Financial well-being as a mediator of the relationship between multimorbidity and health-related quality of life in people with cancer.

BACKGROUND: It is unknown whether financial well-being mediates the impact of multimorbidity on the health-related quality of life (HRQoL) of cancer patients. METHODS: Participants were recruited from three outpatient oncology clinics of Hong Kong public hospitals. Multimorbidity was assessed using the Charlson Comorbidity Index. Financial well-being, the mediator of the association between multimorbidity and HRQoL outcomes, was assessed using the Comprehensive Score for Financial Toxicity Functional Assessment of Chronic Illness Therapy. The HRQoL outcomes were assessed using the Functional Assessment of Cancer Therapy - General (FACT-G) and its four sub-dimensions. Mediation analyses were conducted using SPSS PROCESS v4.1. RESULTS: Six-hundred and forty cancer patients participated in the study. Multimorbidity had a direct effect on FACT-G scores independent of financial well-being (ß for path c' = -0.752, p < 0.001). In addition, multimorbidity had an indirect effect on FACT-G scores through its effect on financial well-being (ß for path a = -0.517, p < 0.05; ß for path b = 0.785, p < 0.001). Even after adjustments were made for the covariates, the indirect effect of multimorbidity on FACT-G via financial well-being remained significant, accounting for 38.0% of the overall effect, indicating partial mediation. Although there were no statistically significant associations between multimorbidity, social well-being, and emotional well-being, the indirect effects of multimorbidity on physical and functional well-being through financial well-being remained significant. CONCLUSIONS: Poor financial well-being attributable to multimorbidity partially mediates the direct impact of chronic conditions on HRQoL in Chinese cancer patients, particularly their physical and functional well-being.

Identifying a cut-off score for the COST measure to indicate high financial toxicity and low quality of life among cancer patients.

PURPOSE: To identify a cut-off score for the COmprehensive Score for financial Toxicity (COST) to predict a clinical implication of a high level of financial toxicity (FT). METHODS: A total of 640 cancer patients were recruited from three regional hospitals in Hong Kong. They completed a questionnaire comprising the COST measure and the Functional Assessment of Cancer Therapy - General (FACT-G) instrument. The cut-off score for the COST that predicts the lowest quartile of the FACT-G total score was identified by receiver operating characteristic (ROC) analysis. The sample was then stratified by this cut-off score, and characteristics were compared using Fisher's exact, chi-squared or independent sample t-test. RESULTS: The mean scores were 20.1 ± 8.8 for the COST and 71.6 ± 15.5 for the FACT-G. The ROC analysis suggested that the cut-off of 17.5 yielded an acceptable sensitivity and specificity. Characteristics of patients with a higher level of FT included being younger, having a monthly household income of < 10,000 HKD (approximately 1290 USD), being more likely not employed, having stage IV cancer and receiving targeted and/or immunotherapy. In terms of financial support, a higher proportion of these patients had discussed financial issues with health care professionals and had received financial assistance. In addition, fewer of them were covered by private health insurance. CONCLUSION: Our findings suggest a cut-off for the COST that can be used to screen for FT in clinical settings. In addition, while a considerable proportion of high-FT patients received targeted therapy, they often received financial assistance. There is a gap between financial hardship and assistance that warrants attention.

Translation and validation of the Traditional Chinese version of the COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (Version 2).

BACKGROUND: Cancer patients often experience severe financial distress due to the high cost of their treatment, and strategies are needed to objectively measure this financial distress. The COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) is one instrument used to measure such financial distress. This study aimed to translate the COST-FACIT (Version 2) [COST-FACIT-v2] instrument into traditional Chinese (COST-FACIT-v2 [TC]) and evaluate its psychometric properties. METHODS: The Functional Assessment of Chronic Illness Therapy (FACIT) translation method was adopted. The translated version was reviewed by an expert panel and by 20 cancer patients for content validity and face validity, respectively, and 640 cancer patients, recruited from three oncology departments, completed the translated scale. Its reliability was evaluated in terms of internal consistency and test-retest reliability. Confirmatory factor analysis has been used to evaluate the one- and two-factor structures of the instrument reported in the literature. The convergent validity was examined by the correlation with health-related quality of life (HRQoL) and psychological distress. Known-group validity was examined by the difference in the COST-FACIT-v2 (TC) total mean score between groups with different income levels and frequency of health care service use. RESULTS: The COST-FACIT-v2 (TC) showed good content and face validity and demonstrated high internal consistency (Cronbach's alpha, 0.86) and acceptable test-retest reliability (intraclass correlation coefficient, 0.71). Confirmatory factor analysis showed that the one- and two-factor structures of the instrument that have been reported in the literature could not be satisfactorily fitted to the data. Psychological distress correlated significantly with the COST-FACIT-v2 (TC) score (r = 0.47; p < 0.001). HRQOL showed a weak to moderate negative correlation with the COST-FACIT-v2 (TC) score (r = - 0.23 to - 0.46; p < 0.001). Significant differences were seen among the COST-FACIT-v2 (TC) scores obtained in groups of different income level and frequency of health care service use. CONCLUSIONS: The COST-FACIT-v2 (TC) showed some desirable psychometric properties to support its validity and reliability for assessing cancer patients' level of financial toxicity.

Oncology Nursing in Hong Kong: Milestones over the Past 20 Years.

The article reviews the development of oncology nurses' role, training, education, practice, and service provision in Hong Kong, highlighting milestones over the past two decades and providing directions for future training, practice, and research. There was an expansion of the diversity of roles and practice from the 2000s onward, reflecting the importance of contribution by nurses to clinical practice and service for cancer patients. These areas include advanced roles and competence development, advanced training, service delivery model, cross-cluster collaboration, quality improvement initiatives, and new nurse clinic model. Recognizing the challenges and the opportunities, it helps to identify the future work with newer and more advanced practice foci as well as training initiatives in advanced practice being developed to meet the increased needs of increasing service load and populations in need of ongoing access to oncology care. The role and the continuous efforts of the clinical, academic, and professional bodies to meet this goal will be crucial and strategic in the future.

A Mixed-Methods Study of Unmet Supportive Care Needs Among Head and Neck Cancer Survivors.

BACKGROUND: Head and neck cancer (HNC) survivors face increasing challenges to adjust to the diagnosis and late effects of treatment. Identifying unmet needs among HNC survivors is therefore important to provide a comprehensive supportive care service for them. OBJECTIVE: The aim of this study was to examine the unmet supportive care needs (SCNs) of HNC survivors in the first year after treatment. METHODS: An explanatory sequential mixed-method design with 2 phases was used. In the quantitative phase, standardized questionnaires were administered to 285 Chinese HNC survivors to solicit their demographic and clinical characteristics, unmet SCNs, and access to various support services. In the qualitative phase, individual semistructured interviews were conducted with 53 participants to explore their unmet needs in more detail. RESULTS: The most prevalent unmet SCNs among the survivors were in the health system and information domain. Five categories of unmet needs emerged from the interview data: physical, psychological, health system and information, patient care and support, and sexuality. The findings reflect the inadequacy of the healthcare services for these survivors. CONCLUSION: Chinese HNC survivors experienced a variety of unmet SCNs, particularly in the areas of symptom management and healthcare system and information provision. IMPLICATIONS FOR PRACTICE: The study provides insights that can (1) inform future service development, including regular symptom identification and management, improvements in communication, and counseling services and (2) identify the specific needs of these survivors as the basis for tailoring care to meet their needs.

Patient Safety and Quality of Care are Everybody's Business: Evaluating the Impact of a Continuing Professional Development Program beyond Satisfaction.

This article was migrated. The article was marked as recommended. Background Research integrating Continuing Professional Development (CPD) with patient safety (PS) and quality improvement (QI) is still in its infancy despite advocacy by leaders in the field. Objectives This theory-driven study explored the feasibility to implement and evaluate the impact of a CPD intervention focused on teaching and practicing PS and QI at the levels of satisfaction, usefulness, knowledge, confidence, intention to change behaviour and reported changes in practice. Methods Three workshops targeting healthcare professionals were delivered live between 2014 and 2016. Data was collected longitudinally through four questionnaires and analyzed with descriptive statistics and triangulation of sources. Thematic analysis of qualitative data was guided by the Theoretical Domains Framework. Results Sixty-seven healthcare professionals participated in the study. Across workshops, satisfaction was high and a significant increase in knowledge and confidence were reported immediately post-intervention. Intention to change behavior was high across workshops. 'Moral norm' and ' beliefs about consequences' were consistently rated as the most influential factors in participants' intention to change behavior while ' social influence' was consistently rated as the least influential. At the workshops, participants anticipated improving communication, increasing their knowledge on PS-QI, applying content learned and building teamwork. Commonly anticipated barriers to implementation included lack of resources, environmental stressors, and the organizational climate/culture. These barriers were confirmed six-month post where participants reported partially implementing 78% (18/23) anticipated goals. Conclusions This study showed the feasibility to develop and implement an effective CPD intervention supporting healthcare professionals' knowledge, confidence, and reported change in teaching and practicing PS-QI.

Pressurised irrigation versus swabbing method in cleansing wounds healed by secondary intention: a randomised controlled trial with cost-effectiveness analysis.

BACKGROUND: Wound cleansing should create an optimal healing environment by removing excess debris, exudates, foreign and necrotic material which are commonly present in the wounds that heal by secondary intention. At present, there is no research evidence for whether pressurised irrigation has better wound healing outcomes compared with conventional swabbing practice in cleansing wound. OBJECTIVES: This study investigated the differences between pressurised irrigation and swabbing method in cleansing wounds that healed by secondary intention in relation to wound healing outcomes and cost-effectiveness. DESIGN: Multicentre, prospective, randomised controlled trial. SETTING: The study took place in four General Outpatient Clinics in Hong Kong. METHODS: Two hundred and fifty six patients with wounds healing by secondary intention were randomly assigned by having a staff independent of the study opening a serially numbered, opaque and sealed envelope to either pressurised irrigation (n=122) or swabbing (n=134). Staff undertaking study-related assessments was blinded to treatment assignment. Patients' wounds were followed up for 6 weeks or earlier if wounds had healed to determine wound healing, infection, symptoms, satisfaction, and cost effectiveness. The primary outcome was time-to-wound healing. Patients were analysed according to their treatment allocation. This trial is registered with ClinicalTrials.gov, number NCT01885273. RESULTS: Intention-to-treat analysis showed that pressurised irrigation group was associated with a shorter median time-to-wound healing than swabbing group [9.0 days (95% CI: 7.4-13.8) vs. 12.0 (95% CI: 10.2-13.8); p=0.007]. Pressurised irrigation group has significantly more patients experiencing lower grade of pain during wound cleansing (93.4% vs. 84.2%; p=0.02), and significantly higher median satisfaction with either comfort or cleansing method (MD 1 [95% CI: 5-6]; p=0.002; MD 1 [95% CI: 5-6]; p<0.001) than did swabbing group. Wound infection was reported in 4 (3.3%) patients in pressurised irrigation group and in 7 (5.2%) patients in swabbing group (p=0.44). Cost-effectiveness analysis indicated that pressurised irrigation in comparison with swabbing saved per patient HK$ 110 (95% CI: -33 to 308) and was a cost-effective cleansing method at no extra direct medical cost with a probability of 90%. CONCLUSIONS: This is the first randomised controlled trial to compare the pressurised irrigation and swabbing. Pressurised irrigation is more cost-effective than swabbing in shortening time that wound heals by secondary intention with better patient tolerance. Use of pressurised irrigation for wound cleansing is supported by this trial.

Quality of life in head and neck cancer survivors at 1 year after treatment: the mediating role of unmet supportive care needs.

PURPOSE: The aim of the study was to test a hypothesised model that supportive care needs (SCNs) have a mediating effect on the relationship between characteristics of (Chinese) head and neck cancer (HNC) survivors and their quality of life (QoL). METHODS: A total of 285 Chinese HNC survivors who had finished cancer treatment 1 year earlier completed a self-reported survey covering demographic and clinical characteristics, the Chinese version of the Short-Form Supportive Care Needs Questionnaire (SCNS-SF34-C), the supplementary module of access to healthcare and ancillary support services and the Functional Assessment of Cancer Therapy for Head and Neck Cancer (FACT-H&N). RESULTS: The final path model showed that optimism, educational level, any coexisting disease, number of somatic symptoms, household income, eating ability, support from others, whether the cancer is under control or not and travelling time from home to hospital have direct or indirect effects, or both, on the QoL of HNC survivors, by way of unmet SCNs in the psychological, physical and/or health system information domains, which account for 64 % of the variance in the total FACT-H&N score. CONCLUSIONS: Our study demonstrated the mediating effects of SCNs in the association between HNC survivors and their QoL. Early needs assessment may help healthcare professionals to identify the actual needs of these survivors, and providing the information that HNC survivors want is a significant factor in meeting their psychological needs and thereby improving their overall QoL.

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.

Comparison of health-related quality of life and emotional distress among Chinese cancer survivors.

The purpose of this study is to compare health-related quality of life (HRQoL) and emotional distress among diverse cancer survivors who had completed all treatment within the previous year. A convenience sample of 353 cancers survivors (lung, head and neck, breast and prostate cancers) were recruited to complete a survey, which consisted of (i) Hospital Anxiety and Depression Scales; (ii) Chinese version of the Functional Assessment of Cancer Therapy-General version; and (iii) demographic and clinical data. The HRQoL scores were similar among the four types of survivors. Mild anxiety and depression levels were reported, but no significant difference was noted. Younger females with financial burdens and uncertain prognosis were particularly associated with HRQoL and emotional distress. Further studies are essential to identify specific problems that cancer patients experience after cancer diagnosis that might lead to the early detection of those most at risk of ongoing problems.

Perceived unmet supportive care needs and determinants of quality of life among head and neck cancer survivors: a research protocol.

AIM: To describe a study protocol designed to explore the associations among the perceived unmet supportive care needs, quality of life and the demographic and clinical characteristics of head and neck cancer survivors. BACKGROUND: The prognoses for people with head and neck cancer are improving with medical advances. However, studies have reported that such cancer survivors experience poor quality of life. Current studies mainly focus on Western populations and there is limited research investigating the needs of head and neck cancer survivors. DESIGN: A mixed-design method is proposed, which will include two phases. Phase I will use a quantitative cross-sectional design and Phase II a qualitative descriptive approach. METHODS: The participants will be recruited from the outpatient departments of three public hospitals in Hong Kong. In Phase I, a questionnaire will be used to collect demographic and clinical characteristics, supportive care needs, necessary access to various supportive services and quality of life. Semi-structured interviews will be conducted in Phase II. The study is supported by a grant from the Health and Health Services Research Fund, Hong Kong, September 2011. DISCUSSION: The study will generate in-depth information on the needs of head and neck cancer survivors, to help healthcare professionals allocate resources better and develop new services, which can be more person-centred, to meet the needs of the these survivors.

Perceived unmet needs and health-related quality of life of Chinese cancer survivors at 1 year after treatment.

BACKGROUND: Although advanced cancer treatments prolong survivors' lives, a significant proportion experienced poorer health-related quality of life (HRQoL) than general populations. Identifying their needs is essential to develop a health service delivery model to improve patient outcomes. OBJECTIVE: The objective of this study was to examine the perceived unmet needs and HRQoL of Chinese cancer survivors who completed treatment less than 1 year ago. METHODS: Three hundred seventy-six participants completed a self-report survey: 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: General. Descriptive statistics were used to examine the prevalence of unmet needs. Multivariable logistic regressions were conducted to identify participants' characteristics that were associated with unmet needs. Multiple linear regression was used to delineate which domains of unmet needs were significantly associated with HRQoL with adjustment for potential confounding factors. RESULTS: Healthcare information was the most common unmet needs among the survivors. Age, stage of cancer, and remission were significantly associated with 1 or more unmet need domains. Participants with unmet needs in physical, psychological, and patient care domains, on average, have poorer HRQoL. CONCLUSIONS: Chinese cancer survivors have various unmet needs that might have adverse effects on their HRQoL. Younger age, more advanced stages of cancer, and remission were factors contributing to further unmet needs. IMPLICATIONS FOR PRACTICE: The results provided useful information on the special needs of survivors that may affect their HRQoL, enabling clinicians to plan better how to allocate existing limited resources to those who most require them.

Quantitative measurement of post-irradiation neck fibrosis based on the young modulus: description of a new method and clinical results.

BACKGROUND: Postirradiation fibrosis is one of the most common late effects of radiation therapy for patients with head and neck carcinoma. An objective and quantitative method for its measurement is much desired, but the criteria currently used to score fibrosis are mostly semiquantitative and partially subjective. METHODS: The Young Modulus (YM) is a physical parameter that characterizes the deformability of material to stress. The authors measured the YM in soft tissues of the neck, at defined reference points, using an ultrasound probe and computer algorithm that quantified the indentation (deformation) on tissue due to a measured, applied force. One hundred five patients who had received previous radiation therapy to the entire neck were assessed, and the results were compared with the hand palpation scores and with a functional parameter represented by the range of neck rotation, and all results were correlated with symptoms. RESULTS: The YM was obtained successfully in all patients examined. It had a significant positive correlation with the palpation score and a significant negative correlation with the range of neck rotation. The YM was significantly higher on the side of the neck that received a boost dose of radiation, although the corresponding palpation scores were similar. The results of all three measurement methods were correlated with symptoms. CONCLUSIONS: Postirradiation neck fibrosis can be measured in absolute units based on the YM. The results showed a significant correlation with hand palpation scores, with restriction of neck rotation, and with symptoms. Compared with the palpation method, the YM is more quantitative, objective, focused on small subregions, and better discriminates regions subject to differential radiation dose levels. Its inclusion in the Analytic category of the Late Effects of Normal Tissues-SOMA system should be considered to facilitate comparative studies.