International Survey of Psychosocial Care for Cancer Survivors in Low-/Middle- and High-Income Countries: Current Practices, Barriers, and Facilitators to Care.

PurposeThe number of cancer survivors living with and beyond cancer treatment is rising globally. It is fundamental to understand the extent and type of psychosocial care services offered worldwide. We evaluated models of cancer survivorship care, psychosocial care practices in the post-treatment survivorship phase, and barriers/facilitators to delivery of psychosocial care services, including in low- and middle-income countries (LMICs).MethodsThe International Psycho-Oncology Society (IPOS) Survivorship Special Interest Group led a cross-sectional online survey between March and November 2022. Health care professionals and researchers in psycho-oncology were invited through the IPOS global membership, social media, and snowballing. The survey was administered to individuals but included questions related to practices in their country at a national level.ResultsTwo hundred eighty-three respondents from 37 countries participated (40% from LMICs), with a median of 12 years of experience (IQR, 6-20) in the psycho-oncology field. Participants reported that the most common elements of routine survivorship care were related to the prevention/management of recurrences/new cancers (74%), physical late effects (59%), and chronic medical conditions (53%), whereas surveillance/management of psychosocial late effects (27%) and psychosocial/supportive care (25%) were least common. Service availability was more commonly reported in high-income countries (HICs) than LMICs related to reproductive health (29% v 17%), genetic counseling/support (40% v 20%), and identifying/managing distress (39% v 26%) and pain (66% v 48%). Key barriers included providers focusing on treatment not survivorship (57%), medical not psychosocial care (60%), and a lack of allied health providers to deliver psychosocial care (59%).ConclusionThe psychosocial needs of people living with cancer are not adequately available and/or provided in post-treatment survivorship even in HICs, because of barriers at patient, provider, and system levels

The development of a new Quality of Life measure for Japanese female breast cancer patients with lymphoedema

The main research question is to investigate how perceptions of information provision are associated with the Quality of Life. Three studies were conducted, with participants being recruited from self-help groups in Japan.  First a symptom checklist and physical discomfort scale in lymphoedema was developed.  Test-retest reliability and the internal structure of the scale were investigated by a prospective study.  Second, a qualitative study was conducted in order to explore perceptions of lymphoedema and how they were formed in the society.  A dual analytic approach was applied to primary transcripts: thematic analysis and conceptual analysis using symbolic interactionism.  Based on the findings of the conceptual analysis, a psycho-social discomfort scale was developed. Psychometric properties were investigated.  The WHO QoL-BREF Japanese version was used to check criterion validity in a cross-sectional survey study. Test-retest reliabilities of the check list and physical discomfort scale were acceptable.  Perceptions of information provision at diagnosis and loss of strength were associated with reported discomfort. The qualitative analysis revealed cognitive and emotional processes in breast cancer and lymphoedema.  Experiences of lymphoedema were often interpreted in breast cancer contexts.  The third study showed that the &quot;breast cancer&quot; subscales of the psycho-social discomfort scale had good internal consistency, and good convergent and divergent validity.  However, the lymphoedema subscales had a weak internal structure.  ‘Perceptions of information provision’ were associated with the ‘resources to live with breast cancer’ subscale. In conclusion, the validity of the symptom checklist, physical discomfort scales and breast cancer subscales were acceptable.  Since the lymphoedema subscales had a weak internal structure, further work is needed in the development of the measure.</p

Social disclosure about Lymphoedema symptoms: a qualitative study among Japanese breast cancer survivors

Disclosing illness-related problems is the first step in help-seeking. The aim of this qualitative study was to explore Japanese breast cancer (BC) survivors’ decision-making about disclosure of lymphoedema symptoms to people in their social networks. A total of ten women participated in group discussions in Japan. A dual analytic approach, thematic analysis and conceptual analysis, was applied to the transcripts. Two themes (perceived responsibility of social roles within the family and unsupportive reactions to BC from others) affected participants’ decision-making. Support programs for Japanese BC survivors who feel unable to disclose lymphoedema symptoms to family members are suggested

Development of the psycho-social discomfort scale (PsDS): investigation of psychometric properties among Japanese breast cancer survivors

Objective: To develop a new scale to assess psycho-social discomfort in breast cancer (BC) survivors in Japanese society and to investigate its psychometric properties.Method: A total of 248 Japanese BC survivors completed both the Psycho-social Discomfort Scale (PsDS) and WHO Quality of Life BREF Japanese version (WHO QoL-Jp). A principal component factor analysis (with promax rotation) was performed, and internal consistency was examined using Cronbach's alpha. Divergent and convergent validities and criterion validity were examined using the Spearman's R.Results: The factor analysis extracted three factors: ‘internalised stigma (IS)’, ‘social disclosure of BC (SD)’, and ‘psychological resources to live with BC (PR)’. The factors were moderately correlated. The scale had good internal consistency (alpha = 0.80). All sub-scales were inversely correlated with all the domains in the WHO QoL-Jp (r = ?0.09 to ?0.47). BC stage was significantly correlated with the SD sub-scale, and type of surgery was significantly correlated with the IS sub-scale.Conclusions: The PsDS has 25 items. It measures psycho-social discomfort that Japanese BC survivors experienced or were experiencing in their community. It has a simple factor structure, relatively good internal consistency, and a satisfactory divergent validity.<br/

Arm symptoms and QoL in Japanese breast cancer patients

Background: Post-operative arm complications among breast cancer patients are relatively underestimated in clinical settings, but the symptoms may affect quality of life (QoL). Aims: To assess the relationships between lymphoedema symptom-related variables and QoL among Japanese women with breast cancer who had undergone surgery. Methods: A cross-sectional postal survey investigated the relationships between post-operative arm symptom-related variables (specific arm symptoms, physical discomfort, lymphoedema therapy, self-care and years since the onset of symptoms) and QoL. Self-reported questionnaires, including a standardised QoL measure (WHO QoL-BREF Japanese version), were administered to Japanese women with breast cancer. Of 300 respondents, 138 women who reported arm symptoms on the arm of the operated side were eligible for statistical analysis. Results: Pain, arm weakness, poor range of motion and more severe physical discomfort affected physical well-being. Pain and more severe physical discomfort affected psychological well-being, whereas swelling did not affect any domains in the WHO QoL-BREF. Other variables did not affect any domains in this sample. Conclusions: Symptoms other than swelling should not be underestimated in clinical settings. Declaration of interest: None

Positive changes in Japanese breast cancer survivors: a qualitative study

Despite traumatic experiences of cancer, survivors often report positive changes. Since little research has been conducted into such changes among Japanese breast cancer survivors, our knowledge is minimal. This qualitative study aimed to explore the nature of the positive changes among this group. A thematic analysis suggested that participants had experienced seven types of positive change: attitudinal changes towards life, strengthening trust in family and friends, increased appreciation of life, self-development, future perspectives, education for friends, and efforts towards bodily change. Awareness of vulnerability in life, received social support and social comparisons appear to trigger some of the positive changes

Prevention of glucocorticoid-associated osteonecrosis by intravenous administration of mesenchymal stem cells in a rabbit model

Abstract Background Glucocorticoid-associated osteonecrosis is an intractable condition, making the establishment of preventative strategies of particular importance. Recently various studies using mesenchymal stem cells (MSC) have been conducted. Using a rabbit glucocorticoid-associated osteonecrosis model we administered green fluorescent protein (GFP)-labeled MSC intravenously to investigate their effect on osteonecrosis. Methods A rabbit osteonecrosis model in which methylprednisolone (MP) 20 mg/kg was injected into the gluteus of a Japanese white rabbit was used. Simultaneously with MP, MSC labeled with GFP (GFP-labeled MSC) were injected intravenously. Fourteen days later the animals were killed (MSC(+)/MP(+)/14d), femurs were extracted, and the prevalence of osteonecrosis was determined histopathologically. Also, animals were killed 3 days after simultaneous administration of GFP-labeled MSC and MP (MSC(+)/MP(+)/3d), and western blotting (WB) for GFP was performed of the femur, liver, kidney, lung, blood vessel, and vertebra, in addition to immunohistochemical study of femur. As a control for the histopathological study, animals were killed 14 days after MP administration and intravenous vehicle injection (MSC(−)/MP(+)/14d). For WB, animals were killed 3 days after intravenous GFP-labeled MSC administration and vehicle injection into the gluteus (MSC(+)/MP(−)/3d). Results In MSC(−)/MP(+)/14d osteonecrosis was found in 7 of 10 rabbits (70%), while in MSC(+)/MP(+)/14d, partial bone marrow necrosis was found in only 1 rabbit (12.5%); osteonecrosis was not found in 7 of 8 rabbits (p < 0.05). WB showed expression of GFP in the femur, not in the liver, kidney, lung, blood vessel, or vertebra, of MSC(+)/MP(+)/3d; expression of GFP-labeled MSC was absent in the femur of MSC(+)/MP(−)/3d. In the immunohistochemical study of MSC(+)/MP(+)/3d, homing of GFP-labeled MSC was noted perivascularly in the femur, but not in MSC(+)/MP(−)/3d. Conclusions With transvenous MSC administration a significant prophylactic effect against glucocorticoid-associated osteonecrosis was found. Direct administration of MSC to the site of tissue injury requires highly invasive surgery. In contrast, as shown here the simple and hardly invasive intravenous administration of MSC may succeed in preventing osteonecrosis

Intraarticularly-Injected Mesenchymal Stem Cells Stimulate Anti-Inflammatory Molecules and Inhibit Pain Related Protein and Chondrolytic Enzymes in a Monoiodoacetate-Induced Rat Arthritis Model

Persistent inflammation is well known to promote the progression of arthropathy. mesenchymal stem cells (MSCs) have been shown to possess anti-inflammatory properties and tissue differentiation potency. Although the experience so far with the intraarticular administration of mesenchymal stem cell (MSC) to induce cartilage regeneration has been disappointing, MSC implantation is now being attempted using various surgical techniques. Meanwhile, prevention of osteoarthritis (OA) progression and pain control remain important components of the treatment of early-stage OA. We prepared a shoulder arthritis model by injecting monoiodoacetate (MIA) into a rat shoulder, and then investigated the intraarticular administration of MSC from the aspects of the cartilage protective effect associated with their anti-inflammatory property and inhibitory effect on central sensitization of pain. When MIA was administered in this rat shoulder arthritis model, anti-Calcitonin Gene Related Peptide (CGRP) was expressed in the joint and C5 spinal dorsal horn. Moreover, expression of A disintegrin and metalloproteinase with thrombospondin motifs 5 (ADAMTS5), a marker of joint cartilage injury, was similarly elevated following MIA administration. When MSC were injected intraarticularly after MIA, the expression of CGRP in the spinal dorsal horn was significantly deceased, indicating suppression of the central sensitization of pain. The expression of ADAMTS 5 in joint cartilage was also significantly inhibited by MSC administration. In contrast, a significant increase in the expression of TNF-α stimulated gene/protein 6 (TSG-6), an anti-inflammatory and cartilage protective factor shown to be produced and secreted by MSC intraarticularly, was found to extend to the cartilage tissue following MSC administration. In this way, the intraarticular injection of MSC inhibited the central sensitization of pain and increased the expression of the anti-inflammatory and cartilage protective factor TSG-6. As the least invasive conservative strategies possible are desirable in the actual clinical setting, the intraarticular administration of MSC, which appears to be effective for the treatment of pain and cartilage protection in early-stage arthritis, may achieve these aims