Are digital health interventions valuable to support patients with cancer and caregivers? An umbrella review of web-based and app-based supportive care interventions.

BACKGROUND: Digital health technologies have expanded tremendously in the last two decades, creating an emerging research and clinical field. They are regarded as cost-effective, and their use in healthcare is prioritized by many countries. However, the constant evolution of these technologies has led to an abundance of related literature. Thus, we conducted an umbrella review to identify and characterize digital supportive care interventions for patients with cancer and their relatives. METHODS: A preregistered umbrella review was conducted (PROSPERO registration number CRD42022333110). Five databases were searched (Embase, PsycINFO, PubMed, CINAHL, and the Cochrane Library). To be considered, studies had to be systematic reviews or meta-analyses, be performed on pediatric or adult patients with cancer or survivors or their relatives, report results on web-based or app-based supportive care interventions, and measure psychological, functional, or behavioral variables or quality of life related to cancer. The methodological quality of the studies was assessed using the AMSTAR-2 tool. FINDINGS: Twenty eligible studies were identified. Most of the included studies reported results from adult patients with cancer. Globally, digital interventions were shown to be effective for physical activity in patients with cancer but had mixed results regarding emotional outcomes and quality of life. Additionally, a lack of methodological quality was noted for most of the included reviews. DISCUSSION: Digital supportive care interventions could be an effective tool in cancer care for some outcomes. Recommendations have been formulated for further research in this field using adapted methodologies for the development of digital health interventions.

The self-reported perceptions of the repercussions of the disease and its treatments on daily life for young women with breast cancer and their partners.

PURPOSE: This study aimed to compare the self-reported perceptions of the repercussions of the disease and its treatments and emotional distress in young women with breast cancer and their partners. DESIGN: Cross-sectional study using self-reported questionnaires. SAMPLE: 491 couples in which women were aged <45 years when diagnosed with non-metastatic breast cancer in four different groups of treatment: during chemotherapy with or without Trastuzumab; under Trastuzumab with or without hormone therapy; during hormone therapy; and during the follow-up period. METHODS: Patients and partners completed a questionnaire assessing their self-reported perceptions of the disease and treatments (Patient YW-BCI and Partner YW-BCI for the partners) and their emotional distress (CESD; STAI). FINDINGS: Patients reported more difficulties than partners in the management of child(ren) and everyday life, body image and sexuality, negative affectivity about the disease and apprehension about the future, career management, and finances. While the difficulties were generally more marked in the chemotherapy and Trastuzumab groups than in the hormone therapy and follow-up groups, the negative affectivity about the disease and apprehension about the future was high in all four groups, especially in patients. The partners reported more difficulties in sharing with close relatives, and even more in those groups reflecting the latest treatment phases. No difference appeared between patients and partners in couple cohesion and deterioration of relationships with relatives. Partners were less anxious than patients but as depressed as them. CONCLUSIONS: Difficulties of patients and partners seem particularly severe in the early care pathway, maybe reflecting better adjustment in women under surveillance and their partners. A longitudinal study will substantiate this finding and enable a better identification of some explanatory processes of these differences and similarities in the daily self-reported repercussions of the disease throughout the cancer care pathway. Implications for psychosocial oncology: It seems important to support young women with breast cancer and their partners, as our results evidence distress in both and differences according to the type of treatment the woman is currently receiving. Healthcare providers need consistent methods to identify and respond to couples' distress and reduce significant disparities in support.

Emotional distress and subjective impact of the disease in young women with breast cancer and their spouses.

AIM: Evaluate the influence of emotional distress of young women with breast cancer and their spouses on their daily subjective experience of the disease, through application of the Actor-Partner Interdependence Model. PATIENTS & METHODS: A total of 112 women under 45 years of age were diagnosed with nonmetastatic breast cancer and their spouses answered self-reported measures of anxiety, depression and subjective experience of the disease and its treatment. RESULTS: The patient's emotional distress influenced more the subjective experience of her spouse than the spouse's emotional distress influenced the patient. The spouse's difficulties depended as much on his own distress level as on the patient's distress level. CONCLUSION: These data confirm the importance of implementing couple-focused interventions.

Selection of ultimately ill cancer patients able to fulfill a questionnaire: Identification of inherent biases.

AIM: Physical or psychological well-being is an essential component of quality care assessment in palliative unit. This assessment is mainly based on self-assessment (questionnaires or interviews). The aim of this study is to compare the clinical characteristics of patients able to fulfill a questionnaire and those not able to do that. METHODS: The clinical characteristics of 166 cancer patients admitted in palliative care unit from December 2006 to February 2008 have been collected. Characteristics of patients able to fulfill a questionnaire (80, 48.2%) have been compared to other patients (86, 51.8%). Moreover, functional independence measure (FIM) had been evaluated by nurses. RESULTS: Median age (60 versus 62) and sex ratio (40/40 versus 42/44) are similar in both groups. Lung primaries are significantly less frequent in patients able to fulfill the questionnaire (4% versus 17%, P=0.005). Patients able to fulfill the questionnaire had had better performance status (Karnofsky Index≤30%: 54% versus 21%, P<0.0001). The total score of FIM (56.0 versus 91.5, P<0.00001) and the median overall survivals (2.3 weeks versus 6.6 weeks, P=0.0001) were significantly lower in the group of patients non able to fulfill the questionnaire. CONCLUSIONS: Patients able to fulfill a questionnaire represent only 48.2% of all consecutive admitted patients. These patients are not representative of all patients since they had better performance status, they are less dependent and they display significant better survival. We have to think about new methods to avoid the biases generated by the use of patient-reported outcomes.

Young couples' experiences of breast cancer during hormone therapy: an interpretative phenomenological dyadic analysis.

BACKGROUND: Young women are confronted with the same consequences of cancer as older women are. In addition, they face problems specifically related to their age, such as their children's education and their family responsibilities, marital relationships, and career issues. OBJECTIVE: The objective was to identify the functioning profiles of young couples confronted with hormone therapy. METHODS: This study was both qualitative and dyadic. Interviews with 11 couples revealed 5 themes. RESULTS: Initially, the partners reported increased intimacy and mutual support; however, during hormone therapy, a divergence developed between the patients and their partners. The partners wished for the couple to resume a normal life. The patients' loved ones, also helpful in the beginning, were tempted to promote this resumption of normalcy, with the risk that the patients' suffering would no longer be acknowledged. The risk of cancer recurrence appeared to immobilize the patients, who were unable to adopt a long-term perspective. Finally, the experience of the disease led the participants to reorganize their priorities and promoted self-centering. CONCLUSIONS: Breast cancer affects both the patient and her loved ones. Future research should focus on qualitative extensions to other stages of cancer treatment and quantitative studies to measure the phenomena revealed in the current work. IMPLICATIONS FOR PRACTICE: Cancer and its treatment have impacts on the patient and her marriage; therefore, the focus for the clinical care should be on the couple rather than just the patient. Additionally, our findings suggest new areas of psychological dyadic counseling for cancer patients and their partners.

Genetic testing for hereditary cancer: effects of alexithymia and coping strategies on variations in anxiety before and after result disclosure.

This study assessed the impact of the results of genetic testing for hereditary cancer from a multifactorial health psychology perspective, considering that emotional expression plays a key role in psychological adjustment. Measures of dispositional and transactional coping strategies, anxiety and alexithymia were filled out by 77 participants in a longitudinal study design. Statistical analyses were performed using general linear models and partial least squares path modelling, low-constraint methods that are particularly useful in the behavioural sciences. While anxiety levels prior to the result announcement were predictive of the distress experienced by noncarriers, considerable variability was observed for mutation carriers. Some subjects who had lower anxiety levels before the test displayed greater anxiety afterwards, but others seemed to anticipate the distress they would experience with the result that they showed a decrease in anxiety. The mutation carriers behaved as though their adaptive functioning were reshaped by the test result, independent of their disposition and previous emotional state, except in the case of alexithymia. Difficulty expressing emotions prior to genetic testing contributed to a similar difficulty after receiving the result, adding to the latter's emotional impact by promoting emotion-focused coping strategies and increasing distress.

Participation in randomised clinical trials is linked to emotion regulation strategies.

OBJECTIVES: Cancer patients' anxiety may curb their enrolment in clinical trials (CTs). Thus, the strategies they employ to reduce their anxiety may also determine their enrolment in CTs. The purposes of this study are (1) to compare the anxiety and emotion regulation strategies between patients who are enrolled in CTs (cases) and patients receiving standard cancer treatments who have never taken part in any CT (controls), and (2) to assess the links between these strategies and anxiety. METHODS: In total, 76 cases and 108 controls completed two validated questionnaires assessing their emotion regulation style (ERQ) and anxiety (STAI-Y). RESULTS: Overall, anxiety scores in cases and controls do not differ. The two groups do not differ in regards to their cognitive reappraisal of situations. However, cases inhibit their emotional expressions less than controls. Both cognitive reappraisal and emotional expressions are linked to lower scores of anxiety. CONCLUSIONS: Patients enrolled in CTs do not seem to be more anxious than those receiving a standard treatment. However, cancer patients' anxiety depends on the emotion regulation strategies they use. Emotion regulation during physician-patient interactions should be investigated further as a possible factor for CT enrolment determination.

Factual understanding of randomized clinical trials: a multicenter case-control study in cancer patients.

Objective Several reports have shown that despite the informed consent process, enrolled patients misunderstand the modalities and goals of randomized clinical trials (RCTs). We believe that this may be linked to a priori misconceptions in the main population. The purpose of this study is to compare the knowledge about cancer RCTs in enrolled participants (cases) versus patients treated under cancer standard care who have never taken part in RCTs (controls). Methods We submitted a validated questionnaire (ICEC-R) to both populations to explore their knowledge about RCTs. A total of 75 cases and 107 controls were included. Results Globally, the cases' knowledge was significantly better, especially about (i) the randomization process, (ii) the uncertain potential benefits, and (iii) the right to withdraw consent. Both populations presented the lowest scores for items exploring the randomization process and uncertain treatment benefits. Conclusion Enrolled patients' comprehension of the goals and means of RCTs is actually better than controls'. Nevertheless, additional efforts should be made to enhance information about clinical research to patients as well as to the main population. Practice Implications Having better knowledge about patients' difficulties in understanding RCTs would allow physicians to adjust the information they give and then to enhance patients' well-being.

Crossed evaluations of temptation to drink, strain and adjustment in couples with alcohol problems.

The aim was to describe discrepancies between patients' and spouses' dyadic adjustment scores, spouse strain and patients' temptation to drink during abstinence. Patients overestimated the dyadic adjustment scores of their partner and spouses underestimated patients' scores. Spouses overestimated patients' temptation to drink. Correlations between patients' and spouses' scores were generally high (.61 to .78) except for five measures of spouse strain which were lower (.31 to .50). Results show discrepancies concerning marital function and the temptation to drink which could be important when planning treatment and prevention of relapse.

[An index of understanding randomised clinical trials in oncology]. / Index de compréhension des essais cliniques randomisés en oncologie.

The first aim of this study was to build a French validated tool (ICEC-R) assessing the objective comprehension of the modalities and purposes of participating to a randomised clinical trial (phase II or III). The second goal of the study was to compare the scores different groups of participants got at the ICEC-R in accordance with their level of expertness in this domain (physicians vs patients included in a randomised CT vs patients with standard treatment vs uninformed) and to assess whether these scores of objective comprehension were, or not, impacted by the patients' anxiety state or their satisfaction about the care they receive. The sample was composed of 474 participants, namely 73 "target patients" suffering from cancer and participating to a randomised clinical trial, 97 "standard patients" suffering from cancer but who were not included in a clinical trial, 25 "physicians" who include patients in clinical trials, 18 "caregivers" who do not include patients in clinical trials, and 261 "uninformed" (psychology students). "Target" or "standard" patients received a questionnaire composed of the randomised clinical trials comprehension inventory (ICEC-R), a trait-state anxiety scale (STAI-Y), and a scale assessing their satisfaction about the care (SAT). In addition to general information, physicians, caregivers and uninformed only completed the ICEC-R. The analyzes led us to keep a one-dimensional comprehension inventory composed of ten items which are sufficiently discriminant among the patients and for which expert physicians gave consensual answers. Finally, the patients' answers to this questionnaire seem not to be influenced by either their anxiety or their satisfaction about the care. Better evaluations of the knowledge of the patients who participate to randomised clinical trials seem to be a distinct asset to improve these patients' global clinical care.