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Wong, Kwok F., Jackie Charman, Thomas Round, and Katherine E. Henson. "Cancer patients and primary care prescribed medications: offering insights into symptoms, polypharmacy and multimorbidity." British Journal of General Practice 68, suppl 1 (2018): bjgp18X697001. http://dx.doi.org/10.3399/bjgp18x697001.
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BackgroundNational Cancer Registration and Analysis Service (NCRAS) are responsible for registering data on all cases of cancer. For the first time individual patient level prescribing data is available, offering potential unique insights into treatment and co-morbidity.AimTo investigate the patterns of polypharmacy in cancer patients compared to non-cancer patients.MethodPrimary care prescriptions data (electronic and FP10) is currently available from April to July 2015 inclusive. Unique prescription items were summarised for each registered cancer patient; with an initial focus on opioids. These summaries were broken down by age of the patient at prescription for the most common cancers (invasive breast, colorectal, lung and prostate). Non-cancer patients were used as a comparisonResultsOverall 1,680,764 cancer patients were dispensed prescriptions during the period. On average, patients diagnosed with breast, colorectal, prostate and lung cancers received 7, 8, 8 and 10 unique drugs, respectively, throughout the 4 months. In all cases 2 of these unique drugs were opioids. In comparison, patients not diagnosed with cancer received 4 unique drugs on average: of which 2 were unique opioid drugs. Cancer patients aged 0–39, 40–69 and 70+, at prescription date, received 4, 6 and 8 unique prescriptions respectively compared to 3, 5 and 7, for non-cancer patients.ConclusionThis provides insight into primary care polypharmacy for all cancer patients in England. Analysis is underway to assess the cumulative dosage of unique drugs that patients receive, and the potential use of the data as a marker of polypharmacy/co-morbidity with larger patient level datasets.
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Waheed, Amina. "Pathways to cancer diagnosis: current state and recommendations." British Journal of General Practice 73, suppl 1 (2023): bjgp23X734313. http://dx.doi.org/10.3399/bjgp23x734313.
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BackgroundDiagnosing cancer early is crucial in improving patient outcomes. Primary care networks are encouraged to audit routes to cancer diagnosis, as suggested by the Network Contract Directed Enhanced Service Early Cancer Diagnosis Guidance.AimWe aim to measure how many patients were diagnosed with cancer in the period of April 2021 to March 2022 at an Essex GP practice, and for each of those patients, to ascertain the route of their diagnosis. We also conducted learning event analyses for patients whose diagnoses were not detected through 2-week wait (2WW) or screening.MethodSystmOne Read codes were utilised to identify all patients coded with ‘cancer’, and ‘fast-track cancer referral’. We measured the conversion rate of 2WW referrals to cancer diagnoses. For diagnoses not detected via 2WW or screening, we analysed patient notes for previous consultations and eventual route to diagnosis.ResultsIn total, 160 2WW referrals were made with a 6.25% conversion rate to cancer diagnoses. In total, 26 patients were diagnosed with cancer. Seventeen patients were diagnosed through 2WW, three through national screening programmes, three through accident and emergency, two through routine referral, and one through incidental finding. For the six patients not diagnosed through 2WW or screening, reasons why included poor patient engagement with healthcare services, referrals requiring chasing, patients passed between specialties, and failure to detect pertinent clinical signs.ConclusionIt is promising that the majority of cancers are diagnosed through 2WW and screening; however, improving patient engagement, streamlining referrals, and thorough clinical examination and documentation will reduce delayed or missed diagnoses.
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Clift, Kristin, Sarah Macklin-Mantia, Margaret Barnhorst, et al. "Comparison of a Focused Family Cancer History Questionnaire to Family History Documentation in the Electronic Medical Record." Journal of Primary Care & Community Health 13 (January 2022): 215013192110697. http://dx.doi.org/10.1177/21501319211069756.
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Introduction: Family health history can be a valuable indicator of risk to develop certain cancers. Unfortunately, patient self-reported family history often contains inaccuracies, which might change recommendations for cancer screening. We endeavored to understand the difference between a patient’s self-reported family history and their electronic medical record (EMR) family history. One aim of this study was to determine if family history information contained in the EMR differs from patient-reported family history collected using a focused questionnaire. Methods: We created the Hereditary Cancer Questionnaire (HCQ) based on current guidelines and distributed to 314 patients in the Department of Family Medicine waiting room June 20 to August 1, 2018. The survey queried patients about specific cancers within their biological family to assess their risk of an inherited cancer syndrome. We used the questionnaire responses as a baseline when comparing family histories in the medical record. Results: Agreement between the EMR and the questionnaire data decreased as the patients’ risk for familial cancer increased. Meaning that the more significant a patient’s family cancer history, the less likely it was to be recorded accurately and consistently in the EMR. Patients with low-risk levels, or fewer instances of cancer in the family, had more consistencies between the EMR and the questionnaire. Conclusions: Given that physicians often make recommendations on incomplete information that is in the EMR, patients might not receive individualized preventive care based on a more complete family cancer history. This is especially true for individuals with more complicated and significant family history of cancer. An improved method of collecting family history, including increasing patient engagement, may help to decrease this disparity.
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Palos, Guadalupe R., and Martha Hare. "Patients, family caregivers, and patient navigators." Cancer 117, S15 (2011): 3590–600. http://dx.doi.org/10.1002/cncr.26263.
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CARLOS, Celina Angélica Lisboa Valente, and Karla Maria Damiano TEIXEIRA. "ONCOLOGICAL DIAGNOSIS AND TREATMENT: REFLECTION ON THE CHANGES IN THE LIFE OF THE PATIENT AND HIS FAMILY." Boletim de Conjuntura (BOCA) 13, no. 39 (2023): 473–90. https://doi.org/10.5281/zenodo.7786596.
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The diagnosis of cancer is usually received with fear and anguish and its consequences may establish a series of changes and disruptions for the patient and his family. Thus, with the aim of reflecting on the main changes experienced by cancer patients and their families as a result of the diagnosis and treatment of the disease, a systematic literature review was carried out. For the survey of scientific production, SciELO was defined as the database and the words “cancer, changes in the family and treatment” as descriptors. For the analysis of the data found, the IRAMUTEQ software was used, prioritizing the descending hierarchical classification and the similarity classification. From the analyses, it is concluded that cancer patients undergo a series of changes both at a personal and professional level, which have an impact on family routine, family finances, spirituality, family relationships and coexistence.
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Swann, Ruth, Sean McPhail, Jana Witt, et al. "Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit." British Journal of General Practice 68, no. 666 (2017): e63-e72. http://dx.doi.org/10.3399/bjgp17x694169.
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BackgroundContinual improvements in diagnostic processes are needed to minimise the proportion of patients with cancer who experience diagnostic delays. Clinical audit is a means of achieving this.AimTo characterise key aspects of the diagnostic process for cancer and to generate baseline measures for future re-audit.Design and settingClinical audit of cancer diagnosis in general practices in England.MethodInformation on patient and tumour characteristics held in the English National Cancer Registry was supplemented by information from GPs in participating practices. Data items included diagnostic timepoints, patient characteristics, and clinical management.ResultsData were collected on 17 042 patients with a new diagnosis of cancer during 2014 from 439 practices. Participating practices were similar to non-participating ones, particularly regarding population age, urban/rural location, and practice-based patient experience measures. The median diagnostic interval for all patients was 40 days (interquartile range [IQR] 15–86 days). Most patients were referred promptly (median primary care interval 5 days [IQR 0–27 days]). Where GPs deemed diagnostic delays to have occurred (22% of cases), patient, clinician, or system factors were responsible in 26%, 28%, and 34% of instances, respectively. Safety netting was recorded for 44% of patients. At least one primary care-led investigation was carried out for 45% of patients. Most patients (76%) had at least one existing comorbid condition; 21% had three or more.ConclusionThe findings identify avenues for quality improvement activity and provide a baseline for future audit of the impact of 2015 National Institute for Health and Care Excellence guidance on management and referral of suspected cancer.
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Jefferson, Laura, Karl Atkin, Rebecca Sheridan, et al. "Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs." British Journal of General Practice 69, no. 689 (2019): e850-e859. http://dx.doi.org/10.3399/bjgp19x706625.
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BackgroundThe 2-week-wait urgent referral policy in the UK has sought to improve cancer outcomes by accelerating diagnosis and treatment. However, around 5–7% of symptomatic referred patients cancel or do not attend their hospital appointment. While subsequent cancer diagnosis was less likely in non-attenders, those with a diagnosis had worse early mortality outcomes.AimTo examine how interpersonal, communication, social, and organisational factors influence a patient’s non-attendance.Design and settingQualitative study in GP practices in one Northern English city.MethodIn-depth, individual interviews were undertaken face-to-face or by telephone between December 2016 and May 2018, followed by thematic framework analysis.ResultsIn this study 21 GPs, and 24 patients who did not attend or had cancelled their appointment were interviewed, deriving a range of potential explanations for non-attendance, including: system flaws; GP difficulties with booking appointments; patient difficulties with navigating the appointment system, particularly older patients and those from more deprived areas; patients leading ‘difficult lives’; and patients’ expectations of the referral, informed by their beliefs, circumstances, priorities, and the perceived prognosis. GPs recognised the importance of communication with the patient, particularly the need to tailor communication to perceived patient understanding and anxiety. GPs and practices varied in their responses to patient non-attendance, influenced by time pressures and perceptions of patient responsibility.ConclusionFailure to be seen within 2 weeks of urgent referral resulted from a number of patient and provider factors. The urgent referral process in general practice and cancer services should accommodate patient perceptions and responses, facilitate referral and attendance, and enable responses to patient non-attendance.
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Hopkins, Rhian, Sarah ER Bailey, William T. Hamilton, and Elizabeth A. Shephard. "Microcytosis as a risk marker of cancer in primary care: a cohort study using electronic patient records." British Journal of General Practice 70, no. 696 (2020): e457-e462. http://dx.doi.org/10.3399/bjgp20x709577.
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BackgroundMicrocytosis (smaller than normal red blood cells) has previously been identified as a possible early risk marker for some cancers. However, the role of microcytosis across all cancers has not been fully investigated.AimTo examine cancer incidence in a cohort of patients with microcytosis, with and without accompanying anaemia.Design and settingCohort study of patients aged ≥40 years using UK primary care electronic patient records.MethodThe 1-year cancer incidence was compared between cohorts of patients with a mean red cell volume of <85 femtolitres (fL) (low) or 85–101 fL (normal). Further analyses examined sex, age group, cancer site, and haemoglobin values.ResultsOf 12 289 patients with microcytosis, 497 had a new cancer diagnosis within 1 year (4.0%, 95% confidence interval [CI] = 3.7 to 4.4), compared with 1465 of 73 150 without microcytosis (2.0%, CI = 1.9 to 2.1). In males, 298 out of 4800 with microcytosis were diagnosed with cancer (6.2%, CI = 5.5 to 6.9), compared with 940 out of 34 653 without (2.7%, CI = 2.5 to 2.9). In females with microcytosis, 199 out of 7489 were diagnosed with cancer (2.7%, CI = 2.3 to 3.1), compared with 525 out of 38 497 without (1.4%, CI = 1.3 to 1.5). In patients with microcytosis but normal haemoglobin, 86 out of 2637 males (3.3%, CI = 2.6 to 4.0) and 101 out of 5055 females (2.0%, CI = 1.6 to 2.4) were diagnosed with cancer.ConclusionMicrocytosis is a predictor of underlying cancer even if haemoglobin is normal. Although a benign explanation is more likely, clinicians in primary care should consider simple testing for cancer on encountering unexplained microcytosis, particularly in males.
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Williams, Pauline, Peter Murchie, and Christine Bond. "Patient and primary care delays in the diagnostic pathway of gynaecological cancers: a systematic review of influencing factors." British Journal of General Practice 69, no. 679 (2019): e106-e111. http://dx.doi.org/10.3399/bjgp19x700781.
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BackgroundGynaecological cancers are the second most common female cancer type, with survival rates in the UK lower than in many comparable countries. A potentially important factor in the UK’s poorer cancer outcomes is diagnostic delay; gynaecological cancers are the cancer type most likely to be affected by less timely diagnosis.AimTo examine current evidence for factors that contribute to patient and primary care delays in the diagnostic pathway of gynaecological cancer.Design and settingA systematic review of the available literature.MethodPRISMA guidelines were followed. MEDLINE and Embase databases and the Cochrane Library were searched using three terms: primary care; gynaecological cancer; and delay. Citation lists of all identified articles were searched. Two authors independently screened the titles, abstracts, and full texts of publications. Data extraction was performed by one author and quality assured by a second reviewer in a 20% sample of selected articles. Synthesis was narrative.ResultsA total of 1253 references was identified, of which 37 met the inclusion criteria. Factors associated with delayed diagnosis were categorised as either patient factors (patient demographics, symptoms or knowledge, and presentation to the GP) or primary care factors (doctor factors: patient demographics, symptoms or knowledge, and referral process); and system factors (such as limited access to investigations).ConclusionDelayed diagnosis in the patient and primary care intervals of the diagnostic journey of gynaecological cancer is complex and multifactorial. This review identifies areas of future research that could lead to interventions to enable prompter diagnosis of gynaecological cancers.
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Wulandari, Sarah Kartika, Yanti Hermayanti, Ahmad Yamin, and Ferry Efendi. "Family Process with Breast Cancer Patient in Indonesia." Jurnal Ners 12, no. 2 (2017): 180. http://dx.doi.org/10.20473/jn.v12i2.5970.
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Introduction: Breast cancer occupies the first position in Asia’s women cancer cases in recent years. Signs and symptoms experienced by the patient affect the stress condition of the patient as well as the family as a caregiver. The condition changes to deal with problems during patient assistance as a major problem in an outpatient setting. The demands of adaptation to through the needs during the period of assistance by the family is more complex. The study aimed to determine the experience of stress and adaptation of breast cancer patient’s family. Methods: The qualitative method used with in-depth interviews on seven respondents who were the family caregiver of breast cancer patients. Setting carried out at the shelter house in Bandung. The analysis process used thematic analysis based on Braun & Clarke. Results: The results found five main themes are: 1) Stressor on breast cancer patients, 2) Crisis fulfillment of companion needs, 3) Crisis accompaniment, 4) Coping mechanisms of caregiver, and 5) Ability in adaptation. Conclusions: Family experience in assisting breast cancer patients who undergo outpatient also impact families tension who traversed with a subjective effort optimally to adapt in accompanying patients and the needs of other resource support system. Suggestions for future step are early recognition of stress by health workers especially nurses to be able to provide targeted interventions to develop positive adaptation to clients. The development through research is needed in applying family center care both the outpatient and inpatient care in an integrated manner.
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Swann, Ruth, ÒJana Witt, Brian Shand, et al. "National Cancer Diagnosis Audit: initial results on avoidable delays." British Journal of General Practice 68, suppl 1 (2018): bjgp18X696677. http://dx.doi.org/10.3399/bjgp18x696677.
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BackgroundAn earlier diagnosis of cancer can increase cancer survival and quality of life. Characterising avoidable delays to a patient’s diagnosis of cancer can help to direct quality improvement initiatives.AimTo evaluate avoidable delays to cancer diagnoses and the variation by cancer type and patient characteristics using primary care data collected as part of the National Cancer Diagnosis Audit (NCDA).MethodEnglish general practices participating in the NCDA (439) entered primary care data on patients (17,042) diagnosed with cancer in 2014. Using a taxonomy developed from the National Audit of Cancer Diagnosis in Primary Care (2011), GPs reported delays to the diagnosis that in their judgement were avoidable.ResultsIn 22% of NCDA patient records (n = 3380), the GP considered there to be an avoidable delay to the patient receiving their cancer diagnosis. There was variation by cancer type; 7% of breast cancer patients experienced delays compared to 34% of stomach cancer patients. 49% of avoidable delays occurred in primary care and 38% in secondary or tertiary care. Of all delays, 28% were attributed to clinician factors and 34% to health care system factors. Results will be presented by patient characteristics.ConclusionPrimary care data from the NCDA can be used to better understand potentially avoidable delays to diagnosis and identify possible solutions for improving the diagnostic pathway. Avoidable delays during cancer diagnosis occur for many reasons. These insights can inform quality improvement initiatives, which should be directed at both clinical and organisational factors in primary care and hospital settings.
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Lin, Rui, Tao Wang, Shanshan Xiao, Ruifang Mao, Yue Pu, and Hong Liu. "A rare family case study of multiple siblings with multiple synchronous primary lung cancers." Journal of Clinical Oncology 38, no. 15_suppl (2020): e21028-e21028. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e21028.
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e21028 Background: Familial lung cancer is rare, let alone inherited lung cancer with multiple synchronous primary lung cancer lesions. Study of inherited lung cancer may facilitate the understanding of the molecular mechanism of the tumorigenesis. Methods: We identified an extremely rare family of five siblings, four with multiple primary lung adenocarcinomas by pathological examination. DNA samples were extracted from the patient tumor tissues and libraries were prepared for next-generation sequencing (NGS) analysis using a custom 500-gene cancer panel. Results: EGFR L858R or 19DEL mutations were identified in at least one lesion in all of the four lung cancer patients. Interestingly, lung cancer patient L1 had EGFR 19DEL in one lesion and L858R in the other, lung cancer patient L2 had EGFR L858R and KRAS G12C mutation in lesion 1 and lesion 2, respectively. The mutation statuses of EGFR and KRAS were confirmed by ARMS-PCR. The mutational spectrum of the two lesions from the same patient distinguished significantly based on the 500-gene NGS panel analysis, further demonstrating the heterogeneity of cancer mutations. Taken together, these results indicate that patients L1 and L2 both had synchronous primary lung cancers. Due to the small lesions, the two lesions for patient L3 were mixed together; the concurrent EGFR L858R and 19DEL mutations in the tissue sample implicated different drivers in the two different lesions since co-occurring of these two mutations was very rare. For patient L4, EGFR L858R was identified in one lesion and uncommon mutations with low frequencies were observed in the other lesion, consistent with different driving mechanisms for the two lesions. Conclusions: To our knowledge, this is the first study identifying a family of multiple siblings with multiple synchronous primary lung cancers and using NGS to reveal the genetics. Together with germline mutation analysis, this study may shed light on the tumorigenesis of familial lung cancer.
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Round, Thomas, Carolynn Gildea, Mark Ashworth, and Henrik Møller. "Association between use of urgent suspected cancer referral and mortality and stage at diagnosis: a 5-year national cohort study." British Journal of General Practice 70, no. 695 (2020): e389-e398. http://dx.doi.org/10.3399/bjgp20x709433.
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BackgroundThere is considerable variation between GP practices in England in their use of urgent referral pathways for suspected cancer.AimTo determine the association between practice use of urgent referral and cancer stage at diagnosis and cancer patient mortality, for all cancers and the most common types of cancer (colorectal, lung, breast, and prostate).Design and settingNational cohort study of 1.4 million patients diagnosed with cancer in England between 2011 and 2015.MethodThe cohort was stratified according to quintiles of urgent referral metrics. Cox proportional hazards regression was used to quantify risk of death, and logistic regression to calculate odds of late-stage (III/IV) versus early-stage (I/II) cancers in relation to referral quintiles and cancer type.ResultsCancer patients from the highest referring practices had a lower hazard of death (hazard ratio [HR] = 0.96; 95% confidence interval [CI] = 0.95 to 0.97), with similar patterns for individual cancers: colorectal (HR = 0.95; CI = 0.93 to 0.97); lung (HR = 0.95; CI = 0.94 to 0.97); breast (HR = 0.96; CI = 0.93 to 0.99); and prostate (HR = 0.88; CI = 0.85 to 0.91). Similarly, for cancer patients from these practices, there were lower odds of late-stage diagnosis for individual cancer types, except for colorectal cancer.ConclusionHigher practice use of referrals for suspected cancer is associated with lower mortality for the four most common types of cancer. A significant proportion of the observed mortality reduction is likely due to earlier stage at diagnosis, except for colorectal cancer. This adds to evidence supporting the lowering of referral thresholds and consequent increased use of urgent referral for suspected cancer.
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Mettlin, Curtis J., Morton Bard, Foster J. Boyd, et al. "Patient/psychosocial issues. Patient and family education." Cancer 68, S5 (1991): 1184–85. http://dx.doi.org/10.1002/1097-0142(19910901)68:5+<1184::aid-cncr2820681314>3.0.co;2-b.
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Abel, Gary A., Silvia C. Mendonca, Sean McPhail, Yin Zhou, Lucy Elliss-Brookes, and Georgios Lyratzopoulos. "Emergency diagnosis of cancer and previous general practice consultations: insights from linked patient survey data." British Journal of General Practice 67, no. 659 (2017): e377-e387. http://dx.doi.org/10.3399/bjgp17x690869.
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BackgroundEmergency diagnosis of cancer is common and aetiologically complex. The proportion of emergency presenters who have consulted previously with relevant symptoms is uncertain.AimTo examine how many patients with cancer, who were diagnosed as emergencies, have had previous primary care consultations with relevant symptoms; and among those, to examine how many had multiple consultations.Design and settingSecondary analysis of patient survey data from the 2010 English Cancer Patient Experience Survey (CPES), previously linked to population-based data on diagnostic route.MethodFor emergency presenters with 18 different cancers, associations were examined for two outcomes (prior GP consultation status; and ‘three or more consultations’ among prior consultees) using logistic regression.ResultsAmong 4647 emergency presenters, 1349 (29%) reported no prior consultations, being more common in males (32% versus 25% in females, P<0.001), older (44% in ≥85 versus 30% in 65–74-year-olds, P<0.001), and the most deprived (35% versus 25% least deprived, P = 0.001) patients; and highest/lowest for patients with brain cancer (46%) and mesothelioma (13%), respectively (P<0.001 for overall variation by cancer site). Among 3298 emergency presenters with prior consultations, 1356 (41%) had three or more consultations, which were more likely in females (P<0.001), younger (P<0.001), and non-white patients (P = 0.017) and those with multiple myeloma, and least likely for patients with leukaemia (P<0.001).ConclusionContrary to suggestions that emergency presentations represent missed diagnoses, about one-third of emergency presenters (particularly those in older and more deprived groups) have no prior GP consultations. Furthermore, only about one-third report multiple (three or more) consultations, which are more likely in ‘harder-to-suspect’ groups.
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Soriano, Gabriela, Mary Beth Landrum, Jane C. Weeks, et al. "The role of families in decisions about cancer treatments." Journal of Clinical Oncology 31, no. 15_suppl (2013): 6528. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.6528.
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6528 Background: Shared decision-making is an important component of patient-centered care and is associated with improved health outcomes. Little is known about patients’ involvement of family members in decisions about cancer treatments or whether family involvement varies by patient demographic or clinical characteristics. Methods: Data for this study were collected as part of the Cancer Care Outcomes Research and Surveillance (CanCORS) study, a large multi-regional prospective cohort study of cancer care and outcomes of lung and colorectal cancer patients. Patients were surveyed about the roles of their families in decisions about surgery, radiation, and/or chemotherapy. We used multinomial logistic regression to identify patient factors independently associated with family roles in decisions. Results: Among 5284 patients, 28.5% reported little or no family input in decisions, 22.1% reported making decisions after considering the family’s opinion, 47.9% reported the patient and family made decisions together, and 1.5% reported the family made decisions. In adjusted analyses, married, female, older, and insured patients were more likely to report making decisions with their family (all P<.001). Family involvement varied substantially by race/ethnicity and language, with Chinese-speaking Asian (63.5%) and Spanish-speaking Hispanic (56.8%) patients reporting making decisions with their family more often than English-speaking Hispanic patients (48.5%) and whites (48.3%). Patients from Veterans Affairs hospitals were least likely to report making decisions together with family (P<.001). Family involvement varied statistically by cancer type, stage, comorbidity, health status, and depression, but differences were minimal. Conclusions: Most patients with a new diagnosis of lung or colorectal cancer involve family members in treatment decisions. Certain groups, such as non-English speaking Hispanics and Asians rely significantly on family; for these groups, it is important that physicians inquire about patients’ preferences for family involvement and work to integrate family members in decisions accordingly. Further studies are needed to determine the impact of family involvement in treatment decisions on oncology outcomes.
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Hodgson, Jennifer L., Susan L. McCammon, Daniel P. Marlowe, and Ryan J. Anderson. "Medical Family Therapy in Cancer Care: Patient and Family Experiences." American Journal of Family Therapy 40, no. 3 (2012): 258–66. http://dx.doi.org/10.1080/01926187.2011.611783.
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Kurniasih, Dwi, Elly Marce Titihalawa, and Septiani Vivin Rahayu Tiningsih. "Family support in cervical cancer patients treated: A qualitative case study." Malahayati International Journal of Nursing and Health Science 6, no. 5 (2023): 399–404. http://dx.doi.org/10.33024/minh.v6i5.12629.
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Background: Cervical cancer not only has the potential to cause physical suffering but also causes psychological suffering. Considering the negative impact of cervical cancer, cervical cancer sufferers need family support. Family support is the attitude, actions and acceptance of the family towards a sick family member. Family attention is very helpful in choosing the health of his family.Purpose: To determine the impact that cervical cancer patients receive when they receive family support.Method: Qualitative research with a case study research strategy. Data collection was carried out through semi-structured interviews involving three participants. The data is then subjected to domain analysis.Results: In this research, 2 themes were found, namely, knowing the support provided by the family and knowing the impact felt by the patient when receiving family support.Conclusion: Family support is very important for cervical cancer patients undergoing the treatment process, because it will have an impact that will be felt by the patient later. The impact is felt like the patient feels cared for, given appreciation, loved and feels owned by his family. so that the patient has the motivation to recover and has confidence in worrying about the disease they are suffering from.
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Miklasevics, Edvins, Mikko Kupila, Dagnija Kalniete, et al. "Chromosomal Aberration in Colorectal Cancer Family." Acta Chirurgica Latviensis 15, no. 1 (2015): 8–11. http://dx.doi.org/10.1515/chilat-2016-0002.
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Summary Introduction. Lynch syndrome, previously more commonly known as hereditary nonpolyposis colorectal cancer, is a hereditary cancer syndrome with an autosomal dominant inheritance pattern. Usually it is caused by mutations the MMR genes. In 20 - 25% of cases patients are not found to have mutations in any of these genes. Chromosomal aberrations as a cause of the Lynch syndrome were examined in this study. Aim of the study. To identify chromosomal aberrations which may lead to colorectal cancer. Material and methods. Twelve patients, corresponding to either Amsterdam I/II criteria or Bethesda guidelines, which have been tested negative for mutations in Lynch genes have been karyotyped were karyotyped with SNP array chips, in order to determine if they had potentially heritable chromosomal aberrations which could be responsible for increased risk of malignancy. Results. One patient with a 14.7Mbp duplication framed by small deletions was chosen to be the most likely patient to suffer from an inherited carcinogenic chromosomal aberration. The preceding deletion was found to contain the coding region of BRE, encoding a component of the BRCA1-A complex; we believe that this deletion is the most carcinogenic component of the aberration and likely responsible for Lynch syndrome in this case. The larger duplication furthermore contained the coding regions for 83 genes, some of which have been shown to promote malignant disease when overexpressed. Conclusion. Because of the clinically grossly tolerable nature of the aberration it is possible that it was vertically transmitted and contributed to the onset of colorectal cancer in the patient and his mother and maternal aunt.
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Suzuki, J., T. Hojo, K. Jimbo, S. Asaga, and T. Kinoshita. "Risk of breast cancer among Japanese women with a positive family history." Journal of Clinical Oncology 29, no. 27_suppl (2011): 191. http://dx.doi.org/10.1200/jco.2011.29.27_suppl.191.
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191 Background: Most breast cancer cases are sporadic, rather than associated with inherited gene mutations, such as BRCA1 and BRCA2. However, women with a family history of breast cancer are at increased risk of developing breast cancer compared to those women without any family history, even if they lack these gene mutations. Methods: We analyzed 10892 patients including bilateral breast cancer cases (total of 11398 breast cancers) who underwent surgery at our hospital between 1962 and 2009. We excluded 295 cases whose family history data were not available. Clinical and pathological differences between following patient groups were tested; 9528 patients or 9955 cancers (88%) with negative family history (FH-), 896 patients or 951 cancers (8%) who had at least one first-degree relative with breast cancer (1FH+), 468 patients or 492 cancers (4%) who had second-degree relative with breast cancer (2FH+), and 1364 patients or 1443 cancers (12%) with family history regardless of first- or second-degree relative (FH+). Significance was established at a p-value of < 0.05. Results: Among the family members, sisters were more likely to have treated for breast cancer (38% in FH+ group), followed by mothers (27%), aunts (26%), grandmothers (7%), and daughters (2%). The incidence of developing contralateral breast cancer was significantly higher in 1FH+ group, compared to patients in FH- and 2FH+ groups. No other factors showed any significant difference, including the incidence of cancer in other organs, pathological characteristics, and age of onset, although BRCA1 and BRCA2 mutation may be associated with increased risk of developing breast cancer at younger age. Outcome studies with available data did not show any significant difference in overall survival between FH+ and FH- patients. Conclusions: A Japanese woman with a positive family history has a higher risk of developing breast cancer than women without any close relatives with breast cancer, similar to the results reported in Western countries where prevalence of breast cancer is higher. Regular checkup of contralateral breast is important for those patients whose first-degree relatives have also been diagnosed with breast cancer.
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Yumni, Fathiya Luthfil. "The Relationship Between Family Support And Quality of Life of Cervical Cancer Patients in Rumah Singgah Sasana Marsudi Husada Indonesia." Critical Medical and Surgical Nursing Journal 12, no. 1 (2023): 14–18. http://dx.doi.org/10.20473/cmsnj.v12i1.46826.
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Introduction: Patients with cervical cancer are in need of support from people around them, especially families, sometimes they need hospital treatment also required encouragement and motivation of family members to reduce psychological burden and quality of life of patients with cancer increases. The purpose of this research is to determine the relationship between family support and quality of life of cervical cancer patient at Rumah Singgah Sasana Marsudi Husada Yayasan Kanker Indonesia (YKI), East Java, Indonesia. Methods: The research design used correlation analysis with cross sectional study design. Thirty patients with cervical cancer were involved through purposive sampling technique. The independent variable was family support and dependent variable was quality of life. The instrument used in this research was the WHOQOL-BREF questionnaire. The data were analyzed by Spearman Rank (Rho) test with α < 0.05. Results: Statistical result showed that family support significantly relate to quality of life of cervical cancer patient with a value of p = 0,000 and correlation coefficient (r) = 0,994 which means it has a strong relationship. Conclusion: There is a positive and strong relationship between family support and the quality of life of cervical cancer patients. The higher the family support, the better the quality of life felt by cervical cancer patient. All staffs of the institution or foundation is expected to encourage families to support and care for sick family members (cervical cancer patient). Thus, health workers must also enhance their knowledge and skills to detect any changes in the life situation (especially family support) experienced by cancer patients, because this will affect their quality of life.
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Swann, Ruth, Georgios Lyratzopoulos, Greg Rubin, Elizabeth Pickworth, and Sean McPhail. "National Cancer Diagnosis Audit: avoidable delays to diagnosis." British Journal of General Practice 69, suppl 1 (2019): bjgp19X703073. http://dx.doi.org/10.3399/bjgp19x703073.
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BackgroundA prolonged time taken to diagnose cancer can lead to poorer survival and reduced quality of life. Characterising avoidable delays to a patient’s diagnosis could help to direct quality improvement initiatives aimed at enhancing patient safety and ultimately patient outcomes.AimTo assess the validity of data on avoidable delays collected as part of the English National Cancer Diagnosis Audit (NCDA) and to estimate the predictors of avoidable delays to diagnosis by patient demographics and cancer type.MethodParticipating general practices (n = 439; 5% practices) submitted primary care data on patients (n = 17 042) diagnosed with cancer in 2014 in England. GPs reported delays to the diagnosis that they considered avoidable. Quantile regression was used to understand the impact of an avoidable delay on the diagnostic interval. Logistic regression models were used to investigate the factors associated with avoidable delay.ResultsThe GP recorded an avoidable delay to cancer diagnosis in 24% of cases (n = 3372). The median diagnostic interval was 57 days longer in patients where an avoidable delay was recorded. Results have shown significant associations between avoidable delay and certain cancer types (odds ratio [OR] 1.73 for stomach versus lung cancer) and an increasing number of comorbidities (OR 1.43 for patients with ≥3 versus 0).ConclusionGP-reported data showed a longer diagnostic interval in patients thought to have had an avoidable delay to their diagnosis, indicating construct validity of the data collected. Data from the NCDA is being used to better understand avoidable delays to diagnosis, and identify possible solutions for improving the diagnostic pathway in some cases.
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Feliciano, Josephine, Breanna Becker, Manish Shukla, and Joann Bodurtha. "Lung cancer and family-centered patient concerns." Supportive Care in Cancer 26, no. 9 (2018): 3047–53. http://dx.doi.org/10.1007/s00520-018-4159-4.
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Burkhalter, Jack E., and Stacey R. Bromberg. "Family-Oncologist Communication in Cancer Patient Care." Cancer Investigation 21, no. 6 (2003): 915–23. http://dx.doi.org/10.1081/cnv-120025094.
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Krivonis, T. "Peculiarities of psychological status families with oncological patient at different stages of disease development." Reports of Vinnytsia National Medical University 23, no. 4 (2019): 712–16. http://dx.doi.org/10.31393/reports-vnmedical-2019-23(4)-26.
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Annotation. Cancer affects not only the patient but also affects the functioning of the whole family. The purpose of the work is to identify the peculiarities of the psychological status of the family with the cancer patient at different stages of the disease. On the base of informed consent, 286 families of cancer patients examined: 174 families with patient-wife and 112 families with patient-husband. Families examined at different stages of the treatment process, namely, at the first episode of the disease — 78 women and 51 men, and after return of the disease or its relapse — 96 women and 63 men. The FACES-3 family adaptation and cohesion scale was used. It is established that in families with cancer patients found changes in family functioning caused by the disease, which expressed in the formation of a specific behaviour patterns, most often by type of excessive care. In patients with continued illness observed changes in behaviour model in form of excessive care or distancing which reflected in levels of cohesion and adaptation. Thus, changes in family functioning in families with a patient suffering from cancer necessitate the development of family-oriented medical-psychological help.
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Suciati, Suciati, and Rakha Syah Al Kindy. "Family Supportive Communication to Cancer Patients at Dharmais Cancer Hospital Jakarta." International Journal of Research and Innovation in Social Science VII, no. VIII (2023): 498–511. http://dx.doi.org/10.47772/ijriss.2023.7836.
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This study aims to get an overview of supportive communication provided by families in increasing the enthusiasm for treatment and the enthusiasm for the life of cancer patients at the Dharmais cancer hospital in Jakarta. The is situated in the theory of categories of defensive and supportive behavior. A qualitative descriptive type approach was employed, with data collected through in-depth interviews and observation. The participants were selected using a purposive sampling technique. Results show that the families of patients at the Dharmais Cancer Hospital, Jakarta, had implemented several messages in supportive communication for sufferers byothers: a) providing mutual support and not blaming the patient’s condition, b) solving problems together for the smooth running of patient treatment, c) being open to each other, especially regarding the information on patient conditions, d) listening to each other’s complaints and understanding each other’s conditions, e) having strong emotional closeness so that there is not the slightest distance, and f) accepting each other’s opinions, especially regarding the food consumed by the patient. However, there is a uniqueness in terms of solving the problem, in the informant I pair they have to work together to convince both parents and family so that the patient can continue to carry out the chemotherapy treatment recommended by the doctor, in the informant II pair, to increase appetite, the patient is given leeway in choosing the food they want to consume so that the patient’s appetite increases, and for the pair of informants III, distance and private transportation costs were a problem so they decided to use public transportation at a more affordable cost compared to renting an inn around the hospital. The factor that influences the form of supportive communication in the three pairs of informants is the affection from a family, which demands sacrifice for one another.
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Indah, Crisnah. "A Literature Review of Depression and Anxiety in Breast Cancer Patient." Scientia Psychiatrica 4, no. 2 (2021): 394–99. http://dx.doi.org/10.37275/scipsy.v4i2.120.
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Breast cancer that is one of the most common cancers experienced by women (adult or elderly) has a great effect on the patient's psychology. The most common psychological problems found in breast cancer patients are depression and anxiety. Many factors affect the incidence of depression and anxiety, such as lack of family support, lack of social support, prolonged therapy, changes in body shape, divorce, income and age. There are several ways to diagnose depression and anxiety in cancer patients, such as a distress thermometer or Patient Health Questionnaire (PHQ)-4. Actually, depression and anxiety disorders have a poor impact on these patients. There are several alternative non-pharmacological therapies that can be chosen, like cognitive behavioral therapy, family support and social support.
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Kusumaningrum, Tiyas, Retnayu Pradanie, Esti Yunitasari, and Sih Kinanti. "PERAN KELUARGA DAN KUALITAS HIDUP PASIEN KANKER SERVIKS." Jurnal NERS 11, no. 1 (2016): 112. http://dx.doi.org/10.20473/jn.v11i12016.112-117.
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Introduction. Cervical cancer diagnosis has been a major burden both for patients and their family. For patients, cervical cancer obliterated some of their role as a wife and a mother. Most patients with advance cancer have low score of quality of life indicating they have problems. Family must take care of their beloved ones dealing with the diagnosis, treatment, and side effects of cervical cancer. Family as a caregiver might be ill prepared to undertake that role. The objective of this research was to identify the correlation of family health task on quality of life in patients with cervical cancer. Methods. This research employed cross-sectional design. Population in this research was all patients with cervical cancer in gynecology ward Dr Soetomo Hospital in Surabaya. Participant for this research were patients with cervical cancer and their family. Data were taken by structured interview using Fact Cx for Quality of life and family health task question form. Linear regression analysis was applied with level of significance ≤0.05. Results. Most family had moderate level of family health task while most patients also have moderate level of quality of life. Unfortunately there are no significance correlations of family health task on quality of life in patients with cervical cancer. Discussion. Quality of life in patient with cervical cancer was not affected directly by their family health task. Nonetheless patient gratefully thanks family for their support during their cancer treatments. Keywords: family health task, fact cx, family support, quality of life, cervical cancer
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Lyratzopoulos, Georgios. "Understanding variation in the timeliness of diagnosis of cancer in symptomatic patients." Journal of Clinical Oncology 32, no. 30_suppl (2014): 301. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.301.
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301 Background: Diagnosing cancer promptly in symptomatic patients is a priority for healthcare systems worldwide, but little is known about how initiatives can be targeted to patients at greater risk. Methods: UK data on the number of consultations with a family doctor before specialist referral (‘pre-referral consultations’); the time interval from presentation to referral (‘primary care interval’); and stage at diagnosis, were analysed using multivariable regression models. Results: Both patient experience (41,299 patients, 24 cancers) and clinical audit (13,031 patients, 18 cancers) data indicated wide variation in two correlated measures* of the difficulty of suspecting the diagnosis of cancer once the patient had presented to their family doctor. For example, >30% of patients with multiple myeloma, pancreatic and lung cancer experienced three or more pre-referral consultations; in contrast, this was true for <10% of patients with breast cancer and melanoma (p<0.001). Adjusting for diagnostic case-mix, younger and ethnic minority patients, and women, were more likely to experience three or more pre-referral consultations. Data from 88,657 patients (10 cancers) suggested socio-demographic disparities in stage at diagnosis for some only cancers: For patients with melanoma, breast and endometrial cancer, lower socioeconomic status was associated with higher risk of advanced stage at diagnosis and for, these three cancers, the same was true for older age. Conclusions: Different diagnostic intervals vary widely by cancer diagnosis and patient characteristics. Notable disparities in stage at diagnosis are apparent for ‘easy-to-suspect’ cancers (which are associated with minimal delay post-presentation), strongly implicating psychosocial patient factors as the source of these disparities. These findings can help to appropriately target early diagnosis policy initiatives and future research to patients at greater risk of prolonged diagnostic intervals. *Number of pre-referral consultations with a primary care physician and length of primary care interval (Spearman’s r=0.70).
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Nguyen, Khoa, Julia Boehling, Minh N. Tran, et al. "NEK Family Review and Correlations with Patient Survival Outcomes in Various Cancer Types." Cancers 15, no. 7 (2023): 2067. http://dx.doi.org/10.3390/cancers15072067.
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The Never in Mitosis Gene A (NIMA)–related kinases (NEKs) are a group of serine/threonine kinases that are involved in a wide array of cellular processes including cell cycle regulation, DNA damage repair response (DDR), apoptosis, and microtubule organization. Recent studies have identified the involvement of NEK family members in various diseases such as autoimmune disorders, malignancies, and developmental defects. Despite the existing literature exemplifying the importance of the NEK family of kinases, this family of protein kinases remains understudied. This report seeks to provide a foundation for investigating the role of different NEKs in malignancies. We do this by evaluating the 11 NEK family kinase gene expression associations with patients’ overall survival (OS) from various cancers using the Kaplan–Meier Online Tool (KMPlotter) to correlate the relationship between mRNA expression of NEK1-11 in various cancers and patient survival. Furthermore, we use the Catalog of Somatic Mutations in Cancer (COSMIC) database to identify NEK family mutations in cancers of different tissues. Overall, the data suggest that the NEK family has varying associations with patient survival in different cancers with tumor-suppressive and tumor-promoting effects being tissue-dependent.
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Yun, Young Ho, Chang Geol Lee, Si-young Kim, et al. "The Attitudes of Cancer Patients and Their Families Toward the Disclosure of Terminal Illness." Journal of Clinical Oncology 22, no. 2 (2004): 307–14. http://dx.doi.org/10.1200/jco.2004.07.053.
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PurposeTo ascertain the attitude of cancer patients and their families toward disclosure of terminal illness to the patient.Patients and MethodsWe constructed a questionnaire that included demographic and clinical information and delivered it to 758 consecutive individuals (433 cancer patients and 325 families that have a relative with cancer) at seven university hospitals and one national cancer center in Korea.Results380 cancer patients and one member from each of 281 families that have a relative with cancer completed the questionnaire. Cancer patients were more likely than family members to believe that patients should be informed of the terminal illness (96.1% v 76.9%; P < .001). Fifty percent of the family members and 78.3% of the patients thought that the doctor in charge should be the one who informs the patient. Additionally, 71.7% of the patients and 43.6% of the family members thought that patients should be informed immediately after the diagnosis. Stepwise multiple logistic regression indicated that the patient group was more likely than the family group to want the patient to be informed of the terminal illness (odds ratio [OR], 9.76; 95% CI, 4.31 to 22.14), by the doctor (OR, 4.00; 95% CI, 2.61 to 6.11), and immediately after the diagnosis (OR, 3.64; 95% CI, 2.45 to 5.41).ConclusionOur findings indicated that most cancer patients want to be informed if their illness is terminal, and physicians should realize that the patient and the family unit may differ in their attitude toward such a disclosure. Our results also reflect the importance of how information is given to the patient.
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Adam, Rosalind. "Development of a digital intervention to optimise cancer pain control." British Journal of General Practice 68, suppl 1 (2018): bjgp18X696737. http://dx.doi.org/10.3399/bjgp18x696737.
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BackgroundPain is a frequent and distressing complication of cancer. Patients can have problems reporting pain, communicating about pain with professionals, using medications effectively, and seeking help.AimTo develop an intervention to support patients and professionals improve cancer pain control.MethodAn Intervention Mapping approach was taken to intervention development. Current challenges of managing cancer pain and potential solutions were investigated through systematic literature review and qualitative enquiries with patients, caregivers, and professionals. Behaviour change theory was applied systematically. A digital intervention was produced and prototypes were pre-tested. Patients were recruited with their linked Macmillan nurse and GP to feasibility test the intervention.ResultsA digital app was developed to help patients on strong opioids achieve personal treatment goals. The app includes a short film about pain management. It allows easy recording of short-acting analgesic doses, linked algorithmically to telephone help-screens. A weekly diary asks about pain, side effects, function, and medication adherence. App reports are automatically shared with linked professionals via NHS email. Early feasibility testing has been conducted with two patients, their linked GPs, and Macmillan nurses. Professionals found patient reports thought-provoking. Reports were used to inform clinical encounters, and seemed to promote a shared understanding of patient symptom management goals.ConclusionA digital intervention has been developed using a rigorous, theory-based methodological approach. There are early indications that the intervention could promote patient-centred care and shared decision making in patients with cancer pain. The intervention is ready to be tested on a larger scale.
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Pande, Mala, Connie Okon, Y. Nancy You, Susan K. Peterson, Banu Arun, and Patrick M. Lynch. "Adequacy of self-reported family history in electronic health record for genetic risk assessment for Lynch syndrome." Journal of Clinical Oncology 37, no. 15_suppl (2019): 1515. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.1515.
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1515 Background: Self-reported family cancer history (FCH) is one of the key indicators of hereditary cancer risk. Studies have shown that accurate FCH documentation by healthcare providers is suboptimal, but data regarding patient-provided FCH are limited. We evaluated the quality of FCH as entered by the patient into the electronic health record (EHR) to determine its adequacy for Lynch syndrome (LS) risk assessment. Methods: At our tertiary referral cancer center, FCH is self-reported via an online questionnaire sent prior to appointment, which is reviewed/updated by clinic nurse during initial visit and then imported into EHR review of systems. Records of all new patients from September 2016 to August 2017 were retrospectively reviewed and analyzed. FCH quality was estimated by calculating rates of reporting of 3 FCH variables required for PREMM5, a risk-prediction model for LS. Parameters required for the model were sex, age, personal history of cancer, and for FCH, degree of kinship (first/second degree), cancer site/type, and age at diagnosis. Results: Of 47,647 unique patients, 47.5% reported FCH for 1 or more relative (46.1% were first degree, 64.8% second degree, 3.0% other, and 2.4% missing). A cancer type/site was specified for 88.8% reporting FCH. Age at diagnosis was listed for 21.7% of the relatives’ cancers. Overall, only 20.9% provided all 3 FCH data elements required for running PREMM5 (9.9% of the total sample, n=4738). Fewer men (9.5%) than women (28.1%) provided all 3 FCH elements. Furthermore, 46.7% of breast cancer patients, 21.9% of gastrointestinal cancer patients, 47.2% and 23.1% of patients seen for cancer prevention screening and endoscopy respectively, reported 3 FCH elements. Lower rates were observed for other cancers. Conclusions: Patient self-reported FCH is suboptimal for estimation of LS risk and genetic counseling referral. Future steps to optimize online patient-facing FCH collection to enable routine automated risk-assessment in an essentially provider-free setting may include, patient education regarding importance of FCH, EHR prompts for FCH completion, and implementation of algorithms in EHRs using FCH to identify patients at risk for hereditary cancer predisposition syndromes.
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Sharbafchi, Mohammad Reza, Seyed Mohammad Hossein Mousavi, Ghazaleh Sheikhani, Mahmoud Keyvanara, and Sima Ani. "Caring Challenges of Family Caregivers of Cancer Patients in the COVID-19 Pandemic: A Qualitative Study." Iranian Journal of Nursing and Midwifery Research 30, no. 2 (2025): 175–81. https://doi.org/10.4103/ijnmr.ijnmr_125_23.
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Abstract Background: Caregivers of cancer patients experience significant challenges that affect their physical, psychological, and social well-being. This qualitative study aims to explore the specific challenges faced by caregivers of cancer patients during the COVID-19 pandemic. Materials and Methods: The present study is a conventional qualitative study based on the Graneheim method for content analysis. Data were collected through semi-structured individual interviews with 11 family caregivers of cancer patients in Isfahan, Iran. Results: The challenges faced by family caregivers of cancer patients are classified into three main categories: 1) caregiver burnout which includes, “non-cooperation of the patient with the caregiver,” “funding the costs of care and treatment,” “lack of support for the family caregiver by the family and society,” and “lack of knowledge and proper care skills.” 2) Health threats to the family caregiver which include, “imbalance of self-care versus patient care,” “disruption of a healthy lifestyle,” and “occurrence of psychophysical symptoms caused by stress in caregivers.” 3) Work-family-care conflicts which include: “conflict between patient care and family” and “conflict between patient care and work.” Conclusions: This study provides additional insights into the personal and societal challenges faced by family caregivers of cancer patients during the COVID-19 pandemic. Based on our findings, health policymakers can take concrete steps to address these challenges and enhance the support for family caregivers, who play a crucial role in public health.
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Shams, Salima. "PATIENT EDUCATION: Counseling of oral cancer patients." Canadian Oncology Nursing Journal 34, no. 2 (2024): 232–37. http://dx.doi.org/10.5737/23688076342232.
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The purpose of this manuscript is to summarize key aspects of care for patients with advanced oral cancer, metastatic to the head and neck region. Patients with advanced oral cancer are treated with multimodal treatment. Surgical intervention leads to limitation in speech and swallowing abilities while adverse effects of chemotherapy and radiation treatment can include nausea, vomiting, diarrhea, mucositis, cystitis, dehydration, nephrotoxicity, skin dermatitis, myelosuppression, and nutritional deficiencies leading to weight loss. These toxicities could be overcome through self-care measures practiced by the patient. Oncology nurses could impart knowledge about self-care measures via patient and family counseling. Keywords: advanced oral cancer, head and neck cancer, counseling, self-care measures
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Guhan, Maya, Stacey Crane, Lillian Valerius, et al. "Patient interest in exploring nonsurgical treatment approaches for early-stage breast cancer: A qualitative study." Journal of Clinical Oncology 40, no. 16_suppl (2022): 578. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.578.
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578 Background: Advances in radiotherapy allow the ability to deliver ablative treatments without compromising outcomes, but there has been limited application of these treatments to early-stage breast cancers. The purpose of this study was to explore patients’ interest in pursuing nonsurgical treatment approaches for their early-stage breast cancer. Methods: Investigators conducted a qualitative descriptive study involving semi-structured interviews with 21 early-stage breast cancer patients eligible for participation in a phase 2 trial offering omission of surgery. Interviews were transcribed, and three independent reviewers performed an inductive, thematic analysis to generate themes and subthemes. Results: Data analysis revealed the following factors that impacted patients’ willingness and desire to explore nonsurgical treatment options: Perceptions and feelings about their cancer; Current quality of life and the level of support available in their daily life; External conversations focusing on family members’ and friends’ experiences with cancer and/or cancer treatments; Personal healthcare experiences, including with their current breast cancer diagnosis; Perceptions and feelings about their physicians; Conversations with their physicians about their treatment options; and Self-identified desire to direct care decisions. Specifically, patients described fearing surgery and surgical recovery and wanting to avoid negative surgery-related events previously experienced by friends, family, and themselves. Participants also expressed a desire to preserve their breast(s), receive treatment per the latest research, match the level of treatment with the severity of their cancer, and avoid other comorbidities as reasons for omitting surgery. Patient reasons for pursuing surgery included the desire to remove their cancer immediately, prior positive experiences of friends, family, and themselves with surgery, lack of concern about preserving their breast(s), and prior negative experiences of friends, family, and themselves with radiation. Conclusions: The results of this study highlight that there is patient interest in nonsurgical options for biologically favorable early stage breast cancers. A key factor hindering patient education and awareness of nonsurgical options is how the physician frames the discussion and presents treatment options. In addition, patients’ self-identity and the prior experiences of friends, family, and self with cancer treatment and surgery in general appear to be key factors in their decision-making. The findings from this study demonstrate an unmet need to explore nonsurgical options for early-stage breast cancer. Study results can help shape conversations around shared decision making and clinical trial design and result in more personalized treatment options for women with early-stage breast cancer.
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Guhan, Maya, Stacey Crane, Lillian Valerius, et al. "Patient interest in exploring nonsurgical treatment approaches for early-stage breast cancer: A qualitative study." Journal of Clinical Oncology 40, no. 16_suppl (2022): 578. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.578.
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578 Background: Advances in radiotherapy allow the ability to deliver ablative treatments without compromising outcomes, but there has been limited application of these treatments to early-stage breast cancers. The purpose of this study was to explore patients’ interest in pursuing nonsurgical treatment approaches for their early-stage breast cancer. Methods: Investigators conducted a qualitative descriptive study involving semi-structured interviews with 21 early-stage breast cancer patients eligible for participation in a phase 2 trial offering omission of surgery. Interviews were transcribed, and three independent reviewers performed an inductive, thematic analysis to generate themes and subthemes. Results: Data analysis revealed the following factors that impacted patients’ willingness and desire to explore nonsurgical treatment options: Perceptions and feelings about their cancer; Current quality of life and the level of support available in their daily life; External conversations focusing on family members’ and friends’ experiences with cancer and/or cancer treatments; Personal healthcare experiences, including with their current breast cancer diagnosis; Perceptions and feelings about their physicians; Conversations with their physicians about their treatment options; and Self-identified desire to direct care decisions. Specifically, patients described fearing surgery and surgical recovery and wanting to avoid negative surgery-related events previously experienced by friends, family, and themselves. Participants also expressed a desire to preserve their breast(s), receive treatment per the latest research, match the level of treatment with the severity of their cancer, and avoid other comorbidities as reasons for omitting surgery. Patient reasons for pursuing surgery included the desire to remove their cancer immediately, prior positive experiences of friends, family, and themselves with surgery, lack of concern about preserving their breast(s), and prior negative experiences of friends, family, and themselves with radiation. Conclusions: The results of this study highlight that there is patient interest in nonsurgical options for biologically favorable early stage breast cancers. A key factor hindering patient education and awareness of nonsurgical options is how the physician frames the discussion and presents treatment options. In addition, patients’ self-identity and the prior experiences of friends, family, and self with cancer treatment and surgery in general appear to be key factors in their decision-making. The findings from this study demonstrate an unmet need to explore nonsurgical options for early-stage breast cancer. Study results can help shape conversations around shared decision making and clinical trial design and result in more personalized treatment options for women with early-stage breast cancer.
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Borges, Eliana Lourenço, Juliana Franceschini, Luiza Helena Degani Costa, Ana Luisa Godoy Fernandes, Sérgio Jamnik, and Ilka Lopes Santoro. "Family caregiver burden: the burden of caring for lung cancer patients according to the cancer stage and patient quality of life." Jornal Brasileiro de Pneumologia 43, no. 1 (2017): 18–23. http://dx.doi.org/10.1590/s1806-37562016000000177.
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ABSTRACT Objective: Patients with lung cancer experience different feelings and reactions, based on their family, social, cultural, and religious backgrounds, which are a source of great distress, not only for the patients but also for their family caregivers. This study aimed to evaluate the impact that lung cancer stage and quality of life (QoL) of lung cancer patients have on caregiver burden. Methods: This was a prospective cross-sectional study. Consecutive patient-caregiver dyads were selected and asked to complete the Hospital Anxiety and Depression Scale and the Medical Outcomes Study 36-item ShortForm Health Survey (SF-36). Family caregivers also completed the Caregiver Burden Scale. Group-based modeling was used in order to identify patients with early- or advanced-stage cancer (IA to IIIA vs. IIIB to IV) plus non-impaired or impaired QoL (SF36 total score > 50 vs. ≤ 50). Patient-caregiver dyads were stratified into four groups: early-stage cancer+non-impaired QoL; advanced-stage cancer+non-impaired QoL; early-stage cancer+impaired QoL; and advanced-stage cancer+impaired QoL. Results: We included 91 patient-caregiver dyads. The majority of the patients were male and heavy smokers. Family caregivers were younger and predominantly female. The burden, QoL, level of anxiety, and level of depression of caregivers were more affected by the QoL of the patients than by their lung cancer stage. The family caregivers of the patients with impaired QoL showed a higher median burden than did those of the patients with non-impaired QoL, regardless of disease stage. Conclusions: Caregiver burden is more affected by patient QoL than by lung cancer stage.
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Kusumaningrum, Tiyas, Retnayu Pradanie, Esti Yunitasari, and Sih Kinanti. "Peran Keluarga dan Kualitas Hidup Pasien Kanker Serviks." Jurnal Ners 11, no. 1 (2016): 112–17. http://dx.doi.org/10.20473/jn.v11i1.1920.
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Introduction. Cervical cancer diagnosis has been a major burden both for patients and their family. For patients, cervical cancer obliterated some of their role as a wife and a mother. Most patients with advance cancer have low score of quality of life indicating they have problems. Family must take care of their beloved ones dealing with the diagnosis, treatment, and side effects of cervical cancer. Family as a caregiver might be ill prepared to undertake that role. The objective of this research was to identify the correlation of family health task on quality of life in patients with cervical cancer.Methods. This research employed cross-sectional design. Population in this research was all patients with cervical cancer in gynecology ward Dr Soetomo Hospital in Surabaya. Participant for this research were patients with cervical cancer and their family. Data were taken by structured interview using Fact Cx for Quality of life and family health task question form. Linear regression analysis was applied with level of significance ≤0.05.Results. Most family had moderate level of family health task while most patients also have moderate level of quality of life. Unfortunately there are no significance correlations of family health task on quality of life in patients with cervical cancer.Discussion. Quality of life in patient with cervical cancer was not affected directly by their family health task. Nonetheless patient gratefully thanks family for their support during their cancer treatments.
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Siddiqui, Wamia, Joel E. Pacyna, Sean M. Phelan, Jeremy C. Jones, N. Jewel Samadder, and Richard R. Sharp. "Factors Impacting Intent to Share Multigenic Cancer Testing Results in a Community Hospital Setting." Journal of Personalized Medicine 14, no. 9 (2024): 987. http://dx.doi.org/10.3390/jpm14090987.
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Background/Objectives: Multi-gene, multi-cancer, hereditary cancer risk screenings may be useful in cancer prevention and treatment, not only for cancer patients but also for patients’ family members. If genetic cancer screening is to have the widest possible benefit, it must be extended into diverse cancer care settings that serve diverse patient communities, providing cancer patients and their relatives with individualized cancer risk evaluations. Little research, to date, has examined the impact of extending multigenic cancer screening into diverse settings. Without empirical data characterizing the support needs of cancer patients and their family members, we may not adequately satisfy the needs of all patients and risk exacerbating existing disparities in cancer care and outcomes. Methods: We examined patient perspectives on the sharing of genetic results with at-risk family members by surveying a racially diverse sample of cancer patients receiving a multi-gene, multi-cancer risk screen in a community hospital setting. Results: In a survey of 230 cancer patients, we found that intent to share results with family members was high but varied across family member types. More respondents planned to disclose results to at least one sister (82.5%) compared to at least one brother (73.1%). Over one-fourth of participants (27.4%) were either uncertain about sharing or intended to withhold their genomic screening results from at least one at-risk family member eligible for cascade testing. Participants were more likely to withhold their results from a sibling than from a child. Furthermore, intent to share across all family member types was lower if probands failed to identify at least one benefit to sharing. Conclusions: Understanding factors associated with decisions to share results with at-risk relatives in diverse patient populations can help clinicians support cascade genetic cancer screenings in diverse communities and settings.
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Hansen, Lissi, Susan J. Rosenkranz, and Gina M. Vaccaro. "Living with terminal hepatocellular carcinoma: The patient and family perspective." Journal of Clinical Oncology 31, no. 15_suppl (2013): e20702-e20702. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e20702.
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e20702 Background: Hepatocellular carcinoma (HCC) is a growing problem worldwide; incidence of HCC in the U.S. has increased from 1.4 to 2.4 per 100,000 primarily because of people infected by hepatitis B or C. For those diagnosed with intermediate-advanced or terminal HCC, there is no curative treatment, and duration of survival is typically one to two years. Despite a high death rate, no studies were found examining experiences of living with terminal HCC and how it may affect end of life care from perspectives of both patients and family members. Methods: This pilot study used a prospective, longitudinal descriptive design, and qualitative and quantitative methods (mixed methods). Interview and survey (symptoms, quality of life) data were collected once a month for a 6-month period from 20 patient-family member dyads. Two researchers independently coded transcribed interview data into synthesized themes using inductive analysis, and met regularly to establish consensus on coding disagreements. Results: This poster reports on interview data from a convenience sub-sample of 14 patient-family member dyads. The interview data set comprised 56 interviews (14 conducted with patients, 11 with family members, and 31 with patient-family member dyads). Of the 14 patients, 11 were male and 3 were female (mean age=61.5, range=54-68 years). Of the 14 family members, 4 were male and 10 were female (mean age=57.4, range=22-68 years). Eight patients died during the study period. Findings from patient-family member dyad interviews included 5 major themes: 1) comparing diseases—differences and similarities between HCC and other types of illnesses/cancers (e.g., breast cancer), 2) uncertainty about treatments over time, 3) symptom management, 4) lack of support, and 5) family member caregiving struggles. Differences were found between interviews conducted with patients only and family members only, including perceived challenges in patient-family member relationships. Conclusions: From this first step, knowledge gained will serve as the foundation for a larger scale study and test of future interventions to address challenges (e.g., symptom management, caregiver burden) at the end of life for these cancer patients and their family members.
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Previs, Rebecca A., Heidi Chwan Ko, Zachary D. Wallen, et al. "Real-world clinical and genomic analysis of patients with a personal or family history of cancer undergoing germline testing for BRCA1 and BRCA2." Journal of Clinical Oncology 41, no. 16_suppl (2023): e22538-e22538. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.e22538.
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e22538 Background: Germline genetic testing for hereditary cancer syndromes is essential to the management of patients with cancer, providing information with both therapeutic implications and guidance for preventative strategies for patients and at-risk family members. BRCA1 and BRCA2 are the most common genes with deleterious mutations associated with increased risk of developing hereditary breast, ovarian, prostate and pancreatic cancers. The objective of this study was to explore the prevalence of germline BRCA1 and BRCA2 mutations in individuals with known cancer compared to those with only a family history of cancer in a real-world patient population. Methods: Real-world clinical and genomic data were reviewed for 12,270 consecutive individuals referred to a clinical laboratory for BRCA1 and BRCA2 sequencing and copy number variant analysis. Clinical data were ascertained from testing requisition forms completed by healthcare providers. Germline variants in BRCA1 and BRCA2 were identified by next-generation sequencing. The incidence of pathogenic and likely pathogenic variants (PVs) were calculated for each gene, patient cohort and four common cancer types: breast, ovarian, prostate, and pancreatic. Statistical analysis was performed using chi squared and Fisher’s exact tests. Results: Among the 12,270 individuals referred for germline testing for BRCA1 and BRCA2, the majority were female (11,233, 91.5%). A large proportion of patients (9271, 75.6%) had a family history of breast, ovarian, pancreatic or prostate cancer. A total of 2506 patients (20.4%) had a personal history of one of these cancers. For 493 (4.0%), the exact indication for testing was unknown. The median age of patients with a personal history of cancer was 62 years (range: 18 to 95), significantly higher than the median age of patients with a family history of cancer (41 years, range: 3 to 89) (p < 0.0001). For the 2506 patients who reported a personal history of cancer, the most common cancer was breast (1919, 76.6%) followed by prostate (261, 10.4%), ovarian (253, 10.1%), and pancreatic (107, 4.3%). Testing identified 561 PVs, 243 in BRCA1 and 318 in BRCA2. PVs were identified significantly more often in patients with a family history compared to a personal history of breast cancer (4.4% vs 4.2%; p = 0.009) and pancreatic cancer (4.8% vs 2.8%; p = 0.03). Conclusions: Our data show that the prevalence of pathogenic or likely pathogenic variants in BRCA1 and BRCA2 is higher in individuals with a family history of breast and pancreatic cancers than in individuals with a personal history of these cancers . These results corroborate the utility of germline testing in identifying individuals with an inherited predisposition to cancer regardless of having a personal history of cancer, in a real-world setting.
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Hemminki, Kari, Kristina Sundquist, Jan Sundquist, Asta Försti, Akseli Hemminki, and Xinjun Li. "Familial Risks and Proportions Describing Population Landscape of Familial Cancer." Cancers 13, no. 17 (2021): 4385. http://dx.doi.org/10.3390/cancers13174385.
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Background: Familial cancer can be defined through the occurrence of the same cancer in two or more family members. We describe a nationwide landscape of familial cancer, including its frequency and the risk that it conveys, by using the largest family database in the world with complete family structures and medically confirmed cancers. Patients/methods: We employed standardized incidence ratios (SIRs) to estimate familial risks for concordant cancer among first-degree relatives using the Swedish Cancer Registry from years 1958 through 2016. Results: Cancer risks in a 20–84 year old population conferred by affected parents or siblings were about two-fold compared to the risk for individuals with unaffected relatives. For small intestinal, testicular, thyroid and bone cancers and Hodgkin disease, risks were higher, five-to-eight-fold. Novel familial associations included adult bone, lip, pharyngeal, and connective tissue cancers. Familial cancers were found in 13.2% of families with cancer; for prostate cancer, the proportion was 26.4%. High-risk families accounted for 6.6% of all cancer families. Discussion/Conclusion: High-risk family history should be exceedingly considered for management, including targeted genetic testing. For the major proportion of familial clustering, where genetic testing may not be feasible, medical and behavioral intervention should be indicated for the patient and their family members, including screening recommendations and avoidance of carcinogenic exposure.
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Hemminki, Kari, Kristina Sundquist, Jan Sundquist, Asta Försti, Akseli Hemminki, and Xinjun Li. "Familial Risks and Proportions Describing Population Landscape of Familial Cancer." Cancers (Basel) 13, no. 17 (2021): 1–21. https://doi.org/10.3390/cancers13174385.
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Background: Familial cancer can be defined through the occurrence of the same cancer in two or more family members. We describe a nationwide landscape of familial cancer, including its frequency and the risk that it conveys, by using the largest family database in the world with complete family structures and medically confirmed cancers. Patients/methods: We employed standardized incidence ratios (SIRs) to estimate familial risks for concordant cancer among first-degree relatives using the Swedish Cancer Registry from years 1958 through 2016. Results: Cancer risks in a 20–84 year old population conferred by affected parents or siblings were about two-fold compared to the risk for individuals with unaffected relatives. For small intestinal, testicular, thyroid and bone cancers and Hodgkin disease, risks were higher, five-to-eight-fold. Novel familial associations included adult bone, lip, pharyngeal, and connective tissue cancers. Familial cancers were found in 13.2% of families with cancer; for prostate cancer, the proportion was 26.4%. High-risk families accounted for 6.6% of all cancer families. Discussion/Conclusion: High-risk family history should be exceedingly considered for management, including targeted genetic testing. For the major proportion of familial clustering, where genetic testing may not be feasible, medical and behavioral intervention should be indicated for the patient and their family members, including screening recommendations and avoidance of carcinogenic exposure.
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Heyhoe, Jane, Caroline Reynolds, and Rebecca Lawton. "Developing a safety-netting intervention for the earlier diagnosis of cancer in primary care: the Shared Safety Net Action Plan (SSNAP)." British Journal of General Practice 69, suppl 1 (2019): bjgp19X703049. http://dx.doi.org/10.3399/bjgp19x703049.
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BackgroundDiagnosing cancer earlier broadens treatment options and improves survival outcomes. When symptoms do not indicate a cancer diagnosis referral, evidence suggests patients could play an important role in achieving a faster cancer diagnosis by assisting with symptom follow-up and review. Little is known about how to engage patients in diagnosis and what a safety-netting intervention involving patients in primary care might entail.AimStage 1 assessed components considered important for patient involvement in diagnosing cancer earlier in primary care and explored three possible strategies. Stage 2 aimed to co-design a safety-netting intervention with and for primary care patients and professionals.MethodStage 1 involved a systematic review, thematic analysis of 15 interviews with GPs, nurse practitioners and patients and a dissemination workshop with 18 stakeholders. For intervention development and refinement, stage 2 involved 3 stakeholder workshops using co-design processes; five focus groups with patients and primary care practices, underpinned by COM-B Framework.ResultsStage 1: the systematic review found no interventions involving patients. Interviews identified three key themes for patient involvement: keeping the door open; roles and responsibilities; and fear of cancer. Ideally, safety-netting should involve verbal discussion and plan, written information, and optional post-consultation prompt. Stage 2: barriers and facilitators of capability, opportunity and motivation to use the intervention were identified. A safety-netting intervention for primary care was co-produced, the Shared Safety Net Action Plan (SSNAP).ConclusionKey components for patient involvement and safety-netting were identified. SSNAP is acceptable to patients and health professionals and assessment of feasibility in practice is now required.
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Herbert, Annie, Georgios Lyratzopoulos, Jeremy Whelan, et al. "Diagnostic timeliness in adolescents and young adults with cancer: Cross-sectional findings from the BRIGHTLIGHT cohort." British Journal of General Practice 68, suppl 1 (2018): bjgp18X696689. http://dx.doi.org/10.3399/bjgp18x696689.
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BackgroundAdolescents and young adults (AYA) with cancer are thought to experience prolonged diagnostic intervals but robust evidence quantifying such associations is lacking.AimTo examine diagnostic timeliness in a cohort of young people, identifying sociodemographic factors and cancer sites associated with variation in timeliness.MethodWe analysed data from 830 patients with cancer aged 12–24 who completed BRIGHTLIGHT face-to-face interviews, for variation in the patient interval (time from symptom onset to first healthcare presentation); the number of pre-referral GP consultations; and the total interval (time from symptom onset to diagnosis). We present descriptive statistics of these outcomes by patient characteristics and cancer site and multivariable regression models for adjusted estimates of associations.ResultsAmong participants, 27% experienced a patient interval of >1 month and 35% of those consulting a GP had 3 or more (3+) pre-referral consultations. The median total interval was 62 days. We hereafter highlight significant associations (<0.05). Females were more likely to have 3+ consultations and longer total intervals compared with males. Patients with lymphoma or bone tumours were most likely to have 3+ pre-referral consultations and those with melanoma least likely. Females and patients with bone tumours had the longest median total intervals and those with leukaemia the shortest.ConclusionThese data benchmark diagnostic timeliness for young people with cancer and identify subgroups at higher risk of prolonged diagnostic journeys. Further work is now required to prioritise and stratify early diagnosis initiatives for these subgroups.FundingNational Institute for Health Research (RP-PG-1209-10013); Teenage Cancer Trust; Cancer Research UK (A18180).
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Zheng, Guoqiao, Kristina Sundquist, Jan Sundquist, et al. "Second Primary Cancers After Kidney Cancers, and Kidney Cancers as Second Primary Cancers." EUROPEAN UROLOGY OPEN SCIENCE 24, February 2021 (2021): 52–59. https://doi.org/10.1016/j.euros.2020.12.007.
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Background: Second primary cancers (SPCs) are increasing due to improving survival in first primary cancers. Previous studies on SPCs in renal cell carcinoma (RCC) have focused on treatment and other risk factors, but data of RCC as an SPC are scarce. Objective: In this study, we want to elucidate the risk for any SPC after RCC, and in reverse order, for RCC as an SPC after any cancer. We additionally consider how family histories influence the risks. Design, setting, and participants: Patient data were obtained from the Swedish Cancer Registry from years 1990 through 2015, and family data were obtained from the Multigeneration Register. Outcome measurements and statistical analysis: We employed standardized incidence ratios to estimate bidirectional relative risks of subsequent cancer associated with RCC. Results and limitations: We identified 17 587 RCCs (60% in male patients). The highest increases for SPCs were observed for nervous system hemangioblastoma (HB; 26.8), adrenal (12.09) tumors, and renal pelvic cancer (6.32). In the reverse order, RCC as an SPC, nervous system HB (17.01), and adrenal tumors (15.34) were associated with the highest risks. Risks for many other sites (12 sites and subsites) were increased bidirectionally. For women, a total of seven sites and subsites were increased bidirectionally, and many were shared with men. The only significant sex difference in SPCs was the higher lung cancer risk in women (2.41) than in men (1.28). Patients with a family history of HBs or of prostate, colorectal and lung cancers showed high risks of these cancers as SPCs after RCC. Family history accounted for 30% of prostate cancers after RCC. Conclusions: The bidirectional study design was able to suggest risk factors for SPCs and offered a clinical take-home message urging to consider strategies for early detection and prevention of SPCs. Readily available information on lifestyle (eg, smoking) and family history (eg, prostate cancer) may reveal targets for risk reduction with prognostic benefits. Patient summary: Close to 10% of kidney cancer patients develop another cancer. The cause for these other cancers may not depend on kidney cancer. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology.
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Yadav, Budhi Singh, Suresh C. Sharma, Firuza D. Patel, Bhavana Rai, and Sushmita Ghoshal. "Gynecological Cancer as a Second Malignancy in Patients With Breast Cancer." International Journal of Gynecologic Cancer 27, no. 6 (2017): 1298–304. http://dx.doi.org/10.1097/igc.0000000000000993.
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PurposeThe aim of this study was to determine the incidence and risk factors for gynecological cancer as second malignancy (SM) after treatment of breast cancer (BC).Methods and MaterialsBetween January 1985 and December 2007, a total of 2756 patients with BC were analyzed for gynecological cancers as an SM. Analysis was carried out for patient-, disease-, and treatment-related characteristics. The Cox proportional hazards regression model was used to estimate the relative risk of gynecologic malignancies.ResultsThe median age at BC diagnosis was 49 years and median follow-up of 14 years. In total, 25 cases of gynecological cancer were noted with an incidence of 0.9%. We observed 9 ovarian and endometrium (0.3%) as well as 7 uterine cervix (0.25%) cancers. Family history of BC was the most significant risk factor for SM (relative risk, 7.4; 95% confidence interval, 3.03–18.28; P<0.001). Women with a family history of BC had a higher incidence of endometrial (12%) and ovarian (16%) cancer compared with those who have no family history (0.1%, P = 0.003). Statistically significant higher incidence of endometrial cancer was seen in patients undergoing hormonal therapy (0.4%) as compared with those who are not undergoing hormonal therapy (0.1%, P = 0.001). Most of the endometrial (88.9%) and cervical (71%) cancers were detected at an early stage but ovarian cancers (66.6%) in advanced stage. Chemotherapy and radiotherapy did not increase the risk of gynecological SM.ConclusionsWomen with BC are at risk of developing a second primary gynecological malignancy particularly of endometrium and ovary. Family history of BC was a high risk factor for gynecologic SM. These patients should be followed up for its early detection.
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Okado, Izumi, Ian Pagano, Tracey Hewitt, et al. "Perceptions of cancer care coordination in patient-family caregiver dyads." Journal of Clinical Oncology 38, no. 15_suppl (2020): e14036-e14036. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e14036.
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e14036 Background: Family caregivers (FCGs) can play a key role in coordinating care for cancer patients. However, little is known about FCGs’ perspectives of care coordination (CC). In this cross-sectional study, we evaluated perceptions of CC in cancer patient-family caregiver dyads using the Care Coordination Instrument (CCI), a validated self-report measure with excellent psychometric properties. Methods: Patients receiving active treatment for cancer and their primary FCGs ( N = 54 dyads) completed the 29-item CCI (patient) and the CCICG (a parallel FCG version) at private oncology practices or hospital-based facilities from June to Sept. 2019. The CCI and CCICG assess overall perceptions of CC (Total) and across 3 domains: Communication, Navigation, and Operational. The CCICG includes a supplemental questionnaire that assesses the degree of caregiver CC involvement on a 4-point Likert scale. Mixed regression models were used to examine differences between patients and FCGs’ perceptions of CC and to identify predictors of dyadic differences on the CCI scores. Pearson’s correlation was used to evaluate associations between FCGs’ perceptions of CC and the degree of caregiver involvement. Results: CCICG Total scores demonstrated a bimodal distribution, representing FCGs’ perceptions of CC in distinct high and low subgroups; thus, all analyses were conducted by subgroups (highCG, lowCG). Overall, no dyadic differences were found in the highCG group on the CCI scores. However, in the lowCG group, FCGs reported poorer Total ( p < .01), Communication ( p < .01), Navigation ( p < .01), and Operational ( p < .05) scores than patients. Provider setting (private practices) and the absence of an identified patient navigator significantly predicted poorer FCG Total scores compared to patients’ perceptions ( p < .05). FCGs’ Total scores were inversely associated with the degree of caregiver involvement among FCGs in the lowCG group ( p < .05) but not among FCGs in the highCG group. Conclusions: Our findings demonstrate that a subgroup of FCGs has poorer perceptions of CC that differ significantly from patient perceptions and is most apparent for patients receiving treatment in a private practice setting and in the absence of a patient navigator. These FCGs report a high degree of caregiver involvement and may be providing additional CC support that is not recognized by cancer patients. These findings underscore the need for interventions to support FCG CC involvement as a member of the care team in order to improve the quality and value of patient-centered cancer care delivery.
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Gildea, Carolynn, Georgios Lyratzopoulos, Sean McPhail, Ruth Swann, and Gary Abel. "Investigating the impact of case-mix on general practice cancer diagnostic outcome indicators." British Journal of General Practice 69, suppl 1 (2019): bjgp19X702881. http://dx.doi.org/10.3399/bjgp19x702881.
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BackgroundThe Cancer Services profiles report indicators of cancer diagnostic activity for all English general practices. A recent study reported that several indicators were dominated by chance, with some practice-level variation explained by the practice’s age-sex profile.AimTo assess the variation explained by patient-level case-mix and whether the practice age-sex profile adequately adjusts for this.MethodFive indicators from Cancer Waiting Times (2016/17, 6050 practices) or Routes to Diagnosis (2015, 6355 practices) data were considered: Two Week Wait (TWW) conversion and detection rates, and emergency-, referred- and other-diagnosis proportions. Mixed-effect logistic regression adjusted for patient-level case-mix, using national cancer registration data on age, sex, deprivation, referral/cancer-type and, where possible, ethnicity and stage at diagnosis, with and without practice-level age-sex profile.ResultsChance explained 60–85% of practice-level variation, with the combination of chance and patient-level case-mix explaining 75% (TWW conversion rate) to 89% (emergency diagnosis proportion). For TWW conversion rate, there was considerable overlap in the variance explained by practice- and patient-level factors. For the other indicators, practice- or patient-level factors were largely independent.ConclusionChance is not synonymous with case-mix and is the dominant source of variation in single-year practice indicators. Therefore, we recommend the continued aggregation of data over multiple years. For most studied indicators, adjustment for the age-sex profile of the whole practice population is not a substitute for case-mix of individual cancer patients and so should not be used. Patient-level case-mix adjustment leads to a modest reordering of practices and so may not be a priority.