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Liu S, Cai Y, Yao S, Chai J, Jia Y, Ge H, Huang R, Li A, Cheng H. Perceived social support mediates cancer and living meaningfully intervention effects on quality of life after breast cancer surgery. Future Oncol 2024:1-13. [PMID: 39011969 DOI: 10.1080/14796694.2024.2370237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 06/17/2024] [Indexed: 07/17/2024] Open
Abstract
Aim: To explore the role of perceived social support in enhancing psychological resilience and quality of life in postoperative breast cancer patients. Materials & methods: The Managing Cancer and Living Meaningfully (CALM) intervention was used to improve indicators such as psychological resilience in breast cancer patients, while the role of perceived social support in this was assessed. Results: The intervention group exhibited significant improvements compared with the control group in psychological resilience (F = 9.059, p < 0.01). The analysis showed that increased social support in the control group partly mediated the link between psychological resilience and quality of life. Conclusion: CALM improves overall well-being, indicating that incorporating it into standard care for post-mastectomy patients can positively impact their mental health.
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Affiliation(s)
- Shaochun Liu
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Yinlian Cai
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Senbang Yao
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Jiaying Chai
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Yingxue Jia
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Han Ge
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Runze Huang
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Anlong Li
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Huaidong Cheng
- Shenzhen Clinical Medical School of Southern Medical University, Shenzhen 518000, Guangdong, China
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, Guangdong, China
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
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Chen F, Ou M, Xiao Z, Xu X. The relationship between fear of cancer recurrence and death anxiety among Chinese cancer patients: the serial mediation model. BMC Psychiatry 2024; 24:416. [PMID: 38834978 DOI: 10.1186/s12888-024-05819-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 05/06/2024] [Indexed: 06/06/2024] Open
Abstract
AIMS This study aims to investigate the association between fear of cancer recurrence (FCR) and death anxiety (DA) among Chinese cancer patients, while considering the mediating effects of experiential avoidance (EA) and meaning in life (MIL). METHODS From February to June 2023, convenience sampling was used to select newly diagnosed cancer patients in a tertiary Cancer Hospital in Chinese Hunan Province as the survey objects. A total of 436 cancer patients completed the Fear of Cancer Recurrence Inventory, the Meaning in Life Questionnaire, the Acceptance and Action Questionnaire-II, and the Templer's death anxiety scale. Descriptive analysis and Pearson correlation analysis were conducted using SPSS 28.0 software. Serial mediation analysis was performed by Hayes' PROCESS macro. RESULTS Gender, age, educational level, marital status, residence, occupation, per capita monthly household income, tumor type, and cancer stage were controlled in the model. The results revealed that fear of cancer recurrence had a significant direct effect on death anxiety (Effect = 0.075, 95% CI: 0.064 to 0.087). Additionally, three indirect pathways were identified: (1) through experiential avoidance (Effect = 0.037, 95% CI: 0.026 to 0.049), (2) through meaning in life (Effect = 0.022, 95% CI: 0.014 to 0.031), and (3) through the serial mediators involving meaning in life and experiential avoidance (Effect = 0.016, 95% CI: 0.010 to 0.023). The total indirect effect of the three mediation paths was 63.56%. CONCLUSION Fear of cancer recurrence is a significant psychological distress experienced by cancer patients, which not only directly contributes to death anxiety but also may triggers changes, such as experiential avoidance and meaning in life. Ultimately, this comprehensive psychological distress leads to death anxiety.
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Affiliation(s)
- Furong Chen
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, 410013, China
- School of Nursing, University of South China, Hengyang, Hunan, 421001, China
| | - Meijun Ou
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, 410013, China
| | - Zhirui Xiao
- School of Nursing, University of South China, Hengyang, Hunan, 421001, China
| | - Xianghua Xu
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, 410013, China.
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Ramm M, Jedamzik J, Lenz P, Jürgens L, Heuft G, Conrad R. Older adults coping with critical life events - results of the revised demoralization scale in a representative sample of older adulthood. Front Psychiatry 2024; 15:1389021. [PMID: 38800056 PMCID: PMC11116776 DOI: 10.3389/fpsyt.2024.1389021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Background High suicide rates in older adults are a relevant public health concern. Social isolation or widowhood as well as physical decline play a crucial role for suicidality in older adulthood. Previous evidence suggested that demoralization is an important risk factor for suicide. Whether demoralization is a relevant phenomenon in older adulthood which possibly could account for high suicide rates remains unclear. Methods Demoralization Scale II (DS-II) scores assessed in a survey of the German general population were investigated with respect to older adults (aged ≥ 65 years). DS-II scores were compared between older (≥ 65 years) and younger (< 65 years) adulthood and between young-old (65-74y), middle-old (75-84y), and old-old (85+y) individuals. We tested the impact of sociodemographic factors on DS-II scores within older adults. Results The sample comprised N = 545 adults ≥ 65 years and N = 1922 adults < 65 years. DS-II scores increased in older compared to younger adults (F(1,2465) = 6.1; p = 0.013; d = 0.09) and further from young-old to old-old (Mdiff = 2.7; 95% CI 0.45, 5.46; p = 0.034). One-fourth of individuals ≥ 65 years and almost half of old-old individuals reported DS-II scores above the cut-off > 5. Living with a partner protected from demoralization in old-old individuals. Discussion This study provides first evidence for an increased rate of demoralization in very old adults, in particular women, which is partly related to partnership status. We suggest that demoralization is considered as a crucial entity in older adulthood which can be missed by standard psychological screenings.
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Affiliation(s)
- Markus Ramm
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Johanna Jedamzik
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Philipp Lenz
- West German Cancer Center, University Hospital Münster, Münster, Germany
- Institute of Palliative Care, University Hospital Münster, Münster, Germany
| | - Lara Jürgens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Gereon Heuft
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
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Kim K, Woo J. Characteristics and Effectiveness of Individual Psychotherapy for Palliative and End-of-Life Care: A Literature Review for Randomized Controlled Trials. Psychiatry Investig 2024; 21:433-448. [PMID: 38810992 PMCID: PMC11136579 DOI: 10.30773/pi.2023.0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/01/2024] [Accepted: 03/03/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVE The introduction of psychotherapy in palliative and end-of-life care settings has become increasingly common and is effective in decreasing many psychological problems. This review reports the characteristics and effectiveness of individual psychotherapeutic interventions for patients receiving palliative and end-of-life care. In addition, the review reports the effectiveness of psychotherapies considering the expected life expectancy. METHODS The PubMed, Google Scholar, and Cochrane Library databases were searched for English-language articles published between January 2000 to May 2023. RESULTS Twenty-six studies were included and classified into a total of nine types of psychotherapies, namely, dignity therapy (DT), life review therapy, narrative therapy, managing cancer and living meaningfully (CALM), individual meaning-centered psychotherapy, meaning and purpose therapy, meaning-making therapy, meaning-of-life therapy, and cognitive therapy. CONCLUSION Most of the psychotherapies provided to patients receiving palliative and end-of-life care showed effectiveness in the reduction of negative emotions and positive factors related to end-of-life issues. Most studies targeted patients with advanced cancer; however, studies on DT did not limit the target group to patients with cancer. Considering the expected life expectancy, CALM was found to be suitable for patients receiving early palliative care.
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Affiliation(s)
- Kyungmin Kim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Psychiatry, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Jungmin Woo
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Republic of Korea
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Krakowczyk JB, Truijens F, Teufel M, Lalgi T, Heinen J, Schug C, Erim Y, Pantförder M, Graf J, Bäuerle A. Evaluation of the e-Mental Health Intervention Make It Training From Patients' Perspectives: Qualitative Analysis Within the Reduct Trial. JMIR Cancer 2024; 10:e53117. [PMID: 38592764 DOI: 10.2196/53117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/23/2023] [Accepted: 01/10/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Make It Training is an e-mental health intervention designed for individuals with cancer that aims to reduce psychological distress and improve disease-related coping and quality of life. OBJECTIVE This study evaluated the experienced usefulness and usability of the web-based Make It Training intervention using a qualitative approach. METHODS In this study, semistructured interviews were conducted with participants at different cancer stages and with different cancer entities. All participants had previously taken part in the Reduct trial, a randomized controlled trial that assessed the efficacy of the Make It Training intervention. The data were coded deductively by 2 independent researchers and analyzed iteratively using thematic codebook analysis. RESULTS Analysis of experienced usefulness resulted in 4 themes (developing coping strategies to reduce psychological distress, improvement in quality of life, Make It Training vs traditional psychotherapy, and integration into daily life) with 11 subthemes. Analysis of experienced usability resulted in 3 themes (efficiency and accessibility, user-friendliness, and recommendations to design the Make It Training intervention to be more appealing) with 6 subthemes. Make It Training was evaluated as a user-friendly intervention helpful for developing functional coping strategies to reduce psychological distress and improve quality of life. The consensus regarding Make It Training was that it was described as a daily companion that integrates well into daily life and that it has the potential to be routinely implemented within oncological health care either as a stand-alone intervention or in addition to psychotherapy. CONCLUSIONS e-Mental health interventions such as Make It Training can target both the prevention of mental health issues and health promotion. Moreover, they offer a cost-efficient and low-threshold option to receive psycho-oncological support.
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Affiliation(s)
- Julia Barbara Krakowczyk
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Comprehensive Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Femke Truijens
- Department of Psychology, Educational and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Comprehensive Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Tania Lalgi
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Comprehensive Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Jana Heinen
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Caterina Schug
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center, University Hospital Erlangen, Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center, University Hospital Erlangen, Erlangen, Germany
| | - Michael Pantförder
- Fraunhofer Institute for Software and Systems Engineering, Dortmund, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Comprehensive Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
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Rosberger Z, Henry M. The enormous and continuing challenge of maintaining hope in patients with advanced cancer. J Natl Cancer Inst 2024; 116:491-493. [PMID: 38366874 DOI: 10.1093/jnci/djae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 02/18/2024] Open
Affiliation(s)
- Zeev Rosberger
- Gerald Bronfman Department of Oncology and Departments of Psychology and Psychiatry, McGill University and Lady Davis Institute for Medical Research, Montréal, QC, Canada
| | - Melissa Henry
- Gerald Bronfman Department of Oncology, McGill University and Lady Davis Institute for Medical Research, Montréal, QC, Canada
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Beaussant Y, Tarbi E, Nigam K, Miner S, Sager Z, Sanders JJ, Ljuslin M, Guérin B, Thambi P, Tulsky JA, Agrawal M. Acceptability of psilocybin-assisted group therapy in patients with cancer and major depressive disorder: Qualitative analysis. Cancer 2024; 130:1147-1157. [PMID: 38105653 DOI: 10.1002/cncr.35024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The present study explored the acceptability of psilocybin-assisted group therapy from the perspective of patients with cancer and depression who participated in a clinical trial assessing the safety and efficacy of this novel intervention. METHODS Guided by the conceptual framework of acceptability, the authors conducted semi-structured interviews with participants of the psilocybin trial. Data were analyzed using template and thematic analyses. RESULTS Participants' (n = 28) perspectives on the acceptability of the group and simultaneous sessions was generally positive, both in terms of safety and efficacy: first, the groups contributed to increase participants' sense of safety and preparedness as they were engaging in the therapy; and second, the groups fostered a sense of connection and of belonging, which served to enrich and deepen the meaning of participants' experience, ultimately opening a dimension of self-transcendence and compassion. Other subthemes related to factors influencing the acceptability of the group approach included: 1) the importance of the therapeutic framework, 2) the complementary value of individual sessions, 3) disruptive factors related to the group and/or simultaneous setting, and 4) opportunities and challenges related to group size and how to structure interactions. CONCLUSIONS This study enhances understanding of what promotes acceptability of the psilocybin-assisted therapy group model for the treatment of MDD in cancer patients. PLAIN LANGUAGE SUMMARY We conducted exit interviews with participants of a phase 2 trial of psilocybin-assisted therapy (PAT) conducted in a community cancer center, to assess the acceptability of a novel psilocybin delivery model combining simultaneous individual therapy and group sessions. Our findings support the acceptability of this intervention and suggest that in addition to being feasible, it might also enhance participants' perceived safety and efficacy compared to uniquely individual or group delivery models of PAT. Our analysis highlights critical factors conditioning acceptability and suggests new ways PAT may be scaled and integrated into cancer care.
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Affiliation(s)
- Yvan Beaussant
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Elise Tarbi
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Nursing, University of Vermont, Burlington, Vermont, USA
| | - Kabir Nigam
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Skye Miner
- Department of Medical Humanities and Bioethics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Zachary Sager
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Justin J Sanders
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Michael Ljuslin
- Harvard Medical School, Boston, Massachusetts, USA
- University of Geneva, Geneva, Switzerland
- Palliative Medicine Division, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Benjamin Guérin
- Department of Philosophy, University of Franche Comté, Besançon, France
| | - Paul Thambi
- Sunstone Therapies, Rockville, Maryland, USA
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Shaygan M, Khaki S, Zarei D, Moshfeghinia R, Beheshtaeen F, Sadeghi Y. Effects of meaning-based psychotherapy on post-traumatic growth and death anxiety in patients with cancer: a systematic review and meta-analysis. Support Care Cancer 2024; 32:251. [PMID: 38532225 DOI: 10.1007/s00520-024-08448-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Cancer is one of the leading causes of mortality in the world which imposes numerous psychological burdens on the patients. Psycho-spiritual interventions such as meaning-based therapies may help decrease these challenges. This systematic review and meta-analysis aim to investigate the effects of meaning-based psychotherapy on post-traumatic growth and death anxiety of patients with cancer. METHODS PubMed, Scopus, Proquest, Web of Science, and Google Scholar were searched until 30 September 2023. The Cochrane Collaboration's tool was used to assess the quality of the included studies. A random-effect model was preferred, and statistical analysis was performed by STATA software version 17. RESULTS A total of 17 studies were included in the systematic review. Eleven articles examined the impact of meaning-based interventions on death anxiety and six articles examined post-traumatic growth in cancer patients. Ten studies with a total of 555 participants were included for analysis of the effect of logotherapy versus routine care on death anxiety. Analysis showed a significant decrease effect of logotherapy versus routine care on death anxiety (SMD, - 4.05 (- 6.20, - 1.90); I2, 98.38%). Three studies with a total of 364 participants were included for analysis of the effect of logotherapy versus routine care on post-traumatic growth in patients with cancer. Analysis showed a positive but non-significant effect of logotherapy versus routine care on post-traumatic growth (SMD, 2.05 (- 0.91, 5.01); I2, 99.08%). CONCLUSION The qualitative analysis showed the positive impact of meaning-based psychotherapy interventions on death anxiety and post-traumatic growth in cancer patients, but the results of the meta-analysis on post-traumatic growth were not statistically significant. The review shows the need for more clinical trial studies in larger and more diverse samples in terms of cancer types and cultural background.
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Affiliation(s)
- Maryam Shaygan
- Community Based Psychiatric Care Research Center, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Khaki
- Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Davood Zarei
- Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Moshfeghinia
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fateme Beheshtaeen
- Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Yasin Sadeghi
- Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Thomas C, Kulikowksi JD, Breitbart W, Alici Y, Bruera E, Blackler L, Sulmasy DP. Existential suffering as an indication for palliative sedation: Identifying and addressing challenges. Palliat Support Care 2024:1-4. [PMID: 38419195 PMCID: PMC11358359 DOI: 10.1017/s1478951524000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Columba Thomas
- Kennedy Institute of Ethics, Georgetown University, Washington, DC, USA
| | - Julia D. Kulikowksi
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yesne Alici
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Liz Blackler
- Ethics Committee, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel P. Sulmasy
- Kennedy Institute of Ethics, Georgetown University, Washington, DC, USA
- Departments of Medicine and Philosophy and the Pellegrino Center for Clinical Bioethics, Georgetown University, Washington, DC, USA
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Zhang Y, Pang Y, He Y, You M, Tang L. Feasibility of online managing cancer and living meaningfully (CALM) in Chinese patients with metastatic breast cancer: a pilot randomized control trial. Sci Rep 2024; 14:4892. [PMID: 38418478 PMCID: PMC10902284 DOI: 10.1038/s41598-024-52574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/20/2024] [Indexed: 03/01/2024] Open
Abstract
Metastatic breast cancer could cause various psychological symptoms. Managing Cancer and Living Meaningfully (CALM) is a brief, manualized psychotherapy that has been validated for advanced cancer patients. We conducted a pilot randomized control trial (RCT) to verify the feasibility and preliminary efficacy of CALM therapy in this population. Patients who met the inclusion criteria were randomly assigned into CALM or Wait-list Control (WLC) groups. Patients in the CALM group received CALM therapy and usual care; patients in WLC group first received usual care and then underwent CALM therapy after completing all assessments. All patients were asked to complete three assessments: T0(baseline), T1(3 months), and T2(6 months). The primary outcomes was death anxiety; other outcomes were depression, distress, suicide ideation, attachment security, spiritual well-being and quality of life at the end of life. Analysis of Covariance (ANCOVA) and t-test were used for statistics analysis. Thirty-six patients were randomly assigned to either of the two groups, with 34 patients completing the three assessments. At six months, we found significant between group differences in suicide ideation, distress, and life completion between the CALM and WLC groups. At T2, patients in CALM group reported lower levels of depression (F = 5.016, p = 0.033, partial η2 = 0.143), distress (F = 7.969, p = 0.010, partial η2 = 0.257), attachment avoidance (F = 4.407, p = 0.044, partial η2 = 0.128), and better sense of life completion (F = 5.493, p = 0.026, partial η2 = 0.155) than patients in the WLC group. Compared with results of the T0 assessments, we found significant differences in socres for depression (T2&T0, t = - 2.689, p = 0.011, Cohen's d = 0.940) and distress (T2&T0, t = - 2.453, p = 0.022, Cohen's d = 0.965) between the two groups. CALM therapy was well received by the study population, and CALM therapy can reduce depression, distress, attachment avoidance while improving quality of life in Chinese metastatic breast cancer patients. A Phase III RCT was recommended to verify the impact of CALM therapy on psychological burden and survival in this population.Trial registration: This study is part of the "Preliminary application study for Managing Cancer and Living Meaningfully (CALM) therapy in Chinese advanced cancer patients" clinical trial, with the Trial Registration Number of ChiCTR1900023129 (13/05/2019) in the Chinese Clinical Trial Registry (ChiCTR) website. ( https://www.chictr.org.cn/index.html ).
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Affiliation(s)
- Yening Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital and Institute, Fu-Cheng Road 52, Hai-Dian District, Beijing, 100142, China
| | - Ying Pang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital and Institute, Fu-Cheng Road 52, Hai-Dian District, Beijing, 100142, China
| | - Yi He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital and Institute, Fu-Cheng Road 52, Hai-Dian District, Beijing, 100142, China
| | - Miaoning You
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Bresat Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lili Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital and Institute, Fu-Cheng Road 52, Hai-Dian District, Beijing, 100142, China.
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Dusel J, Meng K, Arnold H, Rabe A, Jentschke E. Effectiveness of structured psycho-oncological counseling for relatives of lung cancer patients based on the CALM approach-study protocol of a randomized controlled trial. Trials 2024; 25:115. [PMID: 38336739 PMCID: PMC10858519 DOI: 10.1186/s13063-024-07954-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The high incidence combined with the high lethality and bad prognosis of lung cancer highlight the need for psycho-oncological care for both patients and their relatives. While psychological interventions for relatives might be helpful, further research on the impact of specific interventions is necessary. Therefore, this trial aims to evaluate structured psycho-oncological counseling for relatives of lung cancer patients based on the Managing Cancer And Living Meaningfully (CALM) approach compared to usual care. In addition, we explore the impact of psycho-oncological support of relatives on the patients' mental health outcomes. METHODS The study is a single-center, prospective, randomized controlled trial with two measurement time points. Relatives of lung cancer patients and, thus, the patients themselves (i.e., dyads) are randomly allocated to the intervention group (IG) or the control group (CG) regardless of their disease or treatment stage. Relatives in the IG receive structured counseling based on the CALM approach (three to six sessions with psycho-oncologists). The CG receives usual psycho-oncological care. In addition, cancer patients in both study arms can request psycho-oncological support (usual care) as needed, but they will not get a specific intervention. Relatives and patients complete assessments at baseline (T0) and after the intervention/6 weeks (T1). The primary outcome for relatives is anxiety. Relatives' secondary outcomes include depressive symptoms, distress, supportive care needs, and quality of life. Patients' outcomes include anxiety, depression, and distress. All outcomes are assessed using self-report validated questionnaires. Intervention effects will be evaluated using analysis of covariance (ANCOVA) adjusting for baseline values. Power calculations reveal the need to enroll 200 subjects to detect an effect of d = 0.4. DISCUSSION The study will provide evidence for the effectiveness of the CALM intervention in relatives of lung cancer patients. Furthermore, study results will contribute to a better understanding of the effectiveness of a psycho-oncological intervention for highly impaired cancer patients and their relatives. If the CALM intervention positively affects the relatives' psychosocial outcome, it may be implemented in routine care. TRIAL REGISTRATION German Clinical Trials Register DRKS00030077. Retrospectively registered on 26 October 2022.
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Affiliation(s)
- Julia Dusel
- University Hospital Würzburg, Comprehensive Cancer Center Mainfranken, Josef-Schneider Str. 6, Würzburg, D-97080, Germany
| | - Karin Meng
- University Hospital Würzburg, Comprehensive Cancer Center Mainfranken, Josef-Schneider Str. 6, Würzburg, D-97080, Germany
| | - Hanna Arnold
- University Hospital Würzburg, Comprehensive Cancer Center Mainfranken, Josef-Schneider Str. 6, Würzburg, D-97080, Germany
| | - Antonia Rabe
- University Hospital Würzburg, Comprehensive Cancer Center Mainfranken, Josef-Schneider Str. 6, Würzburg, D-97080, Germany
| | - Elisabeth Jentschke
- University Hospital Würzburg, Comprehensive Cancer Center Mainfranken, Josef-Schneider Str. 6, Würzburg, D-97080, Germany.
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12
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Dong L, Li L, Wu Y, Zhao X, Zhong H, Cheng X, Liu L, Cheng C, Ouyang M, Tao L. A Systematic Review of Interventions for Demoralization in Patients with Chronic Diseases. Int J Behav Med 2024:10.1007/s12529-024-10262-w. [PMID: 38316668 DOI: 10.1007/s12529-024-10262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Demoralization, a significant mental health concern in patients with chronic diseases, can have a large impact on physical symptom burden and quality of life. The present review aimed to evaluate the effectiveness of interventions for demoralization among patients with chronic diseases. METHOD PubMed, Scopus, Embase, and Web of Science were systematically searched. Research on providing interventions to patients with chronic diseases that included quantitative data on demoralization was then systematically reviewed. RESULTS Fourteen studies were included, most of which considered demoralization as a secondary outcome. Interventions included evidence-based meaning-centered psychotherapy, dignity therapy, psilocybin-assisted psychotherapy, and others. Ten studies used randomized controlled designs. Six of these investigated evidence-based meaning-centered therapy, and four investigated dignity therapy, showing the best empirical support for these intervention types. Most studies showed significant impacts on demoralization in patients with chronic diseases. CONCLUSION This systematic review provides insights into potential psychological interventions for reducing demoralization in patients with chronic diseases. Randomized controlled designs and adequately powered samples, with demoralization as the primary outcome, are needed to more clearly evaluate its effectiveness.
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Affiliation(s)
- Li Dong
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Li Li
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Yunlian Wu
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Xiaoling Zhao
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Hui Zhong
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Xi Cheng
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Lixia Liu
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Changxia Cheng
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Mingqiu Ouyang
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Liande Tao
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China.
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Kissane DW. Education and assessment of psycho-existential symptoms to prevent suicidality in cancer care. Psychooncology 2024; 33:e5519. [PMID: 33463852 DOI: 10.1002/pon.5519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 11/06/2022]
Affiliation(s)
- David W Kissane
- University of Notre Dame Australia and Cunningham Centre for Palliative Care Research, St Vincent's Sydney, Sydney, Australia
- Cabrini Health Psycho-oncology and Palliative Care, Monash University, Melbourne, Australia
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14
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Travado L, Bastos L. Distress and Psycho-Oncological Support for Patients With Advanced Breast Cancer. Semin Oncol Nurs 2024; 40:151555. [PMID: 38081761 DOI: 10.1016/j.soncn.2023.151555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVES Patients with advanced breast cancer (ABC) face an incurable disease that brings along many challenges. Health care professionals, and nurses in particular, have a main role in supporting these patients to adapt and adjust to their condition. In this study, we discuss how good communication skills can be the first level of emotional support to patients and families; and how the high prevalence of distress in this population makes it of great importance to screen for distress regularly and treat it when needed. DATA SOURCES We present our research study on the impact of negative effects on biobehavioral processes that contribute to disease progression, and comment on the psychological interventions that may reduce it, with a particular focus on the CALM therapy model we validated for the Portuguese ABC patients. We also report on the added human value of a retreat for couples and professionals that our team has tested with ABC patients and their partners. CONCLUSION It is critical to screen for distress in ABC patients who have a higher prevalence of distress. There are available evidence-based interventions to assist clinicians in reducing their suffering. CALM therapy and a retreat format may be options to consider with ABC patients. IMPLICATIONS FOR NURSING PRACTICE As front-line clinicians, nurses have an important role in providing provide emotional support to patients using good communication skills, but also in identifying patients at risk for distress, screening for it regularly, and referring patients for specialized psychosocial care when needed.
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Affiliation(s)
- Luzia Travado
- Breast Unit, Champalimaud Clinical & Research Center, Champalimaud Foundation, Lisbon, Portugal.
| | - Leonor Bastos
- Breast Unit, Champalimaud Clinical & Research Center, Champalimaud Foundation, Lisbon, Portugal
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15
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Da Rocha Rodrigues G, Warne DW, Scuderi L, Lilla D, Stanic J, Pautex S. Revie ⊕: Impact of a resource-based life review intervention on patients with advanced cancer: A waitlist controlled trial. Eur J Oncol Nurs 2024; 68:102506. [PMID: 38301385 DOI: 10.1016/j.ejon.2024.102506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/27/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE Life review interventions aim to support individuals facing an incurable disease accompanied by existential concerns and health-related challenges. Based on encouraging feasibility results, this study assessed the effects of Revie ⊕ life review intervention on the self-esteem of patients with advanced cancer, and the effects on well-being, post-traumatic growth, life satisfaction, symptom burden and interaction with nurses. METHOD The study consisted of a two-arm parallel-group, waitlist-controlled trial (WCT) in the oncology division of a Swiss-French University Hospital. Revie ⊕ was composed of nurse-led meeting with the patient to address and document significant life events using a strengths-focused approach and targeting the life project. RESULTS Due to Covid-19 pandemic, adjustments were made regarding study duration and participant's allocation: Fifty-eight patients received Revie ⊕, 39 completed all the measurements. Self-esteem was high at baseline and maintained stability over time. The social well-being decreased in the intervention group before-after Revie ⊕ (-1.7 (3.9), p = 0.044) while emotional and functional well-being showed stability. The intensity of symptoms decreased in the intervention group before-after Revie ⊕: 4.9 (9.4), p = 0.020. CONCLUSIONS This study suggests that patients living with an advanced cancer and who received Revie ⊕ intervention may have maintained their self-esteem high over time. Observed results are promising, particularly considering the influence of the pandemic. Nevertheless, these findings do not allow us to draw definitive conclusions regarding the efficacy of the intervention on self-esteem. WCT seems not to be the appropriate design to highlight the added value of Revie ⊕ for this particularly vulnerable population. CLINICAL TRIAL REGISTRATION NUMBER NCT04254926.
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Affiliation(s)
- Gora Da Rocha Rodrigues
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Switzerland; HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Switzerland.
| | - David W Warne
- Academic Fellow of the Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Switzerland.
| | - Luca Scuderi
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Switzerland.
| | - Déborah Lilla
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Switzerland.
| | - Jelena Stanic
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Switzerland.
| | - Sophie Pautex
- Palliative Medicine Division, Department of Readaptation and Geriatrics, University Hospitals of Geneva, University of Geneva, Switzerland.
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16
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de Vries FE, Mah K, Malfitano C, Shapiro GK, Zimmermann C, Hales S, Rodin G. Clinical evaluation questionnaire in advanced cancer: a psychometric study of a novel measure of healthcare provider interactions. BMJ Support Palliat Care 2024; 13:e1093-e1102. [PMID: 35172981 DOI: 10.1136/bmjspcare-2021-003408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/30/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The Clinical Evaluation Questionnaire (CEQ) is a patient-reported experience measure (PREM) that assesses the perceived benefit of therapeutic interactions of patients with advanced cancer with their healthcare providers concerning issues relevant to their illness. It was developed for a randomised controlled trial of Managing Cancer and Living Meaningfully (CALM), a brief supportive-expressive therapy for patients with advanced cancer. The present study evaluates the preliminary psychometric properties of the CEQ. METHOD Patients in the CALM and usual care groups completed the CEQ 3 (n=195) and 6 (n=186) months after randomisation. The CEQ's internal consistency, factor structure and concurrent validity were evaluated, and CEQ scores in the treatment groups were compared. RESULTS The CEQ demonstrated high internal consistency for both treatment arms (Cronbach's α=0.94 to 0.95), and a single factor was consistently found in exploratory factor analyses. CEQ scores correlated significantly with satisfaction with the relationship with healthcare providers (r=0.23 to 0.61, p≤0.02) and life completion (r=0.24 to 0.37, p≤0.02) in both groups and with spiritual well-being in the CALM group (meaning: r=0.23 to 0.24, p=0.01 to 0.02; faith: r=0.24 to 0.34, p=0.001 to 0.02). The CALM group showed higher CEQ total scores than usual care at 6 months (CALM: 18.19±6.59; usual care: 14.36±7.67, p<0.001). CONCLUSIONS The CEQ is a reliable and valid PREM of the benefit perceived by patients with advanced cancer from their interactions with healthcare providers. Further study is needed to establish its value as a measure of perceived intervention benefit across different clinical and research settings.
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Affiliation(s)
- Froukje E de Vries
- Department of Psychiatry, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
| | - Carmine Malfitano
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), Princess Margaret Cancer Centre (University Health Network) and University of Toronto, Toronto, Ontario, Canada
| | - Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), Princess Margaret Cancer Centre (University Health Network) and University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Research Institute, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), Princess Margaret Cancer Centre (University Health Network) and University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Research Institute, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
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Avery J, Campbell KL, Mosher P, Al-Awamer A, Goddard K, Edwards A, Burnett L, Hannon B, Gupta A, Howard AF. Advanced Cancer in Young Adults (YAs): Living in a Liminal Space. QUALITATIVE HEALTH RESEARCH 2024; 34:72-85. [PMID: 37844970 PMCID: PMC10714712 DOI: 10.1177/10497323231204182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Young adults (YAs), defined as individuals between the ages of 18 and 39 years, experience unique challenges when diagnosed with advanced cancer. Using the social constructivist grounded theory approach, we aimed to develop a theoretical understanding of how YAs live day to day with their diagnosis. A sample of 25 YAs (aged 22-39 years) with advanced cancer from across Canada participated in semi-structured interviews. Findings illustrate that the YAs described day-to-day life as an oscillating experience swinging between two opposing disease outcomes: (1) hoping for a cure and (2) facing the possibility of premature death. Oscillating between these potential outcomes was characterized as living in a liminal space wherein participants were unsure how to live from one day to the next. The participants oscillated at various rates, with different factors influencing the rate of oscillation, including inconsistent and poor messaging from their oncologists or treatment team, progression or regression of their cancer, and changes in their physical functioning and mental health. These findings provide a theoretical framework for designing interventions to help YAs adapt to their circumstance.
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Affiliation(s)
- Jonathan Avery
- Anew Research Collaborative: Reshaping Young Adult Cancer Care, Royal Roads University, Victoria, BC, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Kristin L. Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Pamela Mosher
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ahmed Al-Awamer
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | | | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Abha Gupta
- Division of Medical Oncology, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - A. Fuchsia Howard
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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18
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Kool M, Hafkamp E, Gol J, Aukema EJ, Malfitano C, Reyners A, Hales S, van de Poll L, Rodin G, de Vries F. Managing cancer and living meaningfully (CALM): Implementation in Dutch cancer care. Psychooncology 2024; 33:e6281. [PMID: 38282218 DOI: 10.1002/pon.6281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/29/2023] [Accepted: 12/17/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Managing Cancer and Living Meaningfully (CALM) is a brief, evidence-based psychotherapy tailored for patients with advanced cancer that has not yet been implemented routinely in Dutch cancer care. The aim of this study was to assess the feasibility, acceptability, sustainability and effectiveness of CALM in different clinical settings in the Netherlands. METHODS In 2019 and 2020 a multi-center, intervention-only study was performed in three Dutch cancer care settings. Professionals were trained to provide CALM under supervision. Patients diagnosed with advanced cancer were included and filled out questionnaires to measure depression (Patient Health Questionnaire-9), death anxiety (Death and Dying Distress Scale), and anxiety (hospital anxiety and depression scale-anxiety) at baseline, 3 and 6 months. The Clinical Evaluation Questionnaire was used to assess acceptability of CALM at 3 and 6 months. RESULTS Sixty-four patients (55% of the eligible patients) were included in the study and 85% of the included patients received 3 or more CALM sessions. Of the 24 trained therapists, 15 (63%) started providing CALM. Two years post-study, CALM was provided in each center by a total of 19 therapists. On average, patients perceived CALM to be at least somewhat helpful. A significant decrease in severity of depression (p = 0.006), death anxiety (p = 0.008), and anxiety (p = 0.024) was observed over time. CONCLUSIONS This study shows that CALM therapy is feasible, acceptable, and sustainable in three Dutch cancer care settings, although not all predefined feasibility criteria for therapists were met. CALM can be effective in decreasing feelings of depression, anxiety, and death anxiety in patients with advanced cancer.
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Affiliation(s)
- Marianne Kool
- Center for Quality of Life, Antoni van Leeuwenhoek -Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Emma Hafkamp
- Center for Quality of Life, Antoni van Leeuwenhoek -Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Janna Gol
- Centre of Expertise in Palliative Care, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - Eline J Aukema
- Ingeborg Douwes Centrum (IDC), Centre of Expertise in Psycho-Oncology, OLVG, Amsterdam, the Netherlands
| | - Carmine Malfitano
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - An Reyners
- Centre of Expertise in Palliative Care, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Lonneke van de Poll
- Psychosocial Research and Epidemiology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, the Netherlands
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Froukje de Vries
- Department of Psychiatry, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Netherlands
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McConnell MH, Miljanovski M, Rodin G, O'Connor MF. Measuring double awareness in patients with advanced cancer: A preliminary scale development study. Palliat Support Care 2023:1-6. [PMID: 38124362 DOI: 10.1017/s1478951523001669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Individuals with advanced cancer face the challenge of living meaningfully while also preparing for end of life. The ability to sustain this duality, called "double awareness," may reflect optimal psychological adaptation, but no psychometric scale exists to measure this construct. OBJECTIVES The purpose of this study was to develop a novel scale to measure double awareness in patients living with advanced cancer. METHODS Guided by best practices for scale development, this study addresses the first three of nine steps in instrument development, including domain clarification and item generation, establishment of content validity of the items, and pre-testing of the items with patients. RESULTS Instrument development resulted in a 41-item measure with two dimensions titled "life engagement" and "death contemplation." Items retained in the measure displayed face validity and were found to be both acceptable by patients and relevant to their lived experience. SIGNIFICANCE OF RESULTS The results of this scale development study will allow for full validation of the measure and future use in clinical and research settings. This novel measure of double awareness will have clinical utility and relevance in a variety of settings where patients with advanced cancer are treated.
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Affiliation(s)
| | - Melissa Miljanovski
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Psychiatry, The University of Toronto, Toronto, ON, Canada
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Coutts-Bain D, Sharpe L, Russell H. Death anxiety predicts fear of Cancer recurrence and progression in ovarian Cancer patients over and above other cognitive factors. J Behav Med 2023; 46:1023-1031. [PMID: 37306857 PMCID: PMC10577099 DOI: 10.1007/s10865-023-00422-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023]
Abstract
Death anxiety is understudied in people with cancer, especially in relation to fear of cancer recurrence (FCR) and fear of progression (FOP). The present study aimed to identify if death anxiety can predict FCR and FOP over and above other known theoretical predictors. One hundred and seventy-six participants with ovarian cancer were recruited for an online survey. We included theoretical variables, such as metacognitions, intrusive thoughts about cancer, perceived risk of recurrence or progression, and threat appraisal, in regression analyses to predict FCR or FOP. We investigated whether death anxiety added to the variance over and above these variables. Correlational analyses demonstrated that death anxiety is more strongly associated with FOP than FCR. The hierarchical regression including the theoretical variables described above predicted 62-66% of variance in FCR and FOP. In both models, death anxiety predicted a small but statistically significant unique variance in FCR and FOP. These findings draw attention to the importance of death anxiety in understanding FCR and FOP in people with a diagnosis of ovarian cancer. They also suggest that elements of exposure and existentialist therapies may be relevant in treating FCR and FOP.
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Affiliation(s)
- D Coutts-Bain
- School of Psychology, The University of Sydney, Sydney, NSW, 2050, Australia
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, NSW, 2050, Australia.
| | - H Russell
- Ovarian Cancer Australia, Melbourne, VIC, Australia
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21
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Liu S, Huang R, Li A, Yu S, Yao S, Xu J, Tang L, Li W, Gan C, Cheng H. Effects of the CALM intervention on resilience in Chinese patients with early breast cancer: a randomized trial. J Cancer Res Clin Oncol 2023; 149:18005-18021. [PMID: 37980293 DOI: 10.1007/s00432-023-05498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE Resilience is an important regulating factor for anxiety and depression in breast cancer. The Managing Cancer and Living Meaningfully (CALM) intervention has been confirmed to improve anxiety and depression in patients, but the role of resilience is still unclear. This study explores this issue. METHODS In this study, a cohort of 124 patients diagnosed with breast cancer was recruited and randomly assigned to either the intervention group (IG) or the control group (CG). In addition, we enrolled a group of cancer-free women (regular control group) and assessed their resilience. All patients were evaluated using the Connor-Davidson Resilience Scale (CD-RISC), Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Cancer Therapy (FACT-B) and Perceived Stress Scale (PSS) at different time points. The primary outcomes were resilience, quality of life, anxiety, depression, and perceived stress. A repeated measures ANOVA was used to compare the scores of the IG and CG groups. The relationship between resilience and quality of life was analyzed using Pearson's correlation test. The paired-sample t-test was used to compare the changes in each score at different time points. RESULTS The intervention group showed significant differences in resilience, adamancy, optimism, tenacity, anxiety, depression, perceived stress and QOL scores before and after 6, 12, and 24 weeks (F = 17.411, F = 226.55, F = 29.096, F = 50.67, F = 82.662, F = 105.39, F = 62.66, F = 72.43, F = 34.561, respectively; P < 0.001). Compared to the control group, the intervention group demonstrated significant improvement in resilience and quality of life (t = -11.517, p < 0.001; t = - 4.929, p < 0.001), as well as a significant reduction in anxiety, depression, and perceived stress scores (t = 5.891, p < 0.001; t = 2.654, p < 0.001; t = 4.932, p < 0.001). In the intervention group, a significant positive correlation was observed between resilience in breast cancer survivors and quality of life (QOL) scores. (before CALM treatment: r = 0.3204, P = 0.0111; after 6 weeks: r = 0.3619, P = 0.0038; after 12 weeks: r = 0.3355, P = 0.0077; after 24 weeks: r = 0.2801, P = 0.0274). CONCLUSIONS A positive impact of the CALM intervention can be seen in improved resilience and reduced anxiety and depression, supporting its use as an effective psychological management tool and intervention strategy in the early stages of long-term breast cancer recovery.
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Affiliation(s)
- Shaochun Liu
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Runze Huang
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Anlong Li
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Sheng Yu
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Senbang Yao
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Jian Xu
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Lingxue Tang
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Wen Li
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Chen Gan
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Huaidong Cheng
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China.
- Shenzhen Clinical Medical School of Southern Medical University, Guangzhou, China.
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China.
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22
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van Klinken M, Hafkamp E, Gualtherie van Weezel A, Hales S, Lanceley A, Rodin G, Schulz-Quach C, de Vries F. Teaching Oncology Nurses a Psychosocial Intervention for Advanced Cancer: A Mixed-Methods Feasibility Study. Semin Oncol Nurs 2023; 39:151507. [PMID: 37758582 DOI: 10.1016/j.soncn.2023.151507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVES Psychological interventions for advanced cancer patients are effective in decreasing distress but are not well integrated into cancer care. Oncology nurses are well positioned to deliver such interventions, and their participation may enhance professional satisfaction and wellbeing. Managing Cancer and Living Meaningfully (CALM) is an evidence-based psychotherapy supporting advanced cancer patients. A CALM-Nurses (CALM-N) training program was developed to teach oncology nurses the basics of CALM for use in daily practice. Feasibility and acceptability of CALM-N and its impact on professional wellbeing were assessed in this pilot study. DATA SOURCES Fifty-five nurses attended CALM-N in three groups. Thirty-five nurses completed the first e-learning, 29 nurses (83%) attended the first group session, and 22 (63%) attended all sessions. At baseline, 35 questionnaires were collected. Response rate at follow-up was 63% for Jefferson Scale of Empathy (n=22), 66% for self-efficacy scale (n=23), and for subscales of Professional Quality of Life Scale burnout; 51% (n=18), secondary traumatic stress; 49% (n=17), compassion satisfaction; 57% (n=20). A statistically significant increase in self-efficacy was found, but there were no significant changes in PROQOL and empathy. Focus groups suggested CALM-N helped nurses' understanding of patients and nurse-patient communication and increased reflection and perspective taking. CONCLUSION CALM-N is a feasible and acceptable intervention for oncology nurses, with the potential to improve nurse-patient communication and the nurses' reflective capacities. IMPLICATIONS FOR NURSING PRACTICE CALM-N has the potential to improve the capacity of oncology nurses to provide psychosocial care for advanced cancer patients and its application to nursing practice merits further investigation.
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Affiliation(s)
- Merel van Klinken
- Centre for Quality of Life, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Emma Hafkamp
- Centre for Quality of Life, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Sarah Hales
- Department of Psychiatry, University of Toronto; Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto; and Global Institute of Psychosocial Oncology and Palliative Care (GIPPEC), Princess Margaret Cancer Centre, University of Toronto
| | - Anne Lanceley
- EGA Institute for Women's Health, Dept of Women's Cancer, University College London, London
| | - Gary Rodin
- Department of Psychiatry, University of Toronto; Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto; and Global Institute of Psychosocial Oncology and Palliative Care (GIPPEC), Princess Margaret Cancer Centre, University of Toronto
| | - Christian Schulz-Quach
- Department of Psychiatry, University of Toronto; Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto; and Global Institute of Psychosocial Oncology and Palliative Care (GIPPEC), Princess Margaret Cancer Centre, University of Toronto
| | - Froukje de Vries
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, Canada; and Department of Psychiatry, Netherlands Cancer Institute, Amsterdam, the Netherlands
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23
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Abstract
Background: How people face mortality is a crucial matter for medicine. Yet, there is not a coherent and comprehensive understanding of how people can process the experience such that it is not traumatic. Methods: This article offers a "logic model" of how existential maturation occurs, using analogies from cell biology to explain the process. Results: This model depicts 10 mechanisms that together deal with mortality-salient events. Collectively, they are termed the existential function, which is seen as an innate, ever-evolving, integral part of the mind. An operational boundary selectively manages how realities are taken in. Processing is initiated with other essential people, ushering in reiterative steps of listening, finding, exploring, making meaning, and adjusting. The result is adaptive, integrated, mortality-acknowledging dispositions of mind. The process allows quality of life at the end of life and healthy mourning; impediments to it make for existential suffering and complicated grief. Conclusions: This conceptual model describes how people can face mortality. Its merit depends on its source in human experience, its explanatory power, its ability to guide people as they face mortality, and its ability to stimulate productive perspectives. It is therefore offered as an invitation for discussion, research, revision, and evolution.
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Affiliation(s)
- Linda Emanuel
- Supportive Oncology, Robert H Lurie Comprehensive Cancer Center, Northwestern Medical Group, Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Aging and Serious Illness, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Chicago Psychoanalytic Institute, Chicago, Illinois, USA
- Boston Psychoanalytic Society and Institute, Newton, Massachusetts, USA
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Kissane DW, Bobevski I, Appleton J, Murphy G, Laverty-Wilson A, Kessel P, Michael N, Chye R, Lethborg C. Meaning and Purpose (MaP) therapy in advanced cancer patients: a randomised controlled trial. Support Care Cancer 2023; 31:734. [PMID: 38051407 DOI: 10.1007/s00520-023-08189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE We aimed to examine the efficacy of Meaning and Purpose (MaP) Therapy in promoting posttraumatic growth and meaningful life attitudes (choices and goal seeking) in people living with advanced cancer. METHODS Patients with a prognosis ≥ 1 year were stratified across two sites and randomised to receive MaP therapy and regular oncology/palliative care (Intervention) or usual care (Control). They completed measures at baseline (t0), post-intervention (12 weeks, t1) and 12 weeks later (t2). Our primary outcome was posttraumatic growth (PTGI); secondary outcome measures included life attitudes (LAPR), spiritual wellbeing (FACIT-Sp), anxiety, demoralization and depression. TRIAL REGISTRATION NUMBER ACTRN12618001751268, 7 January 2019. RESULTS We consented 107 from 404 eligible patients (26.5%) and randomised 55 to MaP Invention (35 completing t1, 25 t2) and 52 to Control (32 completing t1, 25 t2). Fidelity of the intervention was sustained. PTGI mean scores were significantly higher post-intervention on analysis by covariance (Cohen's d = 0.7 at t1 & d = 0.5 at t2). Secondary measures were significant, including LAPR (d = 0.4) and FACIT-Sp (meaning subscale d = 0.4; total d = 0.4). Participants completing six sessions achieved more noteworthy effect sizes. CONCLUSION This brief, structured individual intervention shows promise for sustaining sense of coherence, meaning and choices in life despite living with advanced cancer.
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Affiliation(s)
- David W Kissane
- School of Medicine, University of Notre Dame Australia, Sydney, Australia.
- Departments of Palliative Care, Cabrini Health, Melbourne, Australia.
- Department of Palliative Care, St Vincent's Hospital Sydney, Sydney, Australia.
- School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia.
| | - Irene Bobevski
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
- School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia
| | - Jane Appleton
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
- Department of Palliative Care, St Vincent's Hospital Sydney, Sydney, Australia
| | - Genevieve Murphy
- Departments of Palliative Care, Cabrini Health, Melbourne, Australia
- School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia
| | - Anna Laverty-Wilson
- Department of Palliative Care, St Vincent's Hospital Sydney, Sydney, Australia
| | - Pauley Kessel
- School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia
| | - Natasha Michael
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
- Departments of Palliative Care, Cabrini Health, Melbourne, Australia
- School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia
| | - Richard Chye
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
- Department of Palliative Care, St Vincent's Hospital Sydney, Sydney, Australia
| | - Carrie Lethborg
- Centre for Rural Health, University of Tasmania, Launceston, Australia
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Chew NM, Ting EL, Kerr L, Brewster DJ, Russo PL. Psychosocial Interventions at the End-of-Life: A Scoping Review. Cancer Nurs 2023; 46:432-446. [PMID: 35786585 DOI: 10.1097/ncc.0000000000001136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The integration of holistic and effective end-of-life (EOL) care into cancer management has increasingly become a recognized field. People living with terminal cancer and their caregivers face a unique set of emotional, spiritual, and social stressors, which may be managed by psychosocial interventions. OBJECTIVES This study aimed to explore the types and characteristics of psychosocial interventions at the EOL for adult cancer patients and their caregivers and to identify gaps in the current literature. METHODS A systematic search was conducted through MEDLINE (Ovid) and CINAHL from January 1, 2011, to January 31, 2021, retrieving 2453 results. A final 15 articles fulfilled the inclusion criteria, reviewed by 2 independent reviewers. Ten percent of the original articles were cross-checked against study eligibility at every stage by 2 experienced researchers. RESULTS Most interventions reported were psychotherapies, with a predominance of meaning or legacy-related psychotherapies. Most interventions were brief, with significant caregiver involvement. Most studies were conducted in high-income, English-speaking populations. CONCLUSION There is robust, although heterogeneous, literature on a range of psychosocial interventions at the EOL. However, inconsistencies in the terminology used surrounding EOL and means of outcome assessment made the comparison of interventions challenging. IMPLICATION FOR PRACTICE Future studies will benefit from increased standardization of study design, EOL terminology, and outcome assessment to allow for a better comparison of intervention efficacy. There is a need for increased research in psychosocial interventions among middle- to low-income populations exploring social aspects, intimacy, and the impact of COVID-19.
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Affiliation(s)
- Nicolle Marie Chew
- Author Affiliations: School of Medicine, Monash University (Drs Chew and Ting); Cabrini Monash University Department of Nursing Research, Cabrini Health (Drs Chew, Ting, Russo, and Kerr); School of Nursing and Midwifery, Monash University (Drs Russo and Kerr); Intensive Care Unit, Cabrini Hospital (Dr Brewster); and Central Clinical School, Monash University (Dr Brewster), Victoria, Australia
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26
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Kissane DW, Bobevski I, Appleton J, Michael N, King T, Moss G, Eng D, White A, Carboon D, Eade R, Keighley L. Real World Experience of Change in Psycho-Existential Symptoms in Palliative Care. J Pain Symptom Manage 2023; 66:212-220.e2. [PMID: 37290732 DOI: 10.1016/j.jpainsymman.2023.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/21/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
CONTEXT Psycho-existential symptoms in palliative care are addressed insufficiently. Routine screening, ongoing monitoring and meaningful treatment of psycho-existential symptoms may contribute to the relief of suffering in palliative care. OBJECTIVES We sought to explore longitudinal change in psycho-existential symptoms following the routine implementation of the Psycho-existential Symptom Assessment Scale (PeSAS) in Australian palliative care services. METHODS Using a multisite rolling design, we implemented the PeSAS to longitudinally monitor symptoms in a cohort of 319 patients. We assessed change scores for each symptom in groups with mild (≤3), moderate (4-7) and severe (≥8) symptomatology at baseline. We tested significance between these groups and used regression analyses to identify predictors. RESULTS While one half of patients denied clinically important psycho-existential symptoms, for the remainder, overall, more patients improved than deteriorated. Between 20% and 60% of patients with moderate and severe symptoms improved, while another 5%-25% developed new symptom distress. Patients with severe baseline scores improved significantly more than those with moderate baseline scores. CONCLUSION As we better recognize through screening patients carrying psycho-existential distress in palliative care programs, there is considerable room for improvement in ameliorating this suffering. Inadequate clinical skills, poor psychosocial staffing or a biomedical program culture may all contribute to inadequate symptom control. Person-centered care necessitates greater attention to authentic multidisciplinary care that ameliorates psycho-spiritual and existential distress.
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Affiliation(s)
- David W Kissane
- School of Medicine (D.W.K., I.B., J.A., N.M.), University of Notre Dame Australia, Fremantle, Australia; St. Vincent's Hospital (D.W.K., J.A.), Sydney, New South Wales, Australia; Cabrini Health (D.W.K., I.B., N.M., L.K.), Melbourne, Victoria, Australia; School of Clinical Sciences (D.W.K., I.B., N.M., D.C.), Monash University, Victoria, Australia.
| | - Irene Bobevski
- School of Medicine (D.W.K., I.B., J.A., N.M.), University of Notre Dame Australia, Fremantle, Australia; Cabrini Health (D.W.K., I.B., N.M., L.K.), Melbourne, Victoria, Australia; School of Clinical Sciences (D.W.K., I.B., N.M., D.C.), Monash University, Victoria, Australia
| | - Jane Appleton
- School of Medicine (D.W.K., I.B., J.A., N.M.), University of Notre Dame Australia, Fremantle, Australia; St. Vincent's Hospital (D.W.K., J.A.), Sydney, New South Wales, Australia
| | - Natasha Michael
- School of Medicine (D.W.K., I.B., J.A., N.M.), University of Notre Dame Australia, Fremantle, Australia; Cabrini Health (D.W.K., I.B., N.M., L.K.), Melbourne, Victoria, Australia; School of Clinical Sciences (D.W.K., I.B., N.M., D.C.), Monash University, Victoria, Australia
| | - Tania King
- Eastern Palliative Care (T.K.), Victoria, Australia
| | - Graham Moss
- Clare Holland House (G.M.), Canberra, New South Wales, Australia
| | - Derek Eng
- Royal Perth Hospital (D.E., A.W.), Perth, Australia
| | - Alison White
- Royal Perth Hospital (D.E., A.W.), Perth, Australia; St. John of God Murdoch Community Hospice (A.W.), Murdoch, WA, Australia
| | - Danielle Carboon
- School of Clinical Sciences (D.W.K., I.B., N.M., D.C.), Monash University, Victoria, Australia
| | - Rachel Eade
- Eastern Health (R.E.), Melbourne, Victoria, Australia
| | - Luka Keighley
- Cabrini Health (D.W.K., I.B., N.M., L.K.), Melbourne, Victoria, Australia
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27
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Yao S, Zhu Q, Zhang Q, Cai Y, Liu S, Pang L, Jing Y, Yin X, Cheng H. Managing Cancer and Living Meaningfully (CALM) alleviates chemotherapy related cognitive impairment (CRCI) in breast cancer survivors: A pilot study based on resting-state fMRI. Cancer Med 2023; 12:16231-16242. [PMID: 37409628 PMCID: PMC10469649 DOI: 10.1002/cam4.6285] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Chemotherapy related cognitive impairment (CRCI) is a type of memory and cognitive impairment induced by chemotherapy and has become a growing clinical problem. Breast cancer survivors (BCs) refer to patients from the moment of breast cancer diagnosis to the end of their lives. Managing Cancer and Living Meaningfully (CALM) is a convenient and easy-to-apply psychological intervention that has been proven to improve quality of life and alleviate CRCI in BCs. However, the underlying neurobiological mechanisms remain unclear. Resting-state functional magnetic resonance imaging (rs-fMRI) has become an effective method for understanding the neurobiological mechanisms of brain networks in CRCI. The fractional amplitude of low-frequency fluctuations (fALFF) and ALFF have often been used in analyzing the power and intensity of spontaneous regional resting state neural activity. METHODS The recruited BCs were randomly divided into the CALM group and the care as usual (CAU) group. All BCs were evaluated by the Functional Assessment of Cancer Therapy Cognitive Function (FACT-Cog) before and after CALM or CAU. The rs-fMRI imaging was acquired before and after CALM intervention in CALM group BCs. The BCs were defined as before CALM intervention (BCI) group and after CALM intervention (ACI) group. RESULTS There were 32 BCs in CALM group and 35 BCs in CAU group completed the overall study. There were significant differences between the BCI group and the ACI group in the FACT-Cog-PCI scores. Compared with the BCI group, the ACI group showed lower fALFF signal in the left medial frontal gyrus and right sub-gyral and higher fALFF in the left occipital_sup and middle occipital gyrus. There was a significant positive correlation between hippocampal ALFF value and FACT-Cog-PCI scores. CONCLUSIONS CALM intervention may have an effective function in alleviating CRCI of BCs. The altered local synchronization and regional brain activity may be correlated with the improved cognitive function of BCs who received the CALM intervention. The ALFF value of hippocampus seems to be an important factor in reflect cognitive function in BCs with CRCI and the neural network mechanism of CALM intervention deserves further exploration to promote its application.
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Affiliation(s)
- Senbang Yao
- Department of OncologyThe Second Affiliated Hospital of Anhui Medical UniversityHefeiChina
- Cancer and Cognition LaboratoryAnhui Medical UniversityHefeiChina
| | - Qinqin Zhu
- Department of RadiologyQuzhou People's HospitalQuzhouChina
| | - Qianqian Zhang
- Department of OncologyThe Second Affiliated Hospital of Anhui Medical UniversityHefeiChina
- Cancer and Cognition LaboratoryAnhui Medical UniversityHefeiChina
| | - Yinlian Cai
- Department of OncologyThe Second Affiliated Hospital of Anhui Medical UniversityHefeiChina
- Cancer and Cognition LaboratoryAnhui Medical UniversityHefeiChina
| | - Shaochun Liu
- Department of OncologyThe Second Affiliated Hospital of Anhui Medical UniversityHefeiChina
- Cancer and Cognition LaboratoryAnhui Medical UniversityHefeiChina
| | - Lulian Pang
- Department of OncologyThe Second Affiliated Hospital of Anhui Medical UniversityHefeiChina
- Cancer and Cognition LaboratoryAnhui Medical UniversityHefeiChina
| | - Yanyan Jing
- Department of OncologyThe Second Affiliated Hospital of Anhui Medical UniversityHefeiChina
- Cancer and Cognition LaboratoryAnhui Medical UniversityHefeiChina
| | - Xiangxiang Yin
- Department of OncologyThe Second Affiliated Hospital of Anhui Medical UniversityHefeiChina
- Cancer and Cognition LaboratoryAnhui Medical UniversityHefeiChina
| | - Huaidong Cheng
- Department of OncologyThe Second Affiliated Hospital of Anhui Medical UniversityHefeiChina
- Shenzhen Clinical Medical School of Southern Medical UniversityShenzhenChina
- Department of OncologyShenzhen Hospital of Southern Medical UniversityShenzhenChina
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28
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Yamazaki T, Miyamoto S, Matsubara T, Yamagata H, Kobo H, Otani M, Abe H, Sumitani M, Shimizu K, Rodin G, Yoshiuchi K. Development of a Japanese Version of the Quality of Life at the End of Life-Cancer Scale. J Pain Symptom Manage 2023; 66:e189-e195. [PMID: 37121525 DOI: 10.1016/j.jpainsymman.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/16/2023] [Accepted: 04/22/2023] [Indexed: 05/02/2023]
Abstract
CONTEXT The Quality of Life at the End of Life-Cancer Scale (QUAL-EC) is a self-reported instrument to assesses the quality of life of patients with cancer near the end of life. OBJECTIVE To test the reliability and validity of the QUAL-EC-J, a Japanese translated version of the QUAL-EC. METHODS A total of 179 Japanese patients with advanced cancer completed the QUAL-EC-J, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Rosenberg Self-Esteem Scale, Multidimensional Scale of Perceived Social Support, Functional Assessment of Cancer Therapy-General Scale, and Functional Assessment of Chronic Illness Therapy-Spiritual questionnaires. We performed confirmatory factor analysis of the four structures of the QUAL-EC and exploratory factor analysis of the QUAL-EC-J. Internal consistency was assessed using Cronbach's α coefficient and validity was examined by calculating correlations with relevant scales. RESULTS Confirmatory factor analysis showed an inadequate fit to the original QUAL-EC structure. Exploratory factor analysis revealed a three-factor structure of the QUAL-EC-J, with Cronbach's α values of 0.68-0.88. All subscales were negatively correlated with depression and anxiety. Each subscale was correlated with related measures: "symptom control" with "physical well-being"; "acceptance of disease and life" with "social and family well-being" and "meaning/peace"; and "preparation for end of life" with "emotional well-being" and "meaning/peace." CONCLUSIONS The QUAL-EC-J has a three-factor structure with acceptable reliability and sufficient validity. Differences in the factor structure between the QUAL-EC-J and the QUAL-EC may be due to cultural factors. Study findings suggest that utilization of the QUAL-EC-J could help to improve research and clinical care in advanced cancer in Japan.
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Affiliation(s)
- Tadahiro Yamazaki
- Department of Stress Sciences and Psychosomatic Medicine (T.Y., S.M., M.O., K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seraki Miyamoto
- Department of Stress Sciences and Psychosomatic Medicine (T.Y., S.M., M.O., K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshio Matsubara
- Division of Neuropsychiatry, Department of Neuroscience (T.M.), Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Hiroshi Yamagata
- Department of Anesthesiology (H.Y.), Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan; Palliative Care Center (H.Y.), Yamaguchi University Hospital, Yamaguchi, Japan
| | - Hiroshi Kobo
- Department of Psycho-Oncology (H.K., K.S.), Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Makoto Otani
- Department of Stress Sciences and Psychosomatic Medicine (T.Y., S.M., M.O., K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Abe
- Department of Pain and Palliative Medicine (H.A., M.S.), The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine (H.A., M.S.), The University of Tokyo Hospital, Tokyo, Japan
| | - Ken Shimizu
- Department of Psycho-Oncology (H.K., K.S.), Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Gary Rodin
- Department of Supportive Care (G.R.), Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine (T.Y., S.M., M.O., K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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29
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Lynch FA, Rodin G, Jefford M, Duffy M, Lai-Kwon J, Heynemann S, Mileshkin L, Briggs L, Burke J, Leigh L, Spelman T, Ftanou M. Evaluation of Managing Cancer and Living Meaningfully (CALM) in people with advanced non-small cell lung cancer treated with immunotherapies or targeted therapies: protocol for a single-arm, mixed-methods pilot study. BMJ Open 2023; 13:e072322. [PMID: 37524546 PMCID: PMC10391815 DOI: 10.1136/bmjopen-2023-072322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION People with advanced non-small cell lung cancer (NSCLC) treated with immunotherapies (IT) or targeted therapies (TT) may have improved outcomes in a subset of people who respond, raising unique psychological concerns requiring specific attention. These include the need for people with prolonged survival to reframe their life plans and tolerate uncertainty related to treatment duration and prognosis. A brief intervention for people with advanced cancer, Managing Cancer and Living Meaningfully (CALM), could help people treated with IT or TT address these concerns. However, CALM has not been specifically evaluated in this population. This study aims to evaluate the acceptability and feasibility of CALM in people with advanced NSCLC treated with IT or TT and obtain preliminary evidence regarding its effectiveness in this population. METHODS AND ANALYSIS Twenty people with advanced NSCLC treated with IT or TT will be recruited from Peter MacCallum Cancer Centre, Melbourne, Australia. Participants will complete three to six sessions of CALM delivered over 3-6 months. A prospective, single-arm, mixed-methods pilot study will be conducted. Participants will complete outcome measures at baseline, post-intervention, 3 months and 6 months, including Patient Health Questionnaire, Death and Dying Distress Scale, Functional Assessment of Cancer Therapy General and Clinician Evaluation Questionnaire. The acceptability of CALM will be assessed using patient experiences surveys and qualitative interviews. Feasibility will be assessed by analysis of recruitment rates, treatment adherence and intervention delivery time. ETHICS AND DISSEMINATION Ethics approval has been granted by the Peter MacCallum Cancer Centre Human Research Ethics Committee (HREC/82047/PMCC). Participants with cancer will complete a signed consent form prior to participation, and carers and therapists will complete verbal consent. Results will be made available to funders, broader clinicians and researchers through conference presentations and publications. If CALM is found to be acceptable in this cohort, this will inform a potential phase 3 trial.
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Affiliation(s)
- Fiona Anne Lynch
- Psychosocial Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Psychology Department, Andrew Love Cancer Centre, Barwon Health, Geelong, Victoria, Australia
| | - Gary Rodin
- Global Institute of Psychosocial, Palliative and End-of- Life Care (GIPPEC), Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Mary Duffy
- Lung Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sarah Heynemann
- Department of Medical Oncology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Linda Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Lung Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lisa Briggs
- Patient Representative, Melbourne, Victoria, Australia
| | - John Burke
- Patient Representative, Melbourne, Victoria, Australia
| | - Lilian Leigh
- Patient Representative, Sydney, New South Wales, Australia
| | - Tim Spelman
- Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Maria Ftanou
- Psychosocial Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
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30
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de Figueiredo JM, Zhu B, Patel AS, Kohn R, Koo BB, Louis ED. Differential impact of resilience on demoralization and depression in Parkinson disease. Front Psychiatry 2023; 14:1207019. [PMID: 37559912 PMCID: PMC10408307 DOI: 10.3389/fpsyt.2023.1207019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/19/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVES The objective of this study was to study the interrelations of demoralization, depression, and resilience in patients with Parkinson disease, and, more specifically, to determine if higher resilience in patients with Parkinson disease is associated with lower demoralization, lower depression, or both. METHODS Outpatients with Parkinson disease (N = 95) were assessed for demoralization, depression, and resilience, as well as sociodemographic, clinical, and treatment-related variables. Bivariable associations, standard regressions, linear regression with copula correction, and correspondence analysis were used to analyze the data. RESULTS Although the bivariable association between resilience and depression was statistically significant, the association ceased to be significant when demoralization was taken into consideration in both standard regressions and linear regression with copula correction. By contrast, the association between resilience and demoralization was significant when depression was not taken into consideration and continued to be significant when depression was taken into consideration. Correspondence analysis revealed that low resilience was strongly related to demoralization combined with depression, whereas normal resilience was closely correlated with depression without demoralization. CONCLUSION These results expand our understanding of resilience by suggesting that it is a mechanism evolved to reduce or prevent demoralization and not just depression. Reducing demoralization and strengthening resilience as part of a comprehensive treatment plan are likely to improve the prognosis of Parkinson disease.
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Affiliation(s)
- John M. de Figueiredo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Boheng Zhu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Amar S. Patel
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Robert Kohn
- Department of Psychiatry, Brown University School of Medicine, Providence, RI, United States
| | - Brian B. Koo
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Elan D. Louis
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
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Cai Y, Zhao J, Li W, Yu S, Tang L, Yao S, Cheng H. The effects of Managing Cancer and Living Meaningfully (CALM) on psychological distress in esophageal cancer patients. Future Oncol 2023. [PMID: 37469307 DOI: 10.2217/fon-2023-0311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
Aim: To evaluate the effectiveness of Managing Cancer and Living Meaningfully (CALM) in esophageal cancer with psychological distress during treatment. Materials & methods: The study assigned eligible patients to either a CALM group or a usual care group. Psychological distress, anxiety, depression and quality of life scores were assessed for both groups at baseline, during the intervention period and at the end of the intervention. Results: Patients showed a significant reduction in psychological distress, anxiety and depression and demonstrated improved quality of life after the CALM intervention, and the positive effect remained after 1 month of follow-up. Conclusion: This study suggests that CALM may be an effective approach for targeting psychological distress in patients with esophageal cancer.
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Affiliation(s)
- Yinlian Cai
- Department of Oncology, Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, 230601, China
| | - Jie Zhao
- Department of Oncology, Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, 230601, China
| | - Wen Li
- Department of Oncology, Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, 230601, China
| | - Sheng Yu
- Department of Oncology, Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, 230601, China
| | - Lingxue Tang
- Department of Oncology, Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, 230601, China
| | - Senbang Yao
- Department of Oncology, Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, 230601, China
| | - Huaidong Cheng
- Department of Oncology, Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, 230601, China
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, 518000, China
- School of Shenzhen Clinical Medical, Southern Medical University, Shenzhen, Guangdong, 518000, China
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Wang M, Gan C, Zhao J, Li W, Yu S, Yao S, Tang L, Xu J, Cheng H. Positive influence of managing cancer and living meaningfully (CALM) on fear of cancer recurrence in breast cancer survivors. Am J Cancer Res 2023; 13:3067-3079. [PMID: 37559986 PMCID: PMC10408467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/06/2023] [Indexed: 08/11/2023] Open
Abstract
To evaluate the effectiveness and feasibility of managing cancer and living meaningfully (CALM), an intervention used to reduce the fear of cancer recurrence (FCR) in breast cancer survivors and improve their quality of life (QoL). A total of 103 breast cancer survivors were enrolled. Participants were randomly assigned to the CALM group or the care as usual (CAU) group. The participants completed a survey at baseline (T0) and after two (T1), four (T2), and six (T3) intervention sessions. The patients were assessed using the Cancer Worry Scale (CWS), Psychological Distress Thermometer (DT), Functional Assessment of Cancer Therapy-Breast (FACT-B) and Hospital Anxiety and Depression Scale (HADS). After the intervention, the CALM group showed a significant decrease in levels of FCR, distress, anxiety, and depression (χ2=154.353, χ2=130.292, χ2=148.879, and χ2=78.681; P<0.001, 0.001, 0.001, and 0.001, respectively) and an increased QoL (χ2=122.822, P<0.001). Compared with the CAU group, the CALM group showed significant differences in FCR, distress, QoL, anxiety and depression (F=292.431, F=344.156, F=11.115, F=45.124, and F=16.155; P<0.001, P<0.001, P=0.01, P<0.001, and P<0.001, respectively). Negative correlations were found between CWS and FACT-B scores in the CALM group (T0: r=-0.6345, P<0.001; T1: r=-0.4127, P=0.0017; T2: r=-0.2919, P=0.0306; and T3: r=-0.3188, P=0.0177) and in the CAU group (T0: r=-0.7714, P<0.0001; T1: r=-0.6549, P<0.0001; T2: r=-0.5060, P=0.0002; and T3: r=-0.3151, P=0.0291). Thus, the CALM intervention reduced FCR, distress, anxiety and depression in breast cancer survivors and improved QoL.
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Affiliation(s)
- Menglian Wang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei 230601, Anhui, China
| | - Chen Gan
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei 230601, Anhui, China
| | - Jie Zhao
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei 230601, Anhui, China
| | - Wen Li
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei 230601, Anhui, China
| | - Sheng Yu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei 230601, Anhui, China
| | - Senbang Yao
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei 230601, Anhui, China
| | - Lingxue Tang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei 230601, Anhui, China
| | - Jian Xu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei 230601, Anhui, China
| | - Huaidong Cheng
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei 230601, Anhui, China
- Shenzhen Clinical Medical School of Southern Medical UniversityShenzhen 518000, Guangdong, China
- Department of Oncology, Shenzhen Hospital of Southern Medical UniversityShenzhen 518000, Guangdong, China
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Zhao J, Wang M, Huang R, Xu J, Gan C, Yu S, Tang L, Yao S, Li W, Cheng H. Effects of CALM intervention on neutrophil-to-lymphocyte ratio (NLR), fear of cancer recurrence and quality of life in patients with lung cancer. Support Care Cancer 2023; 31:447. [PMID: 37414980 DOI: 10.1007/s00520-023-07929-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/04/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To evaluate the feasibility and practicability of Managing Cancer and Living Meaningfully (CALM) as a psychological intervention to reduce neutrophil to lymphocyte ratio (NLR), fear of cancer recurrence, general distress, and improve quality of life in lung cancer survivors. METHODS Eighty lung cancer patients with FCRI severity subscale (≥13 points) were recruited and randomly assigned to CALM or usual care (UC). NLR was recorded before and after treatment. The Fear of Cancer Recurrence Inventory (FCRI), Quality of Life Questionnaire Core 30 (QLQ-C30) and Depression-Anxiety-Stress Scale (DASS-21) were used to evaluate patients at baseline (T0), immediately after treatment (T1), and at 2 (T2) and 4 (T3) months. RESULTS Compared with UC, NLR was significantly different before and after CALM intervention (z=-5.498; P=0.000). There were significant differences in the scores of QLQ, FCR and general distress before and after the T1, T2 and T3 interventions (F=220.30, F=315.20, F=290.10, respectively; P<0.001). NLR was negatively correlated with QOL both before (r=-0.763; P<0.0001) and after the intervention (r=-0.810, P<0.0001). FCR and general distress were negatively correlated with QOL in CALM (T0: r=-0.726, r=-0.776, respectively; P<0.0001; T1: r=-0.664, r=-0.647, respectively; P<0.0001; T2: r=-0.678, r=-0.695, respectively; P<0.0001; T3: r=-0.511, P = 0.0008; r=-0.650, P<0.0001). CONCLUSION CALM intervention can effectively reduce the NLR, alleviate the recurrence fear and general distress and improve the quality of life in patients. This study suggests that CALM may be an effective psychological intervention for reducing symptoms associated with lung cancer survivors.
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Affiliation(s)
- Jie Zhao
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Menglian Wang
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Runze Huang
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Jian Xu
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Chen Gan
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Sheng Yu
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Lingxue Tang
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Senbang Yao
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Wen Li
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Huaidong Cheng
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China.
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, Guangdong, China.
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Sokol LL, Troost JP, Bega D, Paulsen JS, Kluger BM, Applebaum AJ, Frank S, Nance MA, Anderson KE, Perlmutter JS, Depp CA, Grafman J, Cella D, Carlozzi NE. Death Anxiety in Huntington Disease: Longitudinal Heath-Related Quality-of-Life Outcomes. J Palliat Med 2023; 26:907-914. [PMID: 36607769 PMCID: PMC10316526 DOI: 10.1089/jpm.2022.0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 01/07/2023] Open
Abstract
Objective: Death anxiety, represented by the HDQLIFE™ Concern with Death and Dying (CwDD) patient-reported outcome (PRO) questionnaire, captures a person's worry about the death and dying process. Previous work suggests that death anxiety remains an unremitting burden throughout all stages of Huntington disease (HD). Although palliative interventions have lessened death anxiety among people with advanced cancer, none has yet to undergo testing in the HD population. An account of how death anxiety is associated with longitudinal changes to aspects of health-related quality of life (HRQoL) would help optimize neuropalliative interventions for people with HD. Methods: HDQLIFE collected PROs concerning physical, mental, social, and cognitive HRQoL domains and clinician-rated assessments from people with HD at baseline and 12 and 24 months. Linear mixed-effects models were created to determine how baseline death anxiety was associated with follow-up changes in HRQoL PROs after controlling for baseline death anxiety and other disease and sociodemographic covariates. Results: Higher baseline HDQLIFE CwDD is associated with 12- and 24-month declines in HDQLIFE Speech Difficulties, neurology quality of life (NeuroQoL) Depression, Suicidality, HDQLIFE Meaning and Purpose, and NeuroQoL Positive Affect and Well-being. Interpretation: Death anxiety may be a risk factor for worsening mental health and speech difficulty. A further prospective study is required to evaluate whether interventions on death anxiety or mental health generally can reduce declines in HRQoL for people with HD over time.
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Affiliation(s)
- Leonard L. Sokol
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- McGaw Bioethics Scholars Program, Center for Bioethics and Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jonathan P. Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Danny Bega
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane S. Paulsen
- Department of Neurology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Benzi M. Kluger
- Department of Neurology and Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Allison J. Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Samuel Frank
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Karen E. Anderson
- Department of Psychiatry, Georgetown University, Washington, DC, USA
| | - Joel S. Perlmutter
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Colin A. Depp
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Think + Speak Lab, Shirley Ryan Ability Lab, Chicago, Illinois, USA
| | - David Cella
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Noelle E. Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
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Di Risio M, Thompson A. Current practices in managing end-of-life existential suffering. Curr Opin Support Palliat Care 2023; 17:119-124. [PMID: 37039587 DOI: 10.1097/spc.0000000000000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
PURPOSE OF REVIEW Within the context of palliative care, existential suffering (ES) can be an exclusive source of suffering or intertwined with physical pain and/or psychological and spiritual suffering. With newly emerging modalities for addressing this phenomenon and its increasing salience given that many patients cite ES as a significant contributing factor to requests for hastened death, a review of recent interventions for addressing ES at the end of life is timely. RECENT FINDINGS This review of newer approaches to dealing with ES in the palliative context suggests some promising new modalities and pharmacological interventions, such as brain stimulation and the use of psychedelics. The use of other pharmacological interventions, such as palliative sedation and lethal injections, solely for the alleviation of existential distress remains ethically controversial and difficult to disentangle from other forms of suffering, not least because a clear clinical definition of ES has yet to emerge in the literature. SUMMARY The evaluation of end-of-life (EOL) ES mitigating tools should also consider how broader contexts, such as institutional arrangements and barriers, and cultural factors may influence the optimal management of dying persons' ES in the palliative care setting.
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Affiliation(s)
- Michelle Di Risio
- Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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36
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Andersen BL, Lacchetti C, Ashing K, Berek JS, Berman BS, Bolte S, Dizon DS, Given B, Nekhlyudov L, Pirl W, Stanton AL, Rowland JH. Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update. J Clin Oncol 2023:JCO2300293. [PMID: 37075262 DOI: 10.1200/jco.23.00293] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
PURPOSE To update the American Society of Clinical Oncology guideline on the management of anxiety and depression in adult cancer survivors. METHODS A multidisciplinary expert panel convened to update the guideline. A systematic review of evidence published from 2013-2021 was conducted. RESULTS The evidence base consisted of 17 systematic reviews ± meta analyses (nine for psychosocial interventions, four for physical exercise, three for mindfulness-based stress reduction [MBSR], and one for pharmacologic interventions), and an additional 44 randomized controlled trials. Psychological, educational, and psychosocial interventions led to improvements in depression and anxiety. Evidence for pharmacologic management of depression and anxiety in cancer survivors was inconsistent. The lack of inclusion of survivors from minoritized groups was noted and identified as an important consideration to provide high-quality care for ethnic minority populations. RECOMMENDATIONS It is recommended to use a stepped-care model, that is, provide the most effective and least resource-intensive intervention based on symptom severity. All oncology patients should be offered education regarding depression and anxiety. For patients with moderate symptoms of depression, clinicians should offer cognitive behavior therapy (CBT), behavioral activation (BA), MBSR, structured physical activity, or empirically supported psychosocial interventions. For patients with moderate symptoms of anxiety, clinicians should offer CBT, BA, structured physical activity, acceptance and commitment therapy, or psychosocial interventions. For patients with severe symptoms of depression or anxiety, clinicians should offer cognitive therapy, BA, CBT, MBSR, or interpersonal therapy. Treating clinicians may offer a pharmacologic regimen for depression or anxiety for patients who do not have access to first-line treatment, prefer pharmacotherapy, have previously responded well to pharmacotherapy, or have not improved following first-line psychological or behavioral management.Additional information is available at www.asco.org/survivorship-guidelines.
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Affiliation(s)
| | | | | | | | | | - Sage Bolte
- Inova Health Foundation, Falls Church, VA
| | - Don S Dizon
- Legorreta Cancer Center at Brown University and Lifespan Cancer Institute, Providence, RI
| | | | - Larissa Nekhlyudov
- Brigham and Women's Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
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Garcia ACM, Schneiders M, da Mota KS, da Conceição VM, Kissane DW. Demoralization and spirituality in oncology: an integrative systematic review. Support Care Cancer 2023; 31:259. [PMID: 37052721 DOI: 10.1007/s00520-023-07722-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/01/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To synthesize the scientific findings on demoralization and spirituality in the oncology context. METHODS This is an integrative systematic review, in line with the PRISMA 2020 guidelines, as proposed by Whittemore and Knalf (2005). The MEDLINE via PubMed, Scopus, Web of Science, APA PsycNet, CINAHL, Cochrane Library, EMBASE, and LILACS databases were searched without limitations regarding language or year of publication. The studies were screened for inclusion according to the predefined eligibility criteria. Data extraction and evidence quality assessment were performed. RESULTS Out of the 1587 articles evaluated, 10 studies were included in this review. In general, it was found that demoralization tends to increase with the proximity of death and seems to be inversely related to spirituality, with spiritual well-being being a protective factor against demoralization, while the non-fulfillment of spiritual needs is related to increased demoralization in people with cancer. Furthermore, even among caregivers of people with advanced cancer, demoralization seems to be associated, among other factors, with spiritual suffering. These results should be analyzed with caution, considering that the studies included in this review are all observational studies, which prevents establishing cause and effect relationships. CONCLUSIONS Demoralization tends to increase with growing frailty and the proximity of death in people with cancer, and it seems to be inversely related to spirituality, both in these patients and in their caregivers.
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Affiliation(s)
- Ana Cláudia Mesquita Garcia
- Interdisciplinary Center for Studies in Palliative Care, School of Nursing, Federal University of Alfenas (UNIFAL-MG), Gabriel Monteiro da Silva Street, 700, Centro, Alfenas, MG, 37130-001, Brazil.
| | - Milena Schneiders
- Interdisciplinary Center for Studies in Palliative Care, School of Nursing, Federal University of Alfenas (UNIFAL-MG), Gabriel Monteiro da Silva Street, 700, Centro, Alfenas, MG, 37130-001, Brazil
| | - Kárita Santos da Mota
- Interdisciplinary Center for Studies in Palliative Care, School of Nursing, Federal University of Alfenas (UNIFAL-MG), Gabriel Monteiro da Silva Street, 700, Centro, Alfenas, MG, 37130-001, Brazil
- University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, Brazil
| | - Vander Monteiro da Conceição
- Interdisciplinary Center for Studies in Palliative Care, School of Nursing, Federal University of Alfenas (UNIFAL-MG), Gabriel Monteiro da Silva Street, 700, Centro, Alfenas, MG, 37130-001, Brazil
- Department of Nursing, Federal University of Fronteira Sul, Chapecó, Brazil
| | - David W Kissane
- University of Notre Dame, Sydney, Australia
- Cunningham Centre, St Vincent's Hospital, Sydney, Australia
- Szalmuk Family Psycho Oncology Research Unit, Cabrini Health and Monash Partner's Comprehensive Cancer Centre, Melbourne, Australia
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Grassi L, Caruso R, Riba MB, Lloyd-Williams M, Kissane D, Rodin G, McFarland D, Campos-Ródenas R, Zachariae R, Santini D, Ripamonti CI. Anxiety and depression in adult cancer patients: ESMO Clinical Practice Guideline. ESMO Open 2023; 8:101155. [PMID: 37087199 PMCID: PMC10163167 DOI: 10.1016/j.esmoop.2023.101155] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 03/15/2023] Open
Abstract
•Anxiety and depressive disorders are common in patients with cancer. •A higher prevalence seen in patients with cancer than the general population is often underrecognised. •Psychotherapy, cognitive behavioural therapy and mindfulness-based therapies are effective treatments. •Psychopharmacological treatments have been shown to be effective treatments of anxiety and depressive disorders.
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Affiliation(s)
- L Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - R Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - M B Riba
- Department of Psychiatry, University of Michigan, Ann Arbor; University of Michigan Rogel Cancer Center, University of Michigan, Ann Arbor, USA
| | - M Lloyd-Williams
- Academic Palliative and Supportive Care Studies Group (APSCSG), Primary Care and Mental Health, University of Liverpool, Liverpool; Department of Supportive and Palliative Care, Liverpool John Moores University, Liverpool, UK
| | - D Kissane
- Department of Psychiatry, Monash University and Monash Medical Centre, Monash Health, Clayton, Australia
| | - G Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - D McFarland
- Department of Psychiatry, University of Rochester, Rochester; Wilmont Cancer Institute, University of Rochester Medical Center, Rochester, USA
| | - R Campos-Ródenas
- Department of Psychiatry, Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain
| | - R Zachariae
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, Aarhus; Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - D Santini
- UOC Medical Oncology, AUSL Latina, Sapienza University of Rome, Aprilia
| | - C I Ripamonti
- Oncology-Supportive Care in Cancer, Department of Oncology & Haematology Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Gulbahar Eren M, Üçgül K, Sert H. Effectiveness of Interventions on Death Anxiety and Fear in Adults with Chronic Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231167725. [PMID: 36990654 DOI: 10.1177/00302228231167725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
This systematic review and meta-analysis aimed to synthesize the outcomes of various interventions to alleviate death anxiety and fear. Studies published between January 2010 and June 2022 were searched in the ScienceDirect, Scopus, Web of Science, PubMed, Cochrane Library, and CHINAL databases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement guidelines were used in this meta-analysis. The results were examined using 95% confidence intervals, p-values, and fixed- or random-effects models based on the heterogeneity test. Sixteen studies involving 1262 participants were included in this systematic review. Interventions in seven studies using the Templer Death Anxiety Scale (TDAS) significantly decreased death anxiety levels in the intervention groups compared to the control groups (z = -4.47; p < 0.001; 95% CI: -3.36 to -1.31). This meta-analysis provides insights into implementing logotherapy, cognitive behavioral therapy, spirituality-based care, and educational interventions for death anxiety and the fear experienced by patients with chronic diseases.
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Affiliation(s)
- Merve Gulbahar Eren
- Deparment of Internal Medicine Nursing, Faculty of Health Science, Sakarya University, Sakarya, Turkey
| | - Kübra Üçgül
- Vocational School of Health Services, Sakarya University, Sakarya, Turkey
| | - Havva Sert
- Deparment of Internal Medicine Nursing, Faculty of Health Science, Sakarya University, Sakarya, Turkey
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Liu Q, Ho KY, Lam KKW, Ho JMC, Lam W, Ma P, Abu-Odah H, Belay GM, Ling DL, Ching SSY, Wong FKY. Effectiveness of spiritual interventions on psychological outcomes and quality of life among paediatric patients with cancer: a study protocol for a systematic review. BMJ Open 2023; 13:e070810. [PMID: 36882254 PMCID: PMC10008432 DOI: 10.1136/bmjopen-2022-070810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Cancer and its treatment affect children's physical, psychological and social well-being throughout the disease trajectory. Spiritual well-being is a fundamental dimension of people's overall health and is considered a source of strength to motivate patients to cope with and adapt to their disease. Appropriate spiritual interventions are important to mitigate the psychological impact of cancer on children, with an ultimate goal of improving their quality of life (QoL) throughout the treatment course. However, the overall effectiveness of spiritual interventions for paediatric patients with cancer remains unclear. This paper describes a protocol to systematically summarise the characteristics of studies related to existing spiritual interventions and synthesise their effectiveness on psychological outcomes and QoL among children with cancer. METHODS AND ANALYSIS Ten databases will be searched to identify appropriate literature: MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, PsycINFO, LILACS, OpenSIGLE, the Chinese Biomedical Literature Database, the Chinese Medical Current Contents and the Chinese National Knowledge Infrastructure. All randomised controlled trials that meet our inclusion criteria will be included. The primary outcome will be QoL as evaluated by self-reported measures. The secondary outcomes will be self-reported or objectively measured psychological outcomes, including anxiety and depression. Review Manager V.5.3 will be used to synthesise the data, calculate treatment effects, perform any subgroup analyses and assess the risk of bias in included studies. ETHICAL AND DISSEMINATION The results will be presented at international conferences and published in peer-reviewed journals. As no individual data will be involved in this review, ethical approval is not required.
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Affiliation(s)
- Qi Liu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ka Yan Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | | | | | - Winsome Lam
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Polly Ma
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Hammoda Abu-Odah
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | | | - Dong-Lan Ling
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
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Rojas-Concha L, Hansen MB, Adsersen M, Petersen MA, Groenvold M. Implementation of clinical guidelines in specialized palliative care-results from a national improvement project: A national register-based study. Palliat Med 2023; 37:749-759. [PMID: 36872567 DOI: 10.1177/02692163231155977] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Knowledge about the process and the results of the implementation of clinical guidelines to improve palliative care is limited. A national project aimed at improving the quality of life of advanced cancer patients admitted to specialized palliative care services in Denmark by implementing clinical guidelines for the treatment of pain, dyspnea, constipation, and depression. AIM To investigate the degree of clinical guideline implementation by evaluating the proportion of patients treated according to guidelines among those who qualified (i.e. reported severe symptom level) before and after the 44 palliative care services implemented the guidelines, and how often different types of interventions were provided. DESIGN This is a national register-based study. SETTING/PARTICIPANTS Data from the improvement project were stored in and later obtained from the Danish Palliative Care Database. Adult patients with advanced cancer admitted to palliative care between September 2017 and June 2019 who answered the EORTC QLQ-C15-PAL questionnaire were included. RESULTS In total 11,330 patients answered the EORTC QLQ-C15-PAL. The proportions of services that implemented the four guidelines ranged 73%-93%. Among services that had implemented guidelines, the proportion of patients receiving interventions was roughly constant over time reaching between 54% and 86% (lowest for depression). Pain and constipation were frequently treated pharmacologically (66%-72%), whereas dyspnea and depression were frequently treated non-pharmacologically (61% each). CONCLUSIONS Implementing clinical guidelines was more successful for physical symptoms than for depression. The project generated national data on interventions provided when guidelines were followed, which may be used to understand differences in care and outcomes.
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Affiliation(s)
- Leslye Rojas-Concha
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, and Frederiksberg Hospital, University of Copenhagen, Denmark
| | - Maiken Bang Hansen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, and Frederiksberg Hospital, University of Copenhagen, Denmark
| | - Mathilde Adsersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, and Frederiksberg Hospital, University of Copenhagen, Denmark
| | - Morten Aagaard Petersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, and Frederiksberg Hospital, University of Copenhagen, Denmark
| | - Mogens Groenvold
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, and Frederiksberg Hospital, University of Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Shnayder S, Ameli R, Sinaii N, Berger A, Agrawal M. Psilocybin-assisted therapy improves psycho-social-spiritual well-being in cancer patients. J Affect Disord 2023; 323:592-597. [PMID: 36513161 PMCID: PMC9884542 DOI: 10.1016/j.jad.2022.11.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/15/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND While psychedelics have been shown to improve psycho-spiritual well-being, the underlying elements of this change are not well-characterized. The NIH-HEALS posits that psycho-social-spiritual change occurs through the factors of Connection, Reflection & Introspection, and Trust & Acceptance. This study aimed to evaluate the changes in NIH-HEALS scores in a cancer population with major depressive disorder undergoing psilocybin-assisted therapy. METHODS In this Phase II, single-center, open label trial, 30 cancer patients with major depressive disorder received a fixed dose of 25 mg of psilocybin. Participants underwent group preparation sessions, simultaneous psilocybin treatment administered in adjacent rooms, and group integration sessions, along with individual care. The NIH-HEALS, a self-administered, 35-item measure of psycho-social spiritual healing was completed at baseline and post-treatment at day 1, week 1, week 3, and week 8 following psilocybin therapy. RESULTS NIH-HEALS scores, representing psycho-social-spiritual wellbeing, improved in response to psilocybin treatment (p < 0.001). All three factors of the NIH-HEALS (Connection, Reflection & Introspection, and Trust & Acceptance) demonstrated positive change by 12.7 %, 7.7 %, and 22.4 %, respectively. These effects were apparent at all study time points and were sustained up to the last study interval at 8 weeks (p < 0.001). LIMITATIONS The study lacks a control group, relies on a self-report measure, and uses a relatively small sample size with limited diversity that restricts generalizability. CONCLUSIONS Findings suggest that psilocybin-assisted therapy facilitates psycho-social-spiritual growth as measured by the NIH-HEALS and its three factors. This supports the factors of Connection, Reflection & Introspection, and Trust & Acceptance as underlying elements for psycho-social-spiritual healing in cancer patients, and validates the use of the NIH-HEALS within psychedelic research.
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Affiliation(s)
- Sarah Shnayder
- Sunstone Therapies, Rockville, MD, United States of America.
| | - Rezvan Ameli
- Sunstone Therapies, Rockville, MD, United States of America; Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, United States of America.
| | - Ninet Sinaii
- Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, MD, United States of America.
| | - Ann Berger
- Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, United States of America.
| | - Manish Agrawal
- Sunstone Therapies, Rockville, MD, United States of America.
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Loughan AR, Reid M, Willis KD, Barrett S, Lo K. The emotional journey of neuro-oncology: Primary brain tumor patients share their experience during this life-threatening disease. Neurooncol Pract 2023; 10:71-78. [PMID: 36659970 PMCID: PMC9837771 DOI: 10.1093/nop/npac067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background To achieve patient-centric quality care in neuro-oncology, all aspects of the disease and its impact on quality survival need to be considered. This includes the psychological consequences of a brain tumor diagnosis and subsequent life-altering experiences. Far too often the voice of our patients is unheard. Empowering patients to advocate for their own psychological needs is essential. Methods Data were derived from four focus groups with adult patients with brain tumors (N = 15; M age = 46 years, 53% female). A trained moderator led each 90-min group and posed semi-structured questions regarding patients' care needs throughout their neuro-oncological disease trajectory. Emphasis was placed on the quality of life and distress reduction. Common themes were identified via thematic content analysis using NVivo software. A high inter-rater reliability (M kappa = 0.92, range = 0.85-0.93) was achieved. Two themes are presented here: Emotional Response to Stressors and Existential Considerations. Results Of the two themes presented, 14 codes emerged. Codes were classified into three broad categories: Fear, Despair, and Resilience. The frequency of each category ranged from 31.4% to 34.7%. Example quotes and a discussion of each category follows. Conclusions It is imperative that we include the patient perspective in the development of neuro-oncology programs, thereby considering the quality of survival in addition to quantity. Neuro-oncology quality care must be driven by our patients' experiences and should integrate support for emotional distress while promoting resilience throughout this life-threatening illness.
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Affiliation(s)
- Ashlee R Loughan
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Massey Cancer Center, Richmond, Virginia, USA
| | - Morgan Reid
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kelcie D Willis
- Massey Cancer Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sarah Barrett
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Karen Lo
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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Abstract
This article provides an overview of the fields of psychosocial and integrative oncology, highlighting common psychological reactions to being diagnosed with and treated for cancer, including distress, anxiety, depression, fear of cancer recurrence and caregiver burden, as well as symptoms of fatigue, pain, and sleep disturbance. Patterns of symptomatology across the disease continuum are also discussed. Interventions targeted at treating these symptoms are reviewed, including acceptance-based and mindfulness therapies, mind-body therapies, and meaning-based approaches designed for people with advanced stages of disease, including psychedelic therapy. Common methodological issues and shortcomings of the evidence base are summarized with design recommendations, and a discussion of trends in future research including pragmatic research design, digital health interventions, and implementation science completes the article.
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Affiliation(s)
- Linda E Carlson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada;
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Arshinoff R, Roldan C, Balboni T. Spirituality and spiritual distress in neurologic illness. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:221-234. [PMID: 36599510 DOI: 10.1016/b978-0-12-824535-4.00004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Neurologic illnesses present multiple challenges to patients and their families from the time of initial diagnosis and throughout their illness trajectory, including challenges related to accepting the diagnosis and its various impacts and anxiety about future living with their illness. Often patients and their families rely on their spirituality to cope with and to maintain meaning and dignity in the midst of disease. As a result, spiritual care provision is a critical component of holistic medical care to patients with neurologic illness. Spiritual care provision follows a generalist-specialist model, which requires all healthcare professionals involved in the care of patients facing serious illness to play a role in recognizing and addressing spiritual needs. This model is characterized by generalist spiritual care providers (e.g., nurses, physicians, social workers) who perform spiritual screenings through history taking. Chaplains function as specialist spiritual care providers and can address spiritual care more deeply. In addition, several developed psychotherapeutic approaches may be useful for patients with neurologic disease, and chaplains are especially trained to offer supportive spiritual care to patients with neurologic illnesses and their families and to work together with physicians and other members of the healthcare team as part of a holistic approach to care.
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Affiliation(s)
- Rena Arshinoff
- Department of Spiritual Care, Baycrest Center for Geriatrics, Division of Palliative Care, University of Toronto, Toronto, ON, Canada.
| | - Claudia Roldan
- Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Tracy Balboni
- Departments of Radiation Oncology and of Psychosocial Oncology and Palliative Care, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, United States
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Zarrella GV, Braun SE. In Regard to Ding et al. 2020: "Managing Cancer and Living Meaningfully (CALM) Intervention on Chemotherapy-Related Cognitive Impairment in Breast Cancer Survivors". Integr Cancer Ther 2023; 22:15347354231191706. [PMID: 37605802 PMCID: PMC10467256 DOI: 10.1177/15347354231191706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/16/2023] [Accepted: 07/18/2023] [Indexed: 08/23/2023] Open
Affiliation(s)
| | - Sarah E. Braun
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Cheng H, Ding K, Yao S. Re: Response to In regard to Ding et al. 2020: "Managing Cancer and Living Meaningfully (CALM) Intervention on Chemotherapy Related Cognitive Impairment in Breast Cancer Survivors". Integr Cancer Ther 2023; 22:15347354231191715. [PMID: 37551862 PMCID: PMC10411267 DOI: 10.1177/15347354231191715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023] Open
Affiliation(s)
- Huaidong Cheng
- Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China
- The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ke Ding
- Fuyang Cancer Hospital, Fuyang, Anhui, China
| | - Senbang Yao
- The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Khalid S, Abbas I, Javed S. Psychological Support for Cancer Patients. Cancer Treat Res 2023; 185:255-283. [PMID: 37306913 DOI: 10.1007/978-3-031-27156-4_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
From the time a person is diagnosed with cancer, a psychological sequalae of intense emotional challenges emerge for the patient as well as family members. Different stages require different types of psychosocial support including those for previvors, survivors, and people who need palliative care. Currently, there is an emphasis on not only providing psychological assistance to cope with emotional, interpersonal, and economic stresses, but training programs specially designed to activate personal and social resources to find happiness and meaning in adversity. Within this perspective, the chapter is divided into three sections, each considering the common mental health issues and positive changes and intervention and therapies for cancer patients, family members, caregivers, onco-staff, and professionals.
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Affiliation(s)
- Shazia Khalid
- Department of Psychology, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan.
| | - Imran Abbas
- Oncoplastic Breast Surgeon, Royal Cornwall Hospitals, NHS Trust, Cornwall, UK
| | - Saira Javed
- Department of Psychology, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
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ÜLBE S, DİRİK G. Kanser Tanısı almış Kişilere Uygulanan Anlam Temelli Müdahale Programları: Sistematik bir Derleme. KLINIK PSIKOLOJI DERGISI 2022. [DOI: 10.57127/kpd.26024438m0000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Son yıllarda kanser tanısı almış kişilerin yalnızca yaşadıkları olumsuz psikolojik semptomları azaltmayı değil, aynı zamanda kişilerin yaşamdaki anlam kaynaklarını ve değerleri ile temasa geçerek yaşamlarını zenginleştirmeyi amaçlayan çeşitli anlam temelli müdahale geliştirilmiştir. Mevcut çalışmanın amacı kanser tanısı alan kişilerde doğrudan yaşamda anlam ve amaç duygularını geliştirmeye odaklanan müdahalelerin özelliklerini ve sonuçlarını sistematik olarak incelemektir. Bu kapsamda PsychINFO, MEDLINE, CINAHL Complete, PubMed, Scopus ve Web of Science olmak üzere toplamda altı elektronik veri tabanı kullanılarak sistematik bir literatür taraması yapılmıştır. 2000-2022 yılları arasında yapılan tarama sonucunda kanser tanısı almış kişiler için doğrudan anlam yaratmaya ve yaşamda anlam duygusuna odaklanan 14 farklı müdahale programını içeren 20 çalışmaya ulaşılmıştır. Derlemede yer alan araştırmaların örneklemini çoğunlukla kadın, orta yaş ve üzeri olan ve ileri evre kanser tanısı alan kişiler oluşturmuştur. Meme ve akciğer kanseri bu derlemedeki araştırmalarda en çok yer alan kanser türüdür. Derlemeye dâhil edilen çalışmaların çoğunluğunun kuramsal olarak Frankl’ın çalışmalarından etkilendiği ve psikoterapide varoluşsal yaklaşımı benimsedikleri görülmektedir. Anlam odaklı müdahale programlarının etkileri değerlendirildiğinde ise yapılan müdahalelerin anlam duygusunu, yaşam kalitesini ve spiritüel iyi oluş düzeylerini iyileştirmede büyük oranda etkili olduğu görülmektedir. Ayrıca anksiyete, depresyon, duygusal sıkıntı, iyimserlik ve umutsuzluk düzeyleri üzerinde görece olumlu etkileri olduğu düşünülmektedir. Bu kapsamda anlam odaklı müdahalelerinin kanser tanısı almış kişilerin hem anlam ve varoluşla ilgili sorularını hem de duygusal sıkıntılarını ele almada umut verici bir yaklaşım olduğu görülmektedir. Diğer taraftan anlam odaklı müdahalelere ilişkin daha kapsamlı çıkarımlar yapabilmek için daha titiz bir araştırma metodolojisi kullanan yeni çalışmalara ihtiyaç vardır.
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Burgers VWG, van den Bent MJ, Rietjens JAC, Roos DC, Dickhout A, Franssen SA, Noordoek MJ, van der Graaf WTA, Husson O. "Double awareness"-adolescents and young adults coping with an uncertain or poor cancer prognosis: A qualitative study. Front Psychol 2022; 13:1026090. [PMID: 36591063 PMCID: PMC9795247 DOI: 10.3389/fpsyg.2022.1026090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Adolescents and young adults with an uncertain or poor cancer prognosis (UPCP) are confronted with ongoing and unique age-specific challenges, which forms an enormous burden. To date, little is known about the way AYAs living with a UPCP cope with their situation. Therefore, this study explores how AYAs with a UPCP cope with the daily challenges of their disease. Method We conducted semi-structured in-depth interviews among AYAs with a UPCP. Patients of the three AYA subgroups were interviewed (traditional survivors, new survivors, low-grade glioma survivors), since we expected different coping strategies among these subgroups. Interviews were analyzed using elements of the Grounded Theory by Corbin and Strauss. AYA patients were actively involved as research partners. Results In total 46 AYAs with UPCP participated, they were on average 33.4 years old (age range 23-44) and most of them were woman (63%). Most common tumor types were low-grade gliomas (16), sarcomas (7), breast cancers (6) and lung cancers (6). We identified seven coping strategies in order to reduce the suffering from the experienced challenges: (1) minimizing impact of cancer, (2) taking and seeking control, (3) coming to terms, (4) being positive, (5) seeking and receiving support, (6) carpe diem and (7) being consciously alive. Conclusion This study found seven coping strategies around the concept of 'double awareness' and showcases that AYAs are able to actively cope with their disease but prefer to actively choose life over illness. The findings call for CALM therapy and informal AYA support meetings to support this group to cope well with their disease.
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Affiliation(s)
- Vivian W. G. Burgers
- Psychosocial Research and Epidemiology Department, Netherlands Cancer Institute, Amsterdam, Netherlands,Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Judith A. C. Rietjens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Daniëlle C. Roos
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands,Department of Medical Oncology, Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Annemiek Dickhout
- Internal Medicine, Division Medical Oncology, Maastricht University Medical Center, Maastricht, Netherlands,GROW-School of Oncology and Reproduction, Maastricht University Medical Center, Maastricht, Netherlands,AYA Research Partner, Amsterdam, Netherlands
| | | | | | - Winette T. A. van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands,Department of Medical Oncology, Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Olga Husson
- Psychosocial Research and Epidemiology Department, Netherlands Cancer Institute, Amsterdam, Netherlands,Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands,Department of Surgical Oncology, Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands,Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom,*Correspondence: Olga Husson,
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