Exploring Experiences Among People Diagnosed With Cancer During the COVID-19 Pandemic: A Qualitative Descriptive Study.

OBJECTIVES: To describe the experiences of people diagnosed with cancer during the COVID-19 pandemic. DATA SOURCES: Qualitative data were collected through semistructured interviews conducted with people affected by cancer in the Australian context. Following institutional ethical approval, interviews were conducted over Microsoft Teams and Zoom platforms and complied with confidentiality requirements. Data were transcribed verbatim and analyzed, and emergent themes were developed using thematic analysis to understand patient experiences of cancer care during the COVID-19 pandemic. CONCLUSIONS: The COVID-19 pandemic was disruptive to the daily experiences of supportive care. Four overarching themes were identified related to: 1) the impact on accessing healthcare services, 2) encounters with healthcare professionals, 3) the impact on daily living, and 4) the impact of COVID on psychological well-being. IMPLICATIONS FOR NURSING PRACTICE: As the COVID-19 pandemic held global consequences on cancer practices, it is recommended that nursing and other multidisciplinary healthcare professionals reflect upon these findings, in the context of planning for future pandemics. We encourage further exploration into the sustainability of telehealth services universally, given the issues highlighted in this study.

The unmet supportive care needs of people affected by cancer during the COVID-19 pandemic: an integrative review.

PURPOSE: To critically synthesise evidence regarding the supportive care needs of those living with cancer during the COVID-19 pandemic. METHODS: An integrative systematic review followed a pre-registered protocol, reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Guidelines. We searched three databases (CINAHL, MEDLINE, and APA PsycINFO) using keywords and included all qualitative, quantitative, and mixed methods studies irrespective of research design published between December 2019 and February 2022. All articles were double screened according to a pre-determined eligibility criterion with reference lists of the final included studies checked for further studies. The review process was managed using Covidence systematic review software. Data from the studies were extracted, methodological quality appraisal conducted, and a narrative synthesis conducted. RESULTS: Eighteen publications were included. The findings identified that individuals affected by cancer reported a range of physical, psychological, social, and health system unmet needs during the global pandemic. Unique to the pandemic itself, there was fear of the unknown of the longer-term impact that the pandemic would have on treatment outcomes, cancer care follow-up, and clinical service delays. CONCLUSION: Many individuals living with cancer experienced unmet needs and distress throughout the different waves of the COVID-19 pandemic, irrespective of cancer type, stage, and demographic factors. IMPLICATIONS FOR CANCER SURVIVORS: We recommend clinicians use these findings to identify the individual person-centred needs to optimise recovery as we transition to the post-pandemic cancer care.

Thyrotropin results in euthyroid patients with a past history of hyperthyroidism.

Sensitive TSH levels were measured in 93 euthyroid patients with a past history of hyperthyroidism. Subnormal TSH values were found in 18 out of 75 (24%) patients previously treated with a course of antithyroid drugs, and in 3 out of 18 (17%) post-thyroidectomy patients. These subnormal TSH results are a limitation to the general application of the TSH-first strategy. Twelve months follow-up showed that subnormal TSH values are associated with increased risk of relapse in the antithyroid drug treated group (p less than 0.001). Longer follow-up varies in duration and some late relapses have occurred in drug treated patients with normal baseline TSH levels. To date relapses have occurred in 3 out of 56 normal TSH patients compared with in 6 out of 16 suppressed TSH patients; no thyroidectomy patients have relapsed. Prospective studies are needed to confirm the predictive value of sensitive TSH measurements.

Cerebrospinal fluid B2-microglobulin levels in meningeal involvement by malignancy.

Cerebrospinal fluid (CSF) and serum B2-microglobulin (B2m) levels were measured prospectively in 63 patients with hematological malignancies and 14 patients with solid tumours to evaluate the correlation between elevated levels and malignant infiltration of meninges. Serial CSF B2-m levels were also measured in 18 patients who received prophylactic intrathecal cytotoxic treatment. CSF B2-m levels were significantly higher in patients with central nervous system (CNS) involvement than in those without (p less than 0.001). A CSF B2-m level greater than 1.80 mg/L was closely associated with CNS disease (specificity 96%, sensitivity 76%) and CNS infiltration was also likely when the CSF B2-m level exceeded a simultaneously drawn serum level (specificity 98%, sensitivity 46%). Intrathecal methotrexate prophylaxis resulted in a consistent and significant rise in CSF B2-m levels with an average increase of 96% during a course of intrathecal injections. These results suggest that CSF B2-m levels may not be helpful for predicting early CNS relapse in these patients. However the CSF B2-m level and the corresponding serum B2-m level is a useful adjunct to the cytological diagnosis of CNS involvement by malignancy at presentation. Its value in predicting early CNS relapse and documenting response to CNS treatment requires further clarification.

A method for direct estimation of imprecision profiles, with reference to immunoassay data.

A three-parameter model for directly estimating imprecision profiles from replicated immunoassay results is compared with a six-parameter indirect profile model obtained by the usual method of combining error in the raw response measurements with the slope of the standard curve. Direct estimation is likely to be less reliable when based on the limited data collected from a single assay, and may underestimate variability at high concentrations when many results are clustered at the upper end of the concentration range. However, at concentrations near the assay detection limit (often a region of particular interest), direct estimation is superior to the indirect method if a logistic or related function is used as the standard curve model. Direct estimation of imprecision profiles has useful application whenever the internal details of an assay system are not readily available, for example, in analysis of data collected in external surveys.