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

Adapting care for older cancer patients during the COVID-19 pandemic: Recommendations from the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group

The COVID-19 pandemic poses a barrier to equal and evidence-based management of cancer in older adults. The International Society of Geriatric Oncology (SIOG) formed a panel of experts to develop consensus recommendations on the implications of the pandemic on several aspects of cancer care in this age group including geriatric assessment (GA), surgery, radiotherapy, systemic treatment, palliative care and research. Age and cancer diagnosis are significant predictors of adverse outcomes of the COVID-19 infection. In this setting, GA is particularly valuable to drive decision-making. GA may aid estimating physiologic reserve and adaptive capability, assessing risk-benefits of either providing or temporarily withholding treatments, and determining patient preferences to help inform treatment decisions. In a resource-constrained setting, geriatric screening tools may be administered remotely to identify patients requiring comprehensive GA. Tele-health is also crucial to ensure adequate continuity of care and minimize the risk of infection exposure. In general, therapeutic decisions should favor the most effective and least invasive approach with the lowest risk of adverse outcomes. In selected cases, this might require deferring or omitting surgery, radiotherapy or systemic treatments especially where benefits are marginal and alternative safe therapeutic options are available. Ongoing research is necessary to expand knowledge of the management of cancer in older adults. However, the pandemic presents a significant barrier and efforts should be made to ensure equitable access to clinical trials and prospective data collection to elucidate the outcomes of COVID-19 in this population

The importance of disease associations and concomitant therapy for the long-term management of psoriasis patients

It is well established that several inflammatory-type conditions, such as arthritis, diabetes, cardiovascular disease, and irritable bowel disease exist comorbidly and at an increased incidence in patients with psoriasis. Psoriasis and other associated diseases are thought to share common inflammatory pathways. Conditions such as these, with similar pathogenic mechanisms involving cytokine dysregulation, are referred to as immune-mediated inflammatory diseases (IMIDs). Considerable evidence for the genetic basis of cormobidities in psoriasis exists. The WHO has reported that the occurrence of chronic diseases, including IMIDs, are a rising global burden. In addition, conditions linked with psoriasis have been associated with increasing rates of considerable morbidity and mortality. The presence of comorbid conditions in psoriasis patients has important implications for clinical management. QoL, direct health care expenditures and pharmacokinetics of concomitant therapies are impacted by the presence of comorbid conditions. For example, methotrexate is contraindicated in hepatic impairment, while patients on ciclosporin should be monitored for kidney function. In addition, some agents, such as beta blockers, lithium, synthetic antimalarial drugs, NSAIDs and tetracycline antibiotics, have been implicated in the initiation or exacerbation of psoriasis. Consequently, collaboration between physicians in different specialties is essential to ensuring that psoriasis treatment benefits the patient without exacerbating associated conditions

Falls in Community-dwelling Older Adults with Cancer: Impact on Cancer Treatment, Circumstances, Assessment, Management, and Reporting

Falls are major health issues among older adults and even more so in older cancer patients due to cancer and its treatment. Knowledge on circumstances surrounding falls and fear of falling is vital for understanding how various factors may precipitate falls and for informing development of effective interventions to prevent falls in this population. Delays in cancer treatment caused by fall injuries may have significant implications on disease trajectory and patient outcomes. However, a systematic review found gaps in knowledge in terms of how falls impact cancer treatment in this population. The aim of this research was to explore the circumstances of falls and fear of falling in community-dwelling older adults with cancer, as well as to examine how falls are assessed, reported, and managed in outpatient oncology clinics, and how falls might impact cancer treatment in this population. A cross-sectional study using a convergent-parallel mixed-methods design was conducted at the Princess Margaret Cancer Centre in Toronto, Canada. Data were collected by self-reported survey, chart review, and open-ended interviews. One hundred older adults (aged >=65) and 14 oncologists participated in this study. Falls were not commonly reported by patients to their oncologists (43%), and were rarely assessed by oncologists (7%). One in twenty who fall appears to lead to change in cancer management. However, falls were not commonly reported by patients nor prioritized by oncologists. Older patients perceived falls as minor incidents not worth mentioning (57%). When a fall was reported, oncologists’ actions included determining cause of falls (64%), asking circumstances of falls (36%), and referrals (29%). Oncologists indicated that the majority of older patients were not forthcoming in reporting falls. Circumstances of falls seem to be similar to those in the general geriatric population. This research shows that incorporating routine fall assessment in oncology clinic appointments may help identify those at risk for falls so that timely interventions can be triggered. Additionally, strategies for fall prevention and management used in the general geriatric population can potentially benefit this population as well. Attention may be warranted regarding medication review, health-teaching on fall safety, home evaluation, and referral for balance training.Ph.D

Exploring perceptions of technology use to support self-management amongst adults with cancer and multimorbidities

Peer ReviewedIntroduction Globally, cancer is a leading cause of death and impacts older adults more than any other age group. Self-management is defined as how patients with chronic conditions address and cope with symptoms, treatments, and lifestyle adjustments. Many self-management interventions are moving to an online format. Our objective was to investigate and describe how older adults engage technology for cancer self-management, particularly as they live with multimorbidity. Methods We used a qualitative descriptive approach and semi-structured interviews with older adults with cancer who had at least one other chronic condition. Data were analyzed using descriptive thematic analysis. Results We found that older adults are interested in, if not already, engaging with technology and internet searching to manage their cancer diagnosis and treatment. Data were grouped into two themes: 1) Surfing for answers to take control, and 2) Confidence in technology supports competence in self-management. Participants felt they might need extra support learning how to craft a search, filter facts, and digest information from the internet to manage their cancer. Conclusions Older adults are interested in engaging technology to support self-management. Developing an understanding of what older adults desire from technology to support their cancer and multimorbidities could improve their confidence and wellbeing

A Survey of Older Adults’ 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’, 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 ≥ 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: 65–93), 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’ 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

The Impact of Cognitive Impairment on Treatment Toxicity, Treatment Completion, and Survival among Older Adults Receiving Chemotherapy: A Systematic Review

Cognitive impairment (CI) is common among older adults with cancer, but its effect on cancer outcomes is not known. This systematic review sought to identify research investigating clinical endpoints (toxicity risk, treatment completion, and survival) of chemotherapy treatment in those with baseline CI. A systematic search of five databases (inception to March 2021) was conducted. Eligible studies included randomized trials, prospective studies, and retrospective studies in which the sample or a subgroup were older adults (aged ≥ 65) screened positive for CI prior to receiving chemotherapy. Risk of bias assessment was performed using the Quality in Prognosis Studies (QUIPS) tool. Twenty-three articles were included. Sample sizes ranged from n = 31 to 703. There was heterogeneity of cancer sites, screening tools and cut-offs used to ascertain CI, and proportion of patients with CI within study samples. Severity of CI and corresponding proportion of each level within study samples were unclear in all but one study. Among studies investigating CI in a qualified multivariable model, statistically significant findings were found in 4/6 studies on survival and in 1/1 study on nonhematological toxicity. The lack of robust evidence indicates a need for further research on the role of CI in predicting survival, treatment completion, and toxicity among older adults receiving chemotherapy, and the potential implications that could shape treatment decisions.Applied Science, Faculty ofMedicine, Faculty ofNon UBCMedical Oncology, Division ofMedicine, Department ofNursing, School ofReviewedFacultyResearche

Falls in older patients with cancer: Nursing and Allied Health Group of International Society of Geriatric Oncology review paper

BACKGROUND: Falls are a major health issue in older adults and are of greater concern among those with cancer due to effects of cancer and its treatments. This paper provides an overview of current literature on fall screening/assessment and interventions and a succinct summary of recommendations for oncology nurses to support this vulnerable population. METHODS: A comprehensive search for literature reviews on falls was conducted in Medline and CINAHL. A comprehensive Internet search was also performed for known guidelines on fall prevention and/or management published within the past 10 years. Search results were compared, contrasted, and summarized to develop clinical recommendations for nurses working with older adults with cancer. Levels of evidence were reported based on the Oxford Centre for Evidence-based Medicine. RESULTS: Six guidelines and 17 systematic reviews were identified. Having a history of falls was the most commonly identified fall risk factor/predictor. Multifactorial intervention and exercise appear to be the most commonly recommended. No fall assessment tools were consistently recommended as a reliable means of identifying those at risk for falls. CONCLUSION: Assessing older patients for falls and fall risks is an important first step to identify those who may require further follow-up and intervention. Oncology nurses play a key role in optimizing health outcomes of older adults with cancer - through the use of evidence-based information, such as presented in this publication - and have the capacity to help reduce fall risks during and after treatment through information provision, advocacy, support, and promotion of physical activity.status: publishe