Changing health behaviour with rehabilitation in thoracic cancer: a systematic review and synthesis.

Abstract

Objectives

International guidelines recommend that rehabilitation be offered to people with thoracic cancer to improve symptoms, function and quality of life. When rehabilitation interventions require a change in behaviour, the use of theory and behaviour change techniques (BCTs) enhance participation. Our objective was to systematically identify BCTs and examine their use in relation to the Capability,Opportunity,Motivation-Behaviour model and known enablers and barriers to engagement in this population.

Method

Bibliographic databases and grey literature were searched for controlled trials of rehabilitation interventions for adults with lung cancer or mesothelioma, with no limits on language or date. Data on the application of behavioural change theory and BCTs were extracted, categorized using the BCT Taxonomy (v1) and described according to the 'Capability, Opportunity, Motivation-Behaviour' model.

Results

Twenty-seven studies of exercise (n=15) and symptom self-management (n=12) interventions were identified. Four studies reported use of behavioural change theory, one study used symptom theory. Across studies, a mean (range) of 7 (1-18) BCTs were used, representing 26 of 93 possible BCTs included in the taxonomy. Most frequent enabling BCTs were 'instructions on how to perform behaviours' (74%), 'behavioural practice' (74%) and 'action planning' (70%). BCTs to address barriers were less frequent and included 'information about health consequences' (22%), and 'verbal persuasion about capability' (7%) to change perceptions about benefits, burden and harms.

Conclusion

The application of behavioural change tools appears sub-optimal in this group of patients. Explicit use of BCTs targeting behavioural components upon which outcomes depend may improve the uptake and effectiveness of rehabilitation interventions.

http://ift.tt/2EU19Ck

“I don't want to take chances.”: A qualitative exploration of surgical decision making in young breast cancer survivors

Abstract

Objective

Young women with unilateral breast cancer are increasingly choosing contralateral prophylactic mastectomy (CPM), despite its limited medical benefit for most women. The purpose of this study was to better understand this choice through a qualitative exploration of surgical decision-making in young survivors, including how issues particular to younger women affected their decision and the post-surgical experience.

Methods

Women age ≤40 years with stage 0-III breast cancer, 1-3 years from diagnosis who had undergone breast cancer surgery were recruited to participate. Four focus groups were conducted: two with women who had bilateral mastectomy and two with women who kept their contralateral breast. Focus groups were recorded and transcribed with identifiers removed. Emergent themes were identified by thematic content analysis using NVivo 11.

Results

Of the twenty participants, median age at diagnosis was 37 years. Emergent themes were categorized into the following domains: 1) emotions/feelings surrounding surgery/decision about surgery; 2) factors affecting the decision; 3) communication and interaction with the healthcare team; 4) impact on post-surgical life and recovery; 5) support needs. Young women who chose CPM often were concerned about a future breast event, despite this low risk, suggesting some gain peace of mind by choosing CPM. Young survivors also had many physical and emotional concerns after surgery for which they did not always feel prepared.

Conclusions

Informational resources and decision aids may enhance patient-doctor communication and help young survivors better understand risk and manage expectations surrounding short and longer-term physical and emotional effects after surgery.

http://ift.tt/2FrBLFi

Increased incidence of inguinal hernia in offspring of female survivors of childhood central nervous system tumors

Abstract

Female survivors of childhood central nervous system (CNS) tumors experience an increased risk of infertility and various pregnancy complications. We aimed to explore whether the incidence of inguinal hernia could be higher in offspring of female CNS tumor survivors as compared to the general population. Girls who were younger than 15 years of age and diagnosed with CNS tumors between 1958 and 2013 were identified from the Swedish Cancer Registry. By linking with the Swedish Medical Birth Registry, we identified 580 children who were born to mothers of CNS tumor survivors. After 9662 person-years of follow-up, 23 of them were diagnosed with inguinal hernia, giving an incidence rate (IR) of 2.4 per 1000 person-years, whereas the IR was 1.2 for the matched controls. Cox regression analysis was used to calculate the hazard ratio (HR) of inguinal hernia.After adjusting for some confounding factors, the incidence of inguinal hernia was significantly increased with a HR of 1.92 (95%CI 1.08-3.41). The association was predominant in offspring whose mothers were diagnosed with CNS tumors at the age of 10 and older, and with CNS tumors located in the brain. This article is protected by copyright. All rights reserved.

http://ift.tt/2GFnHY3

Increased incidence of inguinal hernia in offspring of female survivors of childhood central nervous system tumors

Abstract

Female survivors of childhood central nervous system (CNS) tumors experience an increased risk of infertility and various pregnancy complications. We aimed to explore whether the incidence of inguinal hernia could be higher in offspring of female CNS tumor survivors as compared to the general population. Girls who were younger than 15 years of age and diagnosed with CNS tumors between 1958 and 2013 were identified from the Swedish Cancer Registry. By linking with the Swedish Medical Birth Registry, we identified 580 children who were born to mothers of CNS tumor survivors. After 9662 person-years of follow-up, 23 of them were diagnosed with inguinal hernia, giving an incidence rate (IR) of 2.4 per 1000 person-years, whereas the IR was 1.2 for the matched controls. Cox regression analysis was used to calculate the hazard ratio (HR) of inguinal hernia.After adjusting for some confounding factors, the incidence of inguinal hernia was significantly increased with a HR of 1.92 (95%CI 1.08-3.41). The association was predominant in offspring whose mothers were diagnosed with CNS tumors at the age of 10 and older, and with CNS tumors located in the brain. This article is protected by copyright. All rights reserved.

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Web-based counseling for families with parental cancer: a case report

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Web-based counseling for families with parental cancer: a case report

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Severe hypophosphataemia: a rare cause of postoperative muscle weakness

We report a case of severe generalised muscle weakness in a 66-year-old man who underwent revision of left knee arthroplasty. On postoperative day 1, he developed non-focal muscle weakness and shortness of breath which progressed over a 6-hour period. Serum phosphorus level was severely low at 0.5 mg/dL, along with mild degree of hypokalaemia, hypocalcaemia and hypomagnesaemia. His symptoms completely resolved after emergent phosphorus replacement. The authors believe this case is of educational interest to physicians as generalised muscle weakness is an uncommon presentation of severe hypophosphataemia. In a postoperative setting, hypophosphataemia is often multifactorial, thought to result from combination of perioperative catecholamine surge, administration of saline, diuretics, glucose and antacids, poor oral intake and respiratory alkalosis secondary to pain. We report this case to raise awareness among physicians on severe phosphate imbalance as the primary aetiology for acute generalised muscle weakness and respiratory failure, especially after a surgery.

http://ift.tt/2oxmcUi