Post-treatment Experiences Research Articles

Post-Treatment Experiences of Reproductive Concerns Among Young Breast Cancer Survivors: A Descriptive Phenomenological Study

PurposeThe long-term fertility impact of cancer treatments is a significant concern for young breast cancer survivors. These reproductive concerns often become a persistent source of stress, negatively affecting their quality of life. This study aims to explore the reproductive concerns experienced by young breast cancer survivors post-treatment and the factors influencing their perceptions. MethodsThis phenomenological study utilized semi-structured interviews to collect data. Eighteen participants were recruited from a tertiary hospital in Mainland China. The interviews were transcribed verbatim and analysed using Colaizzi's method. ResultsData analysis revealed five themes and fourteen subthemes: (1) multiple emotional burdens interwoven with concerns about fertility; (2) concerns about risks associated with reproduction; (3) dilemma of childrearing; (4) the significance of reproduction; (5) support needs from family, peers, and professionals. ConclusionsYoung breast cancer survivors in China face significant challenges related to reproductive issues. Reproductive health is a crucial aspect of breast cancer survivorship care. Healthcare providers must be attentive to the reproductive concerns of survivors, recognize the importance of multidimensional support for positive adaptation, and offer tailored and ongoing interventions to manage reproductive health in young breast cancer survivors.

Voices of Black men: reflecting on prostate cancer survivorship care plans.

This study addresses the critical issue of survivorship care for Black prostate cancer survivors. The aim was to explore their awareness of survivorship care plans to improve prostate cancer care and survivorship within this high-risk group. Utilizing a thematic analysis approach, we conducted in-depth interviews focused on analyzing post-treatment experiences of Black prostate cancer survivors by applying interpretive explanations to data collected from participants. Participants reported a significant gap in survivorship care plan communication post-treatment, as these plans were seldom discussed. Survivors highlighted the adoption of post-treatment strategies and self-education as means to enhance their comprehension of the survivorship process. Black survivors demonstrated an intrinsic motivation, after feeling "discarded," to find suitable resources to enhance their survivorship care for a better quality of life. The prioritization of post-treatment care for Black prostate cancer survivors is important. By offering comprehensive post-treatment education, improving symptom transparency, and establishing safe spaces for open discussion, the quality of life of Black survivors may be substantially improved. There is a pressing need for dynamic post-treatment care coordination tailored to Black prostate cancer survivors. A lack of crucial post-treatment education for this population that experiences disproportionate burden of prostate cancer may exacerbate cancer health disparities. Addressing this care coordination gap may improve support systems, survivor well-being, and better cancer outcomes.

Experiences and management of uncertainty following treatment for prostate cancer

This article explores men’s experiences and management of uncertainty following treatment for prostate cancer. Qualitative interviews with 29 men, recruited from two prostate cancer support groups (PCSGs) in the Southeast of England, explored prostate cancer and post-treatment experiences of uncertainty. Data were analysed thematically using a constructivist grounded theory approach. Four common uncertainties were identified: (1) fear of cancer recurrence from continued biomedical monitoring following treatment; (2) fear of cancer recurrence from unexplained bodily symptoms; (3) concerns about post-treatment side effects; and (4) concern with having made the ‘right’ treatment choice. Three strategies for how men managed these uncertainties were also identified: (1) interpreting biomedical knowledge; (2) planning for future uncertain events; and (3) engaging with support groups that served as vigilance networks. Nuanced strategies of vigilance are identified, of reinterpreted pasts and imagined futures to manage uncertainties. These strategies temporally displace the uncertain present and are employed individually and communally as part of vigilance networks. This article adds to theoretical resources for understanding uncertainty management and evidences the chronicity of men’s post-treatment experiences of prostate cancer.

Abstract 7447: Understanding survivorship: A national survey of post-treatment experiences in Black prostate cancer survivors

Abstract Prostate cancer, impacts over 3.1 million survivors, poses persistent challenges in post-treatment care, creating uncertainties regarding the best course of follow-up actions for leading productive lives. Unfortunately, these concerns, especially among ethnically diverse Black men, are frequently overlooked. The post-treatment journey for Black prostate cancer survivors is dependent on how they navigate survivorship to determine how it impacts their quality of life and emotional wellbeing. This study evaluated the post-treatment cancer experience and gauge satisfaction with care among a cohort of Black survivors (n = 45). Utilizing data from the 2023 National Coalition for Cancer Survivorship State of Survivorship Study (n = 1303), conducted between May 9th to June 6th, 2023, the research specifically targets self-identified Black males, constituting 10% of the study population and spanning an age range from 18 to 80 years. Results revealed that oncologists (44%) managed post-treatment care more than primary care physicians (30%). While conversation about follow-up care monitoring cancer tests regularly occurred (68%), while topics such as quality of life (27%), mental and emotional health (21%), and post-treatment survivorship care plans (9%) received minimal attention. Although most survivors felt generally informed about side effects (62% very informed), less than half felt their health care team was very helpful in dealing with them. Symptoms reported by survivors included feeling overly tired (47%), depression, anxiety, and mental health impacts (40%), and uncertainty about the cancer status (34%). Survivors engaging in diverse integrative treatments, including such practices as prayer and exercise, represented 29% and 28%, respectfully. Notably, 80% and 60% of individuals utilizing these modalities reported finding them effective during the post-treatment care phase. The journey from the point of prostate cancer diagnosis to post-treatment can impose a significant mental and physical toll on survivors. To address the emotional and psychological challenges associated with a diagnosis and post-treatment, survivors adopting integrative oncology modalities and exercise prescriptions to cope are crucial. These strategies may help survivors maintain a positive outlook and achieve optimal post-treatment health, with a focus on providing tailored resources that cater to the unique needs of Black survivors. Citation Format: Dottington Fullwood, Daniel Lee, Veronika Panagiotou, Samantha B. Siegel, Mariel Molina, Folakemi T. Odedina. Understanding survivorship: A national survey of post-treatment experiences in Black prostate cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7447.

Exploring Men's Experiences with Follow-Up Care following Primary Treatment for Prostate Cancer in Atlantic Canada: A Qualitative Study.

Prostate cancer is a common and life-altering condition among Canadian men, yet little is known about how follow-up care is provided to those who have completed treatment. Despite improving survival rates, survivors experience ongoing needs and are often not provided with support to manage them. This study sought to investigate the post-treatment experiences and needs of prostate cancer survivors and to determine if and how these needs are being met. Using a qualitative description design, prostate cancer survivors who had completed treatment took part in semi-structured interviews. The interviews were recorded and analyzed thematically. The participants experienced varying levels of satisfaction with their follow-up care. While primary care providers played significant roles, continuity of care and specialist involvement varied. Most participants felt unprepared to manage the long-term effects of their cancer due to a lack of information and resources from their healthcare providers. Instead, participants turned to their peers for support. Ongoing physical and psychosocial needs went unmet and had significant impacts on their daily lives. Participants felt that support for these issues should be automatically integrated into their follow-up care. In summary, this study revealed the importance of integrated, patient-centered follow-up care for prostate cancer in Atlantic Canada.

Patient expectation and experience of MR-guided radiotherapy using a 1.5T MR-Linac

Background and PurposeOnline adaptive MR-guided radiotherapy (MRgRT) is a relatively new form of radiotherapy treatment, delivered using a MR-Linac. It is unknown what patients expect from this treatment and whether these expectations are met. This study evaluates whether patients’ pre-treatment expectations of MRgRT are met and reports patients’ on-table experience on a 1.5 T MR-Linac. Materials and methodsAll patients treated on the MR-Linac from November 2020 until April 2021, were eligible for inclusion. Patient expectation and experience were captured through questionnaires before, during, and three months after treatment. The on-table experience questionnaire included patient’ physical and psychological coping. Patient-expected side effects, participation in daily and social activity, disease outcome and, disease related symptoms were compared to post-treatment experience. ResultsWe included 113 patients who were primarily male (n = 100, 89 %), with a median age of 69 years (range 52–90). For on-table experience, ninety percent of patients (strongly) agreed to feeling calm during their treatment. Six and eight percent of patients found the treatment position or bed uncomfortable respectively. Twenty-eight percent of patients felt tingling sensations during treatment. After treatment, 79 % of patients’ expectations were met. Most patients experienced an (better than) expected level of side effects (75 %), participation in daily- (83 %) and social activity (86 %) and symptoms (78 %). However, 33 % expected more treatment efficacy than experienced. ConclusionTreatment on the 1.5 T MR-Linac is well tolerated and meets patient expectations. Despite the fact that some patients expected greater treatment efficacy and the frequent occurrence of tingling sensations during treatment, most patient experiences were comparable or better than previously expected.

Experiences and management of urinary incontinence following treatment for prostate cancer: Disrupted embodied practices and adapting to maintain masculinity.

This article explores men's experiences of and management strategies for urinary incontinence (UI) following treatment for prostate cancer. Qualitative interviews with 29 men, recruited from two prostate cancer support groups, explored their post-treatment experiences. Drawing on a conceptual toolkit connecting theories of masculinities, embodiment, and chronic illness, this paper identifies older men's experiences and strategies for managing UI and explores how these are shaped by their masculinities. This article identifies interdependence between managing stigma for UI and maintaining masculinity. Men's embodied practices for engaging in activities in public, crucial to masculine identity, were disrupted. In response, they adopted new reflexive body techniques to manage and resolve their UI, and thereby address the threat to their masculine identities, characterised in three strategies: monitoring, planning, and disciplining. The new embodied practices men described suggest three factors as important components for adopting new reflexive body techniques: routine, desire, and unruliness.

QOL-12. “I’M JUST LIKE A BASKET FULL OF PROBLEMS”: QUALITATIVE STUDY OF COGNITIVE DYSFUNCTION AND QUALITY OF LIFE IN GLIOMA SURVIVORS

Abstract For glioma survivors, cognitive impairment can be a central determinant of quality of life, but we need better understanding of their unique challenges and supportive care needs. In this qualitative study, we aimed to explore the post-treatment experiences of cognitive and functional challenges and their impact on quality of life from the perspectives of glioma survivors. Glioma survivors in an observational study were invited to participate in an in-depth qualitative interview. Using a semi-structured interview guide, interviews were audio-recorded and transcribed verbatim. Data were analyzed using a reflexive thematic analysis approach to develop key themes to inform clinical practice. Participants (n=9) ranged in age from 29 to 72 years, and were at least 4 years post-diagnosis. Under the overarching survivorship theme, three key themes were developed. The first theme, “Learning what my brain can and can’t handle,” centered on functional challenges related to cognitive impairments, including difficulties at work and managing home and family responsibilities. In response, participants described generating their own strategies to manage cognitive limitations in daily activities. The second theme, “Such an important crossroads”, reflected the significant emotional impact of persisting impairments (e.g., frustration, disappointment, reduced self-esteem, acceptance), increased anxiety around an uncertain future, and a shift in personal values towards an increased sense of gratitude, crystalizing of intentions, and focus on things of greatest importance. The final theme, “A solid foundation of people around me”, referred to the necessity of social support, in both emotional and instrumental terms. Many expressed a desire for and appreciation of coping tools and support for the support people in their lives. Nearly all participants expressed interest in cognitive rehabilitation – whether or not they were experiencing significant cognitive problems. These findings have implications for clinical practice and can inform the development of effective patient-centered supportive care interventions in this population.

Posttreatment Experiences of Breast Cancer Survivors in Turkey: A Qualitative Study

ObjectivesThis study aimed to explore the posttreatment experiences of breast cancer survivors in Turkey. Data SourcesThe study was conducted in Turkey between February 2020 and April 2020 with 18 breast cancer survivors who completed the treatment process. The data were collected using the individual in-depth interview method with the semi-structured interview form. The interviews were transcribed verbatim, and the data were analyzed using the seven-step Colaizzi method. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to report the study. ConclusionFour main themes emerged in the study which are symptom management, emotional responses, change in life, and challenges in health care. The cancer survivors in Turkey reported that moral values had more meaning for them after treatment, they started to feel extremely worried about their children, they tried to manage their own processes with the information they themselves gained and with some support systems, and they experienced radical changes in their family and social relations. In addition, cancer survivors criticized the inadequacy of health care services, including relapse follow-up after the treatment process. Implications for Nursing PracticeThis study provides an overview of the lived experiences of posttreatment breast cancer survivors in Turkey. The findings of this study can be used to better understand breast cancer survivors, identify their needs based on their experience, and develop interventions to improve patient outcomes.

EP10.01-005 Australian Lung Cancer Survivors Experiences of Novel Treatments, Healthcare, and Ongoing Physical and Psychological Needs

People living with lung cancer remain underrepresented in survivorship research largely because of poorer survival rates and a focus on acute illness. However, earlier detection and improved treatments, such as immunotherapy (IO) and targeted therapy (TT), have led to higher numbers of individuals living longer. Given the profound impact lung cancer and treatments can have on physical and psychological wellbeing, understanding post-treatment experiences of survivors is crucial. In 2019, our group published a meta-review of the qualitative cancer survivorship literature and found a paucity of evidence about lung cancer survivor’s experiences.

Ghosts in the machinery: Living with and beyond radiotherapy treatment for gynaecological cancer.

This paper explores post-treatment experiences of women who have had radiotherapy for gynaecological cancer. Drawing on data from a project which explored post-treatment wellbeing, conceptual metaphors of ghosts/haunting are used to engage with enduring legacies of cancer and 'neglected matters' in post-treatment trajectories. Current arrangements of care contribute to the idea that participants are 'out of the other side of cancer' once active treatment completes. Despite broader ambitions for holistic cancer rehabilitation, fragilities of body and mind persist, even when the outward representation is one of health, of looking well, of moving on. We show how neglected matters of cancer (visceral late effects, psychological suffering and lives not lived) are part of living with and beyond cancer. These 'ghosts' manifest in chronic states of unsettledness that are temporarily relieved by individualised 'fixes', such as mobilisation of 'mind over matter' discourse and mindfulness. This discourse and its associated tools are a powerful yet impoverished framing of approaches to living with and beyond cancer. We argue for the need to attend to 'neglected matters' of post-treatment trajectories differently.

Patient experience before and after treatment with idecabtagene vicleucel (ide-cel, bb2121): qualitative analysis of patient interviews in the KarMMa trial

ObjectiveTo understand the experience of patients with relapsed and refractory multiple myeloma (RRMM) receiving idecabtagene vicleucel (ide-cel), a B-cell maturation antigen-directed chimeric antigen receptor T cell therapy, in the pivotal, phase 2 KarMMa trial. MethodsOptional semi-structured interviews before leukapheresis (pre-treatment) captured expectations and after ide-cel infusion (1, 2, and 3 months post-treatment), assessed treatment experience, ide-cel advantages/disadvantages, and health and well-being. In a mixed-method analysis, treatment experiences were categorized by clinical response status, health and well-being, and self-reported recovery after infusion. ResultsPre-treatment interviews indicated unmet treatment needs. In post-treatment interviews, most patients reported the positives of ide-cel outweighed negatives (69%, n = 27/39). Most common advantages of ide-cel were efficacy (18–64%), favorable side-effect profile (46–68%), and recovery time (13–18%); most common disadvantages were related to side effects (13–20%). When analyzed by clinical response, patients most often had stringent complete or very good partial response and improved health and well-being with mild or severe recovery from the infusion (27/58, 47%). Most patients with minimal clinical response reported mild infusion recovery (5/6, 83%). ConclusionsPatient interviews before ide-cel treatment showed unmet needs in triple-class exposed RRMM. Post-treatment experiences generally favored ide-cel versus previously received treatments.

Exploring Aftercare Experiences and Well-Being after Completion of a Young Adult Addiction Treatment Program

ABSTRACT Adventure therapy (AT) interventions are being integrated with evidence-based treatment models for a variety of clients, including adolescents and young adults, for a wide range of presenting symptomology, including substance use disorders (SUD). Though some studies have explored longer term outcomes, little is known about the posttreatment experiences of clients. Clients from a 90-day AT treatment program were contacted approximately posttreatment and asked to assess their general well-being and current relationship with substance use. Results showed that clients were doing well evidenced by OQ-45 scores that were statistically similar at the discharge and follow-up period (t (92) = −1.693, p < .09; Cohen’s d = −.180). Clients also showed statistically significant increases in mindfulness skills. Results also showed that 70.8% of the participants indicated that they did relapse, while 29.2% indicated they did not. Of those that relapsed, 73.8% indicated the relapse was “severe,” while 26.3% believed their relapse was “not severe.” Clients reflected favorably on their treatment experience and desired more structured aftercare opportunities posttreatment. Implications for professional practice and research include the need to advance perspectives of recovery and develop aftercare support systems that can aid clients in the recovery process.

Recovery of Health and Wellbeing in Rural Cancer Survivors Following Primary Treatment: Analysis of UK Qualitative Interview Data.

Purpose: Rural cancer survivors have poorer experiences and health outcomes compared to their urban counterparts. There is limited research on the post-treatment experiences of UK cancer survivors residing in rural areas. This study aimed to provide an understanding of the specific challenges and opportunities faced by rural cancer survivors and to provide insight into how rurality influences experiences post-primary treatment, ultimately to inform service provision. Methods: A secondary analysis of in-depth interview transcripts (n = 16) from a wider study on self-management in cancer survivors was conducted. An adapted version of Foster and Fenlon’s recovery of health and wellbeing in cancer survivorship framework informed the data coding. Results: Health and wellbeing were interrupted by a variety of problem incidents, and the subsequent steps to recovery were influenced by pre-existing, personal, environmental, and healthcare factors. A prominent theme was support, both from local communities and family as well as from healthcare professionals, with many survivors feeling that their rural setting had a positive influence on their health and wellbeing. Close relationships with local GPs were seen as fundamental to supporting recovery. Access to healthcare was frequently mentioned as a challenge with an emphasis on lengthy travel times and limited bespoke support in rural areas. Conclusions: This study is novel in that it applied a well-established theoretical framework to a rich qualitative dataset on the lived experiences of rural cancer survivors. Rural residency influenced recovery from cancer both positively and negatively. Implications for Cancer Survivors: Future practitioners and policy makers should consider working with local communities to tailor interventions to the specific characteristics of the rural environment.

Abstract 5276: COVID-19 and breast cancer care in Ireland: A qualitative study to explore the perspective of breast cancer patients on their health and health care

Abstract COVID-19 has heightened social inequalities, particularly for those with non-communicable diseases (NCDs), such as cancer, and health services for NCDs have been significantly disrupted. Breast cancer (BC) is the most common cancer for women in Ireland, and the impact of the pandemic on BC care needs to be established. The purpose of this study is to explore the health care experience of women with BC during the pandemic and to investigate whether these experiences vary based on social determinants of health (SDH). The study included semi-structured qualitative interviews with 37 women who had previously participated in a related quantitative study. Individuals were selected through stratified purposive sampling to ensure data was available on information-rich cases based on SDH. Interviews were conducted in early 2021 and thematic analysis was conducted using NVivo software. Three major themes, with additional subthemes, emerged from analysis: breast cancer services; breast cancer support and communication; and mental well-being. There were differences in women’s experiences within the themes that were dependent upon the SDH, including socio-economic status (SES), region, and time since diagnosis. For example, most women experienced disrupted BC services throughout the pandemic, but disruptions were more severe for women of lower SES. Table 1 provides quotation examples as evidence for these different experiences. The pandemic has impacted women with BC considerably, but the impact differed by social inequalities and time of diagnosis. This study highlights areas for improvement in the context of BC care in Ireland and the findings will inform further policy and practice. Table 1. General experiences and variation of experience based on SDH for women receiving BC services during COVID-19 Diagnostic/screening services Active treatment services Post-treatment services General experiences “I felt a lump… so I went to my own GP. She saw me and she faxed a letter straight into [cancer centre]. Within a week, I was in [cancer centre] having seen the doctors and then followed on with biopsies and mammograms.” “Well, it was a stressful period of time because I felt it was growing. And I couldn''t do anything about it. And the hospitals weren''t really taking patients… But eventually I got called again into the… clinic. I had my operation there.” “…the safety net of going in and being told this is all normal, you’re okay. And yeah, that’s gone, even though I know I can pick up the phone if I want to. But it’s not the same.” Experience based on SDH “What happened was… I got an appointment sent out for October. And I phoned them and they said to me look, there’s probably other women that met the criteria, that needed the mammogram before me.” (low SES) “I’d wait for three months or such time until COVID was over… before he would do anything. And I, at that time, I just said “no, I can’t wait that long, that’s too long.” (low SES) “I haven''t had an MRI in about a year and I meant to be getting them every six months. So then when I did, [the lump] just showed up.” (low SES) Citation Format: Charlotte L. Myers, Catherine Waldron, Kathleen Bennett, Caitriona Cahir. COVID-19 and breast cancer care in Ireland: A qualitative study to explore the perspective of breast cancer patients on their health and health care [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5276.

Levels of Anxiety and Fear Related to Non-Surgical Root Canal Treatment Performed by Endodontic Residents and Endodontists

ObjectivesDespite advances in endodontic treatment procedures, root canal treatment is still associated with anxiety and fear. This may cause care avoidance and subsequent oral complications due to untreated endodontic infections. Anxiety and fear levels in response to non-surgical root canal treatment performed by endodontic residents and endodontists were analyzed.MethodsA descriptive, cross-sectional survey was conducted among patients visiting the endodontic clinics at the University Dental Hospital. The questions addressed the participant's demographics, previous root canal treatment visits, clinician's level of training, and post-treatment experience.ResultsDemographics play a role in anxiety and dental fear in root canal treatment. Men scored significantly lower in the high-anxiety category than women, and patients treated by endodontic residents expressed lower levels of anxiety. Post-treatment experience of an endodontist or endodontic resident was a significant factor in reducing dental fear and anxiety.ConclusionThe level of anxiety and fear related to root canal experience of endodontists or endodontic residents is very low. Most of the patients expressed willingness to undergo further root canal treatment to save a tooth.

It’s not fine: A photo-elicitation study of rectal cancer survivors’ emotions and coping strategies

BackgroundComprehensive cancer care includes supporting the psychological health of survivors who are at high risk of distress. However, little is known about the emotional experiences of rectal cancer survivors specifically. We sought to explore psychological well-being and coping strategies utilized by rectal cancer survivors. MethodsTwenty rectal cancer survivors shared photographs of their post-treatment experiences. In follow-up interviews, participants discussed photographs’ meanings and emotional experiences during their cancer journey. Transcribed interviews were analyzed using iterative steps of inductive thematic analysis. ResultsEmotions ranged from sadness to anxiety and fear of cancer recurrence. Coping mechanisms were grouped into 3 categories: (1) seeking support and information; (2) focus on attitudes and perspectives; and (3) distancing strategies. ConclusionOur results highlight the persistent psychological impact of rectal cancer and need for additional support for survivors. Providers may help temper patients’ fear of recurrence by explicitly discussing prognosis and risk of recurrence. Although multidisciplinary survivorship clinics are ideal, all cancer care providers and primary care physicians should feel empowered to screen for psychological distress and refer patients to appropriate resources when needed.

"This is not my body": Therapeutic experiences and post-treatment health of people with rifampicin-resistant tuberculosis.

There are few data on the on post-treatment experiences of people who have been successfully treated for rifampicin-resistant (RR-)TB. To describe the experiences and impact of RR-TB disease and therapy on post-treatment life of individuals who were successfully treated. In this qualitative study in-depth interviews were conducted among a purposively selected sample from a population of individuals who were successfully treated for RR-TB between January 2008 and December 2018. Interview transcripts and notes were analysed using a thematic network analysis which included grounded theory and a framework for understanding pathophysiological mechanisms for post-TB morbidity and mortality. The analysis was iterative and the coding system developed focused on disease, treatment and post-treatment experiences of individuals. This paper follows the COREQ guidelines. For all 12 participants interviewed, the development of RR-TB disease, its diagnosis and the subsequent treatment were a major disruption to their lives as well as a transformative experience. On diagnosis of RR-TB disease, participants entered a liminal period in which their lives were marked with uncertainty and dominated by physical and mental suffering. Irrespective of how long ago they had completed their treatment, they all remembered with clarity the signs and symptoms of the disease and the arduous treatment journey. Post-treatment participants reported physical, social, psychological and economic changes as consequences of their RR-TB disease and treatment. Many participants reported a diminished ability to perform physical activities and, once discharged from the RR-TB hospital, inadequate physical rehabilitation. For some, these physical limitations impacted on their social life, and ultimately on their psychological health as well as on their ability to earn money and support their families. The experiences and impact of RR-TB disease and therapy on post-treatment life of individuals successfully treated, highlights gaps in the current health care system that need to be addressed to improve the life of individuals post-treatment. A more holistic and long-term view of post-TB health, including the provision of comprehensive medical and social services for post-treatment care of physical ailments, social re-integration and the mitigation of the perceived fear and risk of getting TB again could be a central part of person-centred TB care.

Long-Term Outcome Measures of Repeated Non-Animal Stabilized Hyaluronic Acid (Durolane) Injections in Osteoarthritis: A 6-Year Cohort Study with 623 Consecutive Patients.

PurposeTo determine the duration of symptom relief following repeated administration of hyaluronic acid injections for osteoarthritis.Patients and MethodsThis was a 6-year observational study with 623 consecutive patients who had received hyaluronic acid injections. The primary outcome measure was the mean time between injections measured in days. Classical one-sample 2-sided t-tests, one-way analysis of variances and post-hoc analyses were performed to determine if there were statistically significant differences between age, gender, radiographic severity and the type of joints injected. All patients were invited to complete an online post-treatment experience and satisfaction survey.ResultsThe analysis included 727 joints (mean Kellgren-Lawrence grade, 2.9 ± 0.8 (range 2–4)) in 623 patients (297 (47.7%) male; mean age at first injection, 57.8 ± 12.7 years (range 21.2–92.1)). Patients ranged from having 1–8 injections per joint. The mean time between injections in days was 466.8 ± 321.7 (2nd injection, 157 joints), 400.5 ± 164.7 (3rd injection, 58 joints), 378.2 ± 223.1 (4th injection, 27 joints), 405.3 ± 216.3 (5th injection, 7 joints), 268.4 ± 104.4 (6th injection, 5 joints), 289.8 ± 99.4 (7th injection, 4 joints), and 272.5 ± 33.2 (8th injection, 2 joints). Patients with grades 2 and 3 compared to grade 4 osteoarthritis experienced a longer time between injections (F (2, 154) = 3.53, p = 0.0316). No statistically significant differences were observed between age, gender, or joint groups. The survey included 233 participants (109 (46.8% male)). A total of 144 respondents (64.9%) recommended hyaluronic acid injections for osteoarthritis.ConclusionPain relief from hyaluronic acid injections was sustained for on average 466.8 days post initial treatment. Patients who received subsequent 3rd, 4th, and 5th injections also experienced extended duration of benefit. Patients with grades 2 or 3 osteoarthritis are more likely to experience a longer duration of relief.

"Stigma is where the harm comes from": Exploring expectations and lived experiences of hepatitis C virus post-treatment trajectories among people who inject drugs.

The advent of direct-acting antiviral (DAA) medications has facilitated opportunities to treat hepatitis C virus (HCV) among people who inject drugs (PWID). However, there remains a need for data about how to optimally support PWID throughout DAA post-treatment trajectories, including with regard to re-infection prevention. The objective of this study is therefore to identify how PWID with lived experience of HCV describe their expectations and experiences related to health and social outcomes, contexts, and substance use practices following completion of DAA treatment. We thematically analyzed data from in-depth, semi-structured interviews, conducted between January and June 2018, in Vancouver, Canada, with a purposive sample (n = 50) of PWID at various stages of DAA treatment (e.g., pre, peri, post). Our analysis yielded three themes. First, while participants had hoped to experience holistic enhancements in wellbeing following HCV cure, discussions of actual post-treatment experiences tended to be located in physical health (e.g., increased energy). Second, participants often pointed to the ways in which HCV-related and other stigmas had restricted opportunities for health and healthcare access. Participants therefore identified stigma-reduction as a key motivator of HCV cure, and while reductions in internalized stigma were sometimes achieved, participants underscored that other forms of enacted stigma (e.g., related to: substance use, HIV, poverty) had continued to feature prominently in their post-treatment lives. Third, participants described considerable knowledge about how to prevent HCV re-infection following cure, but they also expressed apprehensiveness about how socio-structural barriers, including stigma and criminalization, could interfere with harm reduction and re-infection prevention efforts. DAAs are transforming the health and wellbeing of some PWID. Yet, HCV-related policy must extend beyond the scale-up of DAAs to include concerted public health investments, including anti-stigma efforts and improvements to the social welfare system, to meaningfully advance equity in PWID's post-treatment trajectories and outcomes.