Week 2 RF-Quality of life for people living with and beyond cancer Flashcards
What is Cancer?
-There are over 200 different types of cancer.
-Cancer occurs when abnormal cells grow and divide in an uncontrolled way.
-These abnormal cells can grow and multiply over time and cause a malignant tumour.
What is the prevalence of cancer?
-Number of people diagnosed is increasing, number of people dying decreasing - more people surviving after a cancer diagnosis.
-Maddams et al (2012) projections of cancer prevalence - number of cancer survivors in the UK projected to increase by approximately one million per decade from 2010 to 2040.
-By 2040, almost a quarter of people aged at least 65 will be living with and beyond cancer.
-“Living with and beyond cancer” refers to anyone who is having ongoing treatment for their cancer, or is post-treatment.
What is the lifetime risk for cancer?
-Cancer Research UK (CRUK) describe that 1 in 2 people in the UK will be diagnosed with cancer in their lifetime.
-Estimated lifetime risk of being diagnosed with cancer born after 1960 in the UK (Smittenaar et al., 2016):
-1 in 2 (50%) for males
-1 in 2 (45%) for females
What types of cancers are most prevalent?
-Cancer types with highest lifetime risk estimates are those with the highest past, current and projected future incidence.
-Breast, lung and bowel cancers - more common for females.
-Prostate, lung and bowel cancers - more common for males.
-Oral and associated cancers are relatively low in incidence rates.
What are the survival rates for cancer?
-50% of people diagnosed with cancer in England and Wales survive their disease for ten years or more (2010-11).
-Cancer survival has doubled in the last 40 years in the UK.
-It is important to focus on interventions to improve the quality of life for people living with and beyond cancer.
-375,400 new cancer cases (2016-2018)
Which group of cancer patients can experience higher levels of distress and worse coping and social functioning abilities?
-Those with neck and head cancer
-According to Gill et al’s (2012) study looking at psychological distress in cancer patients pre and post treatment – head and neck cancer patients were shown to have the highest complexity and quality of life concerns compared with breast, colorectal or stomach cancer patients (can be from reasons such as self-consciousness with appearance)
Define Quality of life
According to the National Cancer Institute, quality of life is defined as:
“The overall enjoyment of life… measuring aspects of an individual’s sense of well-being and ability to carry out activities of daily living”
What are the 4 different types of concerns related to quality of life for those living with cancer and beyond?
- Functional concerns [Independence, ability to do certain aspects of daily living, work capacity, mobility]
- Physical concerns [Pain, fatigue, sleep problems] e.g., weight loss
- Social concerns [Stigma, relationships, financial]
- Psychological concerns [Stress, anxiety, depression, fear of recurrence]
-Impact on both patient and caregiver/family members
What are the impacts on the Quality of Life in Head and Neck Cancer? (HaNC)
-HaNC - highlighted as one of the most debilitating cancers (Taib et al., 2018).
-Associated with late presentation of symptoms (Brown et al., 2018) - high symptom burden & complex cancer diagnosis.
-Can severely impact patients’ abilities to breathe, swallow & speak (Hutcheson et al., 2012).
-Alters physical appearance, resulting in appearance-related distress (Clarke et al., 2014).
-People may perceive them differently due to appearance
How can the caregiver’s quality of life be impacted by HaNC?
-Quality of life is important to both patients and caregivers.
-Patients with HaNC can often require assistance from family caregivers during treatment & post-treatment.
-Caregivers - shown to experience poorer psychological health & higher levels of anxiety, compared with patients & with the general population (Longacre et al., 2012).
-Fear of recurrence is evident among caregivers and is associated with poorer psychological health outcomes (Longacre et al., 2012).
-Some certain cancers can also increase the risk of developing other cancers which impacts QoL further
Quality of life concerns have led to what interventions?
-Exercise programmes, prehab and rehab.
-Support groups - patient and caregiver led.
-Professional and community education to minimise labelling and stigma.
What is Goffman’s (1968) theory of social stigma?
-Goffman’s theory of social stigma - stigma can be classified as an attribute which is socially discrediting, causing an individual to be stereotyped as ‘rejected’ rather than accepted.
-A variety of factors influence why certain types of cancer are more stigmatized than others – different cancer types have different causes (e.g., smoking), treatments, and outcomes.
-Stigma can lead to - high levels of guilt, self-blame & increased distress.
-Can lead to avoidance behaviour - reluctance to attend appointments – worse outcomes.
-Can be particularly apparent with head and neck cancers due to the link to smoking, drinking and low socioeconomic status (Hashibe et al., 2007; Anantharaman at al., 2011).
-75% of head and neck cancer cases are associated with the factors in the last point therefore there is heavy stigma associated with this particular cancer type
-Avoidance behaviour could even link to social aspects such as friendship
-Neck and head cancer is typically diagnosed in the late stages
-Low incidence rates could potentially be due to those patients not reaching out for a diagnosis/help (e.g., fear of shame after seeing GP who may shun them)
What 5 triggers did Zola (1973) identify 5 which may lead to an individual seeking help?
-Most people seek help when experiencing worrying symptom(s).
-Seeking medical help is not always the case - many people tolerate their symptoms for some time.
- The occurrence of an interpersonal crisis (e.g., death in a family).
- Perceived interference with social or personal relations (e.g., can’t go out).
- Pressure from others to consult (particularly influential).
- Perceived interference with vocational or physical activity (e.g., can’t go for a walk).
- ‘Temporalizing of symptomatology’ – the setting of a deadline, e.g., “If I’m not well by Monday” (also important!).
-Patients experiencing health-seeking behaviour - higher chance of not attending appointments/ adhering to treatment. Complex treatment pathways & stress for patient and caregiver.
What is COM-B?
-There have been frameworks developed to help support healthcare professionals to support patients to change their behaviour.
-COM-B – most widely recognised (Michie et al., 2011).
-Proposes that for behaviour change to occur, a person must have capability, opportunity and motivation to change behaviour (aka COM-B) (but how can healthcare support those who cannot for factor outside of their control?)
-Some patients may need support across all three areas of COM-B some may need just one i.e., some patients may only need support in the motivational aspects
-COM-B is not a solution to all behaviour change challenges.
-Can offer a comprehensive framework when working with patients and understanding when, and how, to facilitate change.
How is physical activity and exercise a good way to boost QoL?
-Exercise interventions have been developed to improve patient outcomes.
-“Exercise as medicine” – research suggests exercise should be considered as important as other treatments for preventing cancer and reducing treatment-related side effects.
-Exercise can reduce the chance of recurrence, decrease the development of co-morbid conditions, and improve overall quality of life (Low et al., 2014).
-1.6 million of the 2 million people living with and beyond cancer in the UK do not achieve recommended levels of physical activity (Macmillan).
-Macmillan have made recommendations on how to encourage patients to be physically active, evidence lacking about effectiveness and implementation, particularly in head and neck cancer.
