Defining chronic cancer: patient experiences and self-management needs.
Harley Clare,Pini Simon,Bartlett Yvonne Kiera,Velikova Galina
BMJ supportive & palliative care
OBJECTIVE:Chronic cancer is poorly defined and strategies for supporting patients during this disease phase are lacking. This research defines chronic cancer, explores patient experiences and reviews patients' support needs against those described in the 2007 Department of Health Generic Choice Model for Long-term Conditions (DoH-GCM). DESIGN:Semistructured interviews were audio recorded, transcribed and data explored for emergent themes. The a priori themes from DoH-GCM were applied: clinical support; self-care and self-management; supporting independence; psychological support; and social and economic factors. RESULTS:56 patients >12 months postdiagnosis of advanced cancer were recruited from five clinics at a Yorkshire cancer centre: breast (n=11); renal (n=11); colorectal/gastrointestinal (n=12); gynaecological (n=12); and prostate (n=10). Most patients aspired to living normal lives. Challenges included frequent and lengthy hospital appointments, long-term symptom control and uncertainty. Only renal and prostate patients reported routine access to specialist nursing. Uptake of support services was varied and there was generally poor understanding of support pathways for non-medical problems and issues occurring when patients were not receiving active treatment. There was variation in coping strategies and ability of patients to attain a positive outlook on life. CONCLUSIONS:For patients to do well in this cancer phase requires good self-management of symptoms plus taking an active role in accessing appropriate services as needed. Care planning at the point of transition to the chronic phase of cancer should focus on evaluating patients' needs, clarifying support pathways, increasing the profile and involvement of community services and organisations, and supporting patients and families develop effective self-management skills.
10.1136/bmjspcare-2012-000200rep
Health self-management experiences of colorectal cancer patients in postoperative recovery: A qualitative study.
Lo Pei-Shan,Lin Yu-Ping,Hsu His-Hsien,Chang Shih-Chang,Yang Shu-Ping,Huang Wen-Chien,Wang Tsae-Jyy
European journal of oncology nursing : the official journal of European Oncology Nursing Society
PURPOSE:Health self-management helps improve health-related quality of life and life satisfaction, as well as cancer survival. The study aim was to explore the essence of the health self-management experiences and support needs of colorectal cancer patients after surgeries. METHODS:The study was based on phenomenology research methodology. Purposive sampling was used to obtain a heterogeneous sample to provide rich information regarding the research questions. Participants were recruited from colorectal surgery outpatient clinics in a hospital in Taiwan. Data were collected by semi-structured in-depth interviews and analyzed by thematic content analysis. Strategies adapted from Lincoln and Guba were used to enhance the trustworthiness of the study. RESULTS:Ten participants, 5 males and 5 females, were interviewed. Their health self-management experience fell into 3 overarching themes and 9 related subthemes. Our results show that (1) seeking support when experiencing discomfort, (2) when life changes, re-adjust accordingly, and (3) staying positive and self-perseverance are the essences of the health self-management experiences and support needs of postoperative colorectal cancer patients. CONCLUSIONS:Postoperative colorectal cancer patients experienced tremendous physical and psychosocial challenges after returning home from the hospital. Although burdened with multiple stressors, these patients were able to seek support, learning to practice self-care, facing cancer positively, and exhibit positive growth in life. Patients with colorectal cancer have to constantly adjust to the impacts of their diseases. The study results may provide as a reference for supporting postoperative adjustment and promoting health self-management among patients with colorectal cancer.
10.1016/j.ejon.2021.101906
Effects of a Self-Management Program for Patients With Colorectal Cancer and a Colostomy: A Nonrandomized Clinical Trial.
Song Qin Fen,Yin Guangxiao,Guo Xiaopeng,Lv Xue,Yu Keling,Liu Chune
Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society
PURPOSE:We constructed a self-management program for rectal cancer survivors with colostomies and evaluated the effect of the program on self-efficacy, self-management ability, and incidence of stomal and peristomal complications. DESIGN:A prospective, nonrandomized clinical trial. SUBJECTS AND SETTING:Participants were recruited from 4 proctology departments in a tertiary hospital in northeast China. Fifty-five were assigned to the intervention group and 56 were assigned to the control group; 26 were lost to follow-up. Therefore, data analysis was based on 43 participants in the intervention group and 42 in the control group. METHODS:Control group patients received the standard care where guidance and stoma care manuals were given the day before hospital discharge, and regular telephone follow-up twice a month for 3 months. Participants in the experimental group received, in addition to standard care, a self-management program delivered via a multimedia messaging app initiated after discharge available over a 6-week period. Primary outcomes were self-efficacy and self-management ability; we also analyzed the incidence of stomal and peristomal complications as a secondary outcome. Between-groups outcomes were analyzed via a repeated-measures analysis of variance. RESULTS:Analysis indicated intervention group participants had higher levels of self-efficacy and self-management of their colostomies than did control group participants. Analysis also revealed intervention group participants had a lower incidence of peristomal complications; no differences in the incidence of stomal complications were found. CONCLUSIONS:Study findings suggest that use of the multimedia messaging app-based self-management program enhanced self-efficacy and self-management, while reducing the incidence of peristomal complications in rectal cancer survivors with colostomies.
10.1097/WON.0000000000000779
Feasibility of OptiMaL, a Self-Management Programme for Oesophageal Cancer Survivors.
Cancer control : journal of the Moffitt Cancer Center
INTRODUCTION:There is limited availability of self-management interventions for oesophageal cancer survivors at present. This study examined the feasibility of OptiMal, a six-week, self-management programme to improve fatigue, mood and health-related quality of life for oesophageal cancer survivors. METHODS:A mixed methods design was used to evaluate the feasibility of OptiMal. The quantitative arm of the study examined changes in the Multidimensional Fatigue Inventory, Hospital Anxiety and Depression Scale, and the EQ-5D-3L, administered prior to OptiMal (T1), immediately following completion of OptiMal (T2), and three months following completion (T3). Qualitative inquiry in the study was guided by a qualitative descriptive approach through focus groups investigating the experiences of group participants, and individual semi-structured interviews at T3. Qualitative data were analysed using thematic analysis. RESULTS:Two OptiMal programmes were delivered over a six-month period with a total of fourteen individuals who had finished treatment for oesophageal cancer. The attendance rate was 89.3%. Statistically significant reductions were observed in fatigue, difficulty performing usual activities, anxiety and depression at three-month follow-up. Qualitative findings identified acceptability of the content and delivery format of OptiMal. Participants reported applying self-management strategies acquired through OptiMal to increase participation in daily activities and improve their health and well-being. CONCLUSIONS:This feasibility study yielded promising results in terms of self-management outcomes for oesophageal cancer survivors following attendance of OptiMal. Larger scale research studies with control groups are warranted to examine the outcomes in a robust manner.
10.1177/10732748231185002
Efficacy of a self-management program on quality of life in colorectal cancer patients: A randomized controlled trial.
European journal of oncology nursing : the official journal of European Oncology Nursing Society
PURPOSE:To test the efficacy of a self-management program based on acceptance and commitment therapy on quality of life, emotional distress, fatigue, physical activity, and fruit and vegetable intake in patients with colorectal cancer. METHODS:The study was a randomized controlled trial. A sample of 156 patients with colorectal cancer (stage I-III) was recruited by convenience sampling and participants were allocated randomly assigned to control or intervention groups. The intervention included a colorectal cancer self-management information booklet, two personal skills training sessions, and 12 follow-up telephone calls. The control group received health education leaflets. Outcome variables were assessed in both groups at baseline and every two months thereafter during the six-month follow-up period. RESULT:The mean age of participants was 62 years (range: 30-89 years). Generalized estimation equations analyses revealed significant differences over time in changes in anxiety (β = -2.22, p = 0.001), depression (β = -1.48, p = 0.033), fatigue (β = 4.46, p = 0.001), physical and functional measures (β = 6.16, p = 0.005), and colorectal-cancer-specific quality of life (β = 7.45, p = 0.012). However, there were no significant differences in changes in physical activity or fruit and vegetable intake over time. CONCLUSION:The self-management skills provided by oncology nurses, including symptom management, psychological adjustment, and relaxation exercises, help colorectal cancer patients to overcome the challenges of cancer survivorship, accelerate their recovery, and improve their quality of life. THE TRIAL NUMBER:NCT03853278 registered on ClinicalTrials.gov.
10.1016/j.ejon.2023.102431
Factors associated with lymphedema self-management behaviours among breast cancer survivors: A cross-sectional study.
Journal of clinical nursing
AIMS AND OBJECTIVES:The purpose of this empirical study was to explore the current status and associated factors of lymphedema self-management behaviours among Chinese breast cancer survivors. BACKGROUND:Breast cancer-related lymphedema is a lifetime concern for survivors and is currently incurable. Lifetime lymphedema self-management takes a significant role in preventing development and progression of lymphedema. Understanding influencing factors of lymphedema self-management behaviours can help to develop targeted intervention programs. DESIGN:A multicentre cross-sectional study. METHODS:From December 2021 to April 2022, a convenience sample of 586 participants were recruited at four tertiary hospitals in four cities in China. Self-reported questionnaires were used to measure socio-demographic characteristics, disease-and treatment-related characteristics, lymphedema self-management behaviours, lymphedema knowledge, illness perception, self-efficacy, self-regulation and social support. Descriptive analysis, bivariate analysis and hierarchical multiple regression were conducted. This study was registered at Chinese Clinical Trial Registry (ChiCTR2200057084), and was reported followed the STROBE checklist. RESULTS:Breast cancer survivors reported moderate level of lymphedema self-management behaviours. Promotion of lymph reflux management was ranked the least performed self-management behaviours, while the affected limb protection management ranked the most. 36.2% of self-management behaviours was explained by exercise regularly, level of attention on lymphedema prevention, unclear about the tumour stage (vs. stage I), knowledge, self-efficacy, emotional illness representation and social support. CONCLUSIONS:Lymphedema self-management behaviours of breast cancer survivors was insufficient. Performance of lymphedema self-management varied with different socio-demographic characteristics, along with different levels of knowledge, self-efficacy, perception and social support. All these identified predictors should be reckoned in assessment and intervention of lymphedema self-management behaviours. RELEVANCE TO CLINICAL PRACTICE:This study addressed that breast cancer survivors' lymphedema self-management behaviours should be promoted. Focusing on identified predictors, further lymphedema surveillance, knowledge education or social facilitation programs are recommended to enhance their self-management performance and adherence.
10.1111/jocn.16833
International consensus on fasting terminology.
Cell metabolism
Although fasting is increasingly applied for disease prevention and treatment, consensus on terminology is lacking. Using Delphi methodology, an international, multidisciplinary panel of researchers and clinicians standardized definitions of various fasting approaches in humans. Five online surveys and a live online conference were conducted with 38 experts, 25 of whom completed all 5 surveys. Consensus was achieved for the following terms: "fasting" (voluntary abstinence from some or all foods or foods and beverages), "modified fasting" (restriction of energy intake to max. 25% of energy needs), "fluid-only fasting," "alternate-day fasting," "short-term fasting" (lasting 2-3 days), "prolonged fasting" (≥4 consecutive days), and "religious fasting." "Intermittent fasting" (repetitive fasting periods lasting ≤48 h), "time-restricted eating," and "fasting-mimicking diet" were discussed most. This study provides expert recommendations on fasting terminology for future research and clinical applications, facilitating communication and cross-referencing in the field.
10.1016/j.cmet.2024.06.013
Electronic Patient-Reported Outcome-Based Symptom Management Versus Usual Care After Lung Cancer Surgery: Long-Term Results of a Multicenter, Randomized, Controlled Trial.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
JCO We previously reported superior symptom control of electronic patient-reported outcome (ePRO)-based symptom management after lung cancer surgery for up to 1 month postdischarge. Here, we present the long-term results (1-12 months) of this multicenter, randomized trial, where patients were assigned 1:1 to receive postoperative ePRO-based symptom management or usual care daily postsurgery, twice weekly postdischarge until 1 month, and at 3, 6, 9, and 12 months postdischarge. Long-term patient-reported outcomes were assessed with MD Anderson Symptom Inventory-Lung Cancer module. Per-protocol analyses were performed with 55 patients in the ePRO group and 57 in the usual care group. At 12 months postdischarge, the ePRO group reported significantly fewer symptom threshold events (any of the five target symptom scored ≥4; median [IQR], 0 [0-0] 0 [0-1]; = .040) than the usual care group. From 1 to 12 months postdischarge, the ePRO group consistently reported significantly lower composite scores for physical interference (estimate, -0.86 [95% CI, -1.32 to -0.39]) and affective interference (estimate, -0.70 [95% CI, -1.14 to -0.26]). Early intensive ePRO-based symptom management after lung cancer surgery reduced symptom burden and improved functional status for up to 1 year postdischarge, supporting its integration into standard care.
10.1200/JCO.23.01854
Electronic Health Interventions for Patients With Breast Cancer: Systematic Review and Meta-Analyses.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
PURPOSE:Ongoing supportive care using electronic health (eHealth) interventions has the potential to provide remote support and improve health outcomes for patients with breast cancer. This study aimed to evaluate the effectiveness of eHealth interventions on patient-reported outcomes (quality of life [QOL], self-efficacy, and mental or physical health) for patients during and after breast cancer treatment and patient-reported experience measures (acceptability and engagement). METHODS:Systematic review with meta-analyses (random-effects model) of randomized controlled trials was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Nine databases were searched using a prespecified search strategy. Patient-directed eHealth interventions for adult patients during or after active breast cancer treatment measuring QOL, self-efficacy, and mental (depressive, anxiety, and distress symptoms) or physical (physical activity, nutrition, and fatigue) health outcomes were included. Data from eligible full-text articles were independently extracted by six observers. RESULTS:Thirty-two unique studies (4,790 patients) were included. All were health self-management interventions, and most were multicomponent (videos, forums, and electronic reminder systems) websites. Meta-analyses revealed a significant effect of eHealth interventions on QOL (standardized mean difference [SMD], 0.20 [95% CI, 0.03 to 0.36]), self-efficacy (SMD, 0.45 [95% CI, 0.24 to 0.65]), distress (SMD, -0.41 [95% CI,-0.63 to -0.20]), and fatigue (SMD, -0.37 [95% CI, -0.61 to -0.13]). Twenty-five studies (78.1%) measured patient-reported experience measures. Acceptability (n = 9) was high, with high ratings for satisfaction (range, 71%-100%), usefulness (range, 71%-95%), and ease-of-use (range, 73%-92%). Engagement (n = 25) decreased over time, but disease-focused information and interactive support were most engaging. CONCLUSION:eHealth interventions may provide an acceptable and effective strategy for improving QOL, distress, self-efficacy, and fatigue among patients with breast cancer.
10.1200/JCO.21.01171
Nutritional self-management in colorectal cancer patients and survivors: A scoping review.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
AIM:Colorectal cancer (CRC) patients need CRC-specific dietary guidance, but often lack access to adequate nutritional information and support. This scoping review identified study interventions, online resources, which have been produced to support nutritional care self-management for CRC patients from diagnosis, through treatment and into survivorship and guidelines to underpin these. METHODS:The review was carried out in accordance with the JBI method for Scoping Reviews. Study interventions, online resources that support the self-management of nutrition and diet in CRC patients were eligible for inclusion, along with CRC-specific guidelines. Searches up to February 2023, were carried out via MEDLINE, CINAHL, PsycInfo, Embase, and Web of Science for published literature and ProQuest Dissertations, Theses Global, TRIP Medical Database, and Google search engines for grey literature. Two reviewers independently screened titles and abstracts, and relevant full texts for inclusion. Data were analysed descriptively. RESULTS:Eight study interventions, 74 online resources and three guidelines specifically aimed at CRC patients were included in the review. Study interventions were heterogenous with respect to duration, whether it was personalized, who supported delivery and which guidelines underpinned the intervention. Three study interventions resulted in improved quality of life and one lengthened survival. A total of 36 (48.6%) online resources were produced by UK charity organizations. Most of the included information was for patients after completing treatment. Specific advice for patients with a stoma was lacking. Some of the online resources provided conflicting advice. The three guidelines explained how dietary adjustments can help address symptoms related to cancer or treatment and two provided more specific guidance on making dietary changes, with specific examples of how to tailor dietary advice to patient needs. CONCLUSION:This scoping review of study interventions, online resources, and guidelines highlighted the need for reliable, detailed, and personalized information to help CRC patients to self-manage their nutritional care.
10.1111/codi.17108
Effect of self-efficacy on self-management ability for colorectal cancer patients with stoma: a path analysis.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
PURPOSE:Colorectal cancer threatens health and causes heavy social burdens. The purpose of this study is to analyze the pathway model for the effect of self-efficacy on self-management ability in colorectal cancer patients with stoma. METHODS:A cross-sectional study was conducted from December 2022 to April 2023, with a convenience sample of 422 colorectal cancer patients with stoma at six tertiary grade A hospitals in Shandong Province, China. Statistical analysis was undertaken using SPSS 26.0 and Amos 24.0 software. A pathway model based on individual and family self-management theories was developed and analyzed by collecting data through onsite survey and online survey. RESULTS:Chinese colorectal cancer patient's self-management ability score is 105.19 (17.19), which shows medium-level self-management ability. The self-efficacy of colorectal cancer patients with a stoma is influenced by social support, which ultimately leads to changes in their self-management ability. CONCLUSION:The findings may help healthcare professionals to identify the factors that influence self-management skills of colorectal cancer patients with stoma and provide a basis for developing interventions.
10.1007/s00520-024-08883-8
Evaluation of Muscle Mass and Malnutrition in Patients with Colorectal Cancer Using the Global Leadership Initiative on Malnutrition Criteria and Comparing Bioelectrical Impedance Analysis and Computed Tomography Measurements.
Nutrients
OBJECTIVES:The aim of this investigation was to evaluate the discrepancies between bioelectrical impedance analysis (BIA) and computed tomography (CT) in assessing skeletal muscle mass and identifying low muscle mass in patients with colorectal cancer. METHODS:This study recruited 137 patients with colorectal cancer from February 2028 to December 2023. CT scans were analyzed at the Lumbar 3 vertebral level to determine the area of skeletal muscle, which was then utilized to estimate whole-body skeletal muscle mass. [BIA] was also employed to measure skeletal muscle. Both skeletal muscle mass values [kg] were divided by height [m] to calculate the skeletal muscle index [SMI, kg/m], denoted as SMI-CT and SMI-BIA, respectively. RESULTS:The median age was 69.8 + 9.5 years, with the sex ratio being 88/49 [male/female]. Whereas more than one-third of the patients were classified as malnourished based on the Global Leadership Initiative on Malnutrition GLIM-CT criteria using L3-SMI [ = 36.5%], fewer patients were classified as malnourished based on GLIM-BIA using SMI-BIA [ = 19.0%]. According to the CT analysis [low SMI-L3], 52 [38.0%] patients were diagnosed as having poor muscle mass, whereas only 18 [13.1%] patients were identified as having low muscle mass using BIA [low SMIBIA]. The measured SMI showed a positive association with SMI-CT in all patients [r = 0.63, < 0.001]. Using Bland-Altman evaluation, a significant mean bias of 0.45 + 1.41 kg/m [95% CI 0.21-0.70; < 0.001] between SMI-BIA and SMI-CT was reported. Receiver operating characteristic (ROC) curves were generated to detect poor muscle mass using SMI-BIA with CT as the gold standard. The area under the curve (AUC) for SMI-BIA in identifying poor muscle mass was 0.714 (95% CI: 0.624-0.824), with a good cut-off value of 8.1 kg/m, yielding a sensitivity of 68.3% and a specificity of 66.9%. CONCLUSIONS:BIA generally overestimates skeletal muscle mass in colorectal cancer patients when contrasted to CT. As a result, BIA may underestimate the prevalence of poor muscle mass and malnutrition according to the GLIM criteria in this patient population.
10.3390/nu16173035
The short-term impact of colorectal cancer treatment on physical activity, functional status and quality of life: a systematic review.
JBI database of systematic reviews and implementation reports
BACKGROUND:Physical activity, functional status and quality of life (QoL) are important determinants of the quality of life (QoL) after colorectal cancer (CRC) treatment; however, little is known on how the treatment impacts these outcomes. Having this understanding could help clinicians develop and implement strategies that would enhance or maintain the QoL of CRC patients. OBJECTIVES:To identify the impact of curative CRC treatment (surgery with or without radiotherapy and/or chemotherapy) on physical activity, functional status and QoL within one year of treatment or diagnosis. INCLUSION CRITERIA TYPES OF PARTICIPANTS:Colorectal cancer survivors aged 18 years and over. TYPES OF INTERVENTIONS:Curative CRC treatment, which was surgery with or without radiotherapy and/or chemotherapy. TYPES OF STUDIES:Pre- and post-observational and experimental studies. OUTCOMES:Physical activity, ability to perform activities of daily living (functional status) and QoL. SEARCH STRATEGY:CINAHL, Embase, MEDLINE, OpenGrey and ProQuest Dissertations and Theses were used to obtain published and unpublished studies in English. The date range was the start of indexing to February 2015. METHODOLOGICAL QUALITY:All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality. DATA EXTRACTION:Data from included papers were extracted using a modified data extraction tool. Data that were presented graphically were extracted using online software. DATA SYNTHESIS:The differences between postoperative and baseline values were calculated using the Review Manager 5.3.5 (Copenhagen: The Nordic Cochrane Centre, Cochrane) calculator and expressed as mean difference and their corresponding 95% confidence interval. Where possible, study results were pooled in statistical meta-analysis. The physical activity, functional status and some QoL results are presented in a narrative and table form. RESULTS:A total of 23 studies were included in this review: two studies (N = 2019 patients) evaluated physical activity, two studies (N = 6908 patients) assessed functional status and 22 studies (N = 2890 patients) measured QoL. Physical activity was observed to decrease at six months after treatment. The functional status of CRC patients decreased, particularly in the elderly (Summary of findings 1 and 2). As for QoL, only the physical and functional aspects were seen to decline up to six months, but scores almost returned to baseline levels at one year after treatment. The QoL studies that used the European Organization for Research and Treatment of Cancer QLQ-C30 tool were pooled in statistical meta-analysis and summarized in Summary of findings 2. The results must be interpreted carefully due to the heterogeneity of studies and scarcity of recent studies. CONCLUSION:In spite of the limitations, it is likely that the physical and functional capacity of CRC survivors deteriorates after treatment. IMPLICATIONS FOR PRACTICE:The period between diagnosis and treatment provides an opportunity for clinicians to implement interventions (e.g. exercise interventions) that could enhance or restore the physical and functional capacity of CRC survivors. IMPLICATIONS FOR RESEARCH:The paucity of studies and heterogeneity need to be addressed. The outcomes for colon and rectal cancer survivors, ostomates and non-ostomates must be analyzed separately.
10.11124/JBISRIR-2016003282
WITHDRAWN: Interventions for fatigue and weight loss in adults with advanced progressive illness.
The Cochrane database of systematic reviews
BACKGROUND:Fatigue and unintentional weight loss are two of the commonest symptoms experienced by people with advanced progressive illness. Appropriate interventions may bring considerable improvements in function and quality of life to seriously ill people and their families, reducing physical, psychological and spiritual distress. OBJECTIVES:To conduct an overview of the evidence available on the efficacy of interventions used in the management of fatigue and/or unintentional weight loss in adults with advanced progressive illness by reviewing the evidence contained within Cochrane reviews. METHODS:We searched the Cochrane Database of Systematic Reviews (CDSR) for all systematic reviews evaluating any interventions for the management of fatigue and/or unintentional weight loss in adults with advanced progressive illness (The Cochrane Library 2010, Issue 8). We reviewed titles of interest by abstract. Where the relevance of a review remained unclear we reached a consensus regarding the relevance of the participant group and the outcome measures to the overview. Two overview authors extracted the data independently using a data extraction form. We used the measurement tool AMSTAR (Assessment of Multiple SysTemAtic Reviews) to assess the methodological quality of each systematic review. MAIN RESULTS:We included 27 systematic reviews (302 studies with 31,833 participants) in the overview. None of the included systematic reviews reported quantitative data on the efficacy of interventions to manage fatigue or weight loss specific to people with advanced progressive illness. All of the included reviews apart from one were deemed of high methodological quality. For the remaining review we were unable to ascertain the methodological quality of the research strategy as it was described. None of the systematic reviews adequately described whether conflict of interests were present within the included studies. Management of fatigueAmyotrophic lateral sclerosis/motor neuron disease (ALS/MND) - we identified one systematic review (two studies and 52 participants); the intervention was exercise.Cancer - we identified five systematic reviews (116 studies with 17,342 participants); the pharmacological interventions were eicosapentaenoic acid (EPA) and any drug therapy for the management of cancer-related fatigue and the non pharmacological interventions were exercise, interventions by breast care nurses and psychosocial interventions.Chronic obstructive pulmonary disease (COPD) - we identified three systematic reviews (59 studies and 4048 participants); the interventions were self management education programmes, nutritional support and pulmonary rehabilitation.Cystic fibrosis - we identified one systematic review (nine studies and 833 participants); the intervention was physical training.Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) - we identified two systematic reviews (21 studies and 748 participants); the interventions were progressive resistive exercise and aerobic exercise.Multiple sclerosis (MS) - we identified five systematic reviews (23 studies and 1502 participants); the pharmacological interventions were amantadine and carnitine. The non pharmacological interventions were diet, exercise and occupational therapy.Mixed conditions in advanced stages of illness - we identified one systematic review (five studies and 453 participants); the intervention was medically assisted hydration. Management of weight lossALS/MND - we identified one systematic review but no studies met the inclusion criteria for the systematic review; the intervention was enteral tube feeding.Cancer - we identified three systematic reviews with a fourth systematic review also containing extractable data on cancer (66 studies and 5601 participants); the pharmacological interventions were megestrol acetate and eicosapentaenoic acid (EPA) (this systematic review is also included in the cancer fatigue section above). The non pharmacological interventions were enteral tube feeding and non invasive interventions for patients with lung cancer.COPD - we identified one systematic review (59 studies and 4048 participants); the intervention was nutritional support. This systematic review is also included in the COPD fatigue section.Cystic fibrosis - we identified two systematic reviews (three studies and 131 participants); the interventions were enteral tube feeding and oral calorie supplements.HIV/AIDS - we identified four systematic reviews (42 studies and 2071 participants); the pharmacological intervention was anabolic steroids. The non pharmacological interventions were nutritional interventions, progressive resistive exercise and aerobic exercise. Both of the systematic reviews on exercise interventions were also included in the HIV/AIDS fatigue section.MS - we found no systematic reviews which considered interventions to manage unintentional weight loss for people with a clinical diagnosis of multiple sclerosis at any stage of illness.Mixed conditions in advanced stages of illness - we identified two systematic reviews (32 studies and 4826 participants); the interventions were megestrol acetate and medically assisted nutrition. AUTHORS' CONCLUSIONS:There is a lack of robust evidence for interventions to manage fatigue and/or unintentional weight loss in the advanced stage of progressive illnesses such as advanced cancer, heart failure, lung failure, cystic fibrosis, multiple sclerosis, motor neuron disease, Parkinson's disease, dementia and AIDS. The evidence contained within this overview provides some insight into interventions which may prove of benefit within this population such as exercise, some pharmacological treatments and support for self management.Researchers could improve the methodological quality of future studies by blinding of outcome assessors. Adopting uniform reporting mechanisms for fatigue and weight loss outcome measures would also allow the opportunity for meta-analysis of small studies.Researchers could also improve the applicability of recommendations for interventions to manage fatigue and unintentional weight loss in advanced progressive illness by including subgroup analysis of this population within systematic reviews of applicable interventions.More research is required to ascertain the best interventions to manage fatigue and/or weight loss in advanced illness. There is a need for standardised reporting of these symptoms and agreement amongst researchers of the minimum duration of studies and minimum percentage change in symptom experience that proves the benefits of an intervention. There are, however, challenges in providing meaningful outcome measurements against a background of deteriorating health through disease progression. Interventions to manage these symptoms must also be mindful of the impact on quality of life and should be focused on patient-orientated rather than purely disease-orientated experiences for patients. Systematic reviews and primary intervention studies should include the impact of the interventions on standardised validated quality of life measures.
10.1002/14651858.CD008427.pub3
Development of a self-management support practice framework for addressing cancer-related fatigue: a modified Delphi study.
Journal of cancer survivorship : research and practice
PURPOSE:Managing cancer-related fatigue requires individuals to adopt a range of self-management behaviours. However, clinicians report the lack of clear guidance on self-management support practices hinders their provision of supportive care. To develop consensus on a framework of core practices required by health professionals to deliver effective self-management support to cancer patients and survivors experiencing cancer-related fatigue. METHODS:A preliminary framework of 47 practice items (14 Key Practices, 33 Practice Components) was derived from a systematic review, and a self-management support capability outline for primary care professionals. This preliminary framework was presented for consensus rating and comment in a two-round modified Delphi study conducted with a panel of health professionals, research academics, and cancer consumers. RESULTS:Fifty-two panel participants comprising consumers (n = 25), health professionals (n = 19), and researchers (n = 16) were included in Round 1 of the modified Delphi study. Feedback from the panel produced consensus on retaining 27 of 47 original practice items without change. Seventeen items (including 12 modified, and 5 newly created practice items) were sent to the panel for rating in Round 2. Thirty-six experts produced consensus on retaining all 17 practice items in Round 2. The final framework comprised 44 items (13 Key Practices, 31 Practice Components). CONCLUSIONS:The practice framework offers an evidence- and consensus-based model of best practice for health professionals providing self-management support for cancer-related fatigue. IMPLICATIONS FOR CANCER SURVIVORS:This framework is the first to focus on quality provision of self-management support in managing cancer-related fatigue, one of the most prevalent symptoms experienced by cancer patients and survivors.
10.1007/s11764-023-01348-7
A systematic review of Motivational Interviewing interventions in cancer patients and survivors.
Spencer Jennifer C,Wheeler Stephanie B
Patient education and counseling
OBJECTIVE:To explore the use of Motivational Interviewing (MI) interventions among cancer patients and survivors, and determine aspects of intervention design that are common across successful MI interventions for this population. METHODS:We conducted a systematic review of studies addressing behavior change in cancer patients or survivors using Motivational Interviewing techniques. Studies were categorized into three groups based on behavioral outcome; lifestyle behaviors, psychosocial outcomes, and cancer-related symptom management. RESULTS:We included 15 studies in our analysis. Studies addressed behaviors such as diet, exercise, smoking cessation, cancer-related stress, and fatigue management. Counseling sessions varied in frequency and method of delivery, although telephone-based interventions were common. Trained oncology nurses often delivered MI sessions, and the majority of interventions included quality assessment to verify fidelity of MI techniques. CONCLUSION:Solid evidence exists for the efficacy of MI to address lifestyle behaviors as well as the psychosocial needs of cancer patients and survivors. More research is needed on the use of MI for self-management of cancer-related symptoms. PRACTICE IMPLICATIONS:Motivational Interviewing is a promising technique for addressing many types of behavior change in cancer patients or survivors. Intervention design must be sensitive to cancer type, phase of care, and complexity of desired behavior.
10.1016/j.pec.2016.02.003
Telephone interventions for symptom management in adults with cancer.
Ream Emma,Hughes Amanda Euesden,Cox Anna,Skarparis Katy,Richardson Alison,Pedersen Vibe H,Wiseman Theresa,Forbes Angus,Bryant Andrew
The Cochrane database of systematic reviews
BACKGROUND:People with cancer experience a variety of symptoms as a result of their disease and the therapies involved in its management. Inadequate symptom management has implications for patient outcomes including functioning, psychological well-being, and quality of life (QoL). Attempts to reduce the incidence and severity of cancer symptoms have involved the development and testing of psycho-educational interventions to enhance patients' symptom self-management. With the trend for care to be provided nearer patients' homes, telephone-delivered psycho-educational interventions have evolved to provide support for the management of a range of cancer symptoms. Early indications suggest that these can reduce symptom severity and distress through enhanced symptom self-management. OBJECTIVES:To assess the effectiveness of telephone-delivered interventions for reducing symptoms associated with cancer and its treatment. To determine which symptoms are most responsive to telephone interventions. To determine whether certain configurations (e.g. with/without additional support such as face-to-face, printed or electronic resources) and duration/frequency of intervention calls mediate observed cancer symptom outcome effects. SEARCH METHODS:We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1); MEDLINE via OVID (1946 to January 2019); Embase via OVID (1980 to January 2019); (CINAHL) via Athens (1982 to January 2019); British Nursing Index (1984 to January 2019); and PsycINFO (1989 to January 2019). We searched conference proceedings to identify published abstracts, as well as SIGLE and trial registers for unpublished studies. We searched the reference lists of all included articles for additional relevant studies. Finally, we handsearched the following journals: Cancer, Journal of Clinical Oncology, Psycho-oncology, Cancer Practice, Cancer Nursing, Oncology Nursing Forum, Journal of Pain and Symptom Management, and Palliative Medicine. We restricted our search to publications published in English. SELECTION CRITERIA:We included randomised controlled trials (RCTs) and quasi-RCTs that compared one or more telephone interventions with one other, or with other types of interventions (e.g. a face-to-face intervention) and/or usual care, with the stated aim of addressing any physical or psychological symptoms of cancer and its treatment, which recruited adults (over 18 years) with a clinical diagnosis of cancer, regardless of tumour type, stage of cancer, type of treatment, and time of recruitment (e.g. before, during, or after treatment). DATA COLLECTION AND ANALYSIS:We used Cochrane methods for trial selection, data extraction and analysis. When possible, anxiety, depressive symptoms, fatigue, emotional distress, pain, uncertainty, sexually-related and lung cancer symptoms as well as secondary outcomes are reported as standardised mean differences (SMDs) with 95% confidence intervals (CIs), and we presented a descriptive synthesis of study findings. We reported on findings according to symptoms addressed and intervention types (e.g. telephone only, telephone combined with other elements). As many studies included small samples, and because baseline scores for study outcomes often varied for intervention and control groups, we used change scores and associated standard deviations. The certainty of the evidence for each outcome was interpreted using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS:Thirty-two studies were eligible for inclusion; most had moderate risk of bias,often related to blinding. Collectively, researchers recruited 6250 people and studied interventions in people with a variety of cancer types and across the disease trajectory, although many participants had breast cancer or early-stage cancer and/or were starting treatment. Studies measured symptoms of anxiety, depression, emotional distress, uncertainty, fatigue, and pain, as well as sexually-related symptoms and general symptom intensity and/or distress. Interventions were primarily delivered by nurses (n = 24), most of whom (n = 16) had a background in oncology, research, or psychiatry. Ten interventions were delivered solely by telephone; the rest combined telephone with additional elements (i.e. face-to-face consultations and digital/online/printed resources). The number of calls delivered ranged from 1 to 18; most interventions provided three or four calls. Twenty-one studies provided evidence on effectiveness of telephone-delivered interventions and the majority appeared to reduce symptoms of depression compared to control. Nine studies contributed quantitative change scores (CSs) and associated standard deviation results (or these could be calculated). Likewise, many telephone interventions appeared effective when compared to control in reducing anxiety (16 studies; 5 contributed quantitative CS results); fatigue (9 studies; 6 contributed to quantitative CS results); and emotional distress (7 studies; 5 contributed quantitative CS results). Due to significant clinical heterogeneity with regards to interventions introduced, study participants recruited, and outcomes measured, meta-analysis was not conducted. For other symptoms (uncertainty, pain, sexually-related symptoms, dyspnoea, and general symptom experience), evidence was limited; similarly meta-analysis was not possible, and results from individual studies were largely conflicting, making conclusions about their management through telephone-delivered interventions difficult to draw. Heterogeneity was considerable across all trials for all outcomes. Overall, the certainty of evidence was very low for all outcomes in the review. Outcomes were all downgraded due to concerns about overall risk of bias profiles being frequently unclear, uncertainty in effect estimates and due to some inconsistencies in results and general heterogeneity. Unsubstantiated evidence suggests that telephone interventions in some capacity may have a place in symptom management for adults with cancer. However, in the absence of reliable and homogeneous evidence, caution is needed in interpreting the narrative synthesis. Further, there were no clear patterns across studies regarding which forms of interventions (telephone alone versus augmented with other elements) are most effective. It is impossible to conclude with any certainty which forms of telephone intervention are most effective in managing the range of cancer-related symptoms that people with cancer experience. AUTHORS' CONCLUSIONS:Telephone interventions provide a convenient way of supporting self-management of cancer-related symptoms for adults with cancer. These interventions are becoming more important with the shift of care closer to patients' homes, the need for resource/cost containment, and the potential for voluntary sector providers to deliver healthcare interventions. Some evidence supports the use of telephone-delivered interventions for symptom management for adults with cancer; most evidence relates to four commonly experienced symptoms - depression, anxiety, emotional distress, and fatigue. Some telephone-delivered interventions were augmented by combining them with face-to-face meetings and provision of printed or digital materials. Review authors were unable to determine whether telephone alone or in combination with other elements provides optimal reduction in symptoms; it appears most likely that this will vary by symptom. It is noteworthy that, despite the potential for telephone interventions to deliver cost savings, none of the studies reviewed included any form of health economic evaluation. Further robust and adequately reported trials are needed across all cancer-related symptoms, as the certainty of evidence generated in studies within this review was very low, and reporting was of variable quality. Researchers must strive to reduce variability between studies in the future. Studies in this review are characterised by clinical and methodological diversity; the level of this diversity hindered comparison across studies. At the very least, efforts should be made to standardise outcome measures. Finally, studies were compromised by inclusion of small samples, inadequate concealment of group allocation, lack of observer blinding, and short length of follow-up. Consequently, conclusions related to symptoms most amenable to management by telephone-delivered interventions are tentative.
10.1002/14651858.CD007568.pub2
Self-management support for cancer-related fatigue: A systematic review.
International journal of nursing studies
OBJECTIVES:To describe and examine the theories, components, and effectiveness of self-management support interventions for individuals experiencing cancer-related fatigue. METHODS:A systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Statement. CINAHL, PubMed, Cochrane CENTRAL, and EMBASE were searched (from inception to June 2021) for randomised controlled trials examining self-management support interventions for managing cancer-related fatigue. Data were screened, extracted, and appraised by two authors. Data extraction was guided by the Self-management Support Taxonomy (i.e., a modified version of the Practical Reviews in Self-Management Support Taxonomy tailored to cancer). The Revised Cochrane Risk of Bias tool was used for study appraisal. A critical narrative synthesis was conducted. RESULTS:Fifty-one papers representing 50 different studies (n = 7383) were identified. Most interventions were delivered post-treatment (40%) using in-person (i.e., 'face-to-face') encounters (40%), and were facilitated by health professionals (62%). A range of intervention approaches and self-management support strategies were used across studies. The average number of Self-management Support Taxonomy components used across studies was 6.1 (of 14). Thirty-one studies (62%) described a specific behavior change theory to guide their self-management support intervention development. Twenty-nine studies (n = 29/50; 58%) reported a positive intervention effect for fatigue immediately post-intervention. Of these 29 studies, 10 (34%) reported at least one sustained positive effect on fatigue over follow-up periods between two and 12 months. CONCLUSIONS:Self-management support that is delivered after cancer treatment, facilitated by health professionals, and incorporating at least one in-person contact appears to produce the most favourable fatigue and behavioral outcomes. However, further work is needed to better understand how individual self-management support strategies and the application of a behavioral theory influence behavior change. Program developers should guide self-management support with a behavioral theory, and describe their theory application in intervention development, implementation, and evaluation; ensure facilitators receive adequate support training; and seek the delivery preferences of cancer survivors. Future research should incorporate adequate follow-up to sufficiently evaluate the impact of programs on cancer-related fatigue and associated self-management behaviors. Findings from this review are relevant to all healthcare professionals, but are of most relevance to nurses as the largest cancer care workforce with a key role in delivering self-management support.
10.1016/j.ijnurstu.2022.104206