ABSTRACT
Background: Pain affects 40-90% of patients with advanced cancer. Supplementing pharmacologic therapy with behavioral skills may improve pain outcomes. We sought to evaluate patients' perspectives of a pain-cognitive behavioral therapy (CBT) mobile health intervention for cancer pain. Method(s): We recruited patients from the Dana-Faber Cancer Institute outpatient palliative care clinic to review the pain-CBT mHealth intervention. Eligible patients were >21 years old, had an incurable solid malignancy, chronic pain related to cancer, and were using opioids for cancer. We excluded hospitalized patients and those with pain from a recent surgery, dementia/delirium, or an opioid use disorder. In individual, qualitative interviews patients reviewed pain-CBT content modified for advanced cancer and mHealth delivery, and provided feedback on the relevance of the content in the context of their own pain. Result(s): Patients (n = 14) reviewed pain-CBT app content and wireframes. Most rated the content and user interface as highly usable, informative, aesthetically pleasing, convenient, and relevant to their experiences. Suggested improvement included revising technical content to increase clarity/ reduce literacy, shortening length of texts, and including additional tracking for daily opioid use. Six subthemes regarding patients' current pain management approaches were identified. Individuals endorsed using physical coping skills including engaging in physical activity and at times struggling to recognize physical limits. Many endorsed utilizing psychological coping such as accepting their pain, reframing thoughts about pain, and using distraction or relaxation to cope. Social support was relevant to coping for almost all patients, and many described COVID-19 distancing guidelines as disruptive. Patients endorsed complex relationships with opioids including guilt related to use or difficulty understanding prescription instructions. Most patients emphasized the relationship between sleep, stress, and pain as central to their pain management, and that they wished their clinicians reviewed the relationship between pain and stress earlier. Conclusion(s): MHealth delivery was viewed as an attractive method to both integrate and deliver behavioral pain management skills with opioid support to alleviate cancer pain. A future pilot study will evaluate the app's feasibility and acceptability in patients with advanced cancer.
ABSTRACT
Introduction: This study aims to look at the trends in our head and neck cancer patient population over the past 5 years with an emphasis on the past 2 years to evaluate how the coronavirus disease 2019 (COVID-19) pandemic has impacted our disparities and availability of care for patients, especially those living in rural areas. An additional aim is to identify existing disparities at our institution in the treatment of head and neck patients and determine solutions to improve patient care. Materials and Methods: A retrospective chart review was performed to identify patients who were consulted and subsequently treated with at least one fraction of radiation therapy at our institution with palliative or curative intent. Patient demographic information was collected including hometown, distance from the cancer centre based on zip-codes and insurance information and type of appointment (in-person or telehealth). Rural-urban continuum codes were used to determine rurality. Results: A total of 490 head and neck cancer patients (n = 490) were treated from 2017 to 2021. When broken down by year, there were no significant trends in patient population regarding travel distance or rurality. Roughly 20-30% of our patients live in rural areas and about 30% have a commute > 50 miles for radiation treatment. A majority of our patients rely on public insurance (68%) with a small percentage of those uninsured (4%). Telehealth visits were rare prior to 2019 and rose to 5 and 2 visits in 2020 and 2021, respectively. Conclusions: Head and neck cancer patients, despite rurality or distance from a cancer centre, may present with alarmingly enough symptoms despite limitations and difficulties with seeking medical attention even during the COVID-19 pandemic in 2020. However, providers must be aware of these potential disparities that exist in the rural population and seek to address these.