Patients' experiences of the COVID-19 pandemic and the change to telephone consultations in cancer care.

PURPOSE: During the COVID-19 pandemic, teleconsultations have increasingly been used to reduce physical contact and thus risk of infection. This study investigated how patients with cancer experienced the COVID-19 pandemic and how they perceived the change from in-person consultations to telephone consultations in an oncology outpatient clinic. The aim was to provide insights that could optimize the future use of teleconsultations in cancer care. METHODS: This qualitative study included 15 patients with colorectal, breast, gynecological, lung, or prostate cancer treated at the outpatient clinic at the Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark in June or July 2020. Data were collected through semi-structured individual interviews and analyzed by thematic analysis. RESULTS: Patients with cancer experienced social, psychological, and organizational consequences of the COVID-19 pandemic related to their cancer care. Not all patients were comfortable with telephone consultations. Six themes were identified: (1) double burden as a consequence of simultaneous cancer and the COVID-19 pandemic, (2) parameters for patient satisfaction with telephone consultations, (3) the importance of relatives attending consultations, (4) loss of information and nuances during telephone consultations, (5) the impact of physicians' language and communicative skills during telephone consultations, and (6) patients' suggestions for future telephone consultations. CONCLUSION: Beyond the COVID-19 pandemic, it is important that hospitals offering teleconsultations involve patients' preferences, consider for which patients and consultations the solution is suitable, which technology to use, how to prepare patients and relatives, and how to provide physicians with the necessary communicative skills.

A population-based survey of patients' experiences with teleconsultations in cancer care in Denmark during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, teleconsultations (TC) have been increasingly used in cancer care as an alternative to outpatient visits. We aimed to examine patient-related and cancer-specific characteristics associated with experiences with TC among patients with cancer during the COVID-19 pandemic. MATERIAL AND METHODS: This population-based survey included patients with breast, lung, gastrointestinal, urological, and gynaecological cancers with appointments in the outpatient clinics, Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark in March and April 2020. Age- and sex-adjusted logistic regression analyses were used to study associations of sociodemographics, cancer and general health, anxiety, and health literacy with patients' experiences of TC in regards to being comfortable with TC, confident that the doctor could provide information or assess symptoms/side effects and the perceived outcome of TC. RESULTS: Of the 2119 patients with cancer receiving the electronic survey, 1160 (55%) participated. Two thirds of patients (68%) had consultations with a doctor changed to TC. Being male, aged 65-79 years, and having TC for test results were statistically significantly associated with more comfort, confidence, and perceived better outcome of TC. Having breast cancer, anxiety, low health literacy, or TC for a follow-up consultation were statistically significantly associated with less positive experiences with TC. Living alone, short education, disability pension, and comorbidity were statistically significantly associated with anxiety and low health literacy. CONCLUSIONS: Most patients reported positive experiences with TC, but in particular patients with anxiety and low health literacy, who were also the patients with fewest socioeconomic and health resources, felt less comfortable and confident with and were more likely to perceive the outcome negatively from this form of consultation. TC may be suitable for increasing integration into standard cancer care but it should be carefully planned to meet patients' different information needs in order not to increase social inequality in cancer.

Fatigue trajectories during the first 8 months after breast cancer diagnosis.

PURPOSE: The objective of this study was to identify distinct groups of fatigue trajectories among women with breast cancer and to evaluate whether age, anxiety symptoms, physical activity, and type of treatment were associated with belonging to the most adverse fatigue group. METHODS: Women scheduled for breast cancer surgery at Copenhagen University Hospital, Denmark, were consecutively invited to participate in the study (n = 424), resulting in 290 women included in the analyses. Semiparametric group-based mixture modeling was used to identify distinct trajectories of fatigue assessed the week before surgery and 4 and 8 months later. Logistic regression analysis was used to evaluate differences in the distinct fatigue groups. RESULTS: Two distinct groups of fatigue trajectories were identified. One group (21 %) had a high mean level, while the second group (79 %) had a low mean level of fatigue throughout the study. In multivariate analyses, sedentary physical activity (OR 5.78; 95 % CI 1.41-23.75), low physical activity (OR 3.17; 95 % CI 1.15-8.74), and increasing anxiety symptoms (OR 1.23; 95 % CI 1.14-1.33) before surgery were significantly associated with being in the high-fatigue group. CONCLUSIONS: The results show that one-fifth of women with breast cancer experience continuously high fatigue up to 8 months after surgery and may have been more anxious and physically inactive. This knowledge is important in targeting interventions to women with fatigue throughout their treatment and who do not return to a low fatigue level with existing treatment, self-management, or support.

Survey of familial glioma and role of germline p16INK4A/p14ARF and p53 mutation.

There is increasing recognition of familial propensity to glioma as a distinct clinical entity beyond a few rare syndromes; however its genetic basis is poorly understood. The role of p16(INK4A)/p14(ARF) and p53 mutations in sporadic glioma provides a strong rationale for investigating germline mutations in these genes as a cause of familial glioma. To survey the familial glioma phenotype and examine the contribution of germline mutation in p16(INK4A)/p14(ARF) and p53 to the disease we have analyzed a series of 101 index familial cases collected through the GLIOGENE Consortium (http://braintumor.epigenetic.org/). There was little evidence for within family correlations for tumour histology, suggesting generic susceptibility to glial tumors. We did not detect any functional mutations in p16(INK4A) or p14(ARF). One index case with glioblastoma multiforme (GBM) diagnosed at age 54 and had a family history comprised of a paternal aunt with GBM at age 55, carried the p53 R158H mutation, which is predicted to be functional and has previously been implicated as a cause of Li-Fraumeni syndrome. Our findings provide no evidence that p16(INK4A)/p14(ARF) and p53 mutations contribute significantly to familial glioma.