Skip to main content
Top
Published in: Supportive Care in Cancer 1/2018

01-01-2018 | Original Article

Do carer’s levels of unmet needs change over time when caring for patients diagnosed with high-grade glioma and how are these needs correlated with distress?

Authors: G. K. B. Halkett, E. A. Lobb, T. Shaw, M. M. Sinclair, L. Miller, E. Hovey, A. K. Nowak

Published in: Supportive Care in Cancer | Issue 1/2018

Login to get access

Abstract

Purpose

The aim of the current study was to determine how carer needs changed longitudinally and understand associations between unmet needs and distress.

Methods

Family carers of patients with high-grade glioma (HGG) were recruited. Carers completed questionnaires during patients’ chemoradiotherapy (T1), 3 months (T2) and 6 months (T3) including the following: the Distress Thermometer, the General Health Questionnaire-12, the Partner and Carer Supportive Care (PCS) Needs Scale and its supplement the Access to Services Needs Scale and the Brain Tumour Specific Supportive Care Needs Scale. Linear latent growth models were applied.

Results

The time 1 questionnaire was completed by 118 carers; 70 carers provided responses at time 3. While the mean numbers of elevated (moderate to high) needs remained stable over time, the specific needs changed. The most frequently reported PCS needs included the impact of caring on the carer’s working life or usual activities, finding more accessible parking, making life decisions in the context of uncertainty, reducing stress in the patient’s life and understanding the patient’s experience. The most frequently reported need unique to carers of a brain tumour patient was for information on adjusting to cognitive changes in the patient. Other prominent needs included managing difficult aspects of the patient’s behaviour and adjusting to changes in the patient’s personality, both of which increased over time. Higher numbers of unmet needs were associated cross-sectionally with higher distress levels.

Conclusion

Carers of people with HGG remain highly distressed and their needs evolve over time, indicating a requirement for ongoing evaluation of unmet needs and interventions to address carer psychological morbidities.
Appendix
Available only for authorised users
Literature
1.
go back to reference Gorlia T, Delattre JY, Brandes AA, Kros JM, Taphoorn MJ, Kouwenhoven MC, Bernsen HJ, Frenay M, Tijssen CC, Lacombe D, van den Bent MJ (2013) New clinical, pathological and molecular prognostic models and calculators in patients with locally diagnosed anaplastic oligodendroglioma or oligoastrocytoma. A prognostic factor analysis of European Organisation for Research and Treatment of Cancer Brain Tumour Group Study 26951. Eur J Cancer 49(16):3477–3485. doi:10.1016/j.ejca.2013.06.039 PubMedCrossRef Gorlia T, Delattre JY, Brandes AA, Kros JM, Taphoorn MJ, Kouwenhoven MC, Bernsen HJ, Frenay M, Tijssen CC, Lacombe D, van den Bent MJ (2013) New clinical, pathological and molecular prognostic models and calculators in patients with locally diagnosed anaplastic oligodendroglioma or oligoastrocytoma. A prognostic factor analysis of European Organisation for Research and Treatment of Cancer Brain Tumour Group Study 26951. Eur J Cancer 49(16):3477–3485. doi:10.​1016/​j.​ejca.​2013.​06.​039 PubMedCrossRef
2.
go back to reference Stupp R, Mason W, van den Bent M, Weller M, Fisher B, Taphoorn M, Belanger K, Brandes A (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352(10):987–996PubMedCrossRef Stupp R, Mason W, van den Bent M, Weller M, Fisher B, Taphoorn M, Belanger K, Brandes A (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352(10):987–996PubMedCrossRef
3.
go back to reference Perry JR, Laperriere N, O’Callaghan CJ, Brandes AA, Menten J, Phillips C, Fay M, Nishikawa R, Cairncross JG, Roa W, Osoba D, Rossiter JP, Sahgal A, Hirte H, Laigle-Donadey F, Franceschi E, Chinot O, Golfinopoulos V, Fariselli L, Wick A, Feuvret L, Back M, Tills M, Winch C, Baumert BG, Wick W, Ding K, Mason WP, Trial I (2017) Short-course radiation plus temozolomide in elderly patients with glioblastoma. N Engl J Med 376(11):1027–1037. doi:10.1056/NEJMoa1611977 PubMedCrossRef Perry JR, Laperriere N, O’Callaghan CJ, Brandes AA, Menten J, Phillips C, Fay M, Nishikawa R, Cairncross JG, Roa W, Osoba D, Rossiter JP, Sahgal A, Hirte H, Laigle-Donadey F, Franceschi E, Chinot O, Golfinopoulos V, Fariselli L, Wick A, Feuvret L, Back M, Tills M, Winch C, Baumert BG, Wick W, Ding K, Mason WP, Trial I (2017) Short-course radiation plus temozolomide in elderly patients with glioblastoma. N Engl J Med 376(11):1027–1037. doi:10.​1056/​NEJMoa1611977 PubMedCrossRef
5.
go back to reference McConigley R, Halkett G, Lobb E, Nowak A (2010) Caring for someone with high-grade glioma: a time of rapid change for caregivers. Palliat Med 24(5):473–479PubMedCrossRef McConigley R, Halkett G, Lobb E, Nowak A (2010) Caring for someone with high-grade glioma: a time of rapid change for caregivers. Palliat Med 24(5):473–479PubMedCrossRef
6.
go back to reference Piil K, Juhler M, Jakobsen J, Jarden M (2015) Daily life experiences of patients with a high-grade glioma and their caregivers: a longitudinal exploration of rehabilitation and supportive care needs. J Neurosci Nurs 47(5):271–284. doi:10.1097/JNN.0000000000000158 PubMedCrossRef Piil K, Juhler M, Jakobsen J, Jarden M (2015) Daily life experiences of patients with a high-grade glioma and their caregivers: a longitudinal exploration of rehabilitation and supportive care needs. J Neurosci Nurs 47(5):271–284. doi:10.​1097/​JNN.​0000000000000158​ PubMedCrossRef
8.
go back to reference Muñoz C, Juarez G, Muñoz ML, Portnow J, Fineman I, Badie B, Mamelak A, Ferrell B (2008) The quality of life of patients with malignant gliomas and their caregivers. Soc Work Health Care 47(4):455–478PubMedCrossRef Muñoz C, Juarez G, Muñoz ML, Portnow J, Fineman I, Badie B, Mamelak A, Ferrell B (2008) The quality of life of patients with malignant gliomas and their caregivers. Soc Work Health Care 47(4):455–478PubMedCrossRef
9.
go back to reference Thomas C, Morris SM, Harman JC (2002) Companions through cancer: the care given by informal carers in cancer contexts. Soc Sci Med 54(4):529–544PubMedCrossRef Thomas C, Morris SM, Harman JC (2002) Companions through cancer: the care given by informal carers in cancer contexts. Soc Sci Med 54(4):529–544PubMedCrossRef
10.
go back to reference Schmer C, Ward-Smith P, Latham S, Salacz M (2008) When a family member has a malignant brain tumor: the caregiver perspective. J Neurosci Nurs 40(2):78–84PubMedCrossRef Schmer C, Ward-Smith P, Latham S, Salacz M (2008) When a family member has a malignant brain tumor: the caregiver perspective. J Neurosci Nurs 40(2):78–84PubMedCrossRef
11.
go back to reference Sizoo EM, Pasman HR, Dirven L, Marosi C, Grisold W, Stockhammer G, Egeter J, Grant R, Chang S, Heimans JJ, Deliens L, Reijneveld JC, Taphoorn MJ (2014) The end-of-life phase of high-grade glioma patients: a systematic review. Support Care Cancer 22(3):847–857. doi:10.1007/s00520-013-2088-9 PubMedCrossRef Sizoo EM, Pasman HR, Dirven L, Marosi C, Grisold W, Stockhammer G, Egeter J, Grant R, Chang S, Heimans JJ, Deliens L, Reijneveld JC, Taphoorn MJ (2014) The end-of-life phase of high-grade glioma patients: a systematic review. Support Care Cancer 22(3):847–857. doi:10.​1007/​s00520-013-2088-9 PubMedCrossRef
13.
go back to reference Keir S, Calhoun-Eagan R, Swartz U, Friedman H (2008) Screening for distress in patients with brain cancer. Psychooncology 17(6):621–625PubMedCrossRef Keir S, Calhoun-Eagan R, Swartz U, Friedman H (2008) Screening for distress in patients with brain cancer. Psychooncology 17(6):621–625PubMedCrossRef
14.
go back to reference Rooney AG, McNamara S, Mackinnon M, Fraser M, Rampling R, Carson A, Grant R (2013) The frequency, longitudinal course, clinical associations, and causes of emotional distress during primary treatment of cerebral glioma. Neuro-Oncology 15(5):635–643. doi:10.1093/neuonc/not009 PubMedPubMedCentralCrossRef Rooney AG, McNamara S, Mackinnon M, Fraser M, Rampling R, Carson A, Grant R (2013) The frequency, longitudinal course, clinical associations, and causes of emotional distress during primary treatment of cerebral glioma. Neuro-Oncology 15(5):635–643. doi:10.​1093/​neuonc/​not009 PubMedPubMedCentralCrossRef
18.
go back to reference Long A, Halkett G, Lobb E, Shaw T, Hovey E, Nowak A (2016) Carers of patients with high-grade glioma report high levels of distress, unmet needs, and psychological morbidity during patient chemoradiotherapy. Neuro Oncol Pract 3(2):105–112CrossRef Long A, Halkett G, Lobb E, Shaw T, Hovey E, Nowak A (2016) Carers of patients with high-grade glioma report high levels of distress, unmet needs, and psychological morbidity during patient chemoradiotherapy. Neuro Oncol Pract 3(2):105–112CrossRef
19.
go back to reference Halkett GK, Lobb EA, Shaw T, Sinclair MM, Miller L, Hovey E, Nowak AK (2017) Distress and psychological morbidity do not reduce over time in carers of patients with high-grade glioma. Support Care Cancer 25(3):887–893. doi:10.1007/s00520-016-3478-6 PubMedCrossRef Halkett GK, Lobb EA, Shaw T, Sinclair MM, Miller L, Hovey E, Nowak AK (2017) Distress and psychological morbidity do not reduce over time in carers of patients with high-grade glioma. Support Care Cancer 25(3):887–893. doi:10.​1007/​s00520-016-3478-6 PubMedCrossRef
21.
go back to reference Boele FW, Heimans JJ, Aaronson NK, Taphoorn MJ, Postma TJ, Reijneveld JC, Klein M (2013) Health-related quality of life of significant others of patients with malignant CNS versus non-CNS tumors: a comparative study. J Neuro-Oncol 115(1):87–94. doi:10.1007/s11060-013-1198-z CrossRef Boele FW, Heimans JJ, Aaronson NK, Taphoorn MJ, Postma TJ, Reijneveld JC, Klein M (2013) Health-related quality of life of significant others of patients with malignant CNS versus non-CNS tumors: a comparative study. J Neuro-Oncol 115(1):87–94. doi:10.​1007/​s11060-013-1198-z CrossRef
23.
go back to reference Jacobs DI, Kumthekar P, Stell BV, Grimm SA, Rademaker AW, Rice L, Chandler JP, Muro K, Marymont M, Helenowski IB, Wagner LI, Raizer JJ (2014) Concordance of patient and caregiver reports in evaluating quality of life in patients with malignant gliomas and an assessment of caregiver burden. Neuro-oncology Practice 1(2):47–54. doi:10.1093/nop/npu004 PubMedPubMedCentralCrossRef Jacobs DI, Kumthekar P, Stell BV, Grimm SA, Rademaker AW, Rice L, Chandler JP, Muro K, Marymont M, Helenowski IB, Wagner LI, Raizer JJ (2014) Concordance of patient and caregiver reports in evaluating quality of life in patients with malignant gliomas and an assessment of caregiver burden. Neuro-oncology Practice 1(2):47–54. doi:10.​1093/​nop/​npu004 PubMedPubMedCentralCrossRef
24.
go back to reference Sherwood PR, Given BA, Given CW, Schiffman RF, Murman DL, Lovely M, von Eye A, Rogers LR, Remer S (2006) Predictors of distress in caregivers of persons with a primary malignant brain tumor. Research in Nursing & Health 29(2):105–120. doi:10.1002/nur.20116 CrossRef Sherwood PR, Given BA, Given CW, Schiffman RF, Murman DL, Lovely M, von Eye A, Rogers LR, Remer S (2006) Predictors of distress in caregivers of persons with a primary malignant brain tumor. Research in Nursing & Health 29(2):105–120. doi:10.​1002/​nur.​20116 CrossRef
26.
go back to reference Parvataneni R, Polley M-Y, Freeman T, Lamborn K, Prados M, Butowski N, Liu R, Clarke J, Page M, Rabbitt J (2011) Identifying the needs of brain tumor patients and their caregivers. J Neuro-Oncol 104(3):737–744CrossRef Parvataneni R, Polley M-Y, Freeman T, Lamborn K, Prados M, Butowski N, Liu R, Clarke J, Page M, Rabbitt J (2011) Identifying the needs of brain tumor patients and their caregivers. J Neuro-Oncol 104(3):737–744CrossRef
27.
go back to reference Janda M, Steginga S, Dunn J, Langbecker D, Walker D, Eakin E (2008) Unmet supportive care needs and interest in services among patients with a brain tumour and their carers. Patient Educ Couns 71(2):251–258PubMedCrossRef Janda M, Steginga S, Dunn J, Langbecker D, Walker D, Eakin E (2008) Unmet supportive care needs and interest in services among patients with a brain tumour and their carers. Patient Educ Couns 71(2):251–258PubMedCrossRef
28.
go back to reference Collins A, Lethborg C, Brand C, Gold M, Moore G, Sundararajan V, Murphy M, Philip J (2014) The challenges and suffering of caring for people with primary malignant glioma: qualitative perspectives on improving current supportive and palliative care practices. BMJ Support Palliat Care 4(1):68–76. doi:10.1136/bmjspcare-2012-000419 PubMedCrossRef Collins A, Lethborg C, Brand C, Gold M, Moore G, Sundararajan V, Murphy M, Philip J (2014) The challenges and suffering of caring for people with primary malignant glioma: qualitative perspectives on improving current supportive and palliative care practices. BMJ Support Palliat Care 4(1):68–76. doi:10.​1136/​bmjspcare-2012-000419 PubMedCrossRef
30.
go back to reference Halkett G, Lobb E, Oldham L, Nowak A (2010) Information and support needs of patients with high grade glioma. Patient Educ Couns 79(1):112–119PubMedCrossRef Halkett G, Lobb E, Oldham L, Nowak A (2010) Information and support needs of patients with high grade glioma. Patient Educ Couns 79(1):112–119PubMedCrossRef
32.
go back to reference Moore G, Collins A, Brand C, Gold M, Lethborg C, Murphy M, Sundararajan V, Philip J (2013) Palliative and supportive care needs of patients with high-grade glioma and their carers: a systematic review of qualitative literature. Patient Educ Couns 91(2):141–153. doi:10.1016/j.pec.2012.11.002 PubMedCrossRef Moore G, Collins A, Brand C, Gold M, Lethborg C, Murphy M, Sundararajan V, Philip J (2013) Palliative and supportive care needs of patients with high-grade glioma and their carers: a systematic review of qualitative literature. Patient Educ Couns 91(2):141–153. doi:10.​1016/​j.​pec.​2012.​11.​002 PubMedCrossRef
33.
go back to reference Sterckx W, Coolbrandt A, Dierckx de Casterle B, Van den Heede K, Decruyenaere M, Borgenon S, Mees A, Clement P (2013) The impact of a high-grade glioma on everyday life: a systematic review from the patient’s and caregiver’s perspective. Eur J Oncol Nurs 17(1):107–117. doi:10.1016/j.ejon.2012.04.006 PubMedCrossRef Sterckx W, Coolbrandt A, Dierckx de Casterle B, Van den Heede K, Decruyenaere M, Borgenon S, Mees A, Clement P (2013) The impact of a high-grade glioma on everyday life: a systematic review from the patient’s and caregiver’s perspective. Eur J Oncol Nurs 17(1):107–117. doi:10.​1016/​j.​ejon.​2012.​04.​006 PubMedCrossRef
34.
go back to reference Zwahlen D, Hagenbuch N, Carley MI, Recklitis CJ, Buchi S (2008) Screening cancer patients’ families with the distress thermometer (DT): a validation study. Psychooncology 17(10):959–966PubMedCrossRef Zwahlen D, Hagenbuch N, Carley MI, Recklitis CJ, Buchi S (2008) Screening cancer patients’ families with the distress thermometer (DT): a validation study. Psychooncology 17(10):959–966PubMedCrossRef
35.
go back to reference Gessler S, Low J, Daniells E, Williams R, Brough V, Tookman A, Jones L (2008) Screening for distress in cancer patients: is the distress thermometer a valid measure in the UK and does it measure change over time? A prospective validation study. Psychooncology 17(6):538–547. doi:10.1002/pon.1273 PubMedCrossRef Gessler S, Low J, Daniells E, Williams R, Brough V, Tookman A, Jones L (2008) Screening for distress in cancer patients: is the distress thermometer a valid measure in the UK and does it measure change over time? A prospective validation study. Psychooncology 17(6):538–547. doi:10.​1002/​pon.​1273 PubMedCrossRef
36.
go back to reference Goldberg DP, Gater R, Sartorius N, Ustun T, Piccinelli M, Gureje O, Rutter C (1997) The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 27(1):191–197CrossRef Goldberg DP, Gater R, Sartorius N, Ustun T, Piccinelli M, Gureje O, Rutter C (1997) The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 27(1):191–197CrossRef
37.
go back to reference Gao F, Luo N, Thumboo J, Fones C, Li S, Cheung Y (2004) Does the 12-item General Health Questionnaire contain multiple factors and do we need them? Health Qual Life Outcomes 2:63PubMedPubMedCentralCrossRef Gao F, Luo N, Thumboo J, Fones C, Li S, Cheung Y (2004) Does the 12-item General Health Questionnaire contain multiple factors and do we need them? Health Qual Life Outcomes 2:63PubMedPubMedCentralCrossRef
38.
go back to reference Girgis A, Lambert S, Lecathelinais C (2011) The supportive care needs survey for partners and caregivers of cancer survivors: development and psychometric evaluation. Psychooncology 20(4):387–393PubMedCrossRef Girgis A, Lambert S, Lecathelinais C (2011) The supportive care needs survey for partners and caregivers of cancer survivors: development and psychometric evaluation. Psychooncology 20(4):387–393PubMedCrossRef
39.
go back to reference Schlomer GL, Bauman S, Card NA (2010) Best practices for missing data management in counseling psychology. J Couns Psychol 57(1):1PubMedCrossRef Schlomer GL, Bauman S, Card NA (2010) Best practices for missing data management in counseling psychology. J Couns Psychol 57(1):1PubMedCrossRef
40.
go back to reference Girgis A, Lambert SD, McElduff P, Bonevski B, Lecathelinais C, Boyes A, Stacey F (2013) Some things change, some things stay the same: a longitudinal analysis of cancer caregivers’ unmet supportive care needs. Psychooncology 22(7):1557–1564. doi:10.1002/pon.3166 PubMedCrossRef Girgis A, Lambert SD, McElduff P, Bonevski B, Lecathelinais C, Boyes A, Stacey F (2013) Some things change, some things stay the same: a longitudinal analysis of cancer caregivers’ unmet supportive care needs. Psychooncology 22(7):1557–1564. doi:10.​1002/​pon.​3166 PubMedCrossRef
41.
go back to reference Oberoi DV, White V, Jefford M, Giles GG, Bolton D, Davis I, Winship I, Prince HM, Millar J, Harrison S, Kay A, Hill D (2016) Caregivers’ information needs and their ‘experiences of care’ during treatment are associated with elevated anxiety and depression: a cross-sectional study of the caregivers of renal cancer survivors. Support Care Cancer 24(10):4177–4186. doi:10.1007/s00520-016-3245-8 PubMedCrossRef Oberoi DV, White V, Jefford M, Giles GG, Bolton D, Davis I, Winship I, Prince HM, Millar J, Harrison S, Kay A, Hill D (2016) Caregivers’ information needs and their ‘experiences of care’ during treatment are associated with elevated anxiety and depression: a cross-sectional study of the caregivers of renal cancer survivors. Support Care Cancer 24(10):4177–4186. doi:10.​1007/​s00520-016-3245-8 PubMedCrossRef
42.
go back to reference Butow PN, Price MA, Bell ML, Webb PM, de Fazio A, Australian Ovarian Cancer Study G, Australian Ovarian Cancer Study Quality Of Life Study I, Friedlander M (2014) Caring for women with ovarian cancer in the last year of life: a longitudinal study of caregiver quality of life, distress and unmet needs. Gynecol Oncol 132(3):690–697. doi:10.1016/j.ygyno.2014.01.002 PubMedCrossRef Butow PN, Price MA, Bell ML, Webb PM, de Fazio A, Australian Ovarian Cancer Study G, Australian Ovarian Cancer Study Quality Of Life Study I, Friedlander M (2014) Caring for women with ovarian cancer in the last year of life: a longitudinal study of caregiver quality of life, distress and unmet needs. Gynecol Oncol 132(3):690–697. doi:10.​1016/​j.​ygyno.​2014.​01.​002 PubMedCrossRef
44.
go back to reference Boele F, Hoeben W, Hilverda K, Lenting J, Calis A, Sizoo EM, Collette E, Heimans JJ, Taphoorn MJ, Reigneveld J, Klein M (2013) Enhancing quality of life and mastery of informal caregivers of high-grade glioma patients: a randomised controlled trial. J Neuro Oncol 111(3):303–311CrossRef Boele F, Hoeben W, Hilverda K, Lenting J, Calis A, Sizoo EM, Collette E, Heimans JJ, Taphoorn MJ, Reigneveld J, Klein M (2013) Enhancing quality of life and mastery of informal caregivers of high-grade glioma patients: a randomised controlled trial. J Neuro Oncol 111(3):303–311CrossRef
45.
go back to reference Halkett GK, Lobb EA, Miller L, Shaw T, Moorin R, Long A, King A, Clarke J, Fewster S, Nowak AK (2017) Feasibility testing and refinement of a supportive educational intervention for Carers of patients with high-grade glioma—a pilot study. J Cancer Educ. doi:10.1007/s13187-017-1175-x CrossRef Halkett GK, Lobb EA, Miller L, Shaw T, Moorin R, Long A, King A, Clarke J, Fewster S, Nowak AK (2017) Feasibility testing and refinement of a supportive educational intervention for Carers of patients with high-grade glioma—a pilot study. J Cancer Educ. doi:10.​1007/​s13187-017-1175-x CrossRef
46.
go back to reference Halkett GK, Lobb EA, Miller L, Phillips JL, Shaw T, Moorin R, Long A, King A, Clarke J, Fewster S, Hudson P, Agar M, Nowak AK (2015) Protocol for the Care-IS Trial: a randomised controlled trial of a supportive educational intervention for carers of patients with high-grade glioma (HGG). BMJ Open 5(10):e009477. doi:10.1136/bmjopen-2015-009477 PubMedPubMedCentralCrossRef Halkett GK, Lobb EA, Miller L, Phillips JL, Shaw T, Moorin R, Long A, King A, Clarke J, Fewster S, Hudson P, Agar M, Nowak AK (2015) Protocol for the Care-IS Trial: a randomised controlled trial of a supportive educational intervention for carers of patients with high-grade glioma (HGG). BMJ Open 5(10):e009477. doi:10.​1136/​bmjopen-2015-009477 PubMedPubMedCentralCrossRef
Metadata
Title
Do carer’s levels of unmet needs change over time when caring for patients diagnosed with high-grade glioma and how are these needs correlated with distress?
Authors
G. K. B. Halkett
E. A. Lobb
T. Shaw
M. M. Sinclair
L. Miller
E. Hovey
A. K. Nowak
Publication date
01-01-2018
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 1/2018
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-017-3846-x

Other articles of this Issue 1/2018

Supportive Care in Cancer 1/2018 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine