Understanding the impact of chemotherapy on dignity for older people and their partners.

PURPOSE: Chemotherapy poses challenges for older patients, with potential comorbidities, mobility and functional problems that may adversely affect their dignity. Patients may struggle with side-effects but fail to inform health professionals, impacting on clinical management and unresolved needs/concerns. This study aims to explore the impact of dignity during chemotherapy for older people and partners. METHODS: A qualitative study using semi-structured interviews of patients/partners following chemotherapy for non-metastatic cancer. Interviews were audio-recorded, transcribed and analysed using qualitative principles/thematic analysis. RESULTS: Twenty patients, aged 65-81, and 10 partners were recruited. 19/20 patients had adjuvant chemotherapy and one neoadjuvant treatment; 12(60%) had breast cancer and 8(40%) colorectal cancer. Four out of 20(20%) patients failed to complete the full course of chemotherapy and 5(25%) had unplanned hospital admissions. Patients/partners reported positive experiences regarding dignity and compassionate care during chemotherapy. Five main themes were associated with dignity: managing chemotherapy side-effects, personal feelings, maintaining independence, stoicism, and 'being lucky'. Although support from family/friends was high, most patients wanted to maintain their independence and did not want to become a burden. In some cases, patients struggled with chemotherapy toxicities yet often failed to inform clinical staff and played down the severity of adverse effects. This reflected their stoicism, coping strategies and motivations to 'just get on with it'. CONCLUSIONS: Dignity is associated with maintaining independence and stoicism in coping with the impact of chemotherapy. However, some patients failed to report severe adverse effects, which has implications for clinical staff managing their care.

The acceptability and feasibility of lay-health led interventions for the prevention and early detection of cancer.

BACKGROUND: US-based evidence suggests that lay-health worker (LHW) interventions can increase awareness around cancer risk-related lifestyles, symptom recognition, and screening programme uptake. The suitability of LHW interventions in the UK and the potential barriers and facilitators for implementation is currently unknown. This study explored the acceptability and feasibility of developing LHW interventions for cancer prevention, screening, and early diagnosis. METHODS: Purposive sampling recruited 5 separate lay groups: (1) completed cancer treatment; (2) friends/family of cancer patients; (3) cancer hospital volunteers; (4) cancer charity volunteers; and (5) members of the public. Audio-recorded focus groups and semi-structured interviews were transcribed for thematic analysis using framework matrices. RESULTS: Forty-one people (66% female, aged 23-84 years) participated. Three main themes are reported: (1) scope of LHW roles, with a clear remit embedded within communities or primary care practices; (2) defining LHW tasks, with a focus on supporting people overcome barriers including lack of cancer symptom knowledge and non-attendance at screening; and (3) clear boundaries, with LHW training and on-going support from healthcare staff seen as key for intervention success. All groups were uncomfortable about having lifestyle-related risk conversations and potentially inflicting guilt. The post-treatment group expressed less concern about the possible emotional impact of discussing cancer symptoms, compared with the other groups. CONCLUSIONS: LHW interventions to promote early diagnosis or screening were generally considered acceptable in a UK context. LHW interventions focussing on reducing cancer risk may be less feasible.