Breast cancer patient experiences of perioperative distress and anxiety: A qualitative study

Grocott, Bronwen; Reynolds, Kristin; Logan, Gabrielle S.; Hebbard, Pamela; El‐Gabalawy, Renée

doi:10.1016/j.ejon.2023.102299

Cited by 6 publications

(4 citation statements)

References 43 publications

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“…This will allow us to disentangle the potential additive effect of immersion that exists only in VR applications. Finally, recent research by our group [ 72 ] and others demonstrates that PSA for oncological surgery relates to a range of factors, including uncertainty of the health trajectory, recovery [ 79 , 80 ], and the psychosocial implications of surgery. Our prototype intervention only targets 1 component of PSA (ie, exposure to the OR and information regarding induction), which may not result in meaningful reductions among those with PSA related to other factors.…”

Section: Discussionmentioning

confidence: 99%

“…These measures include a background sociodemographic questionnaire (eg, assessing age, marital status, diagnosis, type of surgery, previous history of surgeries, and mental health diagnoses); the Preoperative Intrusive Thoughts Inventory (PITI) [ 61 ]; the Amsterdam Preoperative Anxiety Information Scale (APAIS) [ 62 ]; the NCCN Distress Thermometer (a visual analog scale; also adapted for anxiety) [ 63 , 64 ]; the Peritraumatic Distress Inventory [ 65 ]; the Primary Care Screen for Posttraumatic Stress Disorder Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [ 66 ]; the Brief Resilient Coping Scale (BRCS) [ 67 ]; and the Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety [ 68 ], depression [ 68 ], global health [ 69 ], fatigue [ 70 ], and emotional support scales [ 71 ]. The sociodemographic data collected were informed by the methodology used in a previous study by Grocott et al [ 72 ] that itself informed the current methodological approach. All mental health symptom scales are empirically validated self-report measures in various health populations, languages, and cultures.…”

Section: Methodsmentioning

confidence: 99%

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An Immersive Virtual Reality Intervention for Preoperative Anxiety and Distress Among Adults Undergoing Oncological Surgery: Protocol for a 3-Phase Development and Feasibility Trial

El-Gabalawy,

Sommer,

Hebbard

et al. 2024

JMIR Res Protoc

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Background Preoperative state anxiety (PSA) is distress and anxiety directly associated with perioperative events. PSA is associated with negative postoperative outcomes such as longer hospital length of stay, increased pain and opioid use, and higher rates of rehospitalization. Psychological prehabilitation, such as education, exposure to hospital environments, and relaxation strategies, has been shown to mitigate PSA; however, there are limited skilled personnel to deliver such interventions in clinical practice. Immersive virtual reality (VR) has the potential for greater accessibility and enhanced integration into an immersive and interactive experience. VR is rarely used in the preoperative setting, but similar forms of stress inoculation training involving exposure to stressful events have improved psychological preparation in contexts such as military deployment. Objective This study seeks to develop and investigate a targeted PSA intervention in patients undergoing oncological surgery using a single preoperative VR exposure. The primary objectives are to (1) develop a novel VR program for patients undergoing oncological surgery with general anesthesia; (2) assess the feasibility, including acceptability, of a single exposure to this intervention; (3) assess the feasibility, including acceptability, of outcome measures of PSA; and (4) use these results to refine the VR content and outcome measures for a larger trial. A secondary objective is to preliminarily assess the clinical utility of the intervention for PSA. Methods This study comprises 3 phases. Phase 1 (completed) involved the development of a VR prototype targeting PSA, using multidisciplinary iterative input. Phase 2 (data collection completed) involves examining the feasibility aspects of the VR intervention. This randomized feasibility trial involves assessing the novel VR preoperative intervention compared to a VR control (ie, nature trek) condition and a treatment-as-usual group among patients undergoing breast cancer surgery. Phase 3 will involve refining the prototype based on feasibility findings and input from people with lived experience for a future clinical trial, using focus groups with participants from phase 2. Results This study was funded in March 2019. Phase 1 was completed in April 2020. Phase 2 data collection was completed in January 2024 and data analysis is ongoing. Focus groups were completed in February 2024. Both the feasibility study and focus groups will contribute to further refinement of the initial VR prototype (phase 3), with the final simulation to be completed by mid-2024. Conclusions The findings from this work will contribute to the limited body of research examining feasible and broadly accessible interventions for PSA. Knowledge gained from this research will contribute to the final development of a novel VR intervention to be tested in a large population of patients with cancer before surgery in a randomized clinical trial. Trial Registration ClinicalTrials.gov NCT04544618; https://www.clinicaltrials.gov/study/NCT04544618 International Registered Report Identifier (IRRID) DERR1-10.2196/55692

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

An Immersive Virtual Reality Intervention for Preoperative Anxiety and Distress Among Adults Undergoing Oncological Surgery: Protocol for a 3-Phase Development and Feasibility Trial

El-Gabalawy,

Sommer,

Hebbard

et al. 2024

JMIR Res Protoc

Self Cite

View full text Add to dashboard Cite

show abstract

“…45 It has been reported that psychological disorders and low quality of life occur more frequently during periods of surgery, chemotherapy, and radiotherapy. [46][47][48] A study has identified a positive correlation between depression status and chemotherapy-induced myelosuppression in patients with breast cancer. This finding implies that monitoring depression status before chemotherapy may facilitate better management of adverse events.…”

Section: Discussionmentioning

confidence: 99%

Modulatory Effects of XIAOPI Formula on CXCL1 and Selected Outcomes in Triple-Negative Breast Cancer: A Randomized Controlled Clinical Trial

Guo,

Hong,

Wang

et al. 2024

BCTT

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Background Triple-negative breast cancer (TNBC) is the most aggressive malignancy. Psychological distress and elevated CXCL1 level have been reported to be closely associated with the poor prognosis and quality of life of patients with TNBC. In preclinical studies using xenograft mouse models, XIAOPI formula, a nationally approved drug prescribed to patients at high risk for breast cancer, inhibited CXCL1 expression and improved survival. Traditional Chinese medicine has unique advantages in improving patients’ emotional disorders and quality of life. However, the impact of XIAOPI formula on the serum level of CXCL1, psychological distress, and quality of life among patients with TNBC is currently unknown. Methods In this study, we designed a randomized, double-blind, placebo-controlled trial. Patients with TNBC were randomly assigned to receive either the XIAOPI formula or a placebo for three months. The primary outcomes include serum CXCL1 expression, Self-Rating Anxiety Scale (SAS), and the Self-Rating Depression Scale (SDS). Secondary outcomes included the Pittsburgh Sleep Quality Index (PSQI) and the Functional Assessment of Cancer Therapy-Breast (FACT-B). Results A total of 60 patients with TNBC were enrolled in the investigation. The results showed that the XIAOPI formula significantly decreased CXCL1 expression compared with the control group. Moreover, in comparison to the placebo, the XIAOPI formula increased FACT-B scores while decreasing SDS, SAS, and PSQI scores. Conclusion In patients with TNBC, XIAOPI formula may be effective in reducing CXCL1 levels, enhancing psychological well-being, and quality of life. While our research offers a natural alternative therapy that may enhance the prognosis of TNBC, future validation of its therapeutic effects will require large-scale, long-term clinical trials. Clinical Registration Number Registration website: www.chictr.org.cn , Registration date: 2018-1-19, Registration number: ChiCTR1800014535.

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“…This will allow us to disentangle the potential additive effect of immersion that exists only in VR applications. Finally, recent research by our group [72] El-Gabalawy et al JMIR RESEARCH PROTOCOLS XSL • FO RenderX others demonstrates that PSA for oncological surgery relates to a range of factors, including uncertainty of the health trajectory, recovery [79,80], and the psychosocial implications of surgery. Our prototype intervention only targets 1 component of PSA (ie, exposure to the OR and information regarding induction), which may not result in meaningful reductions among those with PSA related to other factors.…”

Section: Limitationsmentioning

confidence: 96%

An Immersive Virtual Reality Intervention for Preoperative Anxiety and Distress Among Adults Undergoing Oncological Surgery: Protocol for a 3-Phase Development and Feasibility Trial (Preprint)

El-Gabalawy,

Sommer,

Hebbard

et al. 2023

Preprint

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BACKGROUND Preoperative state anxiety (PSA) is distress and anxiety directly associated to perioperative events. PSA is associated with negative postoperative outcomes like longer hospital length of stay, increased pain, higher opioid use, and higher rates of re-hospitalization. Psychological prehabilitation such as education, exposure to hospital environments, and relaxation, has been shown to mitigate PSA, however there are limited skilled personnel in clinical practice. Immersive virtual reality (VR) has the potential for greater accessibility and enhanced integration into an immersive and interactive virtual experience. VR is rarely used in the preoperative setting, but similar forms of stress inoculation training involving exposure to stressful events have improved subjects’ psychological preparation in contexts such as military deployment. This study seeks to develop and investigate a targeted PSA intervention in patients undergoing an oncologic surgical procedure using a single preoperative exposure to a VR program. OBJECTIVE The primary objectives are (i) to develop a novel VR program for patients undergoing oncological surgery with general anesthesia, (ii) to assess the feasibility and acceptability of a single exposure to this intervention in the preoperative period, (iii) to assess the feasibility and acceptability of outcomes measures of perioperative anxiety and distress and (iv) to use these results to refine the VR content and outcome measures for a larger trial of the VR exposure. A secondary objective is to preliminarily assess the clinical utility of the intervention for PSA. METHODS This study comprises 3 phases. Phase 1 (completed) involved the development of a VR prototype targeting PSA, using multidisciplinary iterative input. Phase 2 (ongoing) involves examining the feasibility aspects of the VR intervention. This randomized feasibility trial involves assessing the novel VR preoperative intervention compared to a control VR condition and treatment as usual group among breast cancer surgery patients. Phase 3 will involve refining of the prototype based on feasibility findings and input from people with lived experience for a future clinical trial, employing focus groups with participants from Phase 2. RESULTS This study was funded in March 2019. Phase 1 was completed in April 2020. Phase 2 is currently underway and data collection will be completed in January 2024. Focus groups will also be completed in January 2024. Both the feasibility study and focus groups will contribute to further refinement of the initial VR prototype (Phase 3) in Winter of 2023/2024. CONCLUSIONS The findings from this initiative will contribute to the limited body of research examining feasible and broadly accessible interventions for PSA. Knowledge gained from this research will contribute to the final development of a novel VR intervention to be tested in a large population of oncological patients prior to surgery in a randomized clinical trial. CLINICALTRIAL ClinicalTrials.gov NCT04544618 (Phase 2 only)

show abstract

Breast cancer patient experiences of perioperative distress and anxiety: A qualitative study

Cited by 6 publications

References 43 publications

An Immersive Virtual Reality Intervention for Preoperative Anxiety and Distress Among Adults Undergoing Oncological Surgery: Protocol for a 3-Phase Development and Feasibility Trial

An Immersive Virtual Reality Intervention for Preoperative Anxiety and Distress Among Adults Undergoing Oncological Surgery: Protocol for a 3-Phase Development and Feasibility Trial

Modulatory Effects of XIAOPI Formula on CXCL1 and Selected Outcomes in Triple-Negative Breast Cancer: A Randomized Controlled Clinical Trial

An Immersive Virtual Reality Intervention for Preoperative Anxiety and Distress Among Adults Undergoing Oncological Surgery: Protocol for a 3-Phase Development and Feasibility Trial (Preprint)

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