Assessment of sleep problems with the Insomnia Severity Index (ISI) and the sleep item of the Patient Health Questionnaire (PHQ-9) in cancer patients

Objective The objectives of this study were to examine sleep problems in cancer patients, to test the psychometric properties of the Insomnia Sleep Index (ISI) in comparison with the sleep item of the Patient Health Questionnaire-9 (PHQ-9), and to analyze disrupting factors which might cause the sleep problems. Methods A sample of 1026 mixed-site cancer patients in treatment at a German oncological rehabilitation clinic was examined. Results The reliability of the ISI was very good (Cronbach’s alpha = 0.92), and the results of the confirmatory factor analysis were acceptable. Females reported worse sleep quality (ISI mean: 13.7 ± 6.6) than males (10.7 ± 6.4). Sleep problems as measured with the PHQ-9 sleep item were markedly higher than those in the general population (effect size d = 1.15). Patients reported that, of the factors that disrupted their sleep, psychological factors (brooding, worries) were more relevant than symptom factors (pain, nocturnal urination, or restless legs). Conclusions The ISI is effective in detecting sleep problems in cancer patients. Normative studies with the ISI would be helpful for assessing ISI mean scores. Sex differences should be taken into account when groups of patients are compared. The sleep item of the PHQ-9 can be used in epidemiological studies.

Lymphedema Rehabilitation Using Self-Adaptive Inelastic Compression in Breast Cancer: A Proof-of-Principle Study

Inelastic compression (IC) has been proposed as a therapeutic option in the management of breast cancer-related lymphedema (BCRL). To date, no studies have investigated the reliability of IC in the rehabilitative management of BCRL. Thus, we aimed at evaluating the safety and tolerability of an instantly adjustable IC device for BCRL patients. We included BCRL patients referred to an Oncological Rehabilitation Unit. They were subjected to complex decongestion therapy using a self-adaptive IC device. The primary outcome was safety and tolerability of IC in the rehabilitation treatment of BCRL patients. Secondary outcomes were: BCRL volume modifications; disability; quality of life; IC application time. Outcomes were assessed at the baseline (T0), at the end of the 2-week rehabilitation treatment (T1), and at 1 month (T2). Nine BCRL women, mean aged 56.7 ± 4.4 years, were enrolled. None showed side effects, except for a low discomfort and moderate swelling reported by 1 patient (11.1%). BCRL volume significantly reduced at T1 (p = 0.001) with a positive trend at T2. IC timing was significantly reduced at T1 (p = 0.035) and T2 (p = 0.003). Taken together, these findings suggested that IC could be considered as a safe, well-tolerated, and effective tool in the rehabilitative management of BCRL patients.

National study for multidisciplinary outpatient oncological rehabilitation: online survey to support revised quality and performance criteria

Purpose More and more people survive cancer, but the disease and its treatment often lead to impairment. Multidisciplinary ambulatory oncological rehabilitation (OR) programs have thus been developed. SW!SS REHA, the organization of major Swiss rehabilitation clinics, has defined ambulatory OR quality criteria for its members (about 50% of the Swiss rehabilitation capacity). However, SW!SS REHA criteria are not fully implemented and/or interpreted differently by different specialties or in different linguistic regions in Switzerland. The aim of our study was to carry out an online survey of existing outpatient programs to define quality criteria for an ideal OR program in Switzerland. Methods A mixed methods approach was used for the survey—qualitative and quantitative. The qualitative part consisted of a guided discussion with OR experts and the quantitative part of an online survey. The quantitative part comprised the development and evaluation of an online questionnaire. It served to record the opinions of OR centers in Switzerland on the desired situation of outpatient rehabilitation. Results Eighteen OR centers and 71 (49.7% response rate) OR actors participated in the online survey. The survey results indicate that some of the SW!SS REHA quality and performance criteria only partially match with the desired OR criteria for Switzerland. Key disparities occur particularly in the program design and structure and specifically around how many interventions are required to constitute an OR program, the extent of standardization versus individualization of the program, i.e., how many and which modules in a program should be obligatory, and finally the duration and intensity of the program. The online survey did not generate any statistical evidence that OR requirements vary significantly between different linguistic regions and among different specialties. Conclusions Cancer patients are heterogeneous with respect to cancer type, prognosis, and disability level, such that a standard program cannot be uniformly applied. Therefore, a flexible program is required with few mandatory modules and additional individual modules to achieve the threshold number of modules that would constitute a multidisciplinary OR program. Intensity and frequency of OR needs to consider the health state of the participants. The results indicate a need to modify some of the existing SW!SS REHA criteria to ensure that more patients can gain access and benefit form evidence-based OR interventions. Furthermore, the survey provides important findings so that the existing OR offer can be improved with the goal that OR centers will be able to be quality certified in the future.

Cancer patients searching for cancer- or health-specific online information: A qualitative analysis of navigation strategies and problems when using the Internet (Preprint)

BACKGROUND Searching the Internet for cancer-related information helps cancer patients satisfy their unmet information needs and empower them to play a more active role in the management of their disease. However, to benefit from the search, patients need a sufficient level of skills to search, select, appraise, and apply online health information. OBJECTIVE To study the operational, navigation, information, and evaluation skills and problems of cancer patients performing cancer-related search tasks using the Internet. METHODS Twenty-one cancer patients were recruited during their stay at the rehabilitation clinic for oncological rehabilitation. The participants performed eight cancer-related search tasks using the Internet. The participants were asked to think aloud while performing the tasks, and screen activities were recorded. The types and frequency of performance problems were identified and coded into categories following an inductive coding process. Additionally, the performance and strategic characteristics of task execution were summarized descriptively. RESULTS All the participants experienced problems or difficulties executing the tasks, and a substantial percentage of tasks (40%) could not be completed successfully. The participants’ performance problems were coded into four categories: (1) operating the computer and web browser, (2) navigating and orientating, (3) utilizing search strategies, and (4) evaluating the relevance and reliability of online information. The most frequent problems occurred in the third and fourth categories. Nineteen (90%) participants used nontask-related search terms or nonspecific search terms. Twenty (95%) participants never controlled the source or topicality of the found information. Additionally, none of the participants verified the information on one website with that on another website for each task. CONCLUSIONS A substantial group of cancer patients did not have the necessary skills to benefit from cancer-related Internet searching. Future interventions are needed to support patients in the development of sufficient Internet searching skills, focusing particularly on information and evaluation skills.

Does a Train-the-Trainer Approach for Enhancing Healthcare Professionals’ Skills in Patient Education during Inpatient Medical Rehabilitation Improve Patient Outcomes?

This study is aimed at identifying the impact of a team-based train-the-trainer program (TTT-P) to enhance healthcare professional (HCP) skills in patient education during medical rehabilitation. Focusing on patient-reported outcomes, a prospective, sequential two-cohort study was conducted in the fields of psychosomatic and oncological rehabilitation. Two hundred fifteen patients were evaluated before (Cohort 1) and 196 post implementation of TTT-P (Cohort 2). Patients of both cohorts completed validated questionnaires on self-management (heiQ®), general self-efficacy (GSE scale), and quality of life (WHOQOL-Bref) at the beginning, at the end, and at the 6-month follow-up to analyze short- and intermediate-term effects. Analyses were conducted separately for the psychosomatic and oncological setting. Results showed that TTT-P had no impact on patient outcomes in both rehabilitation settings. Patients did report positive outcomes as a result of the whole inpatient rehabilitation programs, though effects at follow-up were mostly small to medium size. Concerning self-management competencies, cancer patients gained less benefit during rehabilitation than psychosomatic patients. In conclusion, TTT-P did not result in measurable improvements at the patient level, likely because of the limited nature of the intervention. However, these populations of rehabilitants took benefit from participating in a multimodal rehabilitation program, of which patient education is one part.