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Fatigue may lead to disordered sleep. Primary caregivers of patients with cancer may suffer from higher levels of disordered sleep because of care-related fatigue. Older-adult veterans with cancer tend to be emotionally negative, which increases the challenges of care. This study was designed to investigate the veteran status of patients as a possible moderator in the relationship between fatigue and disordered sleep in primary caregivers. In this cross-sectional study, 127 primary caregivers of patients with cancer were randomly recruited from three hospitals in northern Taiwan. Data were collected using a demographics datasheet, the Taiwanese version of the Brief Fatigue Inventory, and the Chinese version of the Pittsburgh Sleep Quality Index. Descriptive statistics, independent t-tests, one-way ANOVA, Pearson correlation analyses, and hierarchical regression analyses were used to analyze the obtained data. Fatigue in the participants was shown to correlate significantly and positively with their sleep qual

背景：疲憊是睡眠障礙主要原因之一，癌症病人主要照顧者易有疲憊感，進而導致睡眠障礙問題；健康欠佳的榮民長者常有負向情緒，使罹癌榮民照顧更具挑戰。目的：探討以病人榮民身分為調節變項對主要照顧者疲憊與睡眠障礙相關性之影響。方法：橫斷式研究設計，隨機抽樣北區某三家醫院共127位癌症病人主要照顧者為研究對象；問卷內容包括癌症病人及主要照顧者人口學之基本資料、台灣版簡明疲憊量表及中文版匹茲堡睡眠品質量表。以描述性統計、獨立t檢定、單因子變異數分析、皮爾森積差相關分析及階層迴歸分析進行資料分析。結果：主要照顧者疲憊與睡眠品質障礙呈顯著正相關（r=.632, p＜.01），且疲憊對睡眠障礙有正向影響（β=.472, p＜.001）。迴歸分析顯示榮民病人身分會正向調節主要照顧者疲憊感與睡眠障礙之間的關係，其正向調節解釋力（b=.148, p＜.001）高於一般民眾病人身分者（b=.091, p＜.001）。結論／實務應用：罹癌病人具榮民身分為影響主要照顧者疲憊與睡眠障礙關聯性之調節變項，護理人員給予病人護理照護的同時，應加強評估主要照顧者的疲憊狀況，提供適當的資源協助。

To explore burden and its related factors among primary caregivers of patients with cancer. This study was conducted in an oncology ward at a medical center in southern Taiwan. A total of 137 dyads of patients with cancer and their primary caregivers were recruited. This cross-sectional correlational study used a structured questionnaire to assess the burden of primary caregivers. Data on patients' basic characteristics and disease profiles were extracted from medical records from January to June 2019. Linear regression analysis was used to identify factors associated with the burden of primary caregivers. The majority of primary caregivers were female (70%) and aged younger than 65 years (85%). Overall, the mean primary caregiver burden score was 38.83 (SD = 12.86), with spiritual burden ranking highest among the four domains assessed. Factors related to overall primary caregiver burden included psychiatric symptoms, daily care hours, patient age, and the lack of rotational support. Hospice and oncology nurses can actively identify psychiatric symptoms in primary caregivers, targeting high-risk groups to provide timely resources or psychiatric referrals, aiming to alleviate future caregiver burden.

Purpose Cancer caregiving, a critical component in the cancer-care model, has deleterious effects on the caregiver’s physical and mental health. The degree to which these negative effects are uniformly experienced by caregivers is unclear; effects may be exacerbated at the end of life when caregiving is intensified. Not all caregivers have the support of an additional involved support person (secondary caregiver). The impact of the secondary caregiver’s absence on the primary caregiver’s well-being is understudied. Methods Terminal cancer patient-caregiver dyads ( n  = 223) were recruited from oncology clinics and followed for six months or until patient death. Longitudinal latent growth models were used to characterize the heterogeneity of caregiver physical health and depressive symptoms; characteristics associated with these trajectories are examined. Results Caregivers were majority female (74%), white (55%) and patient spouses (60%). Two physical health (moderate, stable; initially good, declining) and two depressive symptom (moderate, stable; high, increasing) trajectories were identified. Declining physical health was more likely among caregivers who were healthiest at baseline, had higher levels of education, lower subjective burden, fewer depressive symptoms, cared for patients with fewer functional limitations and reported fewer caregiving tasks rendered by a secondary caregiver. Those with increasing depressive symptoms were more likely to be white, patient’s wife, have higher subjective caregiver burden, lower physical health, and care for a patient with greater functional limitations. Conclusions Decreasing physical health was evident among caregivers who were initially healthier and reported less assistance from secondary caregivers. Increasing depression was seen in white, female spouses with higher subjective burden. Sample heterogeneity revealed hidden groups unexpectedly at risk in the primary cancer caregiver role to which the oncology care team should be alert.

More people are living after a diagnosis of cancer than ever before and now account for around 5% of the US population. The specialty of cancer survivorship has been developing and growing since the mid-1980s, but the term survivor is open to debate by people living with cancer and those caring for them. Regardless of the term used, many ongoing physical, psychological, and social needs affect quality of life for people who are living with cancer and those who have survived the disease. Survivors prefer to have these needs addressed by their oncologist but also want their primary care provider to have a role. However, survivors also believe there are communication and coordination barriers between care providers. The existing method for delivering cancer care is becoming unsustainable and is not adequately configured to deliver high-quality cancer care to this growing population in the USA, especially when confronted with projected health-care shortages by 2020. In this Series paper, we define the term cancer survivor, discuss survivors' ongoing needs and preferences for care over time, and consider the implications for delivering coordinated cancer care in the USA.

Background Informal caregivers play a fundamental role in the care of hematological cancer patients, but less is known about how secondary caregivers are involved. We assessed the presence or absence of a secondary caregiver, the types of caregiving activities performed by primary and secondary caregivers, and examined whether the presence of a secondary caregiver was associated with primary caregiver characteristics and well-being over time. Methods A case series of hematological cancer patient-caregiver dyads ( n  = 171) were recruited from oncology clinics in Virginia and Pennsylvania and followed for 2 years. Multilevel models were developed to examine the associations between the presence of a secondary caregiver and the primary caregivers’ well-being. Results Most (64.9%) primary caregivers reported having secondary caregivers. Multilevel models showed primary caregivers without help had higher baseline mental and physical health, but experienced deteriorating physical health over time, compared to supported primary caregivers. Supported primary caregivers reported improvements in mental health over time that was associated with improvements in physical health. Conclusions Primary caregivers in good physical and mental health at the beginning of their caregiving journey but who have the least assistance from others may be at greatest risk for detrimental physical health effects long term. Attention to the arrangement of caregiving roles (i.e., who provides what care) over time is needed to ensure that caregivers remain healthy and well supported.

Background Lung cancer is typically diagnosed at a late stage. Early presentation and detection of lung cancer symptoms is critical to improving survival but can be clinically complicated and as yet a robust screening method for diagnosis is not available in routine practice. Accordingly, the barriers to help-seeking behaviour and diagnosis need to be considered. This review aimed to document the barriers to early presentation and diagnosis of lung cancer, based on patient and carer perspectives. Methods A systematic review of databases was performed for original, English language articles discussing qualitative research on patient perceived barriers to early presentation and diagnosis of lung cancer. Three major databases were searched: Scopus, PubMed and EBSCOhost. References cited in the selected studies were searched for further relevant articles. Results Fourteen studies met inclusion criteria for review. Barriers were grouped into three categories: healthcare provider and system factors, patient factors and disease factors. Conclusions Studies showed that the most frequently reported barriers to early presentation and diagnosis of lung cancer reported by patients and carers related to poor relationships between GPs and patients, a lack of access to services and care for patients, and a lack of awareness of lung cancer symptoms and treatment. Addressing these barriers offers opportunities by which rates of early diagnosis of lung cancer may be improved.

Significance & Background: Our community cancer center is one of 8 institutions in the United States chosen to participate in a 5-year cooperative grant from the Centers for Disease Control, focused on exploring, understanding, and improving our immunization processes and creating a positive impact in patient outcomes through interventions based on current, established national guidelines and recommendations. The value of immunization as a powerful tool to help patients with cancer improve outcomes is nationally recognized. However, management of immunization care gaps at our practice is generally deferred to primary care providers. This project focuses on the outpatient oncology practitioners and caregivers taking proactive steps in assessing and reconciling immunization care gaps, educating the patients and families, planning and recommending appropriate immunizations, administering vaccines or referring the patient to the primary care, and documenting interventions in the electronic medical record. Purpose: To develop sustainable interventions aimed at making management of immunization care gaps as a standard of care for the outpatient oncology setting at our cancer institute. Interventions: An immunization core team comprised of a Physician Leader, Quality Director, Project Manager, Nurse Practitioner, Clinical Nurse Specialist, and a Nursing Supervisor was organized to help lead the initiatives related to the project. PDSA model was used to guide discoveries and focus on project objectives. A strong collaborative, ongoing partnership between the immunization core team, physician leaders, caregivers, educators, nurses, pharmacists, and ancillary support worked together to address issues and develop interventions. A multi-disciplinary approach using variable methods of education and communication was utilized to address learning gaps and improve on the 3-month PDSA cycles. Surveys offered perspective on project questions and needs. Data was regularly reviewed and reported to the Council of Medical Specialty Societies platform as required by the grant, which guided ongoing and future work on the initiatives. Results: Improvement in the assessment and reconciliation of immunization care gaps as well as administration of vaccines at the cancer institute was established. Variations in practices and revelations of persisting misconceptions and roadblocks to recommendations and administration of vaccines persisted as seen in data review. Discussion: While immunization care gap assessment and reconciliation have improved, opportunities abound in further streamlining processes including onsite administration, patient referral for vaccine administration, immunization ordering, and documentation. Factors influencing vaccine hesitancy also need to be addressed in the system.

Purpose To critically synthesise qualitative research to understand experiences of supportive care in people affected by brain cancer and their informal caregivers. Methods A qualitative systematic review was conducted according to the Joanna Briggs methodology and has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines. Electronic databases were searched by an expert systematic review librarian for all qualitative studies irrespective of research design. All publications were double screened by two reviewers using a pre-determined exclusion and inclusion criteria. The review was managed using Covidence systematic review software. Methodological quality assessment and data extraction were performed. Qualitative findings accompanied by illustrative quotes from included studies were extracted and grouped into categories, which created the overall synthesised findings. Results A total of 33 studies were included which represented a total sample of 671 participants inclusive of 303 patients and 368 informal caregivers. There was a total of 220 individual findings included in this review, which were synthesised into two findings (1) caregivers and patients perceived supports which would have been helpful and (2) caregiver and patient experiences of unmet supportive care needs. Conclusion This review highlighted the suffering and distress caused by brain cancer and associated treatments. Both patients and their informal caregivers experienced disconnect from themselves in renegotiating roles, and a profound sense of loneliness as the physical deterioration of the disease progressed. Both patients and informal caregivers reported similar unmet needs within the current service provision for brain cancer. However, what is apparent is that current cancer services are provided solely for patients, with little or no consideration to the support needs of both the patient and their informal caregiver. Service re-design is needed to improve care coordination with individualised informational support, implementation of holistic needs assessments for both the patients and their caregivers, better community support provision, improved opportunities for emotional care with early referral for palliative care services. Implications for cancer survivors It is recommended that members of the multidisciplinary brain cancer team reflect on these findings to target holistic needs assessments and develop shared self-management care plans for both the patient and the informal caregiver.