Patients' expectations, experience and acceptability of postoperative analgesia: a nested qualitative study within a randomised controlled trial comparing rectus sheath catheter and thoracic epidural analgesia.

Adequate postoperative analgesia is a key element of enhanced recovery programmes. Thoracic epidural analgesia is associated with superior postoperative analgesia but can lead to complications. Rectus sheath catheter analgesia may provide an alternative. In a nested qualitative study (within a two-year randomised controlled trial) focussing on the acceptability, expectations and experiences of receiving the interventions, participants (n = 20) were interviewed 4 weeks post-intervention using a grounded theory approach. Constant comparative analysis, with patient and public involvement, enabled emerging findings to be pursued through subsequent data collection. We found no notable differences regarding postoperative acceptability or the experience of pain management. Pre-operatively, however, thoracic epidural analgesia was a source of anticipatory fear and anxiety. Both interventions resulted in some experienced adverse events (proportionately more with thoracic epidural analgesia). Participants had negative experiences of the insertion of thoracic epidural analgesia; others receiving the rectus sheath catheter lacked confidence in staff members' ability to manage the local anaesthetic infusion pump. The anticipation of the technique of thoracic epidural analgesia, and concerns about its impact on mobility, represented an additional, unpleasant experience for patients already managing an illness experience, anticipating a life-changing operation and dealing with concerns about the future. The anticipation of rectus sheath catheter analgesia was not associated with such anxieties. Patients' experiences start far earlier than the experience of the intervention itself through anticipatory anxieties and fears about receiving a technique and its potential implications. Complex pain packages can take on greater meaning than their actual efficacy in relieving postoperative pain. Future research into patient acceptability and experience should not focus solely on efficacy of pain relief but should include anticipatory fears, anxieties and experiences.

Experiences of breast cancer in Arab countries. A thematic synthesis.

BACKGROUND: Breast cancer is the most common cancer in women globally. Its negative effects on a woman's quality of life are related to the individual and socio-cultural factors. This review aimed to identify and synthesise the reported experiences and quality of life of women with breast cancer in Arab countries. METHODS: PubMed, Embase, Web of Science, SCOPUS, PsychInfo, CINAHL, Allied and Complementary Medicine Database, and Index Medicus for the Eastern Mediterranean Region were searched for articles published from start to March 2019 using PRISMA guidelines. These searches were complimented by citation tracking and  hand searching of relevant journals. A thematic synthesis was carried out on the 'findings/results' sections from the identified papers. RESULTS: Of 5228 records identified, 19 were included in the review which represented 401 women from 11 Arab countries. All used qualitative methods of data collection to produce rich descriptions of experiences. Thematic synthesis of the extracted data identified three major themes, Perceptions and reactions, Coping or enduring and Changing roles. CONCLUSIONS: This review provides a rich description of the reported quality of life and experiences of women with breast cancer in Arab countries. These are influenced by the women's and society's views of cancer, the women's role in society and family, religious faith and the healthcare context and access to treatment choices and information.

Patient-reported outcome measures for use in gynaecological oncology: a systematic review.

BACKGROUND: Patient-reported outcome measures (PROMs) are used to assess the impact of health care on a patient's health. Within the gynaecological oncology setting, multiple PROMs have been adopted but no assessment has been made in terms of their psychometric qualities and robustness. OBJECTIVES: To undertake a systematic review to identify the most psychometrically robust and appropriate PROM used in the gynaecological oncology setting. SEARCH STRATEGY: A search of the bibliographic database of the Oxford PROM group, plus nine additional databases, was carried out along with citation-tracking and hand searches. SELECTION CRITERIA: Studies examining the psychometric properties of outcome measures tested in gynaecological cancer populations were selected by three blinded reviewers. DATA COLLECTION AND ANALYSIS: Studies were independently assessed and data extracted. Analysis included an appraisal of the psychometric properties and functionality of the included PROMs to guide recommendations. MAIN RESULTS: Eighteen PROMs tested in gynaecological oncology settings were identified. These were categorised into seven areas of focus, and the most psychometrically robust tools were identified: (1) generic (no recommendation); (2) general cancer (EORTC QLQ-C30 and FACT-G); (3) pelvic cancer (QUEST GY); (4) ovarian cancer (EORTC QLQ-OV28); (5) cervical cancer (EORTC QLQ-CX24); (6) endometrial cancer (EORTC QLQ-EN 24); and (7) vulval cancer (FACT-V). AUTHOR'S CONCLUSIONS: Seven PROMs were recommended for use in six gynaecological populations. No single tool was identified that had been tested in all disease groups. Some showed promise, but a lack of conceptual clarity about the core outcomes and the rationale for use will require further testing using well-constructed studies.

What is the evidence for the use of acupuncture as an intervention for symptom management in cancer supportive and palliative care: an integrative overview of reviews.

PURPOSE: This study aims to systematically appraise the evidence for the use of acupuncture for symptom management in cancer and supportive care and to identify recommendations for clinical practice and future research. METHODS: A systematic search was carried out to identify reviews of the use of acupuncture in cancer supportive and palliative care, using MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane Library, British Nursing Index, Index to Theses, Dissertations and Theses (via Proquest) and NHS evidence. Search terms included: acupuncture, cancer and symptoms. Data were extracted for analysis. Reviews were assessed for quality using a five-item checklist but were not excluded from the review on grounds of quality, in order to include a comprehensive scope of the subject. RESULTS: Seventeen reviews were included in the review. Evidence was found for the use of acupuncture for treatment-related nausea and vomiting. Benefit was reported for other cancer-related symptoms, including pain, fatigue, hot flushes, xerostomia, dyspnoea and anxiety. Reviewers found a paucity of rigorous trials and heterogeneity of populations, interventions, controls and outcome measures, which challenge the process of systematic review and meta-analysis. CONCLUSION: Acupuncture should be considered for symptom management where there are limited treatment options, using current peer-reviewed guidelines and clinical reasoning. Much of the primary research reported in reviews is innovative and indicates potential benefit for people with cancer-related symptoms. The complexity of acupuncture as an intervention needs to be acknowledged in future research designs and when reviewing research findings. An iterative approach using adequate interventions, appropriate outcome measures and adherence to reporting standards is required to evaluate the efficacy of acupuncture in cancer supportive and palliative care.

Understanding the symptom experience of patients with gastrointestinal cancers in the first year following diagnosis: findings from a qualitative longitudinal study.

BACKGROUND: The aim of the paper was to explore the experiences of people with gastrointestinal cancer within the first year following their diagnosis. The main objective was to contextualise and map the experiences of this cancer population over the first year following diagnosis to determine the indicators of change so that these patients might be supported at the most appropriate time points. METHODS: A qualitative longitudinal study design using semistructured interviews was adopted for this study with a heterogeneous sample of 18 patients with gastrointestinal cancers. Interviews were conducted on four time points over the first year providing a total of 60 interview datasets. RESULTS: Five key themes generated from the analysis including symptoms; impact of symptoms on everyday life; return to work and survivorship; impact on sense of self, and fear and uncertainty. CONCLUSIONS: These findings provide important insight into the process of change which occurs over the first year following diagnosis and enhances our understanding of the most appropriate time points for support.

Knowledge, ignorance and priorities for research in key areas of cancer survivorship: findings from a scoping review.

BACKGROUND: Patients who have completed initial cancer treatment (cancer survivors) have been relatively neglected. We need data to help us better understand the needs of this group and to underpin evidence-based service development. METHODS: Scoping reviews of research published in the last two decades focussing on the problems faced by cancer survivors, and the effectiveness of interventions for these problems were undertaken. The aim was to identify what we know, what we do not know and opportunities where research could provide new information. We searched for, retrieved and rapidly appraised systematic reviews sourced from the most common electronic databases supplemented by more recently published individual studies. RESULTS: The research evidence is surprisingly limited. We have some knowledge of the prevalence and nature of depression, pain and fatigue in cancer survivors. We know much less about cognitive and physical impairment, employment, financial well-being and relationships. Even where we have evidence, it is mostly of only moderate quality, is most often only for breast cancer and focuses almost exclusively on the early phase of survivorship. We have good evidence for the effectiveness of drug treatments for pain and moderate evidence for fatigue and depression, but not for other symptoms. Interventions based on rehabilitative and self-management approaches remain in the early stages of evaluation. INTERPRETATION: There has been a substantial amount of research describing many of the problems experienced by the cancer survivors. This is strongest in the area of symptoms in the period soon after treatment. However, the quality of the evidence is often poor, and some topics have been little examined. We urgently need data on the natural evolution and scale of the problems of cancer survivors obtained from well-designed, large-scale cohort studies and the robust testing of interventions in clinical trials. Given the current financially constrained research funding environment, we suggest areas in which strategic investment might give findings that have the potential to make a major impact on patient well-being in a 5-year time scale.

The physical and practical problems experienced by cancer survivors: a rapid review and synthesis of the literature.

PURPOSE: A rapid and comprehensive review to identify what is known and not known about the physical and practical problems faced by adult cancer survivors. METHODS: A systematic literature review process was used. This focused on published reviews to enable a fast but rigorous identification of both the gaps and well-researched areas within survivorship. RESULTS: The search identified 5121 reviews, of which 42 were screened and 9 met the quality and inclusion criteria. The majority of papers focused on physical well being (n = 6) with the remaining papers focusing on practical well being (employment and finance). The quality of the reviews varied (ranging from weak to good). Gaps identified include sexual function, lower-limb lymphoedema, peripheral neuropathy, bladder and GI problems, hormonal sequelae, older cancer survivors, work impact of cancer and context-specific unmet supportive care needs. The review found a lack of standardised nomenclature for survivorship and methodological limitations. CONCLUSIONS: Four main gaps in knowledge relating to the practical and physical problems associated with cancer survivorship have been identified. These are key symptoms, unmet supportive care needs, employment and older cancer survivors, and should be addressed by future research and systematic literature reviews. Work is also needed to address the nomenclature of survivorship and to improve the methodology of research into cancer survivors (including standardised measures, theoretical frameworks, longitudinal design, inclusion of older survivors and age-matched controls for comparison). The review highlighted the need for better research within the identified areas in order to improve the experiences of cancer survivors.

Clinical features of oral chemotherapy: results of a longitudinal prospective study of breast and colorectal cancer patients receiving capecitabine in the UK.

The aim was to describe the clinical sequelae of patients treated with capecitabine in terms of adverse events, treatment modifications and therapy cessation throughout the treatment trajectory. A total of 1232 toxicity assessments were undertaken on colorectal and breast cancer patients receiving palliative and adjuvant treatment prior to treatment and at days 7, 14 and 21 for six cycles of chemotherapy. Most common adverse events were diarrhoea, nausea, palmar-plantar erythrodysesthesia (PPE), fatigue and pain which were experienced by over 80% of subjects. Grades 2 and 3 adverse events were common (n= 916 and n= 113) but their development into grade 4 was uncommon (n= 2). There was a downward trend in the percentage incidence of toxicity; however, PPE increased. Almost 60% of subjects completed six cycles, or planned treatment. Some 40% of subjects commenced treatment on a dose reduction (<1250 mg/m(2)), and this increased to 70% at cycle 6. In total, 2.8-11.6% of subjects experienced toxicity-related treatment deferrals. While adverse events are common with capecitabine the lack of grade 4 adverse events support the efficacy of current clinical management strategies. The deferral and dose reduction data indicate that cycles 1 and 2 are important and require careful management and clinical interventions in order to prevent high-grade adverse events.