eHealth literacy among older adults living with cancer and their caregivers: A scoping review

Introduction Over 90% of people living with cancer access information online to inform healthcare decisions. Older adults with cancer are also increasingly adopting electronic healthcare services, or eHealth, particularly with the rapid transition to virtual care amidst the pandemic. Therefore, the purpose of this review is to understand the level of eHealth literacy among older adults with cancer and their caregivers, as well as any barriers and facilitators in terms of accessing, comprehending, and implementing eHealth information. Methods This scoping review was guided by Arksey and O'Malley methodology and PRISMA ScR guidelines. Comprehensive searches for the concepts of “eHealth Literacy” and “cancer” were performed in MEDLINE, Scopus, CINAHL, PsycINFO, AMED and EMBASE, from 2000 to 2021. We used descriptive quantitative and thematic analysis to analyze the literature. Results Of the 6076 articles screened by two reviewers, eleven articles were included. Quantitative findings suggest older adults with cancer and their caregivers have low self-perceived eHealth literacy and less confidence evaluating online health information for cancer decision-making. Low socioeconomic status, lower education levels, rapid expansion of digital applications, broadband access, reduced familiarity, and frequency of use were cited as prominent barriers. eHealth literacy appears to be positively correlated with caregivers seeking a second opinion, awareness of treatment options, shared decision making, and trust in the health care system. Conclusion With the growing reliance on eHealth tools, developing credible digital health applications that require minimal internet navigation skills, patient education, and collaborative efforts to address access and affordability are urgently warranted

SF3B1-mutant MDS as a distinct disease subtype:a proposal from the International Working Group for the Prognosis of MDS

The 2016 revision of the World Health Organization classification of tumors of hematopoietic and lymphoid tissues is characterized by a closer integration of morphology and molecular genetics. Notwithstanding, the myelodysplastic syndrome (MDS) with isolated del(5q) remains so far the only MDS subtype defined by a genetic abnormality. Approximately half of MDS patients carry somatic mutations in spliceosome genes, with SF3B1 being the most commonly mutated one. SF3B1 mutation identifies a condition characterized by ring sideroblasts (RS), ineffective erythropoiesis, and indolent clinical course. A large body of evidence supports recognition of SF3B1-mutant MDSas a distinct nosologic entity. To further validate this notion, we interrogated the data set of the International Working Group for the Prognosis of MDS (IWG-PM). Based on the findings of our analyses, we propose the following diagnostic criteria for SF3B1-mutant MDS: (1) cytopenia as defined by standard hematologic values, (2) somatic SF3B1 mutation, (3) morphologic dysplasia (with or without RS), and (4) bone marrow blasts <5% and peripheral blood blasts <1%. Selected concomitant genetic lesions represent exclusion criteria for the proposed entity. In patients with clonal cytopenia of undetermined significance, SF3B1 mutation is almost invariably associated with subsequent development of overtMDS with RS, suggesting that this genetic lesion might provide presumptive evidence of MDS in the setting of persistent unexplained cytopenia. Diagnosis of SF3B1-mutant MDS has considerable clinical implications in terms of risk stratification and therapeutic decision making. In fact, this condition has a relatively good prognosis and may respond to luspatercept with abolishment of the transfusion requirement. (Blood. 2020;136(2):157-170)

TP53 mutation status divides myelodysplastic syndromes with complex karyotypes into distinct prognostic subgroups

Risk stratification is critical in the care of patients with myelodysplastic syndromes (MDS). Approximately 10% have a complex karyotype (CK), defined as more than two cytogenetic abnormalities, which is a highly adverse prognostic marker. However, CK-MDS can carry a wide range of chromosomal abnormalities and somatic mutations. To refine risk stratification of CK-MDS patients, we examined data from 359 CK-MDS patients shared by the International Working Group for MDS. Mutations were underrepresented with the exception of TP53 mutations, identified in 55% of patients. TP53 mutated patients had even fewer co-mutated genes but were enriched for the del(5q) chromosomal abnormality (p 10%), abnormal 3q, abnormal 9, and monosomy 7 as having the greatest survival risk. The poor risk associated with CK-MDS is driven by its association with prognostically adverse TP53 mutations and can be refined by considering clinical and karyotype features

Implications of TP53 allelic state for genome stability, clinical presentation and outcomes in myelodysplastic syndromes

Tumor protein p53 (TP53) is the most frequently mutated gene in cancer1,2. In patients with myelodysplastic syndromes (MDS), TP53 mutations are associated with high-risk disease3,4, rapid transformation to acute myeloid leukemia (AML)5, resistance to conventional therapies6–8 and dismal outcomes9. Consistent with the tumor-suppressive role of TP53, patients harbor both mono- and biallelic mutations10. However, the biological and clinical implications of TP53 allelic state have not been fully investigated in MDS or any other cancer type. We analyzed 3,324 patients with MDS for TP53 mutations and allelic imbalances and delineated two subsets of patients with distinct phenotypes and outcomes. One-third of TP53-mutated patients had monoallelic mutations whereas two-thirds had multiple hits (multi-hit) consistent with biallelic targeting. Established associations with complex karyotype, few co-occurring mutations, high-risk presentation and poor outcomes were specific to multi-hit patients only. TP53 multi-hit state predicted risk of death and leukemic transformation independently of the Revised International Prognostic Scoring System (IPSS-R)11. Surprisingly, monoallelic patients did not differ from TP53 wild-type patients in outcomes and response to therapy. This study shows that consideration of TP53 allelic state is critical for diagnostic and prognostic precision in MDS as well as in future correlative studies of treatment response

A Survey of Older Adults&rsquo; Self-Managing Cancer

Background: Older adults living with cancer can experience significant challenges in managing their cancer treatment[s], care, and health. Cancer self-management is much discussed in the research literature, but less is known about the perceptions and experiences of older adults&rsquo;, including their self-management capacities and challenges. This study explored the factors that supported and hindered cancer self-management for older Canadian adults living with cancer. Methods: We conducted a 17-item population-based telephone survey in the Canadian province of British Columbia among older adults (age &ge; 65) living with cancer. Descriptive and inferential statistics were used to analyze quantitative data and thematic analysis for open-text responses. Results: 129 older adults participated in the study (median age 76, range: 65&ndash;93), of which 51% were living with at least one other chronic illness. 20% reported challenges managing their cancer treatment and appointments, while only ~4% reported financial barriers to managing cancer. We organized the findings around enabling and encumbering factors to older adults cancer self-management. The main encumbering factors to self-management included health system and personal factors (physical and emotional challenges + travel). Whereas enablers included: access to interpersonal support, helpful care team, interpersonal support and individual mindset. Conclusions: Considering factors which enable or encumber older adults&rsquo; cancer self-management is critical to supporting the growing aging population in the work required to manage cancer treatment and navigate cancer services. Our findings may guide the development of tailored resources for bolstering effectual self-management for older Canadians living with cancer

Internet Cancer Information Use by Newly Diagnosed Individuals and Interactions With the Health System

Nearly 40% of Canadians will be diagnosed with cancer in their lifetime, and people with cancer are increasingly turning to the Internet to bolster support and information received from health-care providers. However, little is known about the role of the Internet in patients’ interactions with the health-care system. The goals of this study are (1) to qualitatively explore the content of commonly used websites from a holistic nursing perspective, (2) to explore the prompts to use the Internet and how it informs the ways patients utilize and interact with health services, and (3) to document the types of Internet resources and amounts of usage. This study is guided by a constructivist mixed methods design. Interpretive description will guide the overarching qualitative component, including an analysis of data from commonly used websites and interviews with 16 newly diagnosed individuals. Open-ended interviews will clarify, through exploration, the role of the Internet in participants’ health system interactions. A survey of Internet use will add insight and depth about where, when, and how participants use the Internet. All interviews and website data will be analyzed using thematic analysis. Descriptive statistics will illustrate a summary of Internet usage. Triangulation of findings will provide oncology nurses and interdisciplinary team members with insight into how patients’ use of the Internet informs their use of health services. Methodologically, this study advances the use of qualitative methods for websites analysis, on which relatively little has been documented

Impact of COVID-19 on care of older adults with cancer: a narrative synthesis of reviews, guidelines and recommendations

Purpose of review The aim of this study was to summarize the literature on the impact of COVID-19 on older adults with cancer, including both the impacts of COVID-19 diagnosis on older adults with cancer and the implications of the pandemic on cancer care via a synthesis of reviews, guidelines and other relevant literature. Recent findings Our synthesis of systematic reviews demonstrates that older adults with cancer are prone to greater morbidity and mortality when experiencing concurrent COVID-19 infection. Current evidence related to the association between anticancer treatment and COVID-19 prognosis for older adults with cancer is conflicting. Guidelines and recommendations advocate for preventive measures against COVID-19; the uptake of telemedicine and virtual care; encourage vaccination for older adults with cancer; and the use of geriatric assessment. Summary The COVID-19 virus itself may be particularly deleterious for older adults with cancer. However, the health system and social impact of the pandemic, including global disruptions to the healthcare system and related impacts to the delivery of cancer care services, have equally important consequences

The promise of virtual navigation in cancer care: Insights from patients and health care providers

Virtual navigation (VN) in health care is a proactive process by which patients obtain information and support via Internet resources to manage their illness demands. The objective of this analysis was to explore converging and diverging perspectives of key stakeholders: patients with cancer and Health Care Providers (HCPs), about a cancer-related VN tool called the Oncology Interactive Navigator (OIN™). A qualitative secondary analysis was performed combining data sets from two prior studies exploring perspectives of VN among patients (study 1, n=20) and HCPs (study 2, n=13). An inductive approach was used to explore converging and diverging views across groups. Findings explore how patients’ and HCPs’ views converge and diverge and the processes necessary to ensure optimal uptake of VN innovations in cancer care

Les promesses de la navigation virtuelle dans les soins du cancer : perspectives des patients et des fournisseurs de soins de santé

La navigation virtuelle (NV) dans le domaine des soins de santé est un processus proactif par lequel les patients obtiennent de l’information et du soutien grâce à des ressources sur Internet afin de gérer les exigences découlant de leur maladie. L’objectif de la présente analyse était d’explorer les points de vue convergents et divergents des principaux intervenants, c’est-à-dire les patients atteints de cancer et les fournisseurs de soins de santé (FSS), au sujet de l’outil de NV Oncology Interactive Navigator (OINMC), conçu spécialement pour les patients atteints de cancer. Une analyse qualitative secondaire a été réalisée dans le but de combiner des ensembles de données recueillies dans le cadre de deux études précédentes qui exploraient les points de vue des patients sur la NV (étude 1, n = 20) et des FSS (étude 2, n = 13). Une approche inductive a été utilisée pour examiner les opinions convergentes et divergentes au sein des groupes. Les conclusions présentent les similarités et les différences entre les points de vue des patients et des FSS, ainsi que le processus à adopter pour utiliser de manière optimale les innovations de la navigation virtuelle dans les soins du cancer