Age-related supportive care needs of women with gynaecological cancer: A qualitative exploration.

Women with gynaecological cancer (GC) experience significant morbidity with associated needs for support, not all of which are currently met by the current system. Types and levels of unmet needs vary across age and the care continuum. This study aimed to identify the shared and unique supportive care needs of younger and older GC patients and survivors to inform improved supportive care. Nineteen younger and ten older women, 3 months to 5 years post a GC diagnosis, were purposively recruited during active treatment, and at early and extended survivorship. Audiotaped and transcribed semi-structured interviews were thematically analysed to establish areas of needs. GC patients reported nine shared needs relating to support, isolation, uncertainty, information, asking questions, escape from illness, advocacy, loss and finding meaning. Younger patients reported unique needs related to the impact of treatment-induced menopause. There is a need for a systematic screening process to identify women who require and want additional help, to ensure appropriate and timely assistance or referrals are provided. Identification of needs will allow health professionals to provide relevant and timely information and support services, resulting in improved quality of life for women affected by GC.

Sexual adjustment following early stage cervical and endometrial cancer: prospective controlled multi-centre study.

OBJECTIVE: The primary aim of this study was to investigate objective and subjective aspects of sexual adjustment for women with early stage cervical and endometrial cancer during the first 6 months post-treatment, compared to women with benign and pre-invasive gynaecological conditions. 'Objective' aspects of sexual function were operationalised as the frequency of sexual activity and 'subjective' aspects as the perceived quality of sexual interactions. METHOD: This multi-centre controlled study compared sexual outcomes of women treated for early stage cervical and endometrial cancer (n = 53) with (i) benign gynaecological patients (n = 60), as a comparison group for the physical effects of major pelvic surgery, and (ii) pre-invasive cancer patients (n = 52), as a comparison group for the emotional effect of the perceived threat of cancer. All patients were assessed at baseline and at 6 months follow-up using standardised measures of objective and subjective aspects of sexual function, overall satisfaction with sexual life, relationship satisfaction and psychological distress. RESULTS: Despite experiencing treatment-related physical changes, women with early stage cervical and endometrial cancer did not report more severe or longer-lasting sexual sequelae than the benign or pre-invasive groups. There were no significant differences between the three groups or changes over time for the objective, subjective or overall measures of sexual function, controlling for age, psychological distress and relationship satisfaction. CONCLUSION: The current findings suggest that early stage cervical and endometrial cancer patients fare as well as benign and pre-invasive cancer groups in terms of sexual adjustment over the 6 months post-treatment.

Quantity vs. quality: an exploration of the predictors of posttreatment sexual adjustment for women affected by early stage cervical and endometrial cancer.

INTRODUCTION: Women with early stage cervical and endometrial cancer may experience complex posttreatment changes to their sexual function, but clinical practice and past research have focused more on the quantity than the perceived quality of sexual life. AIM: The aims of this prospective study were to explore the following: (i) the relative importance of quantity vs. quality of sexual life over the first year posttreatment; (ii) the psychological and sexual predictors of overall sexual function; and (iii) the relationship between sexual function and quality of life (QoL). METHODS: Fifty-three cancer patients completed standardized measures at baseline, with follow-up at 6 and 12 months posttreatment. Analyses were based on prespecified linear mixed models with overall sexual function and QoL as outcomes, and quality and quantity of sexual life, anxiety, and depression as the main predictors of interest. Radiotherapy, age, and relationship satisfaction were controlled for as potential confounders. MAIN OUTCOME MEASURES: Derogatis Sexual Functioning Inventory subscales to assess quantity (Drive) and quality (Satisfaction) of sexual life, and overall sexual function (Global Sexual Satisfaction Index); Functional Assessment of Cancer Therapy--General to assess QoL; Hospital Anxiety and Depression Scale to assess psychological distress; and Relationship Satisfaction Interaction Scale to assess relationship satisfaction. RESULTS: The models demonstrated that: (i) overall sexual function was predicted more strongly by the perceived quality than the quantity of sexual interactions, (ii) a small change in perceived quality had a large impact on overall sexual function, and (iii) overall sexual function was a predictor of QoL. CONCLUSION: This study found that quality rather than quantity of sexual life is the best predictor of overall sexual function among women treated for early stage cervical and endometrial cancer, indicating the importance of including quality indices in posttreatment sexual assessment in clinical practice and research studies.

Bacillus spore inactivation differences after combined mild temperature and high pressure processing using two pressurizing fluids.

Spores of six species (28 strains) of dairy Bacillus isolates were added to sterile reconstituted skim milk and pressure processed (600 MPa for 60 s at 75 degrees C) using either a water-based pressurizing fluid or silicon oil. Processing temperatures peaked at 88 and 90 degrees C, respectively, for both fluids. For all strains, the log inactivation was consistently higher in the silicon oil than in the water-based fluid. This has potential implications for food safety assessment of combined pressure-temperature processes. High pressure processing causes mild heating during pressurization of both the target sample (i.e., spores) and the pressurizing fluid used for pressure delivery. Primarily, the adiabatic heat of compression of the fluids as well as other heat-transfer properties of the fluids and equipment determines the magnitude of this heating. Pressure cycles run with silicon oil were 7 to 15 degrees C higher in temperature during pressurization than pressure cycles run with the water-based pressurizing fluid, due to the greater adiabatic heat of compression of silicon oil. At and around the target pressure, however, the temperatures of both pressurizing fluids were similar, and they both dropped at the same rate during the holding time at the target pressure. We propose that the increased spore inactivation in the silicon oil system can be attributed to additional heating of the spore preparation when pressurized in oil. This could be explained by the temperature difference between the silicon oil and the aqueous spore preparation established during the pressurization phase of the pressure cycle. These spore-inactivation differences have practical implications because it is common practice to develop inactivation kinetic data on small, jacketed laboratory systems pressurized in oil, with extensive heat loss. However, commercial deployment is invariably on large industrial systems pressurized in water, with limited heat loss. Such effects should be considered in food safety assessments of combined pressure-temperature processes.

Researching what matters to improve chronic pain care in Canada: A priority-setting partnership process to support patient-oriented research.

BACKGROUND: Chronic pain affects more than 6 million Canadians. Patients need to be involved in setting research priorities to ensure a focus on areas important to those who will be most impacted by the results. AIMS: The aim of this study was to leverage patient experiences to identify chronic pain research priorities in Canada. METHOD: The process was informed by the James Lind Alliance. After gathering an exhaustive list of questions using surveys, town hall meetings, interviews, and social media consultations, we used a computerized Delphi with four successive iterations to select the final list of research priorities. The final Delphi round was conducted by a panel of ten patients living with chronic pain and ten clinicians from different disciplines. RESULTS: We received more than 5000 suggestions from 1500 people. The Delphi process led to the identification of 14 questions fitting under the following 4 themes: (1) improving knowledge and competencies in chronic pain; (2) improving patient-centered chronic pain care; (3) preventing chronic pain and reducing associated symptoms; and (4) improving access to and coordination of patient-centered chronic pain care. Challenges included the issue of chronic pain being ubiquitous to many diseases, leading to many initial suggestions focusing on these diseases. We also identified the need for further engagement efforts with marginalized groups in order to validate the priorities identified or identify different sets of priorities specific to these groups. CONCLUSION: The priorities identified can guide patient-oriented chronic pain research to ultimately improve the care offered to people living with chronic pain.

Contexte: La douleur chronique affecte plus de six millions de Canadiens. Les patients doivent participer à l'établissement des priorités de recherche afin de s'assurer que l'accent soit mis sur les aspects les plus importants aux yeux de ceux qui seront les plus touchés par les résultats.Buts: Tirer parti de l'expérience des patients afin d'établir les priorités de la recherche en matière de douleur chronique au Canada.Méthode: Le processus s'est impiré de la James Lind Alliance. Après avoir dressé une liste exhaustive de questions à l'aide d'enquêtes, d'assemblées publiques, d'entrevues et de consultations via les médias sociaux, nous avons utilisé un processus Delphi informatisé comprenant quatre itérations successives afin de sélectionner la liste finale de priorités de recherche. Le dernier tour du processus Delphi a été mené par un panel composé de 10 patients souffrant de douleur chronique et de 10 cliniciens issus de différentes disciplines.Résultats: Nous avons reçu plus de 5 000 suggestions provenant de 1 500 personnes. Le processus Delphi a permis de déterminer 14 questions qui relèvent des quatre thèmes suivants : (1) améliorer les connaissances et les compétences en matière de douleur chronique ; (2) améliorer les soins axés sur le patient pour contrer la douleur chronique; (3) prévenir la douleur chronique et réduire les symptômes qui y sont associés ; et (4) améliorer l'accès aux soins axés sur le patient pour contrer la douleur chronique et la coordination entre ces soins. Parmi les défis qui se sont présentés, on compte le fait que la douleur chronique soit omniprésente dans de nombreuses maladies, de sorte qu'un grand nombre des suggestions initialement formulées portaient sur ces maladies. Nous avons également déterminé que davantage d'efforts devaient être déployés pour assurer la participation des groupes marginalisés dans le but de valider les priorités déterminées ou déterminer d'autres priorités spécifiques à ces groupes.Conclusion: Les priorités déterminées peuvent orienter la recherche axée sur le patient pour contrer la douleur chronique dans le but ultime d'améliorer les soins offerts aux personnes qui souffrent de douleur chronique.