Information provision to older patients receiving palliative chemotherapy: a quality study

ObjectivesCancer treatment has become increasingly successful. However, prolonging and preserving life has become an important goal of therapy since many patients generally receive palliative chemotherapy. The perception of life changes when patients are informed, that no curative treatment is possible. This raises new dilemmas for patients with incurable cancer, but only sparse information is available about the thoughts of these patients.The aim of this study was to explore how older patients experience the information on absence of curative treatment options.MethodsQualitative interviews were performed in eleven older patients with incurable upper gastrointestinal cancer receiving first-line palliative chemotherapy. Median age was 74 (65–76) years. We used a qualitative approach to collect data through semistructured individual interviews conducted at the hospital or by telephone interviews by an experienced researcher. The thematic analysis was conveyed by Braun and Clarke.ResultsThe interview findings were grouped around three main themes: hope of being cured, hearing but not comprehending, and desired milestones to reach. Further, it was determined that patients hid their feelings and avoided talking about the disease with the health professionals due to fear of being told the truth.ConclusionsReceiving information about their incurable cancer was an ongoing dilemma for the patients. Following the message, patients shared thoughts about reaching important milestones in life, spending time with their family or hope for a cure to be found.

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Experiences and hidden needs of older patients, their families and their physicians in palliative chemotherapy decision-making: a qualitative study

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa020 ◽

2020 ◽

Vol 50 (7) ◽

pp. 779-786 ◽

Cited By ~ 2

Author(s):

Rie Tsuboi ◽

Mihoko Sugishita ◽

Yoshihisa Hirakawa ◽

Yuichi Ando

Keyword(s):

Decision Making ◽

Advanced Cancer ◽

Older Patients ◽

Palliative Chemotherapy ◽

Treatment Options ◽

Spiritual Needs ◽

Evidence Based ◽

Psychological Issues ◽

Individual Interviews ◽

To Receive

Abstract Objective This study aimed to clarify the experiences and hidden needs of older patients with advanced cancer, their families and their physicians in palliative chemotherapy decision-making. Materials and Methods We conducted in-depth qualitative individual interviews with content analysis. Patients who were diagnosed as having advanced cancer, were aged ≥70 years (n = 15, median [range] = 77 [70–82] years) and had volunteered to receive palliative chemotherapy within the past 6 months were enrolled. Their families and physicians were also interviewed. Results The following four themes were identified: (i) physician’s awareness of paternalism; (ii) readiness for communication of serious news; (iii) spiritual care need assessment and (iv) support as a team. The patients and families expected physicians to demonstrate paternalism in their decision-making because they were unconfident about their self-determination capability. Although the physicians were aware of this expectation, they encountered difficulties in recommending treatment and communicating with older patients. The patients had spiritual pain since the time of diagnosis. Psychological issues were rarely discussed during decision-making and treatment, triggering feelings of isolation in the patients and their families. Conclusion Older patients and their families expected a paternalistic approach by the physicians for palliative chemotherapy decision-making. The physicians found it difficult to offer treatment options because of older patient diversity and limitations in evidence-based strategies. Therefore multidisciplinary approaches and evidence-based decision support aids are warranted. Because older patients and their families often have unexpressed psychological burdens including unmet spiritual needs, medical professionals should provide psychological care from the time of diagnosis.

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Healthcare delivery and information provision in bariatric surgery in Germany: qualitative interviews with bariatric surgeons

BMC Health Services Research ◽

10.1186/s12913-021-06629-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jessica Breuing ◽

Nadja Könsgen ◽

Katharina Doni ◽

Annika Lena Neuhaus ◽

Dawid Pieper

Keyword(s):

Bariatric Surgery ◽

Health Information ◽

Information Needs ◽

Healthcare Professionals ◽

Qualitative Content Analysis ◽

Qualitative Interviews ◽

Healthcare Delivery ◽

Information Provision ◽

Telephone Interviews ◽

The Impact

Abstract Background There are several healthcare professionals involved in health information provision regarding bariatric surgery, such as bariatric surgeons, nutritionists, and medical doctors in outpatient settings. Trustworthy health information supports patients in understanding their diagnosis, treatment decisions, and possible prognosis. Therefore, it is necessary to provide health information on bariatric surgery. This study has two distinct objectives. The first is to outline the delivery of healthcare regarding bariatric surgery in Germany. The second is to describe the information provision within healthcare delivery. Methods We conducted 15 semi-structured telephone interviews with bariatric surgeons between April 2018 and February 2019. The interviews were audio recorded and transcribed verbatim. The interview guide consisted of four sections (information about the clinic/surgeon and surgical procedures, preoperative procedure, postoperative procedure, information needs). The transcribed interviews were analyzed using qualitative content analysis supported by MAXQDA software. Results The pre- and postoperative processes differed substantially between clinics. Additionally, every bariatric clinic had its own information provision concept. There were several cost-related issues the surgeons claimed to be relevant for patients, such as nutritional blood tests or postoperative psychotherapy. These issues were often caused by unclearness of responsibility within the medical disciplines involved. Conclusion Healthcare delivery in bariatric surgery in Germany is heterogeneous in terms of pre- and postoperative care. Therefore, preoperative information provision between the clinics differs. The impact of this heterogeneous healthcare delivery and information provision on patients’ information needs regarding bariatric surgery should be further investigated among patients and other healthcare professionals involved.

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Robotic Radiosurgery for Persistent Postoperative Acromegaly in Patients with Cavernous Sinus-Invading Pituitary Adenomas—A Multicenter Experience

Cancers ◽

10.3390/cancers13030537 ◽

2021 ◽

Vol 13 (3) ◽

pp. 537

Author(s):

Felix Ehret ◽

Markus Kufeld ◽

Christoph Fürweger ◽

Alfred Haidenberger ◽

Paul Windisch ◽

...

Keyword(s):

Disease Control ◽

Effective Treatment ◽

Cavernous Sinus ◽

Treatment Options ◽

Cavernous Sinus Invasion ◽

Robotic Radiosurgery ◽

Patient Morbidity ◽

Biochemical Remission ◽

Patients Experience

Background: The rates of incomplete surgical resection for pituitary macroadenomas with cavernous sinus invasion are high. In growth hormone-producing adenomas, there is a considerable risk for persistent acromegaly. Thus, effective treatment options are needed to limit patient morbidity and mortality. This multicenter study assesses the efficacy and safety of robotic radiosurgery (RRS) for patients with cavernous sinus-invading adenomas with persistent acromegaly. Methods: Patients who underwent RRS with CyberKnife for postoperative acromegaly were eligible. Results: Fifty patients were included. At a median follow-up of 57 months, the local control was 100%. The pretreatment insulin-like growth factor 1 (IGF-1) levels and indexes were 381 ng/mL and 1.49, respectively. The median dose and prescription isodose were 18 Gy and 70%, respectively. Six months after RRS, and at the last follow-up, the IGF-1 levels and indexes were 277 ng/mL and 1.14, as well as 196 ng/mL and 0.83, respectively (p = 0.0001 and p = 0.0002). The IGF-1 index was a predictor for biochemical remission (p = 0.04). Nine patients achieved biochemical remission and 24 patients showed biochemical disease control. Three patients developed a new hypopituitarism. Conclusions: RRS is an effective treatment for this challenging patient population. IGF-1 levels are decreasing after treatment and most patients experience biochemical disease control or remission.

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The Role of Conventional and Stereotactic Microwave Ablation for Intrahepatic Cholangiocarcinoma

Journal of Clinical Medicine ◽

10.3390/jcm10132963 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2963

Author(s):

Corina Kim-Fuchs ◽

Daniel Candinas ◽

Anja Lachenmayer

Keyword(s):

Literature Review ◽

Intrahepatic Cholangiocarcinoma ◽

Microwave Ablation ◽

Treatment Options ◽

Tumor Biology ◽

Tumor Ablation ◽

Curative Treatment ◽

Complication Rates ◽

Curative Therapy ◽

Incidence And Mortality

Background: The incidence and mortality of intrahepatic cholangiocarcinoma (ICCA) is increasing worldwide and curative treatment options are limited due to the aggressive tumor biology and often late diagnosis. Resection of the primary tumor remains the only curative therapy available, as the benefit of palliative chemotherapy and radiotherapy is relatively small. In contrast to hepatocellular carcinoma, minimal-invasive thermal tumor ablation, and in particular stereotactic tumor ablation for small primary cancers or metastases, is not established and data are scarce. Methods: We conducted a literature review in the field of ICCA ablation and retrospective analysis of 10 patients treated by stereotactic microwave ablation (SMWA) for either primary ICCA or liver metastases of ICCA. Results: While current guidelines have no consensus for ablation of primary ICCA, some state that it might be an option in inoperable patients or those with recurrent disease. The literature review revealed 11 studies on microwave ablation for ICCA reporting that MWA for ICCA ≤ 5 cm might be safe and could be a treatment option for patients who are not candidates for surgery. No data has been published on stereotactic microwave ablation (SMWA) for ICCA. The analyses of our own data of 10 patients treated by SMWA for primary ICCA (n = 5) or recurrent ICCA (n = 5) show that the treatment is safe and efficient with short hospital stays and low complication rates. Conclusion: Although thermal ablation, and in particular SMWA, might be a minimally invasive and tissue-sparing curative treatment alternative for small ICCA in the diseased liver and ICCA metastases, the oncologic benefit still needs to be shown in larger studies with longer follow-up.

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Spouse Caregivers' Perceptions of Influence of Dementia on Marriage

International Psychogeriatrics ◽

10.1017/s104161020200827x ◽

2002 ◽

Vol 14 (1) ◽

pp. 47-58 ◽

Cited By ~ 36

Author(s):

Ulla Eloniemi-Sulkava ◽

Irma-Leena Notkola ◽

Kaija Hämäläinen ◽

Terhi Rahkonen ◽

Petteri Viramo ◽

...

Keyword(s):

Behavioral Change ◽

Intervention Study ◽

Negative Impact ◽

Behavioral Changes ◽

Telephone Interviews ◽

Before And After ◽

Spouse Caregivers ◽

Dementing Illness ◽

Male Patients ◽

Patients Experience

Objectives: To investigate what kind of changes spouse caregivers of demented patients experience after the onset of dementia (a) in the general atmosphere, happiness, and relations of marriage and (b) in the sexual side of marriage. Design: Semistructured telephone interviews of spouse caregivers of demented patients. Setting: Community-living demented patients and their spouse caregivers in eastern Finland. Participants: The spouse caregivers of 42 demented patients recruited from a previous intervention study. Measures: The questionnaire covered different areas of marriage from the time before and after the onset of dementia. Results: A statistically significant decline had occured in extent of happiness (p = .012), in equal relations (p = .001), and in patients' expressions of sexual needs (p < .001) when compared the time before and after dementia. Twenty-five (60%) of the caregivers reported that the demented patient had shown at least one negative sexual behavioral change during the course of dementia. Seven male patients (24%) had shown the behavioral symptom of constantly expressing need for making love. One in 10 caregivers had experienced positive sexual behavioral changes. In one third of the patients, the expressions of tenderness towards the caregiver had increased. Dementia did not affect significantly the general atmosphere of the marriage. Out of those still in home care, at 3 years from the onset of dementia, 19 couples (46%) continued to practice intercourse, at 5 years the number was 15 couples (41%), and at 7 years it had declined to 7 couples (28%). Conclusions: Dementing illness has a major negative impact on many dimensions of marriage. However, there are also positive changes and preserved aspects of marriage. Dementia seems to have a surprisingly little impact on whether the couple continues to have intercourse when compared with the general aging population.

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Do we achieve the Montgomery standard for consent in orthopaedic surgery?

British Journal of Hospital Medicine ◽

10.12968/hmed.2020.0504 ◽

2021 ◽

pp. 1-7

Author(s):

Xenia N Tonge ◽

Henry Crouch-Smith ◽

Vijay Bhalaik ◽

William D Harrison

Keyword(s):

Treatment Options ◽

Information Provision ◽

Common Source ◽

Health Board ◽

Improvement Project ◽

Specific Patient ◽

Written Information ◽

Orthopaedic Patients ◽

Recorded Data

Aims/Background The Montgomery v Lanarkshire Health Board (2015) case set a precedent that has driven the modernisation of consenting practice. Failure to demonstrate informed consent is a common source of litigation. This quality improvement project aimed to provide pragmatic guidance for surgeons on consent and to improve the patient experience during decision making. Methods Elective orthopaedic patients were assessed and the quality of documented consent was recorded. Data were collected over two discrete cycles, with cycle 1 used as a baseline in practice. The following criteria were reviewed: grade of consenting clinician, alternative treatment options, description of specific risks, place and timing of consent and whether the patient received written information or a copied clinic letter. Cycle 1 results were presented to clinicians; a teaching session was provided for clinicians on the standard of consent expected and implementation of a change in practice was established with a re-audit in cycle 2. Results There were 111 patients included in cycle 1, and 96 patients in cycle 2. Consent was undertaken mostly by consultants (54%). Specific patient risks were documented in 50% of patients in cycle 1 and 60% in cycle 2. Risks associated with a specific procedure were documented in 42% in cycle 1 and 76% in cycle 2, alternative options in 48% (cycle 1) and 66% (cycle 2). A total of 14% of patients in cycle 1 and 8% in cycle 2 had documented written information provision. Copied letters to patients was only seen in 12% of all cycles. Documentation from dedicated consenting clinics outperformed standard clinics. Conclusions Highlighting poor documentation habits and refining departmental education can lead to improvements in practice. The use of consenting clinics should be considered and clinicians should individually reflect on how to address their own shortcomings. Other units should strongly consider a similar audit. This article provides stepwise advice to improve consent and specifics from which to audit.

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Older patients’ experience of primary hypothyroidism: A qualitative study

Health Expectations ◽

10.1111/hex.12656 ◽

2018 ◽

Vol 21 (3) ◽

pp. 628-635

Author(s):

Lorna E. Ingoe ◽

Janis Hickey ◽

Simon Pearce ◽

Tim Rapley ◽

Salman Razvi ◽

...

Keyword(s):

Qualitative Study ◽

Older Patients ◽

Primary Hypothyroidism ◽

Patients Experience

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Matter of TIME: the tumor-immune microenvironment of mesothelioma and implications for checkpoint blockade efficacy

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2021-003032 ◽

2021 ◽

Vol 9 (9) ◽

pp. e003032

Author(s):

James Harber ◽

Tamihiro Kamata ◽

Catrin Pritchard ◽

Dean Fennell

Keyword(s):

Treatment Options ◽

Immune Checkpoint Blockade ◽

Checkpoint Blockade ◽

Phase Iii ◽

Immune Microenvironment ◽

Incurable Cancer ◽

Phase Iii Clinical Trials ◽

Dismal Prognosis ◽

Tumor Immune Microenvironment ◽

Cancer Tumor

Malignant pleural mesothelioma (MPM) is an incurable cancer with a dismal prognosis and few effective treatment options. Nonetheless, recent positive phase III trial results for immune checkpoint blockade (ICB) in MPM herald a new dawn in the fight to advance effective treatments for this cancer. Tumor mutation burden (TMB) has been widely reported to predict ICB in other cancers, but MPM is considered a low-TMB tumor. Similarly, tumor programmed death-ligand 1 (PD-L1) expression has not been proven predictive in phase III clinical trials in MPM. Consequently, the precise mechanisms that determine response to immunotherapy in this cancer remain unknown. The present review therefore aimed to synthesize our current understanding of the tumor immune microenvironment in MPM and reflects on how specific cellular features might impact immunotherapy responses or lead to resistance. This approach will inform stratified approaches to therapy and advance immunotherapy combinations in MPM to improve clinical outcomes further.

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Advanced and metastatic renal cell carcinoma – Ain Shams Clinical Oncology Department Experience

Journal of Solid Tumors ◽

10.5430/jst.v10n1p18 ◽

2020 ◽

Vol 10 (1) ◽

pp. 18

Author(s):

Ahmed Nagy ◽

Mona Kamal ◽

Hesham El Halawani

Keyword(s):

Risk Factors ◽

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Clinical Oncology ◽

Renal Cell ◽

Older Patients ◽

Treatment Options ◽

Tumor Grade ◽

Kaplan Meier ◽

Younger Age

Background: Renal cell carcinoma is a rare tumor and till recently few treatment options were available. It is poorly understood why people develop RCC since only a few etiologic factors have been clinically identified as risk factors for RCC.Purpose: To analyze our experience at Ain Shams University Clinical Oncology department in Egypt with patients presenting with advanced renal cell carcinoma to provide a correlations between clinic-pathological factors, treatment and survival outcomes.Methodology: Retrospective review of the data of 54 patients who were diagnosed as RCC and presented to Ain Shams University Clinical Oncology department in Egypt from 1 May 2013 till 1 May 2015. Descriptive and clinic-pathological data were described using simple and relative frequencies. Survival outcome for the patients will be described using Kaplan Meier curves stratified according to morphology, age group and treatment received.Results: The sample included 54 patients (53.7% were males) of whom 14.3% were less than 40 years and 3.7% were elderly (≥ 70 years old). The median age was 55.5 years (SD ± 13.6 , range 19-71). Median PFS was 6.5 months (SD ± 12.3846 Range 43) while the median OS was 13 months (SD ± 12.161 Range 46). PFS in patients aged below 55.5 years was 9 months (95% CI=6.509-11.491) compared to 4 months (95% CI=2.704-5.296) in older patients (p = .004). PFS in patients who achieved PR after sunitinb was 17 months (95% CI=6.916-27.084) compared to 5 months (95% CI=3.699-6.301) in patients who didn’t achieved PR (p < .001). OS in patients aged below 55.5 years was 15 months (95% CI=9.131-20.869) compared to 11 months (95% CI=8.947-13.053) in older patients (p = .012). Favorable pathology status was associated with prolonged OS of 14 months (95% CI= 9.403-18.597) versus 11 months (95% CI=8.363-13.637) for unfavourable pathology status (p = .11). Low grades histopathogy was associated with prolonged OS of 44 months (95% CI= 38.456-49.544) versus 12 months (95% CI=10.077-13.923) for higher grades (p = < .001).Conclusion: Multivariate analyses supported a conclusion that younger age was an independent prognostic factor for survival along with other known risk factors such as tumor grade and pathology status.

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A cross-sectional study on global disparities in information experiences of patients with lymphoma/CLL.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18517 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18517-e18517

Author(s):

Olufunmilayo Bamigbola ◽

Natalie Dren ◽

Lorna Warwick

Keyword(s):

Side Effects ◽

Medical Information ◽

Information Source ◽

Treatment Options ◽

Information Provision ◽

Patient Advocacy ◽

Patient Survey ◽

Cross Sectional ◽

Treatment Side Effects ◽

First Choice

e18517 Background: Patient-centricity remains a cornerstone in the care of patients with lymphoma and CLL, as informed patients are consistently associated with better outcomes and experiences. This study uses the Lymphoma Coalition (LC) 2020 Global Patient Survey (GPS) on Lymphomas and CLL to describe the global differences in the top choices for medical information among patients with lymphoma, as well as differences in their understanding of this information relating to various aspects of their care. Methods: Globally, 9,179 patients from 89 countries took part in the LC 2020 GPS. The countries were grouped into regions, and the regions with greater than 200 patients were included in the analysis (Table). The demographics of the regions were examined, and descriptive analyses of questions relating to information source preferences, information provision at diagnosis (addressing treatment options; process and stages of care; managing treatment side effects), and corresponding levels of patient understanding were performed in IBM SPSS v27. Results: Doctors were the first choice for medical information for patients in each region (SA-82%, AS- 75%, EU-69%, OC-63%, NA-61%). In EU, NA and SA, websites were the most prevalent second and third choice for information (27% and 28%; 30% and 32%; 35% and 27%, respectively). In AS, patient advocacy organisations were the most prevalent second and third choices for information (32% and 40%, respectively), while in OC, the most prevalent second and third choices were nurses (27%) and patient advocacy groups (32%) respectively. Over a fifth of NA patients were not given information on the process and stages of care and how to manage side effects of treatment (21% and 29%, respectively). About a third of patients from SA (32%) reported not getting information on treatment options. Over half of OC patients reported being given information on and completely understanding the different treatment options (51%), processes and stages of care (53%) and how to manage treatment side-effects (58%). Patients from AS were the most prevalent in reporting across the three categories, that they were given information but did not understand it (10%, 7%, 5%, respectively). Conclusions: Globally, patients with lymphoma use various avenues to source the medical information they need, and they differ in their information experiences. Access to appropriate and adequate medical information remains an essential aspect of a successful patient experience and LC advocates that this information be contextual and accessible to all patients with lymphoma. [Table: see text]

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