Annabel Pollard

A longitudinal study of distress (depression and anxiety) up to 18 months after radiotherapy for head and neck cancer.

The aim of the study was to assess symptoms of depression and anxiety in patients with head and neck cancer up to 18 months after radiotherapy.

Unmet needs in cancer patients: development of a supportive needs screening tool (SNST)

Goals of workA diagnosis of cancer can have a profound impact on the physical, emotional, psychological, social and spiritual areas of a person’s life. Supportive care services are directed towards this full range of issues associated with cancer. Identification of need is the first step in meeting supportive care concerns, but there is a lack of tools and processes regularly used in clinical practice. This article reports the first steps in the development of a supportive needs screening tool appropriate for use in an oncology outpatient setting.Materials and methodsA review of the literature was undertaken, and a draft tool developed using a process of item reduction. A small pre-test followed by a pilot test with 87 patients attending Peter MacCallum Cancer Centre, Melbourne Australia was undertaken. Evaluation to identify usability and acceptability in clinical practice included descriptive statistics to profile patient needs and referrals generated by the supportive needs screening tool (SNST), interviews with a small sample of participants and surveys completed by staff.Main resultsThe SNST was developed with 41 questions, the majority requiring a yes/no response. From the tool, a total of 1,085 needs were identified (mean = 12 needs/patient). A total of 264 referrals were generated, with 72% of patients receiving at least one referral. Patients and staff reported high acceptability.ConclusionsThe SNST has face validity and demonstrated usability in an ambulatory care oncology stetting, as first steps in instrument development. Further testing of reliability and validity are being undertaken.

Understanding how cancer patients actualise, relinquish, and reject advance care planning: implications for practice

PurposeAlthough advance care planning (ACP) is recognised as integral to quality cancer care, it remains poorly integrated in many settings. Given cancer patients’ unpredictable disease trajectories and equivocal treatment options, a disease-specific ACP model may be necessary. This study examines how Australian cancer patients consider ACP. Responses will inform the development of an Australian Cancer Centre’s ACP programme.MethodsA constructivist research approach with grounded theory design was applied. Eighteen adults from lung and gastro-intestinal tumour streams participated. Participants first described their initial understanding of ACP, received ACP information, and finally completed a semi-structured interview assisted by the vignette technique. Qualitative inter-rater reliability was integrated.ResultsParticipants initially had scant knowledge of ACP. On obtaining further information, their responses indicated that: For cancer patients, ACP is an individualised, dynamic, and shared process characterised by myriad variations in choices to actualise, relinquish, and/or reject its individual components (medical enduring power of attorney, statement of choices, refusal of treatment certificate, and advanced directive). Actualisation of each component involves considering, possibly conversing about, planning, and communicating a decision, usually iteratively. Reactions can change over time and are informed by values, memories, personalities, health perceptions, appreciation of prognoses, and trust or doubts in their substitute decision makers.ConclusionFindings endorse the value of routinely, though sensitively, discussing ACP with cancer patients at various time points across their disease trajectory. Nonetheless, ACP may also be relinquished or rejected and ongoing offers for ACP in some patients may be offensive to their value system.

Development of a Psychoeducational Intervention for Men with Prostate Cancer

This study aimed to develop and implement a nurse-led psychoeducational group program for men receiving radiotherapy for prostate cancer. These groups are part of a larger multidisciplinary care intervention, which is designed to enhance patient involvement in care. The manual for the groups was developed using a literature review and expert opinion from a multidisciplinary team consisting of radiation oncologists, urology nurses, behavioral scientists, psychologists, radiation therapists, and consumers. The group was pilot tested with 10 participants and further refined based on patient and facilitator feedback. The final program consisted of four, 1-hour, psychoeducational group sessions, with modules covering anatomy, treatment side effects, physical/lifestyle/ emotional impacts of prostate cancer, sexuality and communication, and survivorship delivered at pretreatment, midtreatment, end of treatment, and posttreatment. The modular design of this intervention is innovative in that men in the group can collectively nominate which modules they wish to focus on. Feedback from patients and facilitators was positive with minimal changes made to the manual, apart from session 4 that required expansion to permit group members to have greater choice over the content. Participants endorsed the psychoeducational groups as being useful, an appropriate length, and addressing their issues of concern. Further testing of the psychoeducational groups is currently being undertaken as part of a larger randomized controlled trial of the multidisciplinary care intervention.

The practical challenges of recruitment and retention when providing psychotherapy to advanced breast cancer patients

Goals of workThe goal of the present study was to investigate recruitment issues relevant to psychotherapy trials for metastatic cancer patients. First, we undertook a literature review of the psychotherapy intervention research for metastatic cancer patients. Second, we piloted pragmatic recruitment methods for a couples’ intervention for women with metastatic breast cancer and their partners.MethodsAn extensive literature search was conducted to identify psychotherapy trials involving people with metastatic cancer published in peer-reviewed journals. Study characteristics and recruitment methodologies were examined. In the pilot study, we trialled the recruitment strategies of approaching participants at outpatients’ appointments, via letter, referral from the treating team and through direct advertising using two community support services.ResultsThe literature search identified 1,905 potentially relevant articles, which were narrowed to 18 studies specifically involving metastatic cancer patients involving a professionally trained facilitator and a specified theoretical orientation. Limited information was found on recruitment rates and the success of recruitment strategies. Barriers to recruitment identified in the literature included degree of patient illness, lack of interest/perceived benefit, insufficient time, socio-demographic factors and negative clinician attitudes. Our pilot study identified 72 eligible couples of which 66 were approached. Our recruitment strategies resulted in six couples consenting (9.1%) but only three couples completing the study (4.5%). The main reasons for study refusal were the intervention was not needed, lack of interest, insufficient time, patient illness and travel distance.ConclusionsRecruitment for couple-based psychotherapy interventions is challenging. More work is required on developing acceptable and feasible recruitment processes for metastatic cancer patients to be able to access support.

Depression and cancer.

• Specialist psycho-oncology services (where available) can help with more complex and severe presentations of depression by advising on the prescription of antidepressants and providing psychotherapy programs that address the patient’s psychological orientation and needs and consider the patient’s cancer type and stage. an tre int and chem C cer is a life-threatening and dreaded illness. Its atments can have direct organic effects on mood; eractions can occur between antidepressants otherapy agents; and, as patients undergo cancer treatment, they may be debilitated, immunosuppressed, underweight and in pain for considerable periods of time. When active cancer treatment is complete, patients often have to adjust to changes in body function, persistent pain, alterations in role and sense of self, and the possibility of cancer recurrence. All these factors put patients with cancer at increased risk of depression,1,2 which can have consequences including reduced quality of life,3,4 greater risk of cancer mortality5 and higher risk of suicide.6,7 A particular challenge can be persuading a patient to accept treatment for depression at the same time as onerous cancer treatment. Early detection of depression and expeditious commencement of treatment can be difficult to achieve in the context of complex and busy cancer treatment protocols.