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Anderson N, Ozakinci G. Effectiveness of psychological interventions to improve quality of life in people with long-term conditions: rapid systematic review of randomised controlled trials. BMC Psychol 2018; 6:11. [PMID: 29587884 PMCID: PMC5870214 DOI: 10.1186/s40359-018-0225-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/13/2018] [Indexed: 01/12/2023] Open
Abstract
Background Long-term conditions may negatively impact multiple aspects of quality of life including physical functioning and mental wellbeing. The rapid systematic review aimed to examine the effectiveness of psychological interventions to improve quality of life in people with long-term conditions to inform future healthcare provision and research. Methods EBSCOhost and OVID were used to search four databases (PsychInfo, PBSC, Medline and Embase). Relevant papers were systematically extracted by one researcher using the predefined inclusion/exclusion criteria based on titles, abstracts, and full texts. Randomized controlled trial psychological interventions conducted between 2006 and February 2016 to directly target and assess people with long-term conditions in order to improve quality of life were included. Interventions without long-term condition populations, psychological intervention and/or patient-assessed quality of life were excluded. Results From 2223 citations identified, 6 satisfied the inclusion/exclusion criteria. All 6 studies significantly improved at least one quality of life outcome immediately post-intervention. Significant quality of life improvements were maintained at 12-months follow-up in one out of two studies for each of the short- (0–3 months), medium- (3–12 months), and long-term (≥ 12 months) study duration categories. Conclusions All 6 psychological intervention studies significantly improved at least one quality of life outcome immediately post-intervention, with three out of six studies maintaining effects up to 12-months post-intervention. Future studies should seek to assess the efficacy of tailored psychological interventions using different formats, durations and facilitators to supplement healthcare provision and practice.
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Affiliation(s)
- Niall Anderson
- Public Health Department, NHS Borders, Melrose, TD6 9BD, UK. .,School of Medicine, University of St Andrews, St Andrews, KY16 9TF, UK.
| | - Gozde Ozakinci
- School of Medicine, University of St Andrews, St Andrews, KY16 9TF, UK
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Kalter J, Verdonck-de Leeuw IM, Sweegers MG, Aaronson NK, Jacobsen PB, Newton RU, Courneya KS, Aitken JF, Armes J, Arving C, Boersma LJ, Braamse AMJ, Brandberg Y, Chambers SK, Dekker J, Ell K, Ferguson RJ, Gielissen MFM, Glimelius B, Goedendorp MM, Graves KD, Heiney SP, Horne R, Hunter MS, Johansson B, Kimman ML, Knoop H, Meneses K, Northouse LL, Oldenburg HS, Prins JB, Savard J, van Beurden M, van den Berg SW, Brug J, Buffart LM. Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs. Psychooncology 2018; 27:1150-1161. [PMID: 29361206 PMCID: PMC5947559 DOI: 10.1002/pon.4648] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/02/2018] [Accepted: 01/10/2018] [Indexed: 01/25/2023]
Abstract
Objective This individual patient data (IPD) meta‐analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF), and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention‐related characteristics. Methods Relevant studies were identified via literature searches in 4 databases. We pooled IPD from 22 (n = 4217) of 61 eligible randomized controlled trials. Linear mixed‐effect model analyses were used to study intervention effects on the post‐intervention values of QoL, EF, and SF (z‐scores), adjusting for baseline values, age, and cancer type. We studied moderator effects by testing interactions with the intervention for demographic, clinical, personal, and intervention‐related characteristics, and conducted subsequent stratified analyses for significant moderator variables.Results: PSI significantly improved QoL (β = 0.14,95%CI = 0.06;0.21), EF (β = 0.13,95%CI = 0.05;0.20), and SF (β = 0.10,95%CI = 0.03;0.18). Significant differences in effects of different types of PSI were found, with largest effects of psychotherapy. The effects of coping skills training were moderated by age, treatment type, and targeted interventions. Effects of psychotherapy on EF may be moderated by cancer type, but these analyses were based on 2 randomized controlled trials with small sample sizes of some cancer types. Conclusions PSI significantly improved QoL, EF, and SF, with small overall effects. However, the effects differed by several demographic, clinical, personal, and intervention‐related characteristics. Our study highlights the beneficial effects of coping skills training in patients treated with chemotherapy, the importance of targeted interventions, and the need of developing interventions tailored to the specific needs of elderly patients.
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Affiliation(s)
- J Kalter
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - I M Verdonck-de Leeuw
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health research institute and Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - M G Sweegers
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P B Jacobsen
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, Maryland, FL, USA
| | - R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - K S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - J F Aitken
- Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Cancer Council Queensland, Brisbane, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, Australia
| | - J Armes
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - C Arving
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - L J Boersma
- Department of Radiation Oncology, Maastricht University Medical Center (MAASTRO clinic), Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A M J Braamse
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - Y Brandberg
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S K Chambers
- Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Cancer Council Queensland, Brisbane, Australia.,Prostate Cancer Foundation of Australia, Sydney, NSW, Australia
| | - J Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - K Ell
- Department of Adults and Healthy Aging, University of Southern California, Los Angeles, CA, USA
| | - R J Ferguson
- Division of Hematology-Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - M F M Gielissen
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - B Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - K D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - S P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - R Horne
- UCL School of Pharmacy, University College London, London, UK
| | - M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - B Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - H Knoop
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - K Meneses
- University of Alabama at Birmingham, School of Nursing, Birmingham, AL, USA
| | - L L Northouse
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - H S Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J B Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Savard
- School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, QC, Canada
| | - M van Beurden
- Department of Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - S W van den Berg
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Brug
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - L M Buffart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,Department of Medical Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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53
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Rammant E, Decaestecker K, Bultijnck R, Sundahl N, Ost P, Pauwels NS, Deforche B, Pieters R, Fonteyne V. A systematic review of exercise and psychosocial rehabilitation interventions to improve health-related outcomes in patients with bladder cancer undergoing radical cystectomy. Clin Rehabil 2017; 32:594-606. [PMID: 29231044 DOI: 10.1177/0269215517746472] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Summarizing the evidence on the effects of pre- and postoperative exercise and psychosocial rehabilitation interventions on patient-reported outcomes (PROs) and physical fitness in bladder cancer patients undergoing radical cystectomy. DATA SOURCES The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Web of Science and the Physiotherapy Evidence Database were searched independently by two authors from inception until 10 November 2017. Cited references of the studies and citing references retrieved via Web of Science were also checked. REVIEW METHODS Randomized controlled trials (RCTs) and non-randomized studies assessing effects of exercise and psychosocial interventions in bladder cancer patients undergoing radical cystectomy were eligible. Primary outcome measures were PROs and physical fitness. Risk of bias was assessed using the Cochrane Collaboration tool and the Newcastle-Ottawa Scale. RESULTS Five RCTs (three exercise and two psychosocial studies) and one non-randomized psychosocial study comprising 317 bladder cancer patients were included. Timing of the intervention was preoperative ( n = 2), postoperative ( n = 2) or both pre- and postoperative ( n = 2). Positive effects of exercise were found for physical fitness ( n = 3), some health-related quality-of-life (HRQoL) domains ( n = 2), personal activities in daily living ( n = 1) and muscle strength ( n = 1). Psychosocial interventions showed positive effects on anxiety ( n = 1), fatigue ( n = 1), depression ( n = 1), HRQoL ( n = 1) and posttraumatic growth ( n = 1). Quality assessment showed most shortcomings with sample sizes and strong heterogeneity was observed between studies. CONCLUSION The evidence relating to the effects of exercise in bladder cancer is very limited and is even less for psychosocial interventions.
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Affiliation(s)
- Elke Rammant
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | | | - Renée Bultijnck
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Nora Sundahl
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Piet Ost
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Nele S Pauwels
- 3 Knowledge Center Ghent, Ghent University Hospital, Ghent, Belgium
| | | | - Ronny Pieters
- 2 Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Valérie Fonteyne
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
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54
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Jeffers L, Reid J, Fitzsimons D, Morrison PJ, Dempster M. Interventions to improve psychosocial well-being in female BRCA
-mutation carriers following risk-reducing surgery. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Lisa Jeffers
- Regional Medical Genetics Centre; Medical Genetics; Belfast Health and Social Care Trust Lisburn Road Belfast UK BT9 7AB
| | - Joanne Reid
- Queen's University Belfast; School of Nursing and Midwifery; 10 Malone Road Belfast UK BT9 5BN
| | - Donna Fitzsimons
- Queen's University Belfast; School of Nursing and Midwifery; 10 Malone Road Belfast UK BT9 5BN
| | - Patrick J Morrison
- Regional Medical Genetics Centre; Medical Genetics; Belfast Health and Social Care Trust Lisburn Road Belfast UK BT9 7AB
- The Queen's University Belfast; Centre for Cancer Research and Cell Biology; 97 Lisburn Road Belfast UK BT9 7AE
| | - Martin Dempster
- Queen's University Belfast; School of Psychology; University Road Belfast Northern Ireland UK BT7 1NN
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Abstract
Cancer is a devastating disease causing significant psychological problems among patients and their families. In the past few decades, there have been growing implementation and dissemination of screening methods for the psychological consequences of cancer, including distress, depression, anxiety, post-traumatic stress, and demoralisation. Also, guidelines for the management of psychological distress have been developed and endorsed by a number of scientific cancer associations. This review examines some of the most significant related issues, also focusing on recent advances in psychosocial and psychopharmacological interventions as a part of a mandatory, integrated, and comprehensive approach to cancer care.
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Affiliation(s)
- Luigi Grassi
- University Hospital Psychiatric Unit, Integrated Department of Mental Health and Addictive Behavior, S. Anna University Hospital and Health Trust, Ferrara, Italy
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - David Spiegel
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Michelle Riba
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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56
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D’Souza V, Daudt H, Kazanjian A. Survivorship care plans for breast cancer patients: understanding the quality of the available evidence. Curr Oncol 2017; 24:e446-e465. [PMID: 29270054 PMCID: PMC5736484 DOI: 10.3747/co.24.3632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
AIM The overall goal of the present study was to contribute to consistency in the provincial approach to survivorship care planning through knowledge synthesis and exchange. Our review focused on the research concerning the physical and emotional challenges of breast cancer (bca) patients and survivors and the effects of the interventions that have been used for lessening those challenges. METHODS The psychosocial topics identified in bca survivorship care plans created by two different initiatives in our province provided the platform for our search criteria: quality of life (qol), sexual function, fatigue, and lifestyle behaviours. We conducted an umbrella review to retrieve the best possible evidence, and only reviews investigating the intended outcomes in bca survivors and having moderate-to-high methodologic quality scores were included. RESULTS Of 486 reports retrieved, 51 reviews met the inclusion criteria and form part of the synthesis. Our results indicate that bca patients and survivors experience numerous physical and emotional challenges and that interventions such as physical activity, psychoeducation, yoga, and mindfulness-based stress reduction are beneficial in alleviating those challenges. CONCLUSIONS Our study findings support the existing survivorship care plans in our province with respect to the physical and emotional challenges that bca survivors often face. However, the literature concerning cancer risks specific to bca survivors is scant. Although systematic reviews are considered to be the "gold standard" in knowledge synthesis, our findings suggest that much remains to be done in the area of synthesis research to better guide practice in cancer survivorship.
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Affiliation(s)
- V. D’Souza
- BC Cancer Agency–Vancouver Island Centre, Victoria, BC
| | - H. Daudt
- BC Cancer Agency–Vancouver Island Centre, Victoria, BC
| | - A. Kazanjian
- BC Cancer Agency–Vancouver Island Centre, Victoria, BC
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC
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57
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Abstract
There is a paucity of data on whether interventions in individual palliative care units are evidence-based. Thirteen years ago an initial study evaluated the evidence base of interventions in palliative care. Using similar methodology in the present study, we evaluated the evidence for interventions performed in an inpatient palliative care setting, looking at level of evidence as well as quality and outcome of evidence. More than half of all the interventions (47 interventions, 59 percent) we looked at in a Brisbane, Australia, inpatient palliative care setting were based on a high level of evidence in the form of systematic reviews of randomized controlled trials (level I or level II). There were only a few interventions (10 percent) for which no evidence could be retrieved. Our results show that the evidence base for interventions in palliative care continues to evolve, but that there are still areas for which further high-quality studies are needed.
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Affiliation(s)
- Korana Kindl
- Department of Palliative Care, St. Vincent's Private Hospital, Brisbane, Queensland, Australia
| | - Phillip Good
- Mater Research Institute-University of Queensland; Department of Palliative and Supportive Care, Mater Health Services; and Department of Palliative Care, St. Vincent's Private Hospital, 411 Main Street, Kangaroo Point, Brisbane, Queensland, Australia 4169
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58
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Hoeck B, Ledderer L, Ploug Hansen H. Dealing with cancer: a meta-synthesis of patients' and relatives' experiences of participating in psychosocial interventions. Eur J Cancer Care (Engl) 2017; 26:e12652. [PMID: 28169475 DOI: 10.1111/ecc.12652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2016] [Indexed: 11/28/2022]
Abstract
The aim was to synthesise patients' and relatives' experiences of participating in a psychosocial intervention related to having cancer. The study was a meta-synthesis inspired by Noblit & Hare's 'meta-ethnography' approach. We systematically searched six databases and included 33 studies in the meta-synthesis. Inclusion criteria were qualitative studies with relevance to the synthesis topic. The meta-synthesis conceptualised the way in which participants develop their way of living with cancer, and the role psychosocial interventions play in helping them to live through the illness. Five themes symbolising the participants' core experiences were identified: (1) Emotional relief and a sense of well-being, (2) normalisation of experiences and a sense of control, (3) shared experience and a sense of community, (4) a safe place and (5) transformation and adaptability. The findings indicated that psychosocial interventions were used to try to deal with the changes in the human conditions caused by cancer. Sharing their experiences and forming social relationships helped the participants adapt to cancer. An existential perspective may provide a nuanced understanding of patients' and relatives' experiences of participating in psychosocial interventions.
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Affiliation(s)
- B Hoeck
- Research Unit of User Perspectives, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - L Ledderer
- Section for Health Promotion and Health Services, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - H Ploug Hansen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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59
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Liao YC, Liao WY, Sun JL, Ko JC, Yu CJ. Psychological distress and coping strategies among women with incurable lung cancer: a qualitative study. Support Care Cancer 2017; 26:989-996. [PMID: 29019055 DOI: 10.1007/s00520-017-3919-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/02/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Limited research has focused on women with lung cancer (LC) although they are recognized as the most vulnerable to psychological distress. This study explored in-depth the psychological distress experienced by women with incurable LC and analyzed the coping strategies with which they manage that distress. METHODS A qualitative methodology with in-depth interviews was employed for 34 women with advanced or recurrent LC. An inductive data-driven thematic analysis was applied to analyze transcripts. RESULTS Psychological distress was an iterative process for the women. Four themes were identified: shock regarding the diagnosis, distress regarding cancer treatment and its side effects, the facing of a recurrent or progressive disease, and persistent struggle with the life-limiting disease. Various coping strategies applied by the women to manage psychological distress were grouped into four themes: relying upon social support, focusing on positive thoughts, avoidance-based strategies, and religious faith and acceptance. CONCLUSIONS Women with incurable LC experienced substantial iterative psychological distress throughout the illness, regardless of length of illness at time of interview. They applied multiple forms of coping. The findings enrich the limited existing literature on this understudied population and provide direction for the future development of interventions to improve their psychological well-being.
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Affiliation(s)
- Yu-Chien Liao
- Department of Nursing, Yuanpei University of Medical Technology, 306, Yuanpei Street, Hsinchu, 30015, Taiwan.
| | - Wei-Yu Liao
- Department of Internal Medicine, College of Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Jia-Ling Sun
- Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Jen-Chung Ko
- Department of Internal Medicine, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, College of Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
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60
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Caminiti C, Iezzi E, Passalacqua R. Effectiveness of the HuCare Quality Improvement Strategy on health-related quality of life in patients with cancer: study protocol of a stepped-wedge cluster randomised controlled trial (HuCare2 study). BMJ Open 2017; 7:e016347. [PMID: 28988170 PMCID: PMC5640062 DOI: 10.1136/bmjopen-2017-016347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Our group previously demonstrated the feasibility of the HuCare Quality Improvement Strategy (HQIS), aimed at integrating into practice six psychosocial interventions recommended by international guidelines. This trial will assess whether the introduction of the strategy in oncology wards improves patient's health-related quality of life (HRQoL). METHODS AND ANALYSIS Multicentre, incomplete stepped-wedge cluster randomised controlled trial, conducted in three clusters of five centres each, in three equally spaced time epochs. The study also includes an initial epoch when none of the centres are exposed to the intervention, and a final epoch when all centres will have implemented the strategy. The intervention is applied at a cluster level, and assessed at an individual level with cross-sectional model. A total of 720 patients who received a cancer diagnosis in the previous 2 months and about to start medical treatment will be enrolled. The primary aim is to evaluate the effectiveness of the HQIS versus standard care in terms of improvement of at least one of two domains (emotional and social functions) of HRQoL using the EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 items) questionnaire, at baseline and at 3 months. This outcome was chosen because patients with cancer generally exhibit low HRQoL, particularly at certain stages of care, and because it allows to assess the strategy's impact as perceived by patients themselves. The HQIS comprises three phases: (1) clinician training-to improve communication-relational skills and instruct on the project; (2) centre support-four on-site visits by experts of the project team, aimed to boost motivation, help with context analysis and identification of solutions; (3) implementation of Evidence-Based Medicine (EBM) recommendations at the centre. ETHICS AND DISSEMINATION Ethics committee review approval has been obtained from the Ethics Committee of Parma. Results will be disseminated at conferences, and in peer-reviewed and professional journals intended for policymakers and managers. TRIAL REGISTRATION NUMBER NCT03008993; Pre-results.
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Affiliation(s)
- Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, Parma, Italy
| | - Elisa Iezzi
- Research and Innovation Unit, University Hospital of Parma, Parma, Italy
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Caruso R, Nanni MG, Riba MB, Sabato S, Grassi L. The burden of psychosocial morbidity related to cancer: patient and family issues. Int Rev Psychiatry 2017; 29:389-402. [PMID: 28753076 DOI: 10.1080/09540261.2017.1288090] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
With cancer incidence increasing over time, attention to the burden of related psychiatric and psychosocial consequences of the disease and treatment is a major topic for both cancer patients and their caregivers. Among cancer patients, psychiatric (e.g. adjustment, anxiety, depressive disorders) and neuropsychiatric disorders (e.g. cognitive disorders secondary to treatment, delirium) have been shown to affect an average of 30-35% patients, with differences according to stage and type of cancer. Also other psychosocial syndromes (e.g. demoralization, health anxiety, irritable mood) not taken into account in usual nosological systems should be considered for their impact on the patient's quality-of-life. Also, it has been repeatedly reported that psychological distress reverberates substantially throughout the nuclear family, and that a family approach is necessary in cancer care, with the caregiver-patient dyad as a unit to be the focus and direction of assessment and intervention. In this review the most significant psychosocial disorders causing burden for cancer patients and their caregivers are examined, and the main methods of assessment for more proper referral and treatment are summarized.
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Affiliation(s)
- Rosangela Caruso
- a Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences , University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatric Unit , Program of Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Behavior , S. Anna University Hospital and Health Authority , Ferrara , Italy
| | - Mara Giulia Nanni
- a Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences , University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatric Unit , Program of Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Behavior , S. Anna University Hospital and Health Authority , Ferrara , Italy
| | - Michelle B Riba
- c Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA.,d University of Michigan Comprehensive Cancer Center , Ann Arbor , MI , USA.,e Psycho-oncology Program , University of Michigan Comprehensive Cancer Center , Ann Arbor , MI , USA
| | - Silvana Sabato
- a Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences , University of Ferrara , Ferrara , Italy
| | - Luigi Grassi
- a Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences , University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatric Unit , Program of Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Behavior , S. Anna University Hospital and Health Authority , Ferrara , Italy
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Dinnes J, Saleh D, Newton-Bishop J, Cheung ST, Nathan P, Matin RN, Chuchu N, Bayliss SE, Takwoingi Y, Davenport C, Godfrey K, O'Sullivan C, Deeks JJ, Williams HC. Tests to assist in the staging of cutaneous melanoma: a generic protocol. Hippokratia 2017. [DOI: 10.1002/14651858.cd012806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jacqueline Dinnes
- University of Birmingham; Institute of Applied Health Research; Birmingham UK B15 2TT
| | - Daniel Saleh
- Newcastle Hospitals NHS Trust, Royal Victoria Infirmary; Newcastle Hospitals; Newcastle UK
| | - Julia Newton-Bishop
- University of Leeds; Section of Epidemiology and Biostatistics; St James's Hospital Leeds UK LS9 7TF
| | - Seau Tak Cheung
- Dudley Hospitals Foundation Trust, Corbett Hospital; Department of Dermatology; Wicarage Road Stourbridge UK DY8 4JB
| | - Paul Nathan
- Mount Vernon Hospital; Mount Vernon Cancer Centre; Rickmansworth Road Northwood UK HA6 2RN
| | - Rubeta N Matin
- Churchill Hospital; Department of Dermatology; Old Road Headington Oxford UK OX3 7LJ
| | - Naomi Chuchu
- University of Birmingham; Institute of Applied Health Research; Birmingham UK B15 2TT
| | - Susan E Bayliss
- University of Birmingham; Institute of Applied Health Research; Birmingham UK B15 2TT
| | - Yemisi Takwoingi
- University of Birmingham; Institute of Applied Health Research; Birmingham UK B15 2TT
| | - Clare Davenport
- University of Birmingham; Institute of Applied Health Research; Birmingham UK B15 2TT
| | - Kathie Godfrey
- The University of Nottingham; c/o Cochrane Skin Group; Nottingham UK
| | | | - Jonathan J Deeks
- University of Birmingham; Institute of Applied Health Research; Birmingham UK B15 2TT
| | - Hywel C Williams
- The University of Nottingham; Centre of Evidence Based Dermatology; Queen's Medical Centre Derby Road Nottingham UK NG7 2UH
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Memaryan N, Ghaempanah Z, Saeedi MM, Aryankhesal A, Ansarinejad N, Seddigh R. Content of Spiritual Counselling for Cancer Patients Undergoing Chemotherapy in Iran: A Qualitative Content Analysis. Asian Pac J Cancer Prev 2017; 18:1791-1797. [PMID: 28749107 PMCID: PMC5648381 DOI: 10.22034/apjcp.2017.18.7.1791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Cancer is one of the leading causes of human death. Besides clinical treatment, cancer patients may need emotional and spiritual counselling to overcome their mental and morale problems. Such counselling sessions have been reported influential by many patients. We aimed to explore the structure of spiritual counselling sessions and their content as one of services provided to patients who experience chemotherapy in Iranian hospitals. Methods: Through a qualitative content analysis study, we recorded the discussions between a counsellor, who was a cleric as well, and cancer cases who were undergoing chemotherapy in a hospital in Tehran. The sessions were only recorded if the patient consented to attend at the study. All consideration were taken to avoid release of patients’ identity. The recorded discussions were transcribed verbatim and analyzed thematically after each session, until no new theme was emerged. Result: Twenty two sessions were held. The patients aged 53 years old on average. The content of discussions were analyzed along which 165 codes emerged. Four general themes or phases were recognized through counseling as (i) history-Taking (including demographic, disease-related and spiritual history and characteristics), (ii) general advice, (iii) spiritual-religious advice, and (iv) dealing with patients’ spiritual or religious ambiguities and paradoxes. Conclusion: Counselling of cancer patients needs special and in depth knowledge on spiritual and religious issues. The counsellor should be able to motivate patients, among whom many are disappointed, to follow the curative instructions well and stay hopeful about their treatment and life. Exploring and understanding what happens during a spiritual counselling session can counselling to the conformity and standardization of such interventions.
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Affiliation(s)
- Nadereh Memaryan
- Spiritual Health Research Center, Iran UNiversity of Medical Sciences, Tehran, Iran.
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Qualitatively Comparing the Support Needs of People with Cancer Based on Their History of Anxiety/Depression. Oncol Ther 2017; 5:41-51. [PMID: 28680954 PMCID: PMC5488146 DOI: 10.1007/s40487-017-0045-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Indexed: 12/05/2022] Open
Abstract
Introduction Research rarely considers the origin or history of a cancer patient’s anxiety and/or depression, instead assuming that these illnesses are related to the cancer experience. The aim of this study was to compare differences in the support needs of people who have experienced anxiety/depression as part of the cancer experience and people who have not, as well as between people who have experienced episodic anxiety/depression and people who have experienced long-term anxiety/depression. Methods Twenty-one semi-structured interviews were conducted with people with a current or previous diagnosis of cancer, and a current or previous experience with anxiety and/or depression. Participants were split into four groups based on their history with cancer and anxiety/depression, and an inductive thematic analysis was conducted to identify themes across groups. Results Two superordinate themes (with three and two subordinate themes respectively) were found: ‘coping with cancer’ and ‘health care system support provision’. Important differences were found across groups, with participants who had a history of anxiety/depression that was unrelated to their cancer diagnosis coping better with the combined burden of cancer and anxiety/depression, experiencing less fear of cancer recurrence, and highlighting more positive hospital and support service related experiences, than those whose anxiety/depression was cancer related. Conclusion The origin and history of a person’s anxiety/depression is important to consider when determining how they might cope with cancer, what their support needs are, and how much support they may require. Electronic supplementary material The online version of this article (doi:10.1007/s40487-017-0045-3) contains supplementary material, which is available to authorized users.
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Caruso R, GiuliaNanni M, Riba MB, Sabato S, Grassi L. Depressive Spectrum Disorders in Cancer: Diagnostic Issues and Intervention. A Critical Review. Curr Psychiatry Rep 2017; 19:33. [PMID: 28488207 PMCID: PMC5423924 DOI: 10.1007/s11920-017-0785-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Depressive spectrum disorders, including major depression, persistent depression, minor and sub-syndromal depression, and other forms of depressive conditions, such as demoralization, are among the most common psychiatric consequences of cancer patients, affecting up to 60% of patients. In spite of the negative effects and the burden for cancer patients and their families, these disorders often remain under-recognized and undertreated. The present review aims at summarizing the relevant data concerning the diagnostic challenges within the depressive spectrum disorders among cancer patients. Also, the most relevant data relative to integrated intervention, including psychopharmacological and psychosocial treatment, for depression in cancer patients are critically evaluated. It is mandatory that health care professionals working in oncology (e.g., oncologists, surgeons, radiation oncologists, primary care physicians, nurses, social workers, psychologists) receive training in the diagnosis and integrated management of the different types of disorder within the spectrum of clinical depression.
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Affiliation(s)
- Rosangela Caruso
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Disorders, S. Anna University Hospital and Health Authorities, Ferrara, Italy
| | - Maria GiuliaNanni
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Disorders, S. Anna University Hospital and Health Authorities, Ferrara, Italy
| | - Michelle B Riba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
- Psycho-oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Silvana Sabato
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy.
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Disorders, S. Anna University Hospital and Health Authorities, Ferrara, Italy.
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Greenlee H, DuPont-Reyes MJ, Balneaves LG, Carlson LE, Cohen MR, Deng G, Johnson JA, Mumber M, Seely D, Zick SM, Boyce LM, Tripathy D. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin 2017; 67:194-232. [PMID: 28436999 PMCID: PMC5892208 DOI: 10.3322/caac.21397] [Citation(s) in RCA: 402] [Impact Index Per Article: 57.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society.
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Affiliation(s)
- Heather Greenlee
- Assistant Professor, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
- Member, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | - Melissa J DuPont-Reyes
- Doctoral Fellow, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Lynda G Balneaves
- Associate Professor, College of Nursing, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Linda E Carlson
- Professor, Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Misha R Cohen
- Adjunct Professor, American College of Traditional Chinese Medicine at California Institute of Integral Studies, San Francisco, CA
- Clinic Director, Chicken Soup Chinese Medicine, San Francisco, CA
| | - Gary Deng
- Medical Director, Integrative Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jillian A Johnson
- Post-Doctoral Scholar, Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA
| | | | - Dugald Seely
- Executive Director, Ottawa Integrative Cancer Center, Ottawa, ON, Canada
- Executive Director of Research, Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Suzanna M Zick
- Research Associate Professor, Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI
- Research Associate Professor, Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Lindsay M Boyce
- Research Informationist, Memorial Sloan Kettering Library, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debu Tripathy
- Professor, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Leclerc AF, Jerusalem G, Devos M, Crielaard JM, Maquet D. Multidisciplinary management of breast cancer. ACTA ACUST UNITED AC 2016; 74:50. [PMID: 27980734 PMCID: PMC5137213 DOI: 10.1186/s13690-016-0163-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/17/2016] [Indexed: 12/14/2022]
Abstract
Breast cancer, with an increasing incidence, is the most frequently diagnosed cancer in women worldwide. The treatments proposed, generally a combination of surgery, radiotherapy, chemotherapy, endocrine therapy and/or targeted therapy, are constantly improving, allowing a reduction in the mortality rate, but they are still causing many side effects, not only early but also late, which leads us to consider the post-cancer period as a chronic condition. Side effects, reviewed in this commentary, may affect physical functions, psychological status, social situation, body composition, well-being and quality of life of the patient. In view of the extent of these areas in which side effects of breast cancer and of its treatments can be found, the supportive care offered at the end of treatment need to be multidisciplinary. Different supportive care interventions may be proposed to the patients such as psychological and behavioral interventions, complementary therapies, diet interventions, physical activity/rehabilitation or also physiotherapy interventions for example, all having shown some beneficial effects in the literature. The benefits of these supportive care interventions are thereby already established and they are described in this article, but others studies will be needed to clearly define indications and most optimal modalities of application to reduce side effects and improve quality of life of patients.
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Affiliation(s)
- Anne-France Leclerc
- Department of Sports and Rehabilitation Sciences, Liège University, Allée des Sports 4 - B21, 4000 Liège, Belgium ; Department of Physical Medicine, Liège University Hospital, Avenue de l'Hôpital 1 - CHU B35, 4000 Liège, Belgium
| | - Guy Jerusalem
- Division of Medical Oncology, Liège University Hospital, Liège University, Avenue de l'Hôpital 1 - CHU B35, 4000 Liège, Belgium
| | - Martine Devos
- Department of Clinical Hematology, Liège University Hospital, Avenue de l'Hôpital 1 - CHU B35, 4000 Liège, Belgium
| | - Jean-Michel Crielaard
- Department of Sports and Rehabilitation Sciences, Liège University, Allée des Sports 4 - B21, 4000 Liège, Belgium ; Department of Physical Medicine, Liège University Hospital, Avenue de l'Hôpital 1 - CHU B35, 4000 Liège, Belgium
| | - Didier Maquet
- Department of Sports and Rehabilitation Sciences, Liège University, Allée des Sports 4 - B21, 4000 Liège, Belgium ; Department of Physical Medicine, Liège University Hospital, Avenue de l'Hôpital 1 - CHU B35, 4000 Liège, Belgium
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Schouten B, Bekkering GE, Vankrunkelsven P, Mebis J, Van Hoof E, Hellings J, Van Hecke A. Systematic screening and assessment of psychosocial well-being and care needs of people with cancer. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Bojoura Schouten
- Hasselt University; Research Group Health Care, Faculty of Medicine and Life Sciences; Hasselt Limburg Belgium 3500
| | - Geertruida E Bekkering
- Belgian Centre for Evidence-Based Medicine - Cochrane Belgium; Kapucijnenvoer 33 Blok J Bus 7001 Leuven Belgium 3000
- KU Leuven; Department of Public Health and Primary Care - Faculty of Medicine; Kapucijnenvoer 33 Blok J Bus 7001 Leuven Belgium 3000
| | - Patrick Vankrunkelsven
- Belgian Centre for Evidence-Based Medicine - Cochrane Belgium; Kapucijnenvoer 33 Blok J Bus 7001 Leuven Belgium 3000
- KU Leuven; Department of Public Health and Primary Care - Faculty of Medicine; Kapucijnenvoer 33 Blok J Bus 7001 Leuven Belgium 3000
| | - Jeroen Mebis
- Jessa Hospital; Department of Medical Oncology; Hasselt Belgium
- Hasselt University; Research Group Immunology and Biochemistry; Faculty of Medicine and Life Sciences Hasselt Belgium
| | - Elke Van Hoof
- Jessa Hospital; Department of Medical Oncology; Hasselt Belgium
| | - Johan Hellings
- Hasselt University; Research Group Health Care, Faculty of Medicine and Life Sciences; Hasselt Limburg Belgium 3500
- Free University of Brussels; Department of Experimental and Applied Psychology, Faculty of Psychological and Educational Sciences; Brussels Belgium
| | - Ann Van Hecke
- Ghent University; University Centre for Nursing and Midwifery, Department of Public Health; De Pintelaan 185 Ghent Belgium 9000
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Zhang C, Franklin T, Sarkar DK. Inhibition of Mammary Cancer Progression in Fetal Alcohol Exposed Rats by β-Endorphin Neurons. Alcohol Clin Exp Res 2016; 40:134-40. [PMID: 26727531 DOI: 10.1111/acer.12941] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/21/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Fetal alcohol exposure (FAE) increases the susceptibility to carcinogen-induced mammary cancer progression in rodent models. FAE also decreases β-endorphin (β-EP) level and causes hyperstress response, which leads to inhibition of immune function against cancer. Previous studies have shown that injection of nanosphere-attached dibutyryl cyclic adenosine monophosphate (dbcAMP) into the third ventricle increases the number of β-EP neurons in the hypothalamus. In this study, we assessed the therapeutic potential of stress regulation using methods to increase hypothalamic levels of β-EP, a neuropeptide that inhibits stress axis activity, in treatment of carcinogen-induced mammary cancer in fetal alcohol exposed rats. METHODS Fetal alcohol exposed and control Sprague Dawley rats were given a dose of N-Nitroso-N-methylurea (MNU) at postnatal day 50 to induce mammary cancer growth. Upon detection of mammary tumors, the animals were either transplanted with β-EP neurons or injected with dbcAMP-delivering nanospheres into the hypothalamus to increase β-EP peptide production. Spleen cytokines were detected using reverse transcription polymerase chain reaction assays. Metastasis study was done by injecting mammary cancer cells MADB106 into jugular vein of β-EP-activated or control fetal alcohol exposed animals. RESULTS Both transplantation of β-EP neurons and injection of dbcAMP-delivering nanospheres inhibited MNU-induced mammary cancer growth in control rats, and reversed the effect of FAE on the susceptibility to mammary cancer. Similar to the previously reported immune-enhancing and stress-suppressive effects of β-EP transplantation, injection of dbcAMP-delivering nanospheres increased the levels of interferon-γ and granzyme B and decreased the levels of epinephrine and norepinephrine in fetal alcohol exposed rats. Mammary cancer cell metastasis study also showed that FAE increased incidence of lung tumor retention, while β-EP transplantation inhibited lung tumor growth in both normal and fetal alcohol exposed rats. CONCLUSIONS Our results suggest that increase of β-EP production in the hypothalamus may serve as a potential therapeutic strategy for treating the cancer growth in patients with chronic stress and compromised immune function, such as the patients with FAE.
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Affiliation(s)
- Changqing Zhang
- Endocrine Program, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey.,Endocrinolgy and Animal Biosciences Graduate Program, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey
| | - Tina Franklin
- Endocrine Program, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey.,Molecular Biosciences Graduate Program, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey
| | - Dipak K Sarkar
- Endocrine Program, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey.,Department of Animal Sciences, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey
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Aelbrecht K, Pype P, Vos J, Deveugele M. Having cancer in a foreign country. PATIENT EDUCATION AND COUNSELING 2016; 99:1708-1716. [PMID: 27234174 DOI: 10.1016/j.pec.2016.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 04/14/2016] [Accepted: 05/08/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Although immigration and cancer care are two frequently discussed topics in healthcare, the combination of both has seldom been done. Little is known about how immigrant patients experience having cancer in a foreign country. The aim of the study is to gain deeper insight into the meaning of having cancer, in a foreign country and to identify the expectations and experiences of immigrant patients confronted with this disease. METHODS Thirty adult non-western immigrant cancer patients were interviewed by means of an in-depth interview technique. The technique of constant comparison, derived from the constructivist grounded theory, was used to analyze the data from the interviews. RESULTS Having cancer is a human experience, regardless of one's country of origin. Patients show universal reactions and reaction patterns when confronted with cancer and dealing with cancer treatment. Immigrant patients experience specific obstacles when dealing with cancer, of which the language barrier is the most important. A general lack of accurate basic knowledge about health and disease was found, making certain patients more vulnerable. CONCLUSIONS AND PRACTICE IMPLICATIONS When dealing with cancer, immigrant patients are confronted with two major obstacles: a language barrier and a lack of knowledge about health and disease. The implications for a better practice occur on three levels: empowering patients, training healthcare professionals and adapting policy.
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Affiliation(s)
- Karolien Aelbrecht
- Faculty of Medicine and Health Sciences, Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
| | - Peter Pype
- Faculty of Medicine and Health Sciences, Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Jolien Vos
- College of Social Science, Community and Health Research Unit (CaHRU), University of Lincoln, Lincoln, UK
| | - Myriam Deveugele
- Faculty of Medicine and Health Sciences, Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
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Involvement of patients with lung and gynecological cancer and their relatives in psychosocial cancer rehabilitation: a narrative review. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:127-43. [PMID: 25142155 DOI: 10.1007/s40271-014-0076-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Getting cancer is stressful for most patients and their relatives, and research has shown that psychosocial support is needed. Still, cancer care fails to appropriately address psychosocial problems associated with cancer. Research on this topic is often seen from the perspective of either the patient or the relative, even though it is suggested that psychosocial support is beneficial for the patient and the relative as a pair. Furthermore, research on the need for psychosocial support rarely involves patients with gynecological and lung cancer and their relatives, even though they often suffer from isolation and stigmatization. The aim of this review was therefore to summarize knowledge about psychosocial support with regard to individual needs, involvement of significant others, and providers of psychosocial support focusing on this specific population. METHOD A narrative review procedure was chosen. This method is a specific kind of review, which summarizes, explains, and interprets evidence on a selected topic. The review process was structured according to typical scholarly articles with attention to the search and review process. RESULTS A total of 16 studies were included in the review. The studies were divided into two main categories: (1) studies focusing on needs for psychosocial support; and (2) studies focusing on interventions. The needs studies were analyzed, and three themes emerged: the needs of the patient and the significant other across the cancer trajectory; the needs of the significant other as a carer; and needs and ongoing and tailored support. The intervention studies were directed toward the patient and the relative, the patient, or the relative. Five interventions comprising various forms of support that were purely supportive and were carried out by healthcare professionals were identified. CONCLUSION There were overlaps between the needs of the patient and the relative, but there were also distinctive characteristics of the needs in the two groups. The needs varied during the cancer trajectory, and we therefore recommend that support be offered continuously. It was also evident that the relatives should be involved in the patients' care and that the involvement was beneficial for both the patient and the relative.
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Zhu L, Ranchor AV, van der Lee M, Garssen B, Almansa J, Sanderman R, Schroevers MJ. Co-morbidity of depression, anxiety and fatigue in cancer patients receiving psychological care. Psychooncology 2016; 26:444-451. [DOI: 10.1002/pon.4153] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 03/30/2016] [Accepted: 04/10/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Lei Zhu
- Department of Health Psychology, University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- School of Psychology; Shaanxi Normal University; Xi'an China
| | - Adelita V. Ranchor
- Department of Health Psychology, University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Marije van der Lee
- Centre for Psycho-Oncology; Helen Dowling Institute; Bilthoven The Netherlands
| | - Bert Garssen
- Centre for Psycho-Oncology; Helen Dowling Institute; Bilthoven The Netherlands
| | - Josué Almansa
- Department of Health Sciences, Division of Community and Occupational Medicine, University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Robbert Sanderman
- Department of Health Psychology, University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- Department of Psychology, Health and Technology; University of Twente; Enschede The Netherlands
| | - Maya J. Schroevers
- Department of Health Psychology, University Medical Center Groningen; University of Groningen; Groningen The Netherlands
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Abstract
The diagnosis and treatment of breast cancer can involve a series of life-altering, traumatic experiences, leading to distress, reduced quality of life, and long-standing fears of recurrence. Distress may exacerbate physical symptoms, impair coping, impact health behaviors, and reduce compliance with cancer treatment. Psychological treatments have focused on alleviating distress and improving quality of life. Given the growing evidence of the role of stress and behavior on cancer outcomes, a biobehavioral approach to treatment may serve to achieve these traditional treatment goals while also impacting disease course. Shapiro’s (2001) eye movement desensitization and reprocessing (EMDR) protocol for illness and somatic disorders was greatly informed by her interest in mind–body approaches to health and the newly emerging (1992) field of psychoneuroimmunology. The protocol includes first identifying and addressing the realistic fears and challenges a woman faces. Once appropriate, EMDR therapy turns to the reprocessing of past memories, present triggers, and the development of positive future templates of health. This article focuses on situations, usually in the early diagnosis and intensive phases of cancer treatment, when the reprocessing phases of EMDR therapy need to be delayed because of the demands of cancer treatment or insufficient client stability. Resourcing interventions that are compatible with biobehavioral goals are provided, with brief clinical examples.
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Hasanpour-Dehkordi A. Self-care Concept Analysis in Cancer Patients: An Evolutionary Concept Analysis. Indian J Palliat Care 2016; 22:388-394. [PMID: 27803559 PMCID: PMC5072229 DOI: 10.4103/0973-1075.191753] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Self-care is a frequently used concept in both the theory and the clinical practice of nursing and is considered an element of nursing theory by Orem. The aim of this paper is to identify the core attributes of the self-care concept in cancer patients. Materials and Methods: We used Rodgers’ evolutionary method of concept analysis. The articles published in English language from 1980 to 2015 on nursing and non-nursing disciplines were analyzed. Finally, 85 articles, an MSc thesis, and a PhD thesis were selected, examined, and analyzed in-depth. Two experts checked the process of analysis and monitored and reviewed the articles. Results: The analysis showed that self-care concept is determined by four attributes of education, interaction, self-control, and self-reliance. Three types of antecedents in the present study were client-related (self-efficacy, self-esteem), system-related (adequate sources, social networks, and cultural factors), and healthcare professionals-related (participation). Conclusion: The self-care concept has considerably evolved among patients with chronic diseases, particularly cancer, over the past 35 years, and nurses have managed to enhance their knowledge about self-care remarkably for the clients so that the nurses in healthcare teams have become highly efficient and able to assume the responsibility for self-care teams.
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Affiliation(s)
- Ali Hasanpour-Dehkordi
- Department of Medical-surgical Nursing, Nursing and Midwifery Palliative Care Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
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75
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Krebber AMH, Jansen F, Cuijpers P, Leemans CR, Verdonck-de Leeuw IM. Screening for psychological distress in follow-up care to identify head and neck cancer patients with untreated distress. Support Care Cancer 2015; 24:2541-8. [PMID: 26694718 PMCID: PMC4846709 DOI: 10.1007/s00520-015-3053-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/07/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the study is to investigate screening in follow-up care to identify head and neck cancer (HNC) patients with untreated psychological distress. METHODS From November 2009 until December 2012, we investigated the use of OncoQuest (a touch screen computer system to monitor psychological distress (Hospital Anxiety and Depression Scale (HADS)) and quality of life (HRQOL; EORTC QLQ-C30 and H&N35 module) in routine follow-up care. Patients who screened positive for psychological distress (HADS-T >14, HADS-A >7, or HADS-D >7) were asked whether they received psychological or psychiatric treatment. RESULTS During the study period of 37 months, OncoQuest was used by 720 individual HNC patients, of whom 714 had complete HADS data. Psychological distress was present in 206 patients (29 %). Of those patients who fulfilled in- and exclusion criteria (n = 137), 25 received psychological treatment (18 %). Receipt of psychological treatment was significantly related to a higher score on the HADS total scale (19.6 vs. 16.9; p = 0.019), a lower (worse) score on the EORTC QLQ-C30 scale emotional functioning (46.0 vs. 58.6; p = 0.023), a higher (worse) score on fatigue (58.2 vs. 46.4; p = 0.032), problems with sexuality (44.1 vs. 34.4; p = 0.043), oral pain (43.8 vs. 28.8; p = 0.011) and speech problems (37.0 vs. 25.3; p = 0.042). CONCLUSIONS Screening for psychological distress via OncoQuest is beneficial because 82 % of HNC patients identified with an increased level of distress who do not yet receive mental treatment were identified. Patients who did receive treatment reported more distress and worse quality of life, which may be explained because patients with more severe problems maybe more inclined to seek help or might be detected easier by caregivers and referred to supportive care more often.
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Affiliation(s)
- Anne-Marie H Krebber
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Femke Jansen
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, The Netherlands. .,Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands.
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Meneses K, Gisiger-Camata S, Schoenberger YM, Weech-Maldonado R, McNees P. Adapting an evidence-based survivorship intervention for Latina breast cancer survivors. ACTA ACUST UNITED AC 2015; 11:109-19. [PMID: 25776285 DOI: 10.2217/whe.14.65] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM About 120,000 Latina breast cancer survivors (LBCS) live in the USA with the numbers expected to increase. LBCS experience survivorship disparities and report poor quality of life outcomes. Despite poor outcomes, few survivorship interventions for LBCS are available. Adapting evidence-based interventions for Latinas may be one strategy to reduce disparities. MATERIALS & METHODS An evidence-based intervention called the Breast Cancer Education Intervention was adapted for Latinas. First, certified translation and cognitive interview to assess cultural relevance were conducted. Next, a pilot sample of 40 Latinas who participated in the intervention were asked to provide follow-up evaluation of their satisfaction with and usefulness of the translated education manual and intervention. RESULTS Thirty LBCS completed the intervention, and 14 LBCS submitted an evaluation summary expressing satisfaction with usefulness, readability and relevance. CONCLUSION The process by which translation and cultural adaptation of an evidence-based intervention provides beginning foundation to support and reduce disparities among LBCS.
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Affiliation(s)
- Karen Meneses
- Office of Research & Scholarship, School of Nursing, University of Alabama at Birmingham, AL 35294, USA
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Navidian A, Ebrahimi H, Keykha R. Supportive Nursing Care and Satisfaction of Patients Receiving Electroconvulsive Therapy: A Randomized Controlled Clinical Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e27492. [PMID: 26473077 PMCID: PMC4601241 DOI: 10.5812/ircmj.27492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/15/2015] [Accepted: 05/04/2015] [Indexed: 12/20/2022]
Abstract
Background: Patient satisfaction is the most important criterion in evaluating the quality of care. Besides, its assessment in patients with severe mental disorder treated by electroconvulsive therapy (ECT) is highly appropriate. The ECT is accompanied by lower satisfaction and may exacerbate the patients’ condition. Objectives: The current study aimed to determine the effect of supportive nursing care on the satisfaction of patients receiving ECT. Patients and Methods: This randomized controlled trial was conducted in the education center of Baharan psychiatric hospital, Zahedan, Iran. Seventy hospitalized patients receiving ECT were randomly divided into two groups of control (n = 35) and intervention (n = 35).The socio-personal and Webster Satisfaction Questionnaire were used as data collection tools. The intervention group received supportive nursing care by nurses trained in informational, emotional, and physical aspects. The control group received only regular nursing care. The levels of satisfaction were measured and compared between groups, before and after the intervention. Data were analyzed using the SPSS software, and Chi-square, independent and paired t tests, as well as covariance analysis were performed. Results: The results showed similarities in socio-personal characteristics of both groups. However, there was a significant difference (P < 0.001) between the means of satisfaction in the groups, predominantly for the intervention group. In other words, a significant difference (P < 0.001) was observed between the means of satisfaction of the intervention (54.71 ± 5.27) and control (36.28 ± 7.00) groups after intervention by controlling the effect of socio-personal variables. Conclusions: Results of the current study confirmed the effect of supportive nursing care on increasing the level of satisfaction in ECT receiving patients, recommending the use of this therapeutic method.
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Affiliation(s)
- Ali Navidian
- Department of Counseling, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Hossein Ebrahimi
- Department of Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Roghaieh Keykha
- Department of Nursing, Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Corresponding Author: Roghaieh Keykha, Department of Nursing, Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel: +98-5433442482, Fax: +98-5433442481, E-mail:
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Greenlee H, Balneaves LG, Carlson LE, Cohen M, Deng G, Hershman D, Mumber M, Perlmutter J, Seely D, Sen A, Zick SM, Tripathy D. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr 2015; 2014:346-58. [PMID: 25749602 DOI: 10.1093/jncimonographs/lgu041] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The majority of breast cancer patients use complementary and/or integrative therapies during and beyond cancer treatment to manage symptoms, prevent toxicities, and improve quality of life. Practice guidelines are needed to inform clinicians and patients about safe and effective therapies. METHODS Following the Institute of Medicine's guideline development process, a systematic review identified randomized controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment. Trials were included if the majority of participants had breast cancer and/or breast cancer patient results were reported separately, and outcomes were clinically relevant. Recommendations were organized by outcome and graded based upon a modified version of the US Preventive Services Task Force grading system. RESULTS The search (January 1, 1990-December 31, 2013) identified 4900 articles, of which 203 were eligible for analysis. Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A). Stress management, yoga, massage, music therapy, energy conservation, and meditation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B). Many interventions (n = 32) had weaker evidence of benefit (Grade C). Some interventions (n = 7) were deemed unlikely to provide any benefit (Grade D). Notably, only one intervention, acetyl-l-carnitine for the prevention of taxane-induced neuropathy, was identified as likely harmful (Grade H) as it was found to increase neuropathy. The majority of intervention/modality combinations (n = 138) did not have sufficient evidence to form specific recommendations (Grade I). CONCLUSIONS Specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment. Most integrative therapies require further investigation via well-designed controlled trials with meaningful outcomes.
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Affiliation(s)
- Heather Greenlee
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT).
| | - Lynda G Balneaves
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Linda E Carlson
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Misha Cohen
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Gary Deng
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Dawn Hershman
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Matthew Mumber
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Jane Perlmutter
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Dugald Seely
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Ananda Sen
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Suzanna M Zick
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Debu Tripathy
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
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Schoenberger YM, Benz R, McNees P, Meneses K. Patient-centered outcome evaluation of the Rural Breast Cancer Survivors Intervention. Support Care Cancer 2015; 24:1841-8. [PMID: 26452487 DOI: 10.1007/s00520-015-2974-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/28/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Patient-centered evaluation is a critical but often overlooked component of intervention research. The Rural Breast Cancer Survivors (RBCS) Intervention is a survivorship education and support intervention designed for rural breast cancer survivors. Here, we describe evaluation of the RBCS Intervention from the participants' experience. METHODS Three hundred sixty-four breast cancer survivors participating in the RBCS Intervention were asked to complete the RBCS Evaluation Survey that consisted of 6 quantitative statements and 12 qualitative questions via mail. RESULTS Two hundred twenty-one participants (61 %) returned the RBCS Evaluation Survey. All 221 completed the qualitative component, and 91 (25 %) completed the quantitative. Overall, participants indicated that the education materials were easy to understand and addressed their quality of life concerns. Majority (94 %) indicated that the survivorship information was helpful in making health decisions and communicating concerns to family (87 % strongly agree/agree) and oncology team (88 % strongly agree/agree). Only 66 % indicated that the survivorship educational materials were provided at an appropriate time after completion of primary breast cancer treatment. Qualitative data suggested that participants had positive perceptions and experiences and found the RBCS Intervention helpful. One-on-one interaction with the intervention nurses was the single most highly valued aspect. CONCLUSION Overall, the RBCS Intervention was helpful. Education materials addressed quality of life concerns. Breast cancer survivors developed skills in communicating with their family and oncology team. Intervention nurses were identified as the most valuable aspect of the program. Suggestions include earlier timing of survivorship education and support, and adaptation using social media access to serve other rural survivors. RELEVANCE Patient-centered evaluations, using both quantitative and qualitative data, provide enriched understanding of evidence-based survivorship interventions and should be considered a standard for future work.
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Affiliation(s)
- Yu-Mei Schoenberger
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Ave S, MT 624, Birmingham, AL, 35294, USA.
| | - Rachel Benz
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Patrick McNees
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.,Kirchner Group, Birmingham, AL, 35242, USA
| | - Karen Meneses
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
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Pisu M, Meneses K, Azuero A, Benz R, Su X, McNees P. Variation in resources needed to implement psychosocial support interventions for rural breast cancer survivors. J Cancer Surviv 2015; 10:375-83. [PMID: 26341349 DOI: 10.1007/s11764-015-0483-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/21/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Understanding how resources are used provides guidance to disseminating effective interventions. Here, we report data on implementation resources needed for the Rural Breast Cancer Survivors (RBCS) study that tested a telephone-delivered psychoeducational education and support intervention to survivors in rural Florida. Intervention resources included interventionists' time on one intake assessment (IA) call, three education calls (ED), one follow-up education call (FUE), six support (SUP) calls, and documentation time per survivor. METHODS Interventionists logged start and end times of each type of call. Average interventionist time in minutes was calculated by call type. Associations between interventionists' time and participants' characteristics including age, race/ethnicity, time since treatment, cancer treatment, depressive symptoms, education, income, employment, and support, was assessed using linear mixed models with repeated measures. RESULTS Among 328 survivors, IA calls lasted 66.9 min (SD 21.7); ED lasted 50.6 (SD 16.7), 48.1 (SD 15.9), and 39.6 (SD 14.8); FUE lasted 24.7 (SD 14.8); and SUP 42.8 (SD 29.6) min. Documentation time was 18.4 min for IA, 23-27 for ED, 12.3 for FUE, and 23.0 for SUP. CONCLUSION Interventionists spent significantly more time with participants with depressive symptoms, who already used other support, and who received SUP calls before the ED vs. after. There were no significant differences by time since or type of cancer treatment, or other personal characteristics. IMPLICATIONS FOR CANCER SURVIVORS Resources vary by survivor characteristics. Careful consideration of mental health status or support available is warranted for planning implementation and dissemination of effective survivorship interventions on a broad scale.
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Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karen Meneses
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
- University of Alabama at Birmingham, 1701 University Blvd., Birmingham, AL, 35294, USA.
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel Benz
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Xiaogang Su
- Department of Mathematical Sciences, University of Texas at El Paso, El Paso, TX, USA
| | - Patrick McNees
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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DeRouen MC, Smith AW, Tao L, Bellizzi KM, Lynch CF, Parsons HM, Kent EE, Keegan THM. Cancer-related information needs and cancer's impact on control over life influence health-related quality of life among adolescents and young adults with cancer. Psychooncology 2015; 24:1104-15. [PMID: 25611943 PMCID: PMC4510026 DOI: 10.1002/pon.3730] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 09/13/2014] [Accepted: 11/05/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Adolescents and young adults (AYAs) diagnosed with cancer between 15 and 39 years of age often report need for greater amounts of cancer-related information and perceive that cancer has had a negative impact on control over their life. We examined whether unmet information need and perceived control over life are associated with health-related quality of life (HRQOL). METHODS We examined data from 484 AYA cancer survivors recruited from population-based cancer registries in 2007-2008. Participants completed surveys a median of 11 months after diagnosis. Multivariable linear regression analyses estimated associations of unmet cancer-related information needs and impact of cancer on control over life on HRQOL (SF-12). RESULTS Two-thirds of AYAs reported an intermediate or high level of unmet information need, and half (47%) reported a negative impact of cancer on control. Greater unmet information need was associated with lower overall mental and physical HRQOL and lower levels of all HRQOL subscales except vitality. A negative impact on control over life was associated with lower overall mental HRQOL as well as lower HRQOL across all subscales except general health perceptions (all p <0.05). In multivariable analyses, perceived control and unmet information need were independently associated with HRQOL (p-values for interaction >0.1). CONCLUSIONS Adolescent and young adult patients with cancer have high levels of unmet cancer-related information needs and perceived negative impact of cancer on control over life; both were independently associated with lower HRQOL. Addressing unmet information needs among AYA cancer survivors and finding ways to increase their sense of control may help improve HRQOL in this understudied population.
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Affiliation(s)
- Mindy C. DeRouen
- Cancer Prevention Institute of California, 2001 Walnut Ave, Suite 300, Fremont, CA 94538
| | - Ashley Wilder Smith
- Control and Population Sciences, National Cancer Institute, National Institutes of Health, 6130 Executive Blvd, Bethesda, MD 20892
| | - Li Tao
- Cancer Prevention Institute of California, 2001 Walnut Ave, Suite 300, Fremont, CA 94538
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5110
| | - Keith M. Bellizzi
- Department of Human Development and Family Studies, University of Connecticut, 348 Mansfield Rd, Storrs, CT 06269
| | - Charles F. Lynch
- Department of Epidemiology, University of Iowa, 105 River St, Iowa City, IA 52242
| | - Helen M. Parsons
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, Mail Code 7933, San Antonio, TX 78229
| | - Erin E. Kent
- Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 6130 Executive Blvd, Bethesda, MD 20892
| | - Theresa H. M. Keegan
- Cancer Prevention Institute of California, 2001 Walnut Ave, Suite 300, Fremont, CA 94538
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
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Smith PR, Cope D, Sherner TL, Walker DK. Update on research-based interventions for anxiety in patients with cancer. Clin J Oncol Nurs 2015; 18 Suppl:5-16. [PMID: 25427605 DOI: 10.1188/14.cjon.s3.5-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anxiety may begin at the moment a person is diagnosed with cancer and may fluctuate throughout the cancer trajectory as physical illness improves or declines. The purpose of this article is to present current evidence for nurses to implement interventions to reduce anxiety in patients who have cancer. The PubMed and CINAHL® databases were searched to identify relevant citations addressing interventions that treat or prevent anxiety symptoms in patients with cancer. Based on available evidence, the interventions addressed herein are categorized according to the Putting Evidence Into Practice (PEP®) rating schema. Interventions include pharmacologic and nonpharmacologic approaches to care, and meet criteria for three PEP categories: likely to be effective, effectiveness not established (the largest category of results), or effectiveness unlikely.
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Affiliation(s)
- Patsy R Smith
- College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City
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Baliousis M, Rennoldson M, Snowden JA. Psychological interventions for distress in adults undergoing haematopoietic stem cell transplantation: a systematic review with meta-analysis. Psychooncology 2015; 25:400-11. [PMID: 26249330 DOI: 10.1002/pon.3925] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/13/2015] [Accepted: 07/07/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate the characteristics, methodology, quality, and efficacy of psychological interventions for distress in adult patients undergoing haematopoietic stem cell transplantation (HSCT). METHODS A systematic review of relevant studies was conducted using six databases with supplementary hand searching. Included studies employed an experimental or quasi-experimental design, interventions included at least one psychological component, and outcomes involved psychological distress in affective terms. Data were abstracted, and study quality was assessed using Cochrane Foundation criteria amended to include confounder and common factors control. Data were examined and synthesised using a narrative approach and meta-analysis. RESULTS Eleven articles for nine interventions met the inclusion criteria out of 11,741 abstracts. The studies varied in quality, general, intervention, and methodological characteristics while findings were mixed. Interventions tended to show better efficacy when incorporating a major psychological component involving cognitive behavioural or emotional processing methods with substantial interventionist input. However, this was also associated with methodological limitations and threats to internal validity such as poor confounder and common factors control. A meta-analysis yielded a small but significant pooled effect size estimate in favour of interventions with inconsequential heterogeneity. Risk of bias remained a concern. CONCLUSIONS Psychological interventions may provide some benefit in alleviating distress in HSCT but conclusions remain tentative in light of methodological limitations and risk of bias. Further research is needed to evidence the individual contribution of intervention components and mechanism of change together with improving intervention efficiency and methodological quality.
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Affiliation(s)
- Michael Baliousis
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Michael Rennoldson
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Hafeez S, Singhera M, Huddart R. Exploration of the treatment challenges in men with intellectual difficulties and testicular cancer as seen in Down syndrome: single centre experience. BMC Med 2015; 13:152. [PMID: 26123546 PMCID: PMC4485877 DOI: 10.1186/s12916-015-0386-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/03/2015] [Indexed: 01/07/2023] Open
Abstract
Down syndrome is the most common chromosomal disorder in humans as well as the most common cause of inherited intellectual disability. A spectrum of physical and functional disability is associated with the syndrome as well as a predisposition to developing particular malignancies, including testicular cancers. These tumours ordinarily have a high cure rate even in widely disseminated disease. However, individuals with Down syndrome may have learning difficulties, behavioural problems, and multiple systemic complications that have the potential to make standard treatment more risky and necessitates individualized approach in order to avoid unacceptable harm. There is also suggestion that tumours may have a different natural history. Further, people with learning disabilities have often experienced poorer healthcare than the general population. In order to address these inequalities, legislation, professional bodies, and charities provide guidance; however, ultimately, consideration of the person in the context of their own psychosocial issues, comorbidities, and possible treatment strategies is vital in delivering optimal care. We aim to present a review of our own experience of delivering individualized care to this group of patients in order to close the existing health inequality gap.
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Affiliation(s)
- Shaista Hafeez
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK. .,The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Mausam Singhera
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK.,Guy's and St Thomas' NHS Foundation Trust, St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Robert Huddart
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK.,The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
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85
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Boele FW, Rooney AG, Grant R, Klein M. Psychiatric symptoms in glioma patients: from diagnosis to management. Neuropsychiatr Dis Treat 2015; 11:1413-20. [PMID: 26089669 PMCID: PMC4467748 DOI: 10.2147/ndt.s65874] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Patients with primary intrinsic brain tumors can experience neurological, cognitive, and psychiatric symptoms that greatly affect daily life. In this review, we focus on changes in personality and behavior, mood issues, hallucinations, and psychosis, because these are either difficult to recognize, to treat, or are understudied in scientific literature. Neurobehavioral symptoms are common, often multiple, and causation can be multifactorial. Although different symptoms sometimes require a different treatment approach, we advise a comprehensive treatment approach, including pharmacological treatment and/or psychotherapy where appropriate. Further research is needed to obtain a better estimate of the prevalence of psychiatric symptoms in glioma patients, and the extent to which these affect everyday functioning and family life.
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Affiliation(s)
- Florien W Boele
- Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
| | - Alasdair G Rooney
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Robin Grant
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Martin Klein
- Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
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86
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Ostuzzi G, Matcham F, Dauchy S, Barbui C, Hotopf M. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev 2015; 2015:CD011006. [PMID: 26029972 PMCID: PMC6457578 DOI: 10.1002/14651858.cd011006.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Major depression and other depressive conditions are common in people with cancer. These conditions are not easily detectable in clinical practice, due to the overlap between medical and psychiatric symptoms, as described by diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). Moreover, it is particularly challenging to distinguish between pathological and normal reactions to such a severe illness. Depressive symptoms, even in subthreshold manifestations, have been shown to have a negative impact in terms of quality of life, compliance with anti-cancer treatment, suicide risk and likely even the mortality rate for the cancer itself. Randomised controlled trials (RCTs) on the efficacy and tolerability of antidepressants in this population group are few and often report conflicting results. OBJECTIVES To assess the effects and acceptability of antidepressants for treating depressive symptoms in adults (18 years or older) with cancer (any site and stage). SEARCH METHODS We searched the following electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 3), MEDLINE Ovid (1946 to April week 3, 2014), EMBASE Ovid (1980 to 2014 week 17) and PsycINFO Ovid (1987 to April week 4, 2014). We additionally handsearched the trial databases of the most relevant national, international and pharmaceutical company trial registers and drug-approving agencies for published, unpublished and ongoing controlled trials. SELECTION CRITERIA We included RCTs allocating adults (18 years or above) with any primary diagnosis of cancer and depression (including major depressive disorder, adjustment disorder, dysthymic disorder or depressive symptoms in the absence of a formal diagnosis) comparing antidepressants versus placebo, or antidepressants versus other antidepressants. DATA COLLECTION AND ANALYSIS Two review authors independently checked eligibility and extracted data using a form specifically designed for the aims of this review. The two authors compared the data extracted and then entered data into RevMan 5 with a double-entry procedure. Information extracted included study and participant characteristics, intervention details, outcome measures for each time point of interest, cost analysis and sponsorship by a drug company. We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We retrieved a total of nine studies (861 participants), with seven studies contributing to the meta-analysis for the primary outcome. Four of these compared antidepressants and placebo, two compared two antidepressants and one-three armed study compared two antidepressants and a placebo arm. For the acute phase treatment response (6 to 12 weeks), we found very low quality evidence for the effect of antidepressants as a class on symptoms of depression compared with placebo when measured as a continuous outcome (standardised mean difference (SMD) -0.45, 95% confidence interval (CI) -1.01 to 0.11, five RCTs, 266 participants) or as a proportion of people who had depression (risk ratio (RR) 0.82, 95% CI 0.62 to 1.08, five RCTs, 417 participants). No trials reported data on the follow-up response (more than 12 weeks). In head-to-head comparisons we only retrieved data for selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants, providing very low quality evidence for the difference between these two classes (SMD -0.08, 95% CI -0.34 to 0.18, three RCTs, 237 participants). No clear evidence of an effect of antidepressants versus either placebo or other antidepressants emerged from the analyses of the secondary efficacy outcomes (dichotomous outcome, response at 6 to 12 weeks, very low quality evidence). We found very low quality evidence for the effect of antidepressants as a class in terms of dropouts due to any cause compared with placebo (RR 0.87, 95% CI 0.49 to 1.53, six RCTs, 455 participants), as well as between SSRIs and tricyclic antidepressants (RR 0.83, 95% CI 0.53 to 1.30, three RCTs, 237 participants). We downgraded the quality of the evidence because the included studies were at an unclear or high risk of bias due to poor reporting, imprecision arising from small sample sizes and wide confidence intervals, and inconsistency due to statistical or clinical heterogeneity. AUTHORS' CONCLUSIONS Despite the impact of depression on people with cancer, available studies were very few and of low quality. This review found very low quality evidence for the effects of these drugs compared with placebo. On the basis of these results clear implications for practice cannot be made. The use of antidepressants in people with cancer should be considered on an individual basis and, considering the lack of head-to-head data, the choice of which agent should be prescribed may be based on the data on antidepressant efficacy in the general population of individuals with major depression, also taking into account that data on medically ill patients suggest a positive safety profile for the SSRIs. Large, simple, randomised, pragmatic trials comparing commonly used antidepressants versus placebo in people with cancer with depressive symptoms, with or without a formal diagnosis of a depressive disorder, are urgently needed to better inform clinical practice.
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Affiliation(s)
- Giovanni Ostuzzi
- University of VeronaDepartment of Neuroscience, Biomedicine and Movement Sciences, Section of PsychiatryPoliclinico "GB Rossi"Piazzale L.A. Scuro, 10VeronaItaly37134
| | - Faith Matcham
- The Institute of Psychiatry, King's College LondonDepartment of Psychological MedicineWeston Education CentreLondonUKSE5 9RJ
| | - Sarah Dauchy
- Gustave RoussyChef du Département Interdisciplinaire de Soins de Support114 rue Edouard VaillantVillejuifParisFrance94805
| | - Corrado Barbui
- University of VeronaNeuroscience, Biomedicine and Movement Sciences, Section of PsychiatryVeronaItaly
| | - Matthew Hotopf
- The Institute of Psychiatry, King's College LondonDepartment of Psychological MedicineWeston Education CentreLondonUKSE5 9RJ
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Ostuzzi G, Matcham F, Dauchy S, Barbui C, Hotopf M. Antidepressants for the treatment of depression in people with cancer. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [PMID: 26029972 DOI: 10.1002/14651858.cd011006.pub2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Major depression and other depressive conditions are common in people with cancer. These conditions are not easily detectable in clinical practice, due to the overlap between medical and psychiatric symptoms, as described by diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). Moreover, it is particularly challenging to distinguish between pathological and normal reactions to such a severe illness. Depressive symptoms, even in subthreshold manifestations, have been shown to have a negative impact in terms of quality of life, compliance with anti-cancer treatment, suicide risk and likely even the mortality rate for the cancer itself. Randomised controlled trials (RCTs) on the efficacy and tolerability of antidepressants in this population group are few and often report conflicting results. OBJECTIVES To assess the effects and acceptability of antidepressants for treating depressive symptoms in adults (18 years or older) with cancer (any site and stage). SEARCH METHODS We searched the following electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 3), MEDLINE Ovid (1946 to April week 3, 2014), EMBASE Ovid (1980 to 2014 week 17) and PsycINFO Ovid (1987 to April week 4, 2014). We additionally handsearched the trial databases of the most relevant national, international and pharmaceutical company trial registers and drug-approving agencies for published, unpublished and ongoing controlled trials. SELECTION CRITERIA We included RCTs allocating adults (18 years or above) with any primary diagnosis of cancer and depression (including major depressive disorder, adjustment disorder, dysthymic disorder or depressive symptoms in the absence of a formal diagnosis) comparing antidepressants versus placebo, or antidepressants versus other antidepressants. DATA COLLECTION AND ANALYSIS Two review authors independently checked eligibility and extracted data using a form specifically designed for the aims of this review. The two authors compared the data extracted and then entered data into RevMan 5 with a double-entry procedure. Information extracted included study and participant characteristics, intervention details, outcome measures for each time point of interest, cost analysis and sponsorship by a drug company. We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We retrieved a total of nine studies (861 participants), with seven studies contributing to the meta-analysis for the primary outcome. Four of these compared antidepressants and placebo, two compared two antidepressants and one-three armed study compared two antidepressants and a placebo arm. For the acute phase treatment response (6 to 12 weeks), we found very low quality evidence for the effect of antidepressants as a class on symptoms of depression compared with placebo when measured as a continuous outcome (standardised mean difference (SMD) -0.45, 95% confidence interval (CI) -1.01 to 0.11, five RCTs, 266 participants) or as a proportion of people who had depression (risk ratio (RR) 0.82, 95% CI 0.62 to 1.08, five RCTs, 417 participants). No trials reported data on the follow-up response (more than 12 weeks). In head-to-head comparisons we only retrieved data for selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants, providing very low quality evidence for the difference between these two classes (SMD -0.08, 95% CI -0.34 to 0.18, three RCTs, 237 participants). No clear evidence of an effect of antidepressants versus either placebo or other antidepressants emerged from the analyses of the secondary efficacy outcomes (dichotomous outcome, response at 6 to 12 weeks, very low quality evidence). We found very low quality evidence for the effect of antidepressants as a class in terms of dropouts due to any cause compared with placebo (RR 0.87, 95% CI 0.49 to 1.53, six RCTs, 455 participants), as well as between SSRIs and tricyclic antidepressants (RR 0.83, 95% CI 0.53 to 1.30, three RCTs, 237 participants). We downgraded the quality of the evidence because the included studies were at an unclear or high risk of bias due to poor reporting, imprecision arising from small sample sizes and wide confidence intervals, and inconsistency due to statistical or clinical heterogeneity. AUTHORS' CONCLUSIONS Despite the impact of depression on people with cancer, available studies were very few and of low quality. This review found very low quality evidence for the effects of these drugs compared with placebo. On the basis of these results clear implications for practice cannot be made. The use of antidepressants in people with cancer should be considered on an individual basis and, considering the lack of head-to-head data, the choice of which agent should be prescribed may be based on the data on antidepressant efficacy in the general population of individuals with major depression, also taking into account that data on medically ill patients suggest a positive safety profile for the SSRIs. Large, simple, randomised, pragmatic trials comparing commonly used antidepressants versus placebo in people with cancer with depressive symptoms, with or without a formal diagnosis of a depressive disorder, are urgently needed to better inform clinical practice.
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Affiliation(s)
- Giovanni Ostuzzi
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico "GB Rossi", Piazzale L.A. Scuro, 10, Verona, Italy, 37134
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88
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Albrecht TA, Lee Walton A, Leak Bryant A. The unique supportive care needs of a mother with acute myeloid leukemia during treatment. Clin J Oncol Nurs 2015; 19:16-9. [PMID: 25689644 DOI: 10.1188/15.cjon.16-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute myeloid leukemia (AML) is an aggressive cancer of the blood that is linked with poor survival. The disease requires immediate intensive chemotherapy treatment that leaves patients hospitalized for at least one month and often longer, depending on their supportive care needs. Mothers undergoing treatment for AML may benefit from having attention paid to their supportive care needs during that time.
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89
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Raml D, Kelly M, Sharma A. Treatment-resistant depression requiring electroconvulsive therapy following stem cell transplantation. Prim Care Companion CNS Disord 2015; 16:14l01640. [PMID: 25664209 DOI: 10.4088/pcc.14l01640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Dana Raml
- College of Medicine, University of Nebraska, Omaha
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90
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Park HY, Kim JH, Choi S, Kang E, Oh S, Kim JY, Kim SW. Psychological effects of a cosmetic education programme in patients with breast cancer. Eur J Cancer Care (Engl) 2015; 24:493-502. [PMID: 25651297 DOI: 10.1111/ecc.12290] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2014] [Indexed: 12/24/2022]
Abstract
Treatments for breast cancer often include interventions related to psychosocial issues such as negative body image, loss of femininity, and low self-esteem. We identified the psychological effects of a cosmetics education programme in patients with breast cancer. Cosmetic programme is a specific care designed to help patients handle appearance-related side effects. Thirty-one women with breast cancer at a university hospital in South Korea who received a cosmetics education programme were compared with 29 subjects in a control group who received the treatment as usual. Psychological factors including distress, self-esteem, and sexual functioning were assessed three times (before and after the programme, and at the 1-month follow-up). After the programme, patients in the treatment group were significantly less likely than those in the control group to rely on distress (P = 0.038) and avoidance coping (P < 0.001) but not on self-esteem. The mean scores in the treatment group for sexual functioning were higher than those in the control group after the treatment. Our results suggest the potential usefulness of a brief cosmetics education programme for reducing distress and reliance on negative coping strategies. Implementing a cosmetics programme for patients with breast cancer may encourage patients to control negative psychological factors.
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Affiliation(s)
- H Y Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - J H Kim
- Mental Health & Behavioral Medicine Services for Clinical Departments, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - S Choi
- Department of Psychology, Duksung Women's University, Seoul
| | - E Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - S Oh
- Department of Biostatistics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul
| | - J Y Kim
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - S W Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
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91
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The effects of psychological interventions on depression and anxiety among Chinese adults with cancer: a meta-analysis of randomized controlled studies. BMC Cancer 2014; 14:956. [PMID: 25510213 PMCID: PMC4301929 DOI: 10.1186/1471-2407-14-956] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 12/04/2014] [Indexed: 01/06/2023] Open
Abstract
Background Our previous studies found the high prevalence of depression and anxiety among Chinese cancer patients, and many empirical studies have been conducted to evaluate the effects of psychological interventions on depression and anxiety among Chinese cancer patients. This study aimed to conduct a meta-analysis in order to assess the effects of psychological interventions on depression and anxiety in Chinese adults with cancer. Methods The four most comprehensive Chinese academic database- CNKI, Wanfang, Vip and CBM databases-were searched from their inception until January 2014. PubMed and Web of Science (SCIE) were also searched from their inception until January 2014 without language restrictions, and an internet search was used. Randomized controlled studies assessing the effects of psychological interventions on depression and anxiety among Chinese adults with cancer were analyzed. Study selection and appraisal were conducted independently by three authors. The pooled random-effects estimates of standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated. Moderator analysis (meta-regression and subgroup analysis) was used to explore reasons for heterogeneity. Results We retrieved 147 studies (covering 14,039 patients) that reported 253 experimental-control comparisons. The random effects model showed a significant large effect size for depression (SMD = 1.199, p < 0.001; 95% CI = 1.095-1.303) and anxiety (SMD = 1.298, p < 0.001; 95% CI = 1.187-1.408). Cumulative meta-analysis indicated that sufficient evidence had accumulated since 2000–2001 to confirm the statistically significant effectiveness of psychological interventions on depression and anxiety in Chinese cancer patients. Moderating effects were found for caner type, patients’ selection, intervention format and questionnaires used. In studies that included lung cancer, preselected patients with clear signs of depression/anxiety, adopted individual intervention and used State-Trait Anxiety Inventory (STAI), the effect sizes were larger. Conclusions We concluded that psychological interventions in Chinese cancer patients have large effects on depression and anxiety. The findings support that an adequate system should be set up to provide routine psychological interventions for cancer patients in Chinese medical settings. However, because of some clear limitations (heterogeneity and publication bias), these results should be interpreted with caution. Electronic supplementary material The online version of this article (doi:10.1186/1471-2407-14-956) contains supplementary material, which is available to authorized users.
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92
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Fulcher CD, Kim HJ, Smith PR, Sherner TL. Putting evidence into practice: evidence-based interventions for depression. Clin J Oncol Nurs 2014; 18 Suppl:26-37. [PMID: 25427607 DOI: 10.1188/14.cjon.s3.26-37] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression is a distressing emotion that occurs during various times of the cancer trajectory. Depression often goes unrecognized and untreated, which can significantly affect cost, quality of life, and treatment adherence. The Oncology Nursing Society's Putting Evidence Into Practice depression project team reviewed current literature to identify evidence-based interventions to reduce depression in people with cancer. Pharmacologic and nonpharmacologic interventions were evaluated, and opportunities for nurses to integrate recommendations into practice are offered in this article.
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Affiliation(s)
| | - Hee-Ju Kim
- College of Nursing, Catholic University of Korea, Seoul
| | - Patsy R Smith
- College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City
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Zhang C, Murugan S, Boyadjieva N, Jabbar S, Shrivastava P, Sarkar DK. Beta-endorphin cell therapy for cancer prevention. Cancer Prev Res (Phila) 2014; 8:56-67. [PMID: 25403848 DOI: 10.1158/1940-6207.capr-14-0254] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
β-Endorphin (BEP)-producing neuron in the hypothalamus plays a key role in bringing the stress axis to a state of homeostasis and maintaining body immune defense system. Long-term delivery of BEP to obtain beneficial effect on chemoprevention is challenging, as the peptides rapidly develop tolerance. Using rats as animal models, we show here that transplantation of BEP neurons into the hypothalamus suppressed carcinogens- and hormone-induced cancers in various tissues and prevented growth and metastasis of established tumors via activation of innate immune functions. In addition, we show that intracerebroventricular administration of nanosphere-attached dibutyryl cyclic adenosine monophosphate (dbcAMP) increased the number of BEP neurons in the hypothalamus, reduced the stress response, enhanced the innate immune function, and prevented tumor cell growth, progression, and metastasis. BEP neuronal supplementation did not produce any deleterious effects on general health but was beneficial in suppressing age-induced alterations in physical activity, metabolic, and immune functions. We conclude that the neuroimmune system has significant control over cancer growth and progression, and that activation of the neuroimmune system via BEP neuronal supplementation/induction may have therapeutic value for cancer prevention and improvement of general health.
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Affiliation(s)
- Changqing Zhang
- Rutgers Endocrine Program, The State University of New Jersey, New Brunswick, New Jersey. Endocrinology and Animal Biosciences Graduate Program, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Sengottuvelan Murugan
- Rutgers Endocrine Program, The State University of New Jersey, New Brunswick, New Jersey. Department of Animal Sciences, The State University of New Jersey, New Brunswick, New Jersey
| | - Nadka Boyadjieva
- Rutgers Endocrine Program, The State University of New Jersey, New Brunswick, New Jersey. Department of Animal Sciences, The State University of New Jersey, New Brunswick, New Jersey
| | - Shaima Jabbar
- Rutgers Endocrine Program, The State University of New Jersey, New Brunswick, New Jersey. Endocrinology and Animal Biosciences Graduate Program, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Pallavi Shrivastava
- Rutgers Endocrine Program, The State University of New Jersey, New Brunswick, New Jersey. Department of Animal Sciences, The State University of New Jersey, New Brunswick, New Jersey
| | - Dipak K Sarkar
- Rutgers Endocrine Program, The State University of New Jersey, New Brunswick, New Jersey. Endocrinology and Animal Biosciences Graduate Program, Rutgers, The State University of New Jersey, New Brunswick, New Jersey. Department of Animal Sciences, The State University of New Jersey, New Brunswick, New Jersey.
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Hulbert-Williams NJ, Storey L, Wilson KG. Psychological interventions for patients with cancer: psychological flexibility and the potential utility of Acceptance and Commitment Therapy. Eur J Cancer Care (Engl) 2014; 24:15-27. [PMID: 25100576 DOI: 10.1111/ecc.12223] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2014] [Indexed: 11/28/2022]
Abstract
Cancer is an illness affecting patients' physical and psychosocial well-being: high numbers report problematic levels of distress at many points through diagnosis, treatment and survivorship. Conclusive evidence for the long-term benefits of psychological interventions is lacking and this may be because (1) they employ a too limited scope of underlying therapeutic model; or (2) that they are too focused on improving psychopathological outcomes. Acceptance and Commitment Therapy (ACT) may add components not emphasised elsewhere and may provide a more suitable model of adjustment and coping. Following a comprehensive literature search a theoretical and conceptual discussion of the potential for ACT-based oncology interventions is presented. Only a small number of studies have purposively studied the application of ACT within the cancer setting, but this nonetheless presents useful pilot data. The data demonstrate potential clinical- and cost-effectiveness for a range of patients, including those with psychological comorbidity. Within the context of wider cancer adjustment, ACT offers an intervention framework to appropriately build upon the strong empirical base already established for Mindfulness within this specific patient population. The evidence available suggests that the underlying framework of ACT offers an intervention model that is potentially more suited to the individualistic nature of cancer adjustment.
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95
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Thornton LM, Cheavens JS, Heitzmann CA, Dorfman CS, Wu SM, Andersen BL. Test of mindfulness and hope components in a psychological intervention for women with cancer recurrence. J Consult Clin Psychol 2014; 82:1087-100. [PMID: 24884347 DOI: 10.1037/a0036959] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Psychological interventions can attenuate distress and enhance coping for those with an initial diagnosis of cancer, but there are few intervention options for individuals with cancer recurrence. To address this gap, we developed and tested a novel treatment combining Mindfulness, Hope Therapy, and biobehavioral components. METHOD An uncontrolled, repeated measures design was used. Women (N = 32) with recurrent breast or gynecologic cancers were provided 20 treatment sessions in individual (n = 12) or group (n = 20) formats. On average, participants were middle aged (M = 58) and Caucasian (81%). Independent variables (i.e., hope and mindfulness) and psychological outcomes (i.e., depression, negative mood, worry, and symptoms of generalized anxiety disorder) were assessed pre-treatment and 2, 4, and 7 months later. Session-by-session therapy process (positive and negative affect, quality-of-life) and mechanism (use of intervention-specific skills) measures were also included. RESULTS Distress, anxiety, and negative affect decreased, whereas positive affect and mental-health-related quality-of-life increased over the course of treatment, as demonstrated in mixed-effects models with the intent-to-treat sample. Both hope and mindfulness increased, and use of mindfulness skills was related to decreased anxiety. CONCLUSIONS This treatment was feasible to deliver and was acceptable to patients. The trial serves as preliminary evidence for a multi-component intervention tailored to treat difficulties specific to recurrent cancer. The blending of the components was novel as well as theoretically and practically consistent. A gap in the literature is addressed, providing directions for testing interventions designed for patients coping with the continuing stressors and challenges of cancer recurrence.
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Ebrahimi H, Navidian A, Keykha R. Effect of supportive nursing care on self esteem of patients receiving electroconvulsive therapy: a randomized controlled clinical trial. J Caring Sci 2014; 3:149-56. [PMID: 25276758 PMCID: PMC4134177 DOI: 10.5681/jcs.2014.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/15/2014] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Self-esteem is an important potential indicator in etiology, diagnosis and treatment of patients with severe mental illness. ECT is a popular treatment for these patients that can effect on their self-esteem and reinforce their problems. The purpose of this study is to determine the effect of supportive nursing care in increasing self esteem of patients receiving ECT. METHODS This clinical trial was conducted in the Baharan psychiatric hospital of Zahedan. A total of 70 cases of patients who received ECT were randomly allocated to control (n=35) and intervention (n=35) groups. The data were collected by demographic characteristics questionnaire and Rosenberg Self Esteem Scale (RSES). Intervention group received the supportive nursing care. The control group received only routine treatment. Self esteem level was measured and compared before and after intervention for two groups. The data was analyzed by SPSS using the χ(2), t-test and ANCOVA. RESULTS RESULTS showed that both groups were homogeneous on the socio- demographic characteristics. The mean self esteem in the intervention group compared with the control group was significantly increased. While controlling the effects of individual and social variables, the result shows significant differences between two groups in the mean scores of self esteem after the intervention. CONCLUSION The results suggest that supportive nursing care can have positive effect on self esteem of patients receiving ECT. It is recommended to use this method for increasing self esteem of these patients.
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Affiliation(s)
- Hossein Ebrahimi
- Department of psychiatric Nursing, Faculty of Nursing and Midwifery, Tabriz
University of Medical Sciences, Tabriz, Iran
| | - Ali Navidian
- Pregnancy Health Research Center, Statistical Consulting, Zahedan University of
Medical Sciences, Zahedan, Iran
| | - Roghaieh Keykha
- Department of psychiatric Nursing, Faculty of Nursing and Midwifery, Tabriz
University of Medical Sciences, Tabriz, Iran
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97
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Syrjala KL, Jensen MP, Mendoza ME, Yi JC, Fisher HM, Keefe FJ. Psychological and behavioral approaches to cancer pain management. J Clin Oncol 2014; 32:1703-11. [PMID: 24799497 PMCID: PMC4031190 DOI: 10.1200/jco.2013.54.4825] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This review examines evidence for psychological factors that affect pain across the cancer continuum from diagnosis through treatment and long-term survivorship or end of life. Evidence is convincing that emotional distress, depression, anxiety, uncertainty, and hopelessness interact with pain. Unrelieved pain can increase a desire for hastened death. Patients with cancer use many strategies to manage pain, with catastrophizing associated with increased pain and self-efficacy associated with lower pain reports. A variety of psychological and cognitive behavioral treatments can reduce pain severity and interference with function, as indicated in multiple meta-analyses and high-quality randomized controlled trials. Effective methods include education (with coping skills training), hypnosis, cognitive behavioral approaches, and relaxation with imagery. Exercise has been tested extensively in patients with cancer and long-term survivors, but few exercise studies have evaluated pain outcomes. In survivors post-treatment, yoga and hypnosis as well as exercise show promise for controlling pain. Although some of these treatments effectively reduce pain for patients with advanced disease, few have been tested in patients at the end of life. Given the clear indicators that psychological factors affect cancer pain and that psychological and behavioral treatments are effective in reducing varying types of pain for patients with active disease, these methods need further testing in cancer survivors post-treatment and in patients with end-stage disease. Multidisciplinary teams are essential in oncology settings to integrate analgesic care and expertise in psychological and behavioral interventions in standard care for symptom management, including pain.
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Affiliation(s)
- Karen L Syrjala
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC.
| | - Mark P Jensen
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
| | - M Elena Mendoza
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
| | - Jean C Yi
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
| | - Hannah M Fisher
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
| | - Francis J Keefe
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
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98
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Matsuda A, Yamaoka K, Tango T, Matsuda T, Nishimoto H. Effectiveness of psychoeducational support on quality of life in early-stage breast cancer patients: a systematic review and meta-analysis of randomized controlled trials. Qual Life Res 2014; 23:21-30. [PMID: 23881515 PMCID: PMC3929036 DOI: 10.1007/s11136-013-0460-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE Most breast cancer patients receive psychosocial support interventions. However, the effectiveness of these interventions has not yet been clarified. Quality of life (QOL) was an important construct that should be considered when assessing these interventions. The purpose was to evaluate the effectiveness of psychosocial and especially psychoeducational support interventions for early-stage breast cancer patients since the follow-up was bound up to 6 months after finishing the intervention. METHODS We conducted a systematic review and meta-analysis to identify randomized controlled trials with early-stage breast cancer patients receiving psychosocial (psychoeducational and other) support in which QOL was measured as a treatment outcome. We compared mean differences at less than 6 months post-intervention with a control group. The primary outcome was Global Health Status/QOL scale (Global QOL), and secondary outcomes were the subscales of QOL. RESULTS No significant effect was observed for Global QOL; however, individuals receiving psychosocial support scored higher on the Breast Cancer Symptoms subscale. For psychoeducational support in the psychosocial support, significant effect was observed on the Emotional subscale. CONCLUSIONS Our analysis strengthens the evidence of the effectiveness of psychosocial support in improving breast cancer symptoms and psychoeducational support in improving emotional well-being within 6 months post-intervention.
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Affiliation(s)
- Ayako Matsuda
- Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan,
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Parahoo K, McDonough S, McCaughan E, Noyes J, Semple C, Halstead EJ, Neuberger MM, Dahm P. Psychosocial interventions for men with prostate cancer. Cochrane Database Syst Rev 2013:CD008529. [PMID: 24368598 DOI: 10.1002/14651858.cd008529.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND As the incidence and prevalence of prostate cancer continue to rise, the number of men needing help and support to assist them in coping with disease and treatment-related symptoms and their psychosocial effects is likely to increase. OBJECTIVES To evaluate the effectiveness of psychosocial interventions for men with prostate cancer in improving quality of life (QoL), self-efficacy and knowledge and in reducing distress, uncertainty and depression. SEARCH METHODS We searched for trials using a range of electronic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsycINFO to October 2013, together with handsearching of journals and reference lists. SELECTION CRITERIA Randomised controlled trials of psychosocial interventions for men at any stage of prostate cancer. We included psychosocial interventions that explicitly used one or a combination of the following approaches: cognitive behavioural, psychoeducational, supportive and counselling. Interventions had to be delivered or facilitated by trained or lay personnel. DATA COLLECTION AND ANALYSIS Pairs of review authors independently extracted data and assessed risk of bias. We analysed data using standardised mean differences (SMDs), random-effects models and 95% confidence intervals (CIs). MAIN RESULTS Nineteen studies comparing psychosocial interventions versus usual care in a total of 3204 men with prostate cancer were included in this review. All but three of these studies were conducted in the United States.Men in the psychosocial intervention group had a small, statistically significant improvement in the physical component of general health-related quality of life (GHQoL) at end of intervention (1414 participants, SMD 0.12, 95% CI 0.01 to 0.22) based on low-quality evidence. A small improvement in favour of psychosocial interventions (SMD 0.24, 95% CI 0.02 to 0.47) was also seen in the physical component of GHQoL at end of intervention for group-based interventions. No clear evidence of benefit was found for GHQoL scores at end of intervention with individual-based interventions compared with controls. Also, no clear evidence suggested that psychosocial interventions were beneficial in improving the physical component of GHQoL at four to six and at eight to 12 months post-intervention. In addition, no clear evidence showed benefit associated with psychosocial interventions for the mental component of GHQoL at end of intervention (1416 participants, SMD -0.04, 95% CI -0.15 to 0.06) based on moderate-quality evidence. Results for the mental component of GHQoL at four to six and at eight to 12 months post-intervention were compatible with benefit and harm. At end of intervention, cancer-related QoL showed a small improvement following psychosocial interventions (SMD 0.21, 95% CI 0.04 to 0.39), but at eight and 12 months, the effect was compatible with benefit and harm. For prostate cancer-specific and symptom-related QoL, the differences between groups were not significant.No clear evidence indicated that psychosocial interventions were beneficial in improving self-efficacy at end of intervention (337 participants, SMD 0.16, 95% CI -0.05 to 0.38) based on very low-quality evidence in three studies that assessed individual-based interventions. The results for self-efficacy at six to eight and at 12 months post-intervention were compatible with benefit and harm. Men in the psychosocial intervention group had a moderate increase in prostate cancer knowledge at end of intervention (506 participants, SMD 0.51, 95% CI 0.32 to 0.71) based on very low-quality evidence in two studies; this increase was also observed in the subgroups of group-based and individual-based interventions. A small increase in knowledge with psychosocial interventions was noted at three months post-intervention (SMD 0.31, 95% CI 0.04 to 0.58).The results for uncertainty (916 participants, SMD -0.05, 95% CI -0.35 to 0.26) and distress (916 participants, SMD 0.02, 95% CI -0.11 to 0.15) at end of intervention were compatible with both benefit and harm based on very low-quality evidence. No clear evidence suggests that psychosocial interventions were beneficial in reducing uncertainty and distress between groups at six to eight and at 12 months post-intervention. Finally, no clear evidence of benefit is associated with psychosocial interventions for depression at end of intervention (434 participants, SMD -0.18, 95% CI -0.51 to 0.15) based on very low-quality evidence. Individual-based interventions significantly reduced depression when compared with usual care groups. The results for depression at six and at 12 months post-intervention were compatible with benefit and harm.The overall risk of bias in the included studies was unclear or high, primarily as the result of performance bias.No data regarding stage of disease or treatment with androgen deprivation therapy (ADT) were extractable for subgroup analysis. Only one study addressed adverse effects. High attrition could indicate that some participants may not have been comfortable with the interventions. AUTHORS' CONCLUSIONS Overall, this review shows that psychosocial interventions may have small, short-term beneficial effects on certain domains of well-being, as measured by the physical component of GHQoL and cancer-related QoL when compared with usual care. Prostate cancer knowledge was also increased. However, this review failed to demonstrate a statistically significant effect on other domains such as symptom-related QoL, self-efficacy, uncertainty, distress or depression. Moreover, when beneficial effects were observed, it remained uncertain whether the magnitude of effect was large enough to be considered clinically important. The quality of evidence for most outcomes was rated as very low according to GRADE, reflecting study limitations, loss to follow-up, study heterogeneity and small sample sizes. We were unable to perform meaningful subgroup analyses based on disease stage or treatment modality. Although some findings of this review are encouraging, they do not provide sufficiently strong evidence to permit meaningful conclusions about the effects of these interventions in men with prostate cancer. Additional well-done and transparently reported research studies are necessary to establish the role of psychosocial interventions in men with prostate cancer.
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Affiliation(s)
- Kader Parahoo
- Institute of Nursing and Health Research, University of Ulster, Coleraine, UK, BT52 1SA
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Leng J, Lee T, Li Y, Stern C, Chen MH, Winkel G, Gany F. Support needs of Chinese immigrant cancer patients. Support Care Cancer 2013; 22:33-42. [PMID: 23982771 DOI: 10.1007/s00520-013-1950-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 08/13/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE To enable better psychosocial, informational, and practical support of Chinese patients with cancer, this study was conducted to identify the specific support needs of Chinese immigrant cancer patients. METHODS The Cancer Portal Project at Memorial Sloan-Kettering Cancer Center's Center for Immigrant Health and Cancer Disparities is a patient navigation program that assists underserved and minority cancer patients in obtaining social and economic assistance at ten New York City cancer clinics. This need assessment was conducted as part of the Portal Project. Sixty-four questions were added to the existing Portal Intake Form about the needs and preferences for Chinese-language support and survivorship services. Descriptive analysis was performed, as well as an exploratory principal component's factor analysis to determine if there were any patterns in the services and programs in which patients were interested. RESULTS Ninety-six patients were approached for participation; 59 agreed to participate. Eighty-eight percent of participants were born in China. Ninety-seven percent preferred to speak Mandarin, Cantonese, or Fujianese in the healthcare setting. When asked about general interest in support programs, 53 % of the participants were "very interested," 27 % were "maybe interested," and 17 % were "not interested." Programs in which more participants were "very interested" included those that would provide information about obtaining financial assistance (79 %) and social assistance (74 %), information on treatment options (67 %), help in coping with the burden of illness on the family (65 %), and information about general healthcare (63 %). The factor analysis resulted in the identification of five factors: social/financial/treatment and care issues, nutrition and exercise/networking/general health care, coping with fear and stress, herbs and dietary supplements, and acupuncture and acupressure. CONCLUSION In this study, 80 % of the participants expressed interest in programs tailored for Chinese cancer patients. The most frequently preferred topics for potential services were information-based. Findings provide a foundation for future research and the development of culturally and linguistically targeted support programs and interventions for this unique population.
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Affiliation(s)
- Jennifer Leng
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Center for Immigrant Health and Cancer Disparies, Memorial Sloan-Kettering Cancer Center, 300 E. 66th St., 15th Floor, New York, NY, 10065, USA,
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