Ka Ming Chow

Quality of life and most prevalent unmet needs of Chinese breast cancer survivors at one year after cancer treatment

PURPOSE This study aims to examine the supportive care needs of Chinese breast cancer survivors, and investigate the relationships with participant characteristics and quality of life. METHODS A total of 163 participants were recruited from a local public hospital and completed a self-administered questionnaire: the 34-item Supportive Care Needs Survey, the supplementary module of access to healthcare and ancillary support services, and the Functional Assessment of Cancer Therapy. RESULTS The five most commonly reported unmet needs were all in the health system information domain (range: 55-63%), and the majority (84%) reported at least one unmet need in relation to information on healthcare. Stepwise multivariable regression analyses revealed that the time spent on travelling from home to hospital, receiving hormonal therapy, and physical and psychological unmet needs were independently associated with poorer quality of life among the participants. CONCLUSIONS Breast cancer survivors perceive various unmet needs, and health system information is the most common one. Those who have more unmet needs in the physical and psychological domains were more likely to perceive a poorer quality of life.

A feasibility study of a psychoeducational intervention program for gynecological cancer patients

PURPOSE OF THE RESEARCH This study aimed to test the feasibility of implementing a psychoeducational intervention program for gynecological cancer patients. METHODS AND SAMPLE A single-blinded randomized controlled trial and mixed-method design were used. Study subjects were newly diagnosed gynecological cancer patients with surgery as the first-line treatment. They were randomly assigned to the intervention group, in which a psychoeducational intervention program based on a thematic counseling model was offered, or to the attention control group. Quantitative data on sexual functioning, quality of life, uncertainty, anxiety, depression and social support were collected at recruitment, post-operative and during the in-hospital period, and eight weeks after the operation. Participants in the intervention group and three nurses working in the clinical setting were invited to have semi-structured interviews. KEY RESULTS Of the 30 eligible subjects, 26 were successfully recruited into the study. Following the psychoeducational intervention program, there was significant improvement in the level of inconsistent information about the illness within the category of uncertainty among participants in the intervention group. In addition, trends towards improvement were demonstrated in quality of life, uncertainty, depression and perceived social support with the provision of the interventions. Qualitative data indicated the interventions were desired and appreciated by the participants, as well as being feasible and practical to implement in Hong Kong clinical settings. CONCLUSIONS The findings suggest that it is feasible to deliver the psychoeducational intervention program and it may have beneficial effects in gynecological cancer patients. A full-scale study is warranted to confirm the results.

A Review of Psychoeducational Interventions to Improve Sexual Functioning, Quality of Life, and Psychological Outcomes in Gynecological Cancer Patients.

Background: Psychoeducational interventions are recommended for use with clinical gynecological cancer patients to improve their patient care outcomes. However, the evidence of their effectiveness is far from conclusive. Objective: The objective of this study was to identify the best available research evidence related to the effects of psychoeducational interventions on sexual functioning, quality of life, and psychological outcomes in gynecological cancer patients. Methods: A systematic search was conducted to identify English and Chinese articles from the inception of the databases to April 2012 and included 13 English databases and 7 Chinese databases. Gray literature or unpublished studies were also searched. Results: A total of 11 studies involving 975 gynecological cancer patients were included in the review. Meta-analysis results for 4 comparable studies indicated that psychoeducational interventions were effective in treating depressive symptoms among gynecological cancer patients (standardized mean difference = −0.80; 95% confidence interval, −1.05 to −0.54), whereas information provision significantly improved the mental aspect of quality of life (standardized mean difference = −0.41; 95% confidence interval, −0.74 to −0.08). With regard to sexual functioning, psychoeducational interventions appeared to have benefits in improving the sexual life of patients. Conclusions: Findings confirm the effectiveness of psychoeducational interventions on depressive symptoms and mental aspect of the quality of life in gynecological cancer patients. Implications for Practice: The authors discuss the implications of review findings for the effective design of psychoeducational interventions including components, provider, provision time frame, and duration for clinical practice, as well as psychoeducational intervention research.

The Effectiveness of Psychoeducational Intervention on Managing Symptom Clusters in Patients With Cancer: A Systematic Review of Randomized Controlled Trials.

Background: Managing symptom clusters instead of single symptoms could be more beneficial in cancer care. Psychoeducational intervention (PEI) has been highlighted as a promising symptom intervention, but the effect of PEI in the management of cancer symptom clusters remains unknown. Objective: The aim of this study was to evaluate the effectiveness of PEI on managing symptom clusters in patients with cancer. Methods: Six databases were searched, together with hand searching, to identify eligible randomized controlled trials from the year 2001 to July 2014. Data selection, quality appraisal of studies, and data extraction were conducted independently by 2 reviewers. Data were synthesized by use of a systematic narrative approach, and meta-analysis was conducted when this was possible. Results: Four eligible studies involving 343 cancer patients were included in the review. The methodological quality of the studies was generally fair. Symptom clusters seemed to improve with the provision of PEI. Meta-analysis shows significant improvement in functional performance. Conclusions: The evidence that PEI could alleviate cancer symptom clusters is encouraging but inconclusive in this review. Future well-designed investigations testing some commonly used PEI such as progressive muscle relaxation and patient education on various types of cancer symptom clusters are warranted. Implications for Practice: This review suggests a promising role of PEI in managing cancer symptom clusters. Healthcare providers should increase their awareness of managing symptom clusters using PEI to yield more effective and efficient cancer care.

Effect of Music Therapy on Postoperative Pain Management in Gynecological Patients: A Literature Review

Unrelieved postoperative pain may have a negative impact on the physiological and psychological well-being of patients. Pharmacological methods are currently used to relieve such pain in gynecological patients; however, inadequate pain control is still reported, and the use of nonpharmacological pain-relieving methods is increasingly being advocated, one of which is music therapy. The purpose of this literature review was to identify, summarize, and critically appraise current evidence on music therapy and postoperative pain management among gynecological patients. A systematic search of MEDLINE, CINAHL, PsycINFO, British Nursing Index, and Allied and Complementary Medicine was conducted using the search terms music, gynecological, pain, surgery, operative, and post-operative to identify relevant articles in English from 1995 to the present. All identified articles were assessed independently for inclusion into review. A total of 7 articles were included after removal of duplicates and exclusion of irrelevant studies. All the included studies assessed the effects of music therapy on postoperative pain intensity, and three of them measured pain-related physiological symptoms. The findings indicated that music therapy, in general, was effective in reducing pain intensity, fatigue, anxiety, and analgesic consumption in gynecological patients during the postoperative period. It is recommended as an adjunct to pharmacological pain-relieving methods in reducing postoperative pain. Future researches on music therapy to identify the most effective application and evaluate its effect by qualitative study are recommended.

effects of psychoeducational interventions on sexual functioning, quality of life and psychological outcomes in patients with gynaecological cancer: A systematic review

Background The diagnosis of gynaecological cancer and the effects of related treatment have adverse effects on sexual functioning, quality of life and psychological outcomes of patients. Psychoeducational interventions are recommended for use in clinical areas for gynaecological cancer patients to improve patient outcomes. However, the evidence for its effectiveness is far from conclusive. Moreover, such interventions are still scarce or even absent in most countries. Objectives To identify the best available evidence related to the effectiveness of psychoeducational interventions for gynaecological cancer patients on sexual functioning, quality of life and psychological outcomes. Inclusion criteria Types of studies Randomized controlled trials. Types of participants Adult women who with a primary gynaecological cancer confirmed by pathology test. Types of interventions Psychoeducational interventions that aimed at enhancing the acceptance of the disease and recovery from the illness and treatment among gynaecological cancer patients. Types of outcome measures Sexual functioning, quality of life and psychological outcomes including, but not limited to, anxiety, depression, distress, adjustment to illness, mood, self‐esteem, uncertainty, and coping. Search strategy Thirty electronic bibliographic databases in English and Chinese were searched from their inception to April 2012. Methodological quality The Joanna Briggs Institute Critical Appraisal Checklist for experimental studies was used to critically appraise the methodological quality of studies. Data collection Two reviewers extracted and summarized the details of included studies using the Joanna Briggs Institute data extraction form independently. Data synthesis Quantitative results of comparable studies were pooled in statistical meta‐analysis. Standardized mean difference and 95% confidence interval were calculated for the summary effect of continuous data measured by different scales. Results were presented in narrative form where statistical pooling was not appropriate. Results A total of 11 randomized controlled trials involving 975 gynaecological cancer patients were included. Only four studies were comparable to perform meta‐analysis. On the basis of two studies examining the outcome of depression, there was a significant improvement in depressive symptoms (SMD: ‐0.80; 95% CI: ‐1.05 to ‐0.54) among participants in the intervention group in which information provision, cognitive‐behavioral therapy and counseling were combined together. On the basis of another two studies examining the outcome of quality of life, there was no significant benefit in physical aspect of quality of life (SMD: ‐0.12; 95% CI: ‐0.45 to 0.20; p = 0.46) for the intervention group. Conversely, the control group of information‐only therapy demonstrated significant effects on mental aspect of quality of life (SMD: ‐0.41; 95% CI: ‐0.74 to ‐0.08; p = 0.01) compared to those receiving psychoeducational interventions. There were no conclusive findings regarding the effects of psychoeducational interventions on the outcomes of sexual functioning, anxiety, distress, adjustment to illness, mood, self‐esteem, uncertainty and coping among the gynaecological cancer patients. Conclusions The review demonstrated evidence of positive effects of psychoeducational interventions on gynaecological cancer patients. Implications for practice The review suggested that psychoeducational interventions incorporate all four components, i.e. information provision, cognitive‐behavioral therapy, social support and counseling. The format could be individual or group, with or without couple participation. A nurse was preferred to be the ideal provider. Provision time frame should be before the start of the treatment and continued after discharge, and the number of sessions could be four. Each session should be between 30 minutes to one hour long. Implications for research More well‐designed randomized controlled trials are needed to further examine the effects of psychoeducational interventions on psychological outcomes in this group of patients. Due to the diversity of these interventions, the optimal format of each also requires investigation.

Examining the Cervical Screening Behaviour of Women Aged 50 or above and Its Predicting Factors: A Population-Based Survey

Under-screening may increase the risk of cervical cancer in middle-aged women. This study aimed to investigate cervical cancer screening behaviour and its predictors among women aged 50 years or above. A population-based sample of 959 women was recruited by telephone from domestic households in Hong Kong, using random methods, and a structured questionnaire developed to survey participants. Multivariable logistic regressions were performed to examine the factors independently associated with cervical screening behaviour. Nearly half the sample (48%) had never had a cervical smear test. Multivariable analyses showed that age, educational level, marital status, family history of cancer, smoking status, use of complementary therapy, recommendation from health professionals, and believing that regular visits to a doctor or a Chinese herbalist were good for their health were predictors of cervical screening behaviour. Misconceptions concerned with menopause may reduce women’s perceived susceptibility to cervical cancer, especially if they are 50 or above, and exert a negative effect on their screening behaviour. Healthcare professionals should actively approach these high-risk groups–older unmarried women, smokers, those less educated and who are generally not much concerned with their health.

Contributing Factors to Colorectal Cancer Screening among Chinese People: A Review of Quantitative Studies

Colorectal cancer (CRC) is a major health problem in Asia. It has been reported that the Chinese are more susceptible to CRC than many other ethnic groups. Screening for CRC is a cost-effective prevention and control strategy; however, the screening rates among the Chinese are sub-optimal. We conducted a review to identify the factors associated with CRC screening participation among Chinese people. Twenty-two studies that examined the factors related to CRC screening behaviors among the Chinese were identified through five databases. Seven factors were consistently reported to influence CRC screening behaviors in at least one of the studies: socio-demographic characteristics (educational level, health insurance, and knowledge about CRC and its screening); psychological factors (perceived severity of CRC, susceptibility of having CRC, and barriers to screening); and contact with medical provider (physician recommendation). The evidence base for many of these relationships is quite limited. Furthermore, the associations of many factors, including age, gender, income, cancer worry/fear, and self-efficacy with CRC screening behaviors, were mixed or inconsistent across these studies, thereby indicating that more studies are needed in this area.

Translation and validation of tools for assessing health-related quality of life and male sexual function in Hong Kong Chinese patients during transitional cancer survivorship

The incidence of cancer is increasing in Hong Kong at an average annual rate of 3.9% [1]. Because of advances in cancer treatment and therapies over recent decades, many cancer patients are now living longer lives. BCancer survivor^ is a term used to describe those cancer patients who have completed treatment for the disease [2]. There are many definitions to specify the different periods of survivorship. Miller et al. proposed a model they called Bseasons of survivorship^, which consisted of four seasons in the cancer trajectory: acute survivorship, transitional survivorship, extended survivorship, and permanent survival [3]. Transitional survivorship is the period of time spent passing from active treatment to watchful waiting andmaintenance therapy. Cancer survivors are closely monitored during this period for any sign of progression in the disease. In this study, we define transitional survivorship as the period from 1 to 5 years after the completion of curative active cancer treatment, since in the local context cancer patients are followed up for 5 years to check for any recurrence. Within the period of transitional survivorship, cancer survivors have to adapt to the changes in their physical, psychological, sexual, and social lives resulting from the disease and its treatment [3]. Although cancer survivors may experience different side effects in variable levels, many of them report to have adverse changes inmultiple aspects of quality of life (QOL), and such changes may remain with them throughout the rest of their lives [4]. Impact of different diseases and health status on QOL is regarded as health-related quality of life (HRQOL) [5]. Sexual function is one of the important aspects of QOL, but it is largely disrupted after the diagnosis of cancer and its related treatment [6]. Adverse changes in sexual function may be associated with problems in all areas of QOL—physical symptoms, emotional disturbances, self-esteem, self-perception, sense of well-being, satisfaction with life, relationships with partners, and other social relationships [7]. Sexual dysfunction resulting from cancer and its treatment therefore has negative impacts on HRQOL. Previous studies have found that cancer patients are at higher risk of impaired sexual function [8]. As a result, a great deal of the literature has focused on the sexual function and HRQOL of these individuals following their diagnosis, treatment, and recovery from cancer. However, there is no Chinese version of tools for assessing HRQOL and male sexual function for survivors in transitional cancer survivorship. In fact, Chinese cancer survivors may experience substantial stress on sexuality as traditional Chinese culture emphasizes the continuation of one’s family line [9]. This study aims to translate and develop psychometrically sound and culturally appropriate tools for assessing HRQOL and male sexual function in Chinese cancer survivors. During this period, after resumption of their sex life, many patients are found to have a greater degree of sexual dysfunction than the normal population because of the physiological This paper was presented as a poster at the Supportive Care in Cancer MASCC/ISOO 2016 International Symposium in Adelaide 23–25 June 2016

Sexual function, psychosocial adjustment to illness, and quality of life among Chinese gynaecological cancer survivors

Disrupted sexual function is a prevalent and sustained side effect of gynaecological cancer and its related treatment. This problem may pose challenges to the survivors in the process of illness adjustment, leading to elevated psychological distress and impaired quality of life. However, care and interventions in this area have been neglected in most countries.