy lợi ích từ can thiệp và thích ứng với việc can thiệp bằng tiếng Tây Ban Nha, bao gồm SPs và được tiến hành qua điện thoại.

Kết quả của nghiên cứu này cho thấy rằng các can thiệp qua điện thoại tương đối ngắn hạn, phù hợp văn hóa, và dễ tiếp cận, cung cấp hỗ trợ cảm xúc và thông tin có thể mang lại cải thiện đáng kể cho QOL cả đối với phụ nữ Latinas bị ung thư vú và SPs của họ. Bản quyền © 2012 John Wiley & Sons, Ltd.

This study examined support service use and interest in support services among distressed family caregivers of patients recently entering comprehensive cancer care facilities.

Primary family caregivers of lung cancer patients (N = 83) were recruited from three medical centers within 12 weeks of the patient's new visit to the oncology clinic. All family caregivers were screened for psychological distress, and those reporting significant anxiety or depressive symptoms were eligible for this study. Caregivers completed a baseline assessment of support service use (i.e., use of mental health services and complementary and alternative medicine [CAM]) and interest in support services. Support service use was also assessed 3 months later.

Although all caregivers reported clinically meaningful distress, only 26% used mental health and 39% used CAM services during the 3‐month study period. Patients' receipt of chemotherapy was positively associated with caregivers' mental health service use, whereas greater education and receiving assistance with caregiving tasks were associated with CAM use. Forty percent of caregivers who did not use CAM at baseline were interested in CAM. In addition, 29% of caregivers who did not receive mental health services at baseline were interested in professional psychosocial support, and 29% of caregivers who did not receive staff assistance with practical needs at baseline were interested in this service.

Findings suggest that distressed family caregivers of lung cancer patients underuse mental health services and that a sizable minority are interested in professional help with psychosocial and practical needs. Copyright © 2012 John Wiley & Sons, Ltd.

Quality of life (QOL) is a multidimensional construct that includes physical, psychological, and relationship well‐being.

We conducted a systematic review and meta‐analysis of randomized controlled studies published between 1980 and 2012 of interventions conducted with both cancer patients and their partners that were aimed at improving QOL. Using bibliographic software and manual review, two independent raters reviewed 752 articles with a systematic process for reconciling disagreement, yielding 23 articles for systematic review and 20 for meta‐analysis.

Most studies were conducted in breast and prostate cancer populations. Study participants (N = 2645) were primarily middle aged (mean = 55 years old) and white (84%). For patients, the weighted average effect size (g) across studies was 0.25 (95% CI = 0.12–0.32) for psychological outcomes (17 studies), 0.31 (95% CI = 0.11–0.50) for physical outcomes (12 studies), and 0.28 (95% CI = 0.14–0.43) for relationship outcomes (10 studies). For partners, the weighted average effect size was 0.21 (95% CI = 0.08–0.34) for psychological outcomes (12 studies) and 0.24 (95% CI = 0.6–0.43) for relationship outcomes (7 studies).

Therefore, couple‐based interventions had small but beneficial effects in terms of improving multiple aspects of QOL for both patients and their partners. Questions remain regarding when such interventions should be delivered and for how long. Identifying theoretically based mediators and key features that distinguish couple‐based from patient‐only interventions may help strengthen their effects on patient and partner QOL. Copyright © 2012 John Wiley & Sons, Ltd.

Few intervention programs assist patients and their family caregivers to manage advanced cancer and maintain their quality of life (QOL). This study examined (i) whether patient–caregiver dyads (i.e., pairs) randomly assigned to a brief or extensive dyadic intervention (the FOCUS Program) had better outcomes than dyads randomly assigned to usual care and (ii) whether patients' risk for distress and other factors moderated the effect of the brief or extensive program on outcomes.

Advanced cancer patients and their caregivers (N = 484 dyads) were stratified by patients' baseline risk for distress (high versus low), cancer type (lung, colorectal, breast, or prostate), and research site and then randomly assigned to a brief (three‐session) or extensive (six‐session) intervention or control. The interventions offered dyads information and support. Intermediary outcomes were appraisals (i.e., appraisal of illness/caregiving, uncertainty, and hopelessness) and resources (i.e., coping, interpersonal relationships, and self‐efficacy). The primary outcome was QOL. Data were collected prior to intervention and post‐intervention (3 and 6 months from baseline). The final sample was 302 dyads. Repeated measures MANCOVA was used to evaluate outcomes.

Significant group by time interactions showed that there was an improvement in dyads' coping (p < 0.05), self‐efficacy (p < 0.05), and social QOL (p < 0.01) and in caregivers' emotional QOL (p < 0.05). Effects varied by intervention dose. Most effects were found at 3 months only. Risk for distress accounted for very few moderation effects.

Both brief and extensive programs had positive outcomes for patient–caregiver dyads, but few sustained effects. Patient–caregiver dyads benefit when viewed as the ‘unit of care’. Copyright © 2012 John Wiley & Sons, Ltd.

Social support is acknowledged as important in cancer survivorship, but little is known about change in support after cancer diagnosis and factors associated with this, particularly in colorectal cancer. The CREW cohort study investigated social support up to 2 years following curative intent surgery for colorectal cancer.

A total of 871 adults recruited pre‐treatment from 29 UK centres 2010 to 2012 consented to follow‐up. Questionnaires at baseline, 3, 9, 15, and 24 months post‐surgery included assessments of social support (Medical Outcomes Study‐Social Support Survey, MOS‐SSS) and health‐related quality of life (HRQoL). Socio‐demographic, clinical and treatment details were collected. Longitudinal analyses assessed social support over follow‐up, associations with participant characteristics, and HRQoL.

Around 20% were living alone and 30% without a partner. Perceived social support declined in around 29% of participants, with 8% of these reporting very low levels overall from baseline to 2 years (mean MOS‐SSS overall score < 40 on a scale from 0 to 100). Older age, female gender, greater neighbourhood deprivation, presence of co‐morbidities, and rectal cancer site were significantly associated with reductions in perceived support. Poorer HRQoL outcomes (generic health/QoL, reduced wellbeing, anxiety, and depression) were significantly associated with lower levels of social support.

Levels of social support decline following colorectal cancer diagnosis and treatment in nearly a third of patients and are an important risk factor for recovery of HRQoL. Assessment of support early on and throughout follow‐up would enable targeted interventions to improve recovery, particularly in the more vulnerable patient groups at risk of poorer social support.

The aims of the study were to modify the Cancer Survivor's Unmet Need (CaSUN) Scale into a short form and then test its psychometric scale‐specific properties for breast cancer survivors in Taiwan.

Using convenience sampling, recruited breast cancer survivors were separated into 2 samples (sample 1, n = 150, and sample 2, n = 162). First, we translated and modified the CaSUN to ensure cultural adaptation. Second, we used statistical methods to eliminate some items and conducted an exploratory factor analysis (EFA) using sample 1 to explore the factor structure of the CaSUN‐C. Finally, we conducted a confirmatory factor analysis using sample 2 to confirm the structure suggested by the EFA and tested the criterion validity and known‐group validity of the CaSUN‐C.

Twenty items within 4 factors (information, physical /psychological, medical care, and communication needs) were identified for the CaSUN‐C. Each factor had acceptable internal consistency (Cronbach's Alpha = .61 to .82). The criterion validity was supported by the significant correlations between the CaSUN‐C scores and scores on fear of recurrence and depression. Known‐group comparisons revealed that women who survived more than 60 months had fewer physical/psychological needs than those less 60 months, which supported the validity of CaSUN‐C.

The CaSUN‐C demonstrated acceptable reliability and validity for assessing unmet needs among breast cancer survivors in Taiwan. Using this simple assessment to target the individual needs of these survivors can help healthcare professionals provide personalized care efficiently.

This study aimed to provide an in‐depth exploration of follow‐up care experiences and supportive care needs in long‐term colorectal cancer (CRC) survivors within multiethnic Asian communities.

Semi‐structured in‐depth interviews were conducted on a purposive sample of 30 long‐term CRC survivors who had completed all treatment without recurrence ranging 2 to 17 years in Singapore. Interviews were audio‐recorded and transcribed verbatim. Thematic analysis was conducted following grounded theory approach.

Four themes represented the experience of the Asian long‐term CRC survivors: (a) living with long‐term consequences, (b) dealing with unceasing adaptation demands, (c) navigating a healthcare journey with limited direction, (d) regaining mastery through adversity. CRC and its treatment had profound physical impacts on some long‐term survivors and these effected their psychological well‐being. A sense of abandonment and vulnerability following the cessation of a 5‐year follow‐up care was repeatedly expressed. Participants defined recovery from CRC as not merely surviving but also having high physical function and full independence. They often sought less conventional remedies and medicine based on cultural beliefs rather than current evidence. Participants noted pervasive social stigma associated with CRC that impeded their inclusion in the workforce.

Asian long‐term CRC survivors experienced multiple challenges and needs relating to the care experience, information provision and workforce stigmatization, and several of which were unique to the Asian context. Future work will need to consider the implementation of culturally tailored cancer survivorship care plans that incorporate the specific needs of Asian CRC survivors.