Post-treatment Care Research Articles

Acceptance and commitment therapy in adult cancer survivors: a systematic review and conceptual model.

People with cancer experience significant physical and psychological symptoms, during as well as after primary treatment. Acceptance and Commitment Therapy (ACT), a psychological intervention, reduces both types of symptoms among individuals with chronic pain and emotional distress. Due to the unique challenges of cancer survivorship, this systematic review critically evaluates and synthesizes the literature on the context, mechanisms, and effect of ACT among adult cancer survivors. Articles were retrieved from the CINAHL, MEDLINE via Ovid, Web of Science, PsycInfo, Scopus, Embase, Google Scholar, and Cochrane databases. Selected grey literature portals, clinical trial registries, and conference proceedings were also searched. The NIH tools were used to assess study quality and the revised Cochrane Risk-of-Bias tool to assess risk of bias RESULTS: Thirteen articles, reporting on 537 cancer survivors with various cancer types, were included. ACT significantly reduced anxiety, depression, and fear of cancer recurrence and improved psychological flexibility and quality of life. Outcomes such as pain and insomnia were understudied. Lack of participant blinding and non-random assignment were the most common methodological issues. A conceptual model is proposed that describes the possible influencing factors of an ACT-based intervention in cancer survivors. Review findings suggest that ACT is an effective intervention to improve some of the common concerns among cancer survivors. While all the studies in the review were recent (published 2015-2019), they examined only a limited number of outcomes. Hence, more methodologically rigorous studies which examine the effect of ACT on other troubling symptoms among cancer survivors are warranted. Incorporating ACT into comprehensive post-treatment survivorship care can enhance psychological flexibility and reduce anxiety, depression, and fear.

"Looking at future cancer survivors, give them a roadmap": addressing fertility and family-building topics in post-treatment cancer survivorship care.

Fertility is an important issue among adolescent and young adult female (AYA-F) cancer survivors. This study examined AYA-F survivors' unmet needs and recommendations for care to address fertility/family-building in post-treatment survivorship. Semi-structured interviews (45-60min) explored themes related to fertility and family-building after cancer. Coding categories were derived based on grounded theory methods. Themes were identified through an iterative process of coding and review. Participants (N = 25) averaged 29years old (SD = 6.2; range, 15-39) were primarily White and well educated, and averaged 5.81years post-treatment (SD = 5.43); 32% had undergone fertility preservation (pre- or post-cancer). Six recommendations for improving care were identified: addressing patient-provider communication, need to provide informational, emotional, and peer support, financial information, and decision-making support. AYA-Fs believed the best way to learn about resources was through online platforms or doctor-initiated discussions. Telehealth options and digital resources were generally considered acceptable. Face-to-face interactions were preferred for in-depth information, when AYA-Fs anticipated having immediate questions or distressing emotions, and with concerns about Internet security. Thus, a combined approach was preferred such that information (via web-based communication) should be provided first, with follow-up in-person visits and referrals when needed. Informational and support services are needed to better educate patients about gonadotoxic effects and options to have children after cancer treatment is completed. Future work should evaluate how to best support oncology providers in meeting the needs of survivors concerned about fertility and family-building including referral to clinical specialties and supportive resources.

More than learning technical skills: The importance of mentorship and coaching during a brachytherapy fellowship

Brachytherapy exposure during residency varies between residency training programs. As a result, many graduating radiation oncology residents do not feel competent or confident in performing brachytherapy procedures. A brachytherapy fellowship encompasses hands-on procedural skills in addition to clinical decision-making, radiotherapy treatment planning, as well as post-treatment care. During this time, a fellow develops interpersonal relationships with their faculty supervisors in the form of mentorship, sponsorship, and coaching in addition to clinical teaching. The objective of this article is to review these important relationships focusing on brachytherapy fellowship training as an example.

Psychiatric neuromodulation: the underappreciated importance of pre- and post-treatment care.

Psychiatric neuromodulation: the underappreciated importance of pre- and post-treatment care.

Helium plasma dermal resurfacing: Consensus guidelines

AbstractIntroductionNine experienced physician users of a novel helium plasma dermal resurfacing device for heating the skin at a controlled depth to achieve collagen coagulation, tissue contraction, and neocollagenesis convened to discuss their experiences and keys to success with their off‐label use of this device with collectively more than 800 cases performed for facial skin renewal procedures.MethodsA round table discussion format was used to address a variety of topics including pretreatment considerations, optimum treatment parameters, posttreatment healing regimen, and avoidance and management of side effects and complications. All panelists consented to data collection, analysis, compilation, and publication.ResultsIdeal candidates for the procedure were identified along with optimum treatment parameters and posttreatment care. Strategies for avoidance and management of complications and side effects were discussed.ConclusionsConsensus guidelines were developed for patient selection, pretreatment considerations, treatment parameters, posttreatment healing regimen, and avoidance and management of complications and side effects.

Identifying patients' priorities for quality survivorship: conceptualizing a patient-centered approach to survivorship care.

This study explored cancer survivors' experiences with and priorities for cancer survivorship care to describe a patient-centered approach to quality survivorship care. We conducted 22 focus groups with 170 adult survivors of breast, prostate, and colorectal cancer from six cities across the country and online. We used thematic analysis to identify participants' principles and priorities for quality survivorship care. Based on our analysis of a limited group of cancer survivors, we identified two core principles that underlie participants' expectations for survivorship care and 11 practice priorities that reflect opportunities to improve patient-centeredness at the individual, interpersonal, and organizational levels. The principles reflect participants' desire to be better prepared for and equipped to accept and manage their chronic care needs post-cancer treatment. The priorities reflect practices that patients, providers, and cancer centers can engage in to ensure survivors' goals for post-treatment care are met. Results from the study suggest the need to expand conceptualization of high-quality survivorship care. The survivor principles and practice priorities identified in this study challenge the field to organize amore patient-centered survivorship care system that empowers and respects patients and provides a holistic approach to survivors' chronic and long-term needs. Quality cancer survivorship care must reflect patients' priorities. The findings from this study can be used to develop a patient-centered framework for survivorship care that can be used in conjunction with quality guidelines to ensure survivorship care is organized to achieve both clinical and patient-centered outcomes.

The use of survivorship care plans by female racial and ethnic minority breast cancer survivors: a systematic review.

Racial/ethnic breast cancer survivorship disparities persist as minority breast cancer survivors (MBCSs) report fragmentation in survivorship care, namely in the access and delivery of survivorship care plans (SCPs). To better understand care coordination of MCBS, this review elucidated concerns of female MBCS about their preparation for post-treatment survivorship care, the preferred practices for the delivery of a SCP, and the associated content to improve post-treatment survivorship care understanding. A systematic search of articles from PubMed, Ovid-Medline, CINAHL databases, and bibliographic reviews included manuscripts using keywords for racial/ethnic minority groups and breast cancer survivorship care coordination terms. Salient themes and article quality were analyzed from the extracted data. Fourteen included studies represented 5,854 participants and over 12 racial/ethnic groups. The following themes of post-treatment MBCS were identified from the review: (1) uncertainty about post-treatment survivorship care management is a consequence of sub-optimal patient-provider communication; (2) access to SCPs and related materials are desired, but sporadic; and (3) advancements to the delivery and presentation of SCPs and related materials are desired. Representation of only 14 studies indicates that the MBCSs' perspective post-treatment survivorship care is underrepresented in the literature. Themes from this review support access to, and implementation of, culturally tailored SCP for MBCS. There was multi-ethnic acceptance of SCPs as a tool to help improve care coordination. These findings highlight the importance of general education about post-treatment survivorship, post-treatment survivorship needs identification, and the elucidation of gaps in effective SCP delivery among MBCS.

Abstract A015: Post-treatment patient-provider communication and follow-up care: Does written patient-provider communication improve timely follow-up care for rural cancer survivors?

Abstract Purpose: Patient-provider communication is a facilitator for optimizing cancer survivorship care planning. As disparities in rural-urban survivorship rates continue to widen, patient-provider communication regarding post-treatment survivorship care is a potential mechanism to improve survivorship-related outcomes. The current study examines sociodemographic and health predictors of post-treatment patient-provider communication and follow-up care, and associations between written communication and timely follow-up care for rural cancer survivors. Methods: Data was analyzed from post-treatment cancer survivor respondents of the Illinois Rural Cancer Assessment Study. The current study tested associations between sociodemographic variables and health factors on the quality of patient-provider communication and timely post-treatment follow-up care, defined as visits within three months or less of final treatment, and associations between the receipt of written patient-provider communication on timely post-treatment follow-up care. Results: Among 90 rural cancer survivors, respondents with annual incomes less than $50,000 and having a high school diploma or less were more likely to report a high quality of post-treatment patient-provider communication. Post-treatment written communication was reported by 62% of the respondents and 52% reported timely follow-up visits during the first three years of post-treatment care. Patients who reported receiving written patient-provider communication were five times more likely to have timely post-treatment follow-up care after completing active treatment than patients who had not received written patient-provider communication. Conclusions: For rural cancer survivors, written patient-provider communication improved timely follow-up care. This research supports policy and practice that recommends the receipt of a written survivorship care plans. Implementation of written survivorship care recommendations improves timely follow-up visits and has the potential to eliminate cancer survivorship disparities. Citation Format: Marquita W. Lewis-Thames, Leslie R. Carnahan, Aimee S. James, Karriem S. Watson, Yamilé Molina. Post-treatment patient-provider communication and follow-up care: Does written patient-provider communication improve timely follow-up care for rural cancer survivors? [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A015.

The optimal living and wellness program: Piloting a novel survivorship care model.

e14003 Background: Multiple national agencies define cancer survivorship as beginning at the time of cancer diagnosis. However, traditional care models deliver “survivorship care” months or years after diagnosis, which can lead to disruption in care and “transition anxiety”. We hypothesized that an approach centered around wellbeing could be applied across the cancer continuum (starting at diagnosis) and serve as a novel survivorship care model. Methods: We developed the Optimal Living and Wellness Program, a multilevel intervention with 3 key components: 1) a centralized model that provides coordinated multidisciplinary care; 2) an individualized Wellness Plan (WP); and 3) enrollment at the time of cancer diagnosis in order to mitigate the experience of post-treatment transition. Participants complete a digital wellness questionnaire (WQ) prior to the first medical oncology consult, receive a validated algorithm-based WP reviewed by a Wellness Coordinator, and meet with a Wellness Advanced Practice Provider (WAPP) via tele-medicine. The WP consists of individualized education and referrals to indicated supportive services (e.g., nutrition, exercise physiology, financial counseling, integrative medicine). The WAPP will ultimately assume care of the patient in the post-treatment (“survivorship”) phase. We piloted this approach in patients diagnosed with breast cancer beginning in November 2019. The primary outcome is feasibility defined by completion of the WQ. Secondary outcomes include participation in the WAPP visits, attendance at referral appointments, and quality of life (QOL). Results: As of January 31, 2020, a total of 39 eligible patients with newly diagnosed breast cancer were approached. Of these, 36 (92%) have completed the WQ. All 36 participants received a WP with indicated supportive referrals and educational resources. Initial WAPP tele-visits will begin in May 2020. Qualitative data regarding patient experience and QOL will be obtained via focused interviews and feedback will be categorized in thematic domains. Conclusions: In this pilot, the majority of patients with newly diagnosed breast cancer completed a WQ in advance of their initial medical oncology visit, indicating preliminary feasibility. Patient enrollment is ongoing, and updated data including additional feasibility metrics and QOL will be presented. Earlier patient engagement and incorporation of wellness and supportive services from time of diagnosis may significantly improve the transition to post-treatment care.

Effects of an e-home based symptom management and mindfulness training program on quality of life in breast cancer survivors.

TPS12130 Background: The first five years post-treatment for breast cancer are a critical phase, when the survivors may face a multitude of problems, including persistent and/or late-emerging symptoms following the cancer and its treatment, psycho-social distress associated with the risk of cancer recurrence, chronic uncertainty and social disruption. Thus, this trial will answer the research questions of 'Will the combined symptom management and mindfulness-based training programme be a promising approach to assist women with breast cancer in transition from treatment to survivorship?', and 'Since breast cancer survivors have infrequent clinical follow-up, will e-Home based system provide a feasible option for post-treatment care?' Methods: We aim to develop an e-Home based symptom management and mindfulness training programme for breast cancer survivors and to determine its effects on the endpoints including quality of life, symptom distress, psychosocial adjustment, psychological morbidity, and unplanned outpatient attendance or hospitalisation in breast cancer survivors. (ClinicalTrials.gov Identifier: NCT02931864) We employ a randomised clinical trial with four study arms (with 47 subjects, who have completed cancer treatment for stage 0 to 3 breast cancer between 6 months to 5 years previously, in each arm) together with a process evaluation; group 1 (usual care), group 2 (experimental group: five weekly sessions of online symptom management + mindfulness training programme and usual care), group 3 (comparison group 1: online symptom management programme and usual care), and group 4 (comparison group 2: online mindfulness training programme and usual care). Subjects will complete questionnaires measures of 6-item Social Support Questionnaire, Breast Cancer Survivor Self- Efficacy Scale, the Quality of Life-Cancer Survivor Scale, Memorial Symptom Assessment Scale, Psychosocial Adjustment to Illness Scale, short version of the Fear of Recurrence Scale, Hospital and anxiety Depression Scale, and Five Facet Mindfulness Questionnaire at baseline, at 8 weeks from time 1 (time 2), at 12 weeks from time 1 (time 3) and at 24 weeks from time 1 (time 4). Intention-to-treat approach will be used. Repeated measures analysis of variance will be used to examine the differences on outcome measures among the experimental, comparison, and control groups across study time points. Currently, 162 of 188 planned subjects have been enrolled and the trial continues as planned. Clinical trial information: NCT02931864 .

Une expérience d’intervention psychologique après le naufrage d’une pirogue à Bettenty au Sénégal

Senegal was hit once again by a shipwreck that caused the drowning deaths of 21 women and 54 survivors. This shipwreck took place in Bettenty, an isolated island town in Senegal, focused entirely on the local population. Psychological care for survivors, families and local stakeholders was needed. A psychological care mission was dispatched. The mission of this team was medico-psychological care for the 54 survivors, psycho-social support for the families of the victims, and psychological support for the local medical staff. She provided immediate post-treatment care through talk groups, individual debriefings and home visits. This intervention in Bettenty remains a first mission coordinated with the advent of the Mobile Response and Support Team (EMIS) Psychosocial, set up in 2016 by the Center for Sanitary Emergency Operations of the MSAS for actions taken medical and psychological care of disaster victims and their relatives. In fact, Senegal, a developing country, is gradually learning how to set up formal and structured cells for psychological care. From the experiences of medico-psychological intervention, it will be possible to rectify their setting up and unfolding, for later actions to be more effective.

The importance of reflecting on treatment and post-treatment care when assessing the social aspects of cosmetic nanomedicine and transdermal delivery system

In the field of nanomedicine, the development of targeted drug delivery aims to design more effective delivery systems that directly target cancer cells and tumours. The development of transdermal delivery mechanisms is promising. At the same time, these areas of research raise profound social and ethical questions and are tied to significant transformations in the nature of contemporary healthcare and personal subjectivity. Socio- political consideration of these issues is shaped by a wider set of debates concerning the societal dimensions of nanotechnology. In this paper we report findings from an interdisciplinary research project uilising semi-structured interviews with key-informants engaged in cancer research and health-care. We identified narrative constracts that shaped participants' responses to and understandings of novel nanomedicines. This analysis contributes to a growing body of literature on the social and ethical aspects of nanotechnology and nanomedicine, providing evidence for the engagement of publics in the early stage of technological developments.

Association of Patient Demographic Characteristics and Insurance Status With Survival in Cancer Randomized Clinical Trials With Positive Findings

Few new treatments tested in phase 3 cancer randomized clinical trials show an overall survival benefit. Although understanding whether the benefits are consistent among all patient groups is critical for informing guideline care, individual trials are designed to assess the benefits of experimental treatments among all patients and are too small to reliably determine whether treatment benefits apply to demographic or insurance subgroups. To systematically examine whether positive treatment effects in cancer randomized clinical trials apply to specific demographic or insurance subgroups. Cohort study of pooled patient-level data from 10 804 patients in SWOG Cancer Research Network clinical treatment trials reported from 1985 onward with superior overall survival for those receiving experimental treatment. Patients were enrolled from 1984 to 2012. Maximum follow-up was 5 years. Interaction tests were used to assess whether hazard ratios (HRs) for death comparing standard group vs experimental group treatments were associated with age (≥65 vs <65 years), race/ethnicity (minority vs nonminority populations), sex, or insurance status among patients younger than 65 years (Medicaid or no insurance vs private insurance) in multivariable Cox regression frailty models. Progression- or relapse-free survival was also examined. Data analyses were conducted from August 2019 to February 2020. In total, 19 trials including 10 804 patients were identified that reported superior overall survival for patients randomized to experimental treatment. Patients were predominantly younger than 65 years (67.3%) and female (66.3%); 11.4% were black patients, and 5.7% were Hispanic patients. There was evidence of added survival benefits associated with receipt of experimental therapy for all groups except for patients with Medicaid or no insurance (HR, 1.23; 95% CI, 0.97-1.56; P = .09) compared with those with private insurance (HR, 1.66; 95% CI, 1.44-1.92; P < .001; P = .03 for interaction). Receipt of experimental treatment was associated with reduced added overall survival benefits in patients 65 years or older (HR, 1.21; 95% CI, 1.11-1.32; P < .001) compared with patients younger than 65 years (HR, 1.41; 95% CI, 1.30-1.53; P < .001; P = .01 for interaction), although both older and younger patients appeared to strongly benefit from receipt of experimental treatment. The progression- or relapse-free survival HRs did not differ by age, sex, or race/ethnicity but differed between patients with Medicaid or no insurance (HR, 1.32; 95% CI, 1.06-1.64; P = .01) vs private insurance (HR, 1.74; 95% CI, 1.54-1.97; P < .001; P = .03 for interaction). Patients with Medicaid or no insurance may have smaller added benefits from experimental therapies compared with standard treatments in clinical trials. A better understanding of the quality of survivorship care that patients with suboptimal insurance receive, including supportive care and posttreatment care, could help establish how external factors may affect outcomes for these patients.

Anti-recurrence/metastasis and chemosensitization therapy with thioredoxin reductase-interfering drug delivery system

Thioredoxin reductase (TrxR) is an essential mammalian enzyme that possesses a selenocysteine active site. TrxR is overexpressed in many malignant tumors and has a close relationship with apoptosis, drug resistance, recurrence and metastasis of tumors. Recently, TrxR has emerged as a promising target for anticancer therapy. Herein, we developed a TrxR-interfering drug delivery system (DDS) based on RGD-PEG-PUSeSe-PEG-RGD self-assembling micelles for imaging-guided gemcitabine (GEM) chemosensitization and anti-recurrence/metastasis therapy. The diselenide-containing micelles were degraded in response to TrxR stimuli for GEM releasing. In the meantime, the dissociated polymers’ chain segments targeted the active site of TrxR via Se–Se/Se–S dynamic reactions for activity inhibition. This inhibition by the micelles not only provided chemosensitization, but reduced tumor recurrence/metastasis risk via the induction of residual tumor cell apoptosis by triggering ROS production post-chemotherapy. In this work, we took the transformation between Se-containing dynamic covalent bonds developed by our group from in vitro to in vivo, which furthered the knowledge on the biochemistry of selenium and provided aspects to develop new TrxR inhibitors. Overall, the TrxR-interfering DDS combined excellent antitumor effects for primary solid tumors with the inhibition of tumor recurrence/metastasis during post-treatment care, providing new perspectives for efficient cancer therapy.

Global Approaches to the Prevention and Management of Delayed-onset Adverse Reactions with Hyaluronic Acid-based Fillers.

Background:Delayed-onset adverse reactions to hyaluronic acid (HA) fillers are uncommon but have received increased attention, particularly with regard to late-onset nodules. Globally, there is a need for comprehensive prevention and management strategies.Methods:Experts with clinical practices in diverse regions of the world and extensive experience in managing complications related to HA fillers convened to propose and evaluate approaches to prevent delayed-onset adverse reactions after HA filler administration and manage late-onset nodules.Results:The expert panel agreed to define delayed-onset adverse reactions as those presenting more than 4 weeks posttreatment, with swelling, induration, and nodulation being the most common clinical signs. The panel recommended 5 general key approaches for the prevention of delayed-onset reactions (patient selection, anatomic location of injection/product selection, aseptic technique, injection procedure/filler, and posttreatment care). Strategies recommended for managing late-onset nodules included oral antibiotics, oral steroids, nonsteroidal anti-inflammatory drugs if needed, hyaluronidase for noninflammatory nodules (recognizing the limitations and regional availability of this treatment), intralesional antibiotics, intralesional immunosuppressive drugs such as steroids and fluorouracil, and surgical excision as a last resort. The panel noted that late-onset nodules may vary in both clinical presentation and etiology, making them challenging to address or prevent, and stressed individualized treatment based on clinical presentation. Regional differences in aseptic protocols, antibiotic selection, and steroid formulations were described.Conclusion:Insights from global experts on approaches to prevent and manage delayed-onset adverse reactions following HA filler administration, including late-onset nodules, support clinicians worldwide in optimizing patient outcomes and safety.

You just have to have other models, our DNA is different: the experiences of indigenous people who use illicit drugs and/or alcohol accessing substance use treatment

ObjectivesIn Canada, and elsewhere, indigenous peoples who use illicit drugs and/or alcohol (IPWUID/A) commonly experience vulnerability and a disproportionate burden of harm related to substance use. In Vancouver, Canada, there are concerns that inequitable access, retention, and post treatment care within substance use treatment programs may exacerbate these harms. This study sought to understand the policies and practices with the potential to produce inequities and vulnerabilities for IPWUID/A in substance use treatment, situate the vulnerabilities of IPWUID/A in substance use treatment within the context of wider structural vulnerability of IPWUID/A, and generate recommendations for culturally safe treatment options.MethodsThis research employed a qualitative indigenous-led community-based approach using the indigenous methodology of talking circles to explore experiences with substance use treatment. Under the participatory research framework, community researchers led the study design, data collection, and analysis. Talking circles elicited peers’ experiences of substance use treatment and were audio-recorded and transcribed.ResultsThe talking circles identified three key themes that illustrated the experiences of IPWUID/A when accessing substance use treatment: (a) barriers to accessing detox and substance use treatment; (b) incompatible and culturally inappropriate structure, policies, and procedures within treatment programs, such as forced Christianity within treatment settings; and (c) the importance of culturally relevant, peer-led substance use treatment programming.DiscussionOur work demonstrates that some IPWUID/A have limited access to or retention in mainstream treatment due to excessive waiting times, strict rules, and lack of cultural appropriate care while in treatment. However, IPWUID/A narratives revealed strategies that can improve IPWUID/A access and experiences, including those informed by the diverse perspectives of IPWUID/A and those that include trauma-informed and culturally safe practices.

Living with and beyond cancer: a qualitative analysis

Purposeto provide a bicultural perspective on the views of people who have completed cancer treatment and, of health providers.Design/methodology/approachQualitative study using semi-structured interviews with 29 individuals (people who had recently completed cancer treatment and health providers). General inductive analysis was undertaken with all interview data, and a Kaupapa Māori approach was employed with the data from Māori participants.FindingsThemes for Māori participants are as follows: (1) understanding health information is enhanced by connection and relationship; (2) the “professional” is personal and (3) enduring beyond cancer is “our” responsibility. Themes for non-Māori participants are as follows: (1) from survivorship to living with and beyond cancer; (2) from the hospital to primary care and (3) support for living with and beyond cancer.Practical implicationsPositive relationships, communication and self-determination are important for Māori making the transition from hospital to the community after cancer treatment. Well-coordinated processes and services are vital for supporting transitions from hospital to community for non-Māori living with and beyond cancer.Originality/valueThis research presents the diversity of Māori and non-Māori experiences of living with and beyond cancer, adding to the limited New Zealand literature regarding post-treatment supportive care. This paper is among the first to undertake separate interviews and thematic analyses of Māori and non-Māori experiences, and to report these separately. Determinants of positive survivorship experiences are identified, specifying a central and expanded role for cancer care services.

Immediate post-treatment supportive care needs of patients newly diagnosed with head and neck cancer.

This study aimed at identifying supportive care needs of patients with head and neck cancer (HNC-P) immediately post-treatment, finding early predictors of unmet needs, and contrasting how immediate post-treatment needs differed from needs in longer-term survivorship. Prospective longitudinal study of 223 consecutive adults (313 approached; 72% participation) newly diagnosed with a first occurrence of primary HNC. Patients completed the Supportive Care Needs Survey-Short Form (SCNS), the Structured Clinical Interview for DSM-IV, and other outcomes. Medical chart reviews were conducted. A total of 68% of patients (n = 145/223) completed the SCNS. The multiple linear regression indicated that when controlled for medical variables, patients presented higher levels of unmet needs when they presented with higher level of anxiety upon HNC diagnosis (p = 0.03), higher neuroticism (p = 0.03), and more stressful life events in the year pre-diagnosis (p = 0.01). Patients immediately post-treatment had a wider variety of unmet needs compared with those in extended survivorship, with psychological unmet needs most prevalent at both time points. Immediately post-treatment, patients needed more support regarding pain (p = 0.04) and worries about treatment results (p = 0.05), whereas patients in longer-term survivorship needed more support regarding anxiety (p = 0.02), changes in sexual relationships (p = 0.04), and fear of death and dying (p = 0.001). This study identifies areas needing further development to improve quality of care for HNC-P in the immediate post-treatment period, as well as early determinants of unmet needs. HNC clinics may want to routinely screen for anxiety, neuroticism, and burden from other life events, to pro-actively address needs upon treatment completion and alleviate disease burden.

Psychological stress and pancreatic cancer patients: a qualitative systematic review protocol.

The primary objective of this review is to analyze and synthesize the best available evidence on the experiences and perceptions of psychological stress reported by pancreatic cancer patients at any time point from pre-diagnosis, diagnosis, treatment, post-treatment and/or follow-up care. A cancer diagnosis is known to be life-threatening, altering and limiting, and negatively affects an individual's activities of daily living. Despite developments in treatment options for pancreatic cancer patients, it represents the highest mortality and morbidity among cancers. Stress is a subjective phenomenon that negatively impacts an individual's psychological and emotional well-being, and interferes with the ability to cope with cancer symptoms and treatments. Identifying a patient's experience of stress could facilitate educational, spiritual and social resources to address his or her emotional and psychological needs. Qualitative studies that include individuals with pancreatic cancers, regardless of age, sex or ethnicity, will be considered for inclusion in this review. The databases to be searched include PubMed, CINAHL, Cochrane, Web of Science, Embase, Scopus, BioMed Central and PsycINFO. The search for gray literature will include Biosis, OpenGrey, Open Access Theses and Dissertations, and WorldCat. This systematic review will consider all published and unpublished studies with no date limitations. Selected studies will be assessed for methodological quality by two independent reviewers. Coding will be assigned to synthesize any differences in the experiences and perceptions of psychological stress at four time points. Where textual pooling is not possible, conclusions will be presented in narrative form.

Understanding Posttreatment Patient-Provider Communication and Follow-Up Care Among Self-Identified Rural Cancer Survivors in Illinois.

As disparities in rural-urban cancer survivorship rates continue to widen, optimizing patient-provider communication regarding timely follow-up care is a potential mechanism to improving survivorship-related outcomes. The current study examines sociodemographic and health predictors of posttreatment patient-provider communication and follow-up care and associations between written communication and timely follow-up care for cancer survivors who identify as rural. Data were analyzed from posttreatment cancer survivor respondents of the Illinois Rural Cancer Assessment Study. The current study tested associations between sociodemographic variables and health factors on the quality of patient-provider communication and timely posttreatment follow-up care, defined as visits ≤ 3months posttreatment, and associations between the receipt of written patient-provider communication on timely posttreatment follow-up care. Among 90 self-identified rural cancer survivors, respondents with annual incomes < $50,000 and ≤ High School diploma were more likely to report a high quality of posttreatment patient-provider communication. Posttreatment written communication was reported by 62% of the respondents and 52% reported timely follow-up visits during the first 3 years of posttreatment care. Patients who reported receiving written patient-provider communication were more likely to have timely posttreatment follow-up care after completing active treatment than patients who had not received written patient-provider communication. Our findings suggest that written patient-provider communication improved timely follow-up care for self-identified rural cancer survivors. This research supports policy and practice that recommend the receipt of written survivorship care plans. Implementation of written survivorship care recommendations has the potential to improve survivorship care for rural cancer survivors.