Global changes to the chemotherapy service during the covid-19 pandemic

Purpose In response to the COVID-19 pandemic, changes to chemotherapy services were implemented as a means of managing imposed workload strains within health services and protecting patients from contracting COVID-19. Given the rapidly evolving nature of the pandemic many changes were rapidly adopted and were not substantiated by robust evidence. This study aimed to describe the changes adopted internationally to chemotherapy services, which may be used to guide future changes to treatment delivery. Methods A survey was developed to understand the impact of COVID-19 on the delivery of systemic anti-cancer therapies (SACT). It comprised 22 questions and examined the strategies implemented during the pandemic to prioritise and protect patients receiving SACT and the participants’ professional opinion of the strategies employed. The survey was available in English, Spanish and French and was distributed via professional bodies. Results 129 responses were obtained from healthcare professionals working across 17 different countries. 45% of institutions had to implement treatment prioritisation strategies and all hospitals implemented changes in the delivery of treatment, including: reduction in treatments (69%), using less immunosuppressive agents (50%), allowing treatment breaks (14%) and switching to oral therapies (45%). Virtual clinic visits were perceived by participants as the most effective strategy to protect patients. Conclusions The pandemic has forced chemotherapy healthcare professionals to adopt new ways of working by reducing health interactions. Many areas of research are needed following this period, including understanding patients’ perceptions of risks to treatment, utilisation of oral treatments and the impact of treatment breaks on cancer outcomes.

Acknowledging Post-Traumatic Stress Disorder: Treatment Utilisation Amongst Israeli Bedouin and Jewish Combat Veterans

Many veterans coping with combat-post-traumatic stress disorder (PTSD) refrain from seeking psychological treatment. We explored the nature of illness recognition and treatment utilisation in two different cultural groups of Israeli veterans—Bedouin and Jewish. Using qualitative research methods, we interviewed twenty veterans dealing with PTSD (ten Bedouin and ten Jewish) and ten mental health professionals. Participants shared their experiences of symptoms, the ways they coped, and their perception of the costs and benefits of psychological treatment. Two main themes emerged: (i) ‘Veterans’ Perceptions of Their Mental Injury’. In stark contrast to their Jewish counterparts, Bedouin participants described extreme lack of understanding regarding the relationship between their exposure to combat trauma and their distress; (ii) ‘Veterans’ Perceptions of the Mental Health Services’. Bedouin veterans expressed fear of the stigma associated with PTSD and its detrimental social implications, for them and their families. Jewish veterans emphasised the beneficial and informative role of therapy. The findings underscore the impact of different cultural codes on help-seeking behaviours and on the ability to benefit from psychological treatment. It is recommended that mental health practitioners consider cultural backgrounds and individual differences when implementing trauma interventions, to fine-tune their suitability to veterans facing excessive barriers to care.

Help-seeking behaviour of problem gamblers: a narrative review

Background: There is evidence for low rates of help-seeking among problem gamblers. Identifying reasons for and barriers to seeking help is essential for improving help supply and gamblers’ treatment utilisation. The present study examines treatment utilisation of problem or pathological gamblers and reviews the evidence related to motives for and barriers to seeking help. Methods: The databases Medline, PsycInfo, and PubMed were searched for English-, Swedish- and German-language studies published between 2000 and 2017. Furthermore relevant references of included studies were analysed. Results: After exclusion of non-relevant publications 34 journal articles and seven reports covering the prevalence of help-seeking among gamblers or self-reported reasons for/barriers to help-seeking were maintained. The proportion of problem gamblers seeking help was less than 10 % in most studies. Problem severity was found positively associated with treatment attendance. Financial issues, negative emotions and crises were identified as main motives for seeking treatment. Main barriers to seeking treatment were shame, problem denial and lack of treatment availability. The results were similar across the examined studies. Conclusion: Low rates of treatment utilisation by problem gamblers strongly indicate that treatment providers and the society should strive to eliminate structural barriers that hinder gamblers to seek help. To better match problem gamblers´ needs, low-threshold early intervention, increasing knowledge of treatment options and efforts to reduce stigmatisation are important strategies to enhance access to help offers.