Assessing the impact of diagnosis and the related supportive care needs in patients with cutaneous melanoma.

PURPOSE: Despite the large number of people affected by melanoma, little is known about the specific needs of melanoma patients. Understanding the effects of melanoma diagnosis and the specific supportive care needs of this group of patients is a necessary step towards provision of effective psychosocial care. METHODS: Semi-structured interviews were carried out with 15 patients with malignant melanoma of the skin. The sample size, which was purposive, included 8 females and 7 males from 27 to 78 years old. Data were analysed using the NVIVO 8 software and principles of thematic analysis. RESULTS: Four major areas were identified: (a) Emotional effects due to body image, fear of the sun and uncertainty for the future; (b) Effects on Relationships, with some patients in need of more support than others from family and work colleagues; (c) Functional effects due to on-going symptoms such as pain and lymphedema; and (d) Health System and Information Needs, around the clarity, quality and timing of the information received from the health care professionals. CONCLUSIONS: The findings suggest that we often fail to pick up melanoma patients' health and psychosocial needs and fail to refer them appropriately, rather than the services not being available. Interventions should focus on patient and carer education about melanoma and sun protection, psychosocial support and effective information giving. Patient-reported outcome measures should routinely be collected to identify issues of specific concerns to the patients and directing them to the right services based on their individual needs.

Weight changes in oncology patients during the first year after diagnosis: a qualitative investigation of the patients' experiences.

BACKGROUND: Weight changes are one of the most common symptoms experienced by patients with cancer. However, limited empirical data are available on how cancer patients react to changes in their weight following their diagnosis and treatment. OBJECTIVE: The present study aims to acquire a deeper understanding of cancer patients' experiences with the physical manifestations of weight loss or gain, the consequence of these changes on their psychosocial life, and their self-management strategies. METHODS: Semistructured interviews with 54 cancer patients were conducted longitudinally 2 to 3 weeks after their diagnosis. Follow-up interviews were carried out at 3, 6, and 12 months after diagnosis. RESULTS: From the 54 patients recruited, 34 patients disclosed weight gain, whereas 37 experienced weight loss, suggesting that 17 patients experienced weight fluctuation. Analysis generated 4 themes that reflected the complex dynamics of weight change. Themes were "experiences with the physical manifestations of weight loss or gain," "psychological effects," "self-management," and "social consequences." CONCLUSION: This study confirms that weight changes have far more complicated implications for patients with cancer, extending beyond physical problems into psychosocial issues. Changes are a constant reminder of the diagnosis and treatment and are persistent across all stages. IMPLICATIONS FOR PRACTICE: These findings highlight the importance of nutritional psychosocial rehabilitation programs during the cancer trajectory.

Use of antiemetics in the management of chemotherapy-related nausea and vomiting in current UK practice.

PURPOSE: The main aim of the present study was to assess antiemetic prescriptions used during chemotherapy and identify if these are in agreement with internationally agreed consensus guidelines (MASCC/ASCO). METHODS: A web-based survey in the UK was carried out collecting data through a 32-item questionnaire using a snowball sampling technique and the email lists of two large oncology societies in the country. RESULTS: The participants were 154 oncologists and oncology nurse prescribers. Data showed a great variability in antiemetic prescriptions used, most not been in accordance with MASCC/ASCO consensus guidelines. The variability was also reflected in the doses of antiemetics used. Overall, clinicians undertreated patients receiving highly emetogenic chemotherapy and overtreated patients receiving low and minimally emetogenic chemotherapy. Eight of ten clinicians, however, prescribed antiemetics in accordance with consensus guidelines in moderately emetogenic chemotherapy. There was more agreement between clinicians and guidelines for acute nausea/vomiting and less for delayed symptoms. The uptake of MASCC/ASCO guidelines was minimal. CONCLUSIONS: The low level of agreement between actual clinical practice and evidence-based consensus guidelines may be one of the reasons for the considerable incidence of chemotherapy-related nausea and vomiting. There is a need to utilise consensus guidelines more widely and educate clinicians on this aspect of supportive care.