Distress screening in a multidisciplinary lung cancer clinic: prevalence and predictors of clinically significant distress

Risk factors for cancer-related distress in colorectal cancer survivors: one year post surgery

PURPOSES

Cancer-related distress is known to persist long after completion of treatment. Factors related to distress are largely unexplored in colorectal cancer (CRC) survivors. We examined changes over time and risk factors for distress in CRC patients over the first year after surgery.

METHODS

We included 212 CRC patients with data at 6 and 12 months post-surgery from the ColoCare Study in Heidelberg, Germany. Sociodemographic and lifestyle factors, social support, and health-related quality of life (HrQOL) prior to surgery were evaluated as predictors of cancer-related distress. Distress was measured with the Cancer and Treatment Distress instrument (CTXD). Linear regression analyses examined associations between risk factors and distress.

RESULTS

Distress subscale scores varied significantly over time: health burden subscale score increased (P < .001), while finances (P = .004), medical demands (P < .001), and identity (P < .001) subscale scores decreased over time. Uncertainty and family strain subscale scores did not change. Younger age, lower income, advanced tumor stage, poorer social support, and poorer baseline HrQOL predicted higher level distress at 6 and 12 months.

CONCLUSION

Cancer-related distress continues unresolved after surgery. Although some risk factors are difficult to alter, those at highest risk can be identified earlier for possible preventive strategies.

IMPLICATIONS FOR CANCER SURVIVORS

Screening for risk factors pre-surgery would allow for targeted interventions including strategies to improve resources for those with low support, thereby reducing long-term distress in CRC survivors.

Supportive Care Needs of Patients With Lung Cancer in Mainland China: A Cross-Sectional Study

BACKGROUND

The diagnosis and treatment of lung cancer necessitate a variety of supportive care needs. To our knowledge, no studies have been conducted that target specifically the supportive care needs of patients with lung cancer in Mainland China. Cross-cultural studies indicate that supportive care needs vary by cultural background. Thus, it is necessary to investigate the supportive care needs of patients with lung cancer in the cultural context of China.

PURPOSE

This study aimed to describe the level of supportive care required by patients with lung cancer in China and to examine the relationships between supportive care needs and demographic factors and between supportive care needs and treatment variables.

METHODS

A cross-sectional descriptive study design was adopted. Five hundred fifty-four patients with lung cancer were recruited using a convenience sampling method from inpatient departments in four tertiary teaching hospitals that are affiliated with a medical university in Anhui Province, China. The Nursing Professional Social Support Needs Scale and background information list were used as the data collection instruments. A Wilcoxon rank sum test and a Kruskal-Wallis rank sum test were conducted to examine the differences among the professional supportive care needs of patients of different demographic characteristics and under different treatment conditions.

RESULTS

Participants self-reported the highest scores in the domain of informational needs (M = 3.67, interquartile range = 1.25). The most common supportive care need was "to be cared for by nurses with skilled venipuncture techniques." There were significant differences in needs across different genders, age groups, educational levels, and income levels (p < .05). Patients with metastasis and other illnesses had greater supportive care needs in terms of total and subscale scores in Stages III and IV (p < .05).

CONCLUSIONS

Patients with serious diseases and heavy socioeconomic burdens have greater supportive care needs. Therefore, healthcare providers should improve their awareness and expertise to identify the needs of their patients and to provide supportive care to patients with lung cancer. In addition, patients with high supportive care needs should be identified.

Metastatic breast cancer in older patients: A longitudinal assessment of geriatric outcomes

INTRODUCTION

Approximately 20% of older patients with breast cancer either present with metastatic disease or develop distant metastases after early breast cancer. The aims of this study were to assess the prevalence of psychosocial problems in older patients with metastatic breast cancer, and to assess longitudinal changes in functional status, psychosocial functioning, and quality of life.

METHODS

For this prospective cohort study, patients with metastatic breast cancer aged 70 years and older were recruited in four Dutch hospitals. A baseline geriatric assessment was performed evaluating somatic, functional and psychosocial domains. Self-administered questionnaires were performed at baseline, three and six months: the Groningen Activity Restriction Scale, Geriatric Depression Scale, Loneliness scale, Apathy scale, Distress Thermometer and EORTC-QLQ-C30. Longitudinal changes on these scales were assessed by performing crude and adjusted linear mixed models.

RESULTS

Of the 100 patients that were included and underwent a geriatric assessment, 85 patients completed the baseline self-administered questionnaires. Almost half of the patients (46%) had depressive symptoms, and up to 64% experienced distress. Apathy was present in 53%, and 36% experienced loneliness. Three- and six-month questionnaires were completed by 77 and 72 patients, respectively. Although a significant increase in loneliness between baseline and six months was seen, this size of this change was not clinically relevant. No other longitudinal changes were found.

CONCLUSION

The prevalence of distress, depressive symptoms, apathy and loneliness in older patients with metastatic breast cancer is high. Timely detection, for which a geriatric assessment is effective, could potentially improve quality of life.

How Do We Align Health Services Research and Quality Improvement?

Quality improvement (QI) initiatives and health services research (HSR) are commonly used to target health care quality. These disciplines are increasingly important because of the movement toward value-based health care as alternative payment and care delivery models drive institutions and investigators to focus on reducing unnecessary health care use and improving care coordination. QI efforts frequently target medical error and/or efficiency of care through the Plan-Do-Study-Act methodology. Within the QI framework, strategies for data display (e.g., Pareto charts, run charts, histograms, scatter plots) are leveraged to identify opportunities for intervention and improvement. HSR is a multidisciplinary field of study that seeks to identify the most effective way to organize, deliver, and finance health care to maximize the quality and value of care at both the individual and population levels. HSR uses a diverse set of quantitative and qualitative methodologies, such as case-control studies, cohort studies, randomized control trials, and semistructured interview/focus group evaluations. This manuscript provides examples of methodologic approaches for QI and HSR, discusses potential challenges associated with concurrent quality efforts, and identifies strategies to successfully leverage the strengths of each discipline in care delivery.

Cancer-Related Distress: Revisiting the Utility of the National Comprehensive Cancer Network Distress Thermometer Problem List in Women With Gynecologic Cancers

PURPOSE

The Distress Thermometer (DT) includes a measure of cancer-related distress and a list of self-reported problems. This study evaluated the utility of the DT problem list in identifying concerns most associated with distress and poorer quality of life (QOL) in survivors of gynecologic cancer.

METHODS

Demographic, clinical, psychosocial functioning, and DT data were described among 355 women participating in a gynecologic cancer cohort. Problems from the DT list were ranked by prevalence, distress, and QOL. Logistic regression models explored factors associated with problems that were common (≥ 25% prevalence) and associated with distress and QOL.

RESULTS

The average age of participants was 59.9 years (standard deviation [SD], 10.8 years). Most participants were non-Hispanic white (97%) and had ovarian (44%) or uterine (42%) cancer. The mean DT score was 2.7 (SD, 2.7); participants reported a mean of 7.3 problems (SD, 5.9 problems). The most common problems were fatigue (53.6%), worry (49.9%), and tingling (46.3%); least common problems were childcare (2.1%), fevers (2.1%), and substance abuse (1.1%). Report of some common problems, including tingling, sleep, memory, skin issues, and appearance, was not associated with large differences in distress or QOL. In contrast, some rarer problems such as childcare, treatment decisions, eating, housing, nausea, and bathing/dressing were associated with worse distress or QOL. Younger age, lower income, and chemotherapy were risk factors across common problems that were associated with worse distress or QOL (fatigue, nervousness, sadness, fears, and pain).

CONCLUSION

The DT problem list did not easily identify concerns most associated with distress and low QOL in patients with gynecologic cancer. Adaptations that enable patients to report their most distressing concerns would enhance clinical utility of this commonly used tool.

The Quality of Life of Patients with Suspected Lung Cancer before and after Bronchoscopy and the Effect of Mirtazapine on the Depressive Status

Objective Patients with suspected lung cancer often experience adverse side effects such as anxiety, depression, and a decreased appetite. These side effects influence the patients' quality of life and their ability to make decisions concerning appropriate treatment. This study examined the psychological status and quality of life of patients with suspected lung cancer before and after bronchoscopy treatment and evaluated the effect of mirtazapine prescribed to patients with depression. Methods To assess patient characteristics (e.g. age, gender, and medical history), a questionnaire including the Hospital Anxiety and Depression Scale - Japanese version and the Functional Assessment of Cancer Therapy-L was administered. Patients Forty-three patients admitted for bronchoscopy treatment between May 2017 and April 2018 were included. Results The results showed that patients with depression reported a worse quality of life than those without depression. Compared with no medication, the administration of mirtazapine alleviated depressive symptoms. Furthermore, the patients' depressive status was affected by their physical symptoms, including coughing, tightness of chest, and dyspnea. Conclusion Our results emphasize the importance of detecting depression in the early stages of a cancer diagnosis and have significant implications concerning pharmacological intervention in patients with cancer displaying signs of depression.

Symptoms and Needs of Patients with Advanced Lung Cancer: Early Prevalence Assessment

BACKGROUND

Little is known on symptom burden, psychosocial needs, and perception of prognosis in advanced lung cancer patients at the time of diagnosis, although early assessment is strongly recommended within the setting of daily routine care.

METHODS

Twelve study sites cross-sectionally assessed symptoms and psychosocial needs of patients suffering from newly diagnosed incurable lung cancer. Assessment comprised NCCN distress thermometer, FACT-L, SEIQoL-Q, PHQ-4, and shortened and modified SCNS-SF-34 questionnaires. Additional prognostic information from both patients and physicians were collected.

RESULTS

A total of 208 patients were evaluated. Mean age was 63.6 years, 58% were male, 84% suffered from stage IV lung cancer, and 71% had an ECOG performance status of 0-1. Mean distress level was 5.4 (SD 2.5), FACT-L total score was 86 (21.5), and TOI 50.5 (14.9). PHQ-4 was 4.6 (3.3), and shortened and modified SCNS-SF-34 showed 9 (8.7) unmet needs per patient. According to their physicians' perspective, 98.1% of patients were reflecting on and 85.2% were accepting incurability, while 26.5% of patients considered the treatment to be of curative intent.

CONCLUSION

Our findings emphasize substantial domains of symptom burden seen in newly diagnosed, incurable lung cancer patients. Oncologists should be aware of these features and address prognostic issues early in the disease trajectory to facilitate opportunities to improve coping, advance care planning, and appropriate integration of palliative care, thus improving quality of life.

Long-term distress in older patients with cancer: a longitudinal cohort study

BACKGROUND

Receiving a cancer diagnosis can be a major life event which causes distress even years after primary treatment.

AIM

To examine the prevalence of distress in older patients with cancer (OPCs) up until 5 years post-diagnosis, and identify predictors present at time of diagnosis. Results are compared with reference groups of middle-aged patients with cancer (MPCs) and older patients without a cancer diagnosis (OPs).

DESIGN & SETTING

OPCs, MPCs, and OPs participated in a longitudinal cohort study in Belgium and the Netherlands by filling in questionnaires at designated time points from 2010-2019.

METHOD

Data from 541 patients were analysed using multivariable logistic regression analyses.

RESULTS

At baseline, 40% of OPCs, 37% of MPCs, and 17% of OPs reported distress. After 5 years, 35% of OPCs, 23% of MPCs, and 25% of OPs reported distress. No significant predictors for long-term distress in OPCs and OPs were found. For MPCs, it was found that baseline distress (odds ratio [OR] 2.94; 95% confidence intervals [CI] = 1.40 to 6.19) and baseline fatigue (OR 4.71; 95% CI = 1.81 to 12.31) predicted long-term distress.

CONCLUSION

Distress is an important problem for people with cancer, with peaks at different moments after diagnosis. Feelings of distress are present shortly after diagnosis but they decrease quickly for the majority of patients. In the long term, however, OPCs in particular appear to be most at risk for distress. This warrants extra attention from primary healthcare professionals, such as GPs who are often patients' first medical contact point. More research into risk factors occurring later in an illness trajectory might shed more light on predictors for development of long-term distress.

The effect of treatment on patient-reported distress after breast cancer diagnosis

BACKGROUND

The National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) uses a 10-point scale (in which 0 indicates no distress and 10 indicates extreme distress) to measure patient-reported distress. In the current study, the authors sought to examine the relationship between treatment and NCCN DT scores in patients with breast cancer over time.

METHODS

The authors included women aged ≥18 years who were diagnosed with stage 0 to stage IV breast cancer (according to the seventh edition of the American Joint Commission on Cancer staging system) at a 3-hospital health system from January 2014 to July 2016. Linear mixed effects models adjusted for covariates including stage of disease, race/ethnicity, insurance, and treatment sequence (neoadjuvant vs adjuvant) were used to estimate adjusted mean changes in the DT score (MSCs) per week for patients undergoing lumpectomy, mastectomy only, and mastectomy with reconstruction (MR).

RESULTS

The authors analyzed 12,569 encounters for 1029 unique patients (median score, 4; median follow-up, 67 weeks). Patients treated with MR (118 patients) were younger and more likely to be married, white, and privately insured compared with patients undergoing lumpectomy (620 patients) and mastectomy only (291 patients) (all P < .01). After adjusting for covariates, distress scores were found to decline significantly across all 3 surgical cohorts, with patients undergoing MR found to have both the most preoperative distress and the greatest decline in distress prior to surgery (MSC/week: -0.073 for MR vs -0.031 for lumpectomy vs -0.033 for mastectomy only; P = .001). Neoadjuvant therapy was associated with a longitudinal decline in distress for patients treated with lumpectomy (-1.023) and mastectomy only (-0.964). Over time, ductal carcinoma in situ (-0.503) and black race (-1.198) were found to be associated with declining distress among patients treated with lumpectomy and MR, respectively, whereas divorced patients who were treated with mastectomy only (0.948) and single patients treated with lumpectomy (0.476) experienced increased distress (all P < .05).

CONCLUSIONS

When examined longitudinally in consecutive patients, the NCCN DT can provide patient-reported data to inform expectations and guide targeted support for patients with breast cancer.

Improving family caregiver and patient outcomes in lung cancer surgery: Study protocol for a randomized trial of the multimedia self-management (MSM) intervention

OBJECTIVE

To describe the study protocol of the Multimedia Self-Management (MSM) intervention to prepare patients and family caregivers (FCGs) for lung cancer surgery.

DESIGN

The study is a five-year, single site, randomized controlled trial of 160 lung cancer surgery FCG and patient dyads (320 total participants), comparing intervention and attention control arms.

SETTING

One National Cancer-Institute (NCI) designated comprehensive cancer center in Southern California.

PARTICIPANTS

Patients who are scheduled to undergo lung cancer surgery and their FCGs are enrolled as dyads only.

INTERVENTION

Based on the Chronic Care Self-Management Model (CCM), the intervention is a nurse-led, caregiver-based, multimedia care program for lung cancer surgery. Its primary focus is to help FCGs develop self-management skills related to their caregiving role through goal setting, proactive planning, building problem-solving skills, and accessing family support services. The intervention also supports dyads to prepare for surgery and post-operative recovery at home. It includes videos, print, web-based, and post-discharge telephone support.

MAIN OUTCOME MEASURES

FCG and patient psychological distress and QOL; FCG burden and preparedness for caregiving; FCG and patient healthcare resource use (in-home nursing care, urgent care/ER visits, readmissions).

ANALYSIS

Repeated measures ANCOVA statistical design will be used, removing variances prior to examining mean squares for the group by occasion interactions, and co-varying the baseline scores. In addition, structured equation modeling (SEM) will assess whether mediating and moderating factors are associated with outcomes. ClinicalTrials.gov Identifier: NCT03686007.

Distress among African American and White adults with cancer in Louisiana

Purpose/Objectives: Screening for distress is a key priority in cancer care, and African American patients may experience increased distress compared to White patients. However, this question has not yet been addressed in Louisiana. The purpose of the present study was to examine the relationship between African American race and distress at a cancer center in Louisiana.Design/Methods: This was a retrospective study of 1,544 patients who were treated at an academic cancer center in 2015. Extracted data included patient self-reports of distress using the single-item Distress Thermometer (DT) and demographic and clinical characteristics. Hypotheses were tested using logistic regression.Findings: Distress was present in 19.7% of the sample. In univariate analyses, African American patients were more likely than White patients to experience distress (OR = 1.38, p = .013). However, race was no longer associated with distress in a multivariate analysis that adjusted for the covariates of age, gender, cancer site, presence of metastases, and number of distress screenings (OR = 1.07, p = .670). Distress was more common in patients who were younger (OR = 2.26, p < .001), diagnosed with lung/bronchus cancer (OR = 5.28, p < .001), or screened more often (OR = 5.20, p < .001). Distress was less common among patients with female breast cancer (OR = 0.39, p = .015).Conclusions/Implications: This study suggests that African American individuals with cancer in Louisiana are at increased risk for distress, but that this can be attributed to African American patients being younger, more likely to have lung cancer, and screened more frequently. Implications include careful consideration of patient race, age, and cancer site during distress management in cancer care.

Exploring emotion regulation as a mediator of the relationship between resilience and distress in cancer

OBJECTIVES

Distress in patients with cancer is a significant problem that affects up to 32% of patients. Yet research indicates that 35% of cancer patients do maintain high levels of well-being. Resilience is one psychological factor implicated as being protective against distress; however, the mechanisms for this relationship are currently unknown. The present study aimed to explore emotion regulation as a potential mediator of the relationship between resilience and distress.

METHODS

A cross-sectional survey examining emotional regulation, resilience, and distress was completed by 227 patients from two hospitals with heterogeneous cancer types. Measures included the Difficulties in Emotion Regulation Scale (DERS), the Connor Davidson Resilience Scale, and the Depression, Anxiety, Stress Scale.

RESULTS

Difficulties in emotion regulation and resilience explained 33.2% of the variance in distress. Resilience had a significant direct effect on distress, accounting for 15.8% of the variance. However, this effect was no longer significant when difficulties in emotion regulation were controlled for. The indirect effect through difficulties in emotion regulation was significant, b = 0.009, 95% CI [-0.013,-0.007], suggesting that the effect of resilience on distress was fully mediated by emotion regulation. Parallel mediation analyses also examined the differential effects of the six DERS subscales on the relationship between resilience and distress.

CONCLUSION

These findings suggest that emotion regulation is an important mediator of resilience in cancer. Hence, in patients with cancer, difficulties in emotion regulation (and the DERS specifically) might be a useful focus for screening for patients at risk of distress.

Brief emotional screening in oncology: Specificity and sensitivity of the emotion thermometers in the Portuguese cancer population

Objective

This study aimed to determine the cutoff and the specificity and sensitivity of the Emotion Thermometers (ET) in a Portuguese sample of cancer patients.

Method

A total of 147 patients (mean age = 49.2; SD = 12.6) completed the ET, the Brief Symptom Inventory (BSI), and the Subjective Experiences of Illness Suffering Inventory. Data were collected in a cancer support institution and in a major hospital in the North of Portugal.

Result

The optimal cutoff for the Anxiety Thermometer was 5v6 (until 5 and 6 or more), which identified 74% of the BSI-anxiety cases and 70% of noncases. The Depression Thermometer cutoff was 4v5 (until 4 and 5 or more), which identified 85% of BSI-depression cases and 82% of noncases. Cutoff for the Anger Thermometer was 4v5 (until 4 and 5 or more), which identified 83% of BSI-hostility cases and 73% of noncases; for the Distress Thermometer, the optimal cutoff was 4v5 (until 4 and 5 or more), which identified 84% of the suffering cases and 73% of noncases. Finally, for the Help Thermometer, it was 3v4 (until 3 and 4 or more), which helped to identify 93% of the suffering cases and 64% of noncases.

Significance of results

Results supported the Portuguese version of the ET as an important screening tool for identifying the emotional distress in cancer patients.

"I can't get it into my head that I have cancer…"-A qualitative interview study on needs of patients with lung cancer

Background

Caring for patients with advanced lung cancer is of high relevance in different clinical settings. Lung cancer is among the most common causes of death from malignant neoplasms worldwide; with increasing prevalence and mortality.

Aim

To get a better understanding of individual patients’ needs, exploring the experiences and meaning of living with advanced lung cancer at the end of life, and to develop strategies for improving patient-centred care in Germany.

Design

Qualitative explorative interview study with patients, using grounded theory.

Setting/Participants

A sample of 17 adults living with advanced lung cancer in Lower Saxony/Germany was recruited in two university hospitals. Patients were asked to tell of their experiences of living with advanced lung cancer. The emphasis of this study was the period of palliative tumour therapy.

Results

The main phenomenon of living with advanced lung cancer is the feeling of having to redefine one’s own existence, such as social roles within and outside the family. The diagnosis trigger powerlessness, which can lead to information passivity, followed by acceptance of aggressive tumour treatment. Patients perceive a high degree of psychological and social stress, without being able to express this. There is a lack of regular appropriate psychosocial care accompanying chemotherapy. Patients ascribe their physical suffering to the side effects of tumour treatment, which may trigger a desire to die. Finally, patients tend to hide their individual needs, even when asked.

Conclusions

Regarding the patients’ needs, greater emphasis must be placed on psychosocial care as part of the biopsychosocial model to adequately consider the patients’ concerns. Assessments can be helpful to enhance communication at an early stage across all professions into the multi-professional therapy.

Addressing the psychosocial needs of cancer patients: a retrospective analysis of a distress screening and management protocol in clinical care

BACKGROUND

A growing recognition of the impact of distress on the quality of life and adherence to treatment of cancer patients has been documented. As a result, national guidelines and standards of care mandate providers to implement distress screening protocols to connect patients with psychosocial services. However, limited literature has examined whether distressed patients are referred to care and their needs addressed. This article assessed differences in rates of referral and psychosocial services by demographic factors, clinical characteristics, and distress severity. Potential predictors of these two outcomes were investigated.

METHODS

A retrospective analysis of patient data abstracted from electronic medical records of a NCI-designated Academic Comprehensive Cancer Center was conducted. Of the 399 cases meeting the inclusion criteria, 302 (75.7%) were screened for distress with the Distress Thermometer. Differences were examined with chi-square, t-tests, and ANOVAs. Predictors were identified with multivariate logistic regressions.

RESULTS

Overall, patients who were identified as distressed were referred to a psychosocial provider (71.4%) and psychosocial services were delivered in approximately 64% of the cases. Referrals and service delivery rates varied by age group, clinic, health insurance coverage, distress severity, and presence of psychosocial issues. Only the distress score predicted the likelihood of being referred, and of a provider intervention to occur. Conclusions and implications for psychosocial providers: Although the protocol appeared to facilitate referral and service delivery to patients scoring above the cutoff for distress, our results suggest that patients were more likely to not have their distress and psychosocial needs addressed if they were older, without insurance coverage, and were seen in clinics where a social worker was not consistently available. Future studies able to monitor patient outcomes in terms of quality of life, satisfaction with care, and service utilization are recommended.

Use of the Distress Thermometer in Clinical Practice

Distress is experienced by many cancer patients, adversely affecting quality of life and cancer care. Although it is often manageable, it remains woefully underidentified and underreported. Distress can occur anytime during the cancer experience and is associated with depression, anxiety, missed appointments, and adverse outcomes. In 1999, the National Comprehensive Cancer Network (NCCN), recommended routine screening for distress in all cancer patients. The Distress Thermometer (DT) was developed as a simple tool to effectively screen for symptoms of distress. The instrument is a self-reported tool using a 0-to-10 rating scale. Additionally, the patient is prompted to identify sources of distress using a Problem List. The DT has demonstrated adequate reliability and has been translated into numerous languages. The tool is easy to administer and empowers the clinician to facilitate appropriate psychosocial support and referrals.

Assessing the psychosocial needs of newly diagnosed patients with nonsmall cell lung cancer: Identifying factors associated with distress

OBJECTIVE

The Psychosocial Screen for Cancer (PSSCAN-R) questionnaire is a validated screening tool used to identify the psychosocial needs of patients with cancer. It assesses patients' perceived social supports and psychosocial needs, and the presence of symptoms of depression and anxiety. The study goals were to assess the prevalence and factors associated with distress in patients with newly diagnosed nonsmall cell lung cancer (NSCLC).

METHODS

All patients with NSCLC referred to BC Cancer centers from 2011 to 2015, who completed a prospective PSSCAN-R questionnaire at the time of their first visit, were included in the study. Demographics and baseline disease characteristics were collected retrospectively. The chi-squared test, Fisher exact test, and logistical regression analysis were used to compare factors associated with the presence of distress based on sex, age, stage of disease, and performance status (PS).

RESULTS

A total of 4281 NSCLC patients completed the PSSCAN-R questionnaire. Baseline characteristics: 70% were greater than or equal to 65, 50% female, 52% metastatic disease, 47% Eastern Cooperative Oncology Group (ECOG) greater than or equal to two. Patients who were female, less than 65, have metastatic disease and poor PS were more likely to report subclinical or clinical symptoms of anxiety. Symptoms of depression were associated with younger, female, poor PS patients, and social isolation.

CONCLUSIONS

Newly diagnosed patients with NSCLC are likely to report clinical symptoms of anxiety and depression and have a high number of concerns in multiple psychosocial domains. Resource development for lung cancer patients should be based on their care needs with careful consideration of patients' age, gender, stage, and social situation to optimally support their psychosocial needs during treatment and follow-up.

Improving Timeliness of Oncology Assessment and Cancer Treatment Through Implementation of a Multidisciplinary Lung Cancer Clinic

PURPOSE

Timely lung cancer care has been associated with improved clinical outcomes and patient satisfaction. We identified improvement opportunities in lung cancer management pathways at Kingston Health Sciences Centre. Quality improvement strategies led to the implementation of a multidisciplinary lung cancer clinic (MDC).

METHODS

We set an outcome measure of decreasing the time from diagnosis to first cancer treatment by 10 days within 6 months of clinic implementation. We implemented a weekly MDC that involved respirologists, medical oncologists, and radiation oncologists at which patients with new lung cancer diagnoses were offered concurrent oncology consultation. We used Plan-Do-Study-Act cycles to guide our improvement initiatives. A total of five Plan-Do-Study-Act cycles spanned 14 months and consisted of an MDC pilot clinic, large-scale MDC launching, debriefing meetings, and clinic expansion. Pre-MDC data were analyzed retrospectively to establish baseline and prospectively for improvement. Statistical Process Control XmR(i) charts were used to report data.

RESULTS

Since MDC initiation, 128 patients have been seen in 34 MDC clinics (3.8 patients per clinic). Mean days from diagnosis to first oncology assessment decreased from 12.4 days to 3.9 days, and mean days from diagnosis to first cancer treatment decreased from 39.5 to 15.0 days, both of which demonstrated special cause variation. Time to assessment and treatment improved for patients with every stage of lung cancer and for both small-cell and non-small-cell subtypes.

CONCLUSION

MDC shortens the time from lung cancer diagnosis to oncology assessment and treatment. Time to treatment improved more than time to oncology assessment, which suggests the improvement is related to benefits beyond faster oncology assessment.

New lung cancer treatments (immunotherapy and targeted therapies) and their associations with depression and other psychological side effects as compared to chemotherapy

OBJECTIVE

Lung cancer carries a high prevalence of distress, anxiety and depression. New treatments, targeted therapy and immunotherapy have changed the disease course for subsets of patients and confer longer survival, but their psychological associations and possible mechanisms (e.g., inflammation and physical symptoms) are not well described.

METHOD

Patients with metastatic lung cancer undergoing systemic treatment (n = 109) were evaluated for distress, self-endorsed problems using the Distress Thermometer and Problem List, and depression and anxiety using the Hospital Anxiety and Depression Scale. Demography, cancer-related information, and inflammation were evaluated for their associations with chemotherapy, targeted therapy, and immunotherapy. Inflammation was measured by C-reactive protein, albumin, and neutrophil to lymphocyte ratio.

RESULTS

Chemotherapies were given most often followed by immunotherapy and targeted therapies. Depression and anxiety were endorsed by 23.9%, respectively, and 41.1% had significant distress. Chemotherapy was associated with depression (p = .006) and inflammation (p < .001). Physical symptoms were the same among treatment types. Targeted therapy and immunotherapy predicted for less depression (p = .04, p = .04 respectively) than chemotherapy when controlling for age, sex, and performance status however these predictors where not significant when controlled for inflammation.

CONCLUSION

New immunotherapy and targeted therapies are associated with less depression and inflammation among patients who are living longer while their physical symptoms are the same.

Standardized Screening and Psycho-oncological Treatment of Orthopedic Cancer Patients

BACKGROUND/AIM

Psycho-oncological distress is a relevant clinical problem. The aim of this study was to administer a standardized psycho-oncological distress screening for early identification and indication-based treatment of highly distressed orthopedic cancer patients as well as the evaluation of distress patterns.

PATIENTS AND METHODS

In total, 35 patients with cancer were psycho-oncologically screened using a cancer-specific expert rating scale (Basic Documentation for Psycho-Oncology Short Form) at three different time points (day of admission, day before discharge, 3 months postoperatively). Psycho-oncological support was offered to all patients whose distress exceeded a defined cut-off value.

RESULTS

Levels of distress in approximately 51% of patients exceeded the cut-off value at the time of admission and these patients received psycho-oncological support. The high distress levels decreased significantly over time. Patients whose distress did not exceed the cut-off value at the first assessment showed low distress levels at all time points.

CONCLUSION

A relevant number of orthopedic tumor patients suffer from psychosocial distress. Standardized screening might help to identify and adequately treat those patients.

Effects of Shared Decision Making on Distress and Health Care Utilization Among Patients With Lung Cancer: A Systematic Review

CONTEXT

Lung cancer is associated with significant distress, poor quality of life, and a median prognosis of less than one year. Benefits of shared decision making (SDM) have been described for multiple diseases, either by the use of decisions aids or as part of supportive care interventions.

OBJECTIVES

The objective of this study was to summarize the effects of interventions facilitating SDM on distress and health care utilization among patients with lung cancer.

METHODS

We performed a systematic literature search in the CINAHL, Cochrane, EMBASE, MEDLINE, and PsychINFO databases. Studies were eligible when conducted in a population of patients with lung cancer, evaluated the effects of an intervention that facilitated SDM, and measured distress and/or health care utilization as outcomes.

RESULTS

A total of 12 studies, detailed in 13 publications, were included: nine randomized trials and three retrospective cohort studies. All studies reported on a supportive care intervention facilitating SDM as part of their intervention. Eight studies described effects on distress, and eight studies measured effects on health care utilization. No effect was found in studies measuring generic distress. Positive effects, in favor of the intervention groups, were observed in studies using anxiety-specific measures (n = 1) or depression-specific measures (n = 3). Evidence for reductions in health care utilization was found in five studies.

CONCLUSION

Although not supported by all studies, our findings suggest that facilitating SDM in the context of lung cancer may lead to improved emotional outcomes and less aggressive therapies. Future studies, explicitly studying the effects of SDM by using decision aids, are needed to better elucidate potential benefits.

The long-lasting relationship of distress on radiation oncology-specific clinical outcomes

Purpose

The diagnosis and treatment of cancer can have significant mental health ramifications. The National Comprehensive Cancer Network currently recommends using a distress screening tool to screen patients for distress and facilitate referrals to social service resources. Its association with radiation oncology–specific clinical outcomes has remained relatively unexplored.

Methods and materials

With institutional review board approval, National Comprehensive Cancer Network distress scores were collected for patients presenting to our institution for external beam radiation therapy during a 1-year period from 2015 to 2016. The association between distress scores (and associated problem list items and process-related outcomes) and radiation oncology–related outcomes, including inpatient admissions during treatment, missed treatment appointments, duration of time between consultation and treatment, and weight loss during treatment, was considered.

Results

A total of 61 patients who received either definitive (49 patients) or palliative (12 patients) treatment at our institution and completed a screening questionnaire were included in this analysis. There was a significant association between an elevated distress score (7+) and having an admission during treatment (36% vs 11%; P = .04). Among the patients treated with definitive intent, missing at least 1 appointment (71% vs 26%; P = .03) and having an admission during treatment (57% vs 10%; P = .009) were significantly associated with our institutional definition of elevated distress. We found no correlation between distress score and weight loss during treatment or a prolonged time between initial consult and treatment start.

Conclusions

High rates of distress are common for patients preparing to receive radiation therapy. These levels may affect treatment compliance and increase rates of hospital admissions. There remains equipoise in the best method to address distress in the oncology patient population. These results may raise awareness of the consequences of distress among radiation oncology patients. Specific interventions to improve distress need further study, but we suggest a more proactive approach by radiation oncologists in addressing distress.

Validity and feasibility of the Arabic version of distress thermometer for Saudi cancer patients

BACKGROUND

The distress thermometer (DT) has been studied and validated as an effective screening instrument for identifying distress among cancer patients worldwide. This study aims to evaluate the validity of the Arabic version of the DT in Saudi cancer patients, to define the optimal cutoff point of the Arabic DT for detecting clinically significant distress and to determine whether there is any correlation between clinically significant distress and other demographic and Problem List variables.

METHODS

The original form of the DT was translated to Arabic using a forward and backward translation method. Then, a group of 247 cancer patients who were followed up at the Outpatient Oncology Clinic at King Saud Medical City in Riyadh, Saudi Arabia, completed a socio-demographic and clinical status questionnaire, the DT and the Problem List scale, and the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Receiver operating characteristic (ROC) curve analyses picked out an area under the curve of 0.76 when compared with a HADS cutoff score of 15. The DT had the best sensitivity (0.70) and specificity (0.63) with cutoff score of 4. A DT score of 4 or more was found to have a statistically significant correlation with female gender, advanced cancer stages and most of the Problem List items, including child care, work or school, treatment decision, dealing with children and partners, depression, fears, nervousness, sadness, loss of interest in usual activity, religious concerns, appearance, bathing/dressing, breathing, diarrhea, fatigue, feeling swollen, fever, getting around, indigestion, memory and concentration, nausea, dry nose, pain, and sexual problems. In contrast, a multivariate regression analysis confirmed only advanced cancer stages, treatment decision, depression, fear, sadness, worry, breathing, feeling swollen, fever, indigestion, memory and concentration, dry nose and congestion, pain and sleep as independent factors associated with distress in cancer patients.

CONCLUSIONS

We found the Arabic version of the DT to be a valid instrument for screening distress in Saudi patients with cancer. Our study proposes using a cutoff score of 4 as an indicator of clinically significant distress in this population.

Translation and Evaluation of a Lung Cancer, Palliative Care Intervention for Community Practice

CONTEXT

A notable gap in the evidence base for palliative care (PC) for cancer is that most trials were conducted in specialized centers with limited translation and further evaluation in "real-world" settings. Health systems are desperate for guidance on effective, scalable models.

OBJECTIVES

The objective of this study was to determine the effects of a nurse-led PC intervention for patients with non-small-cell lung cancer and their family caregivers (FCGs) in a community-based setting.

METHODS

Two-group, sequential, quasi-experimental design with Phase 1 (usual care [UC]) followed by Phase 2 (intervention) was conducted at three Kaiser Permanente Southern California sites. Participants included patients with Stage 2-4 non-small-cell lung cancer and their FCG. Standard measures of quality of life (QOL) included Functional Assessment of Cancer Therapy-Lung, Functional Assessment of Chronic Illness Therapy-Spirituality Subscale, City of Hope Family QOL; other outcomes were distress, health care utilization, caregiver preparedness, and burden.

RESULTS

Patients in the intervention cohort had significant improvements in three (physical, emotional, and functional well-being) of the five QOL domains at one month that were sustained through three month compared to UC (P < 0.01). Caregivers in the intervention cohort had improvements in physical (P = 0.04) and spiritual well-being (P = 0.03) and preparedness (P = 0.04) compared to UC. There were no differences in distress or health care utilization between cohorts.

CONCLUSION

Our findings suggest that a research-based PC intervention can be successfully adapted to community settings to achieve similar, if not better, QOL outcomes for patients and FCGs compared to UC. Nonetheless, additional modifications to ensure consistent referrals to PC and streamlining routine assessments and patient/FCG education are needed to sustain and disseminate the PC intervention.

Effects of two translated phrases of distress thermometer on screening distress in Chinese cancer patients: A comparative study

AIMS AND OBJECTIVES

To compare the screening effectiveness of two translated phrases of the Distress Thermometer (DT), namely the XinLiTongKu Thermometer (DT-X) and KunRao Thermometer (DT-K), in Chinese patients with cancer.

BACKGROUND

The DT is one of the most commonly used tools to screen cancer patients' psychological states. However, translations of the DT are not uniform in China; this may affect the screening effectiveness of this tool.

DESIGN

Cross-sectional survey with randomisation and self-control.

METHODS

A sample of 172 cases was screened using the two DT translations, to check and compare the screening effectiveness of the two translations. The correlation between them was also investigated. The causes of the differences in screening effectiveness of the two translations were analysed, using 90 of the above 172 cases and an additional 68 cases. STROBE guidelines were used in reporting this study.

RESULTS

For the DT-X (using a cut-off score of 4), the sensitivity value was 0.82 and the specificity value was 0.95, where for the DT-K (using a cut-off score of 3), the values were 0.78 and 0.79, respectively. The area under the receiver operating characteristic curve (AUC) was 0.914 and 0.797, respectively. Scores of the DT-X and the DT-K were positively correlated. In concepts of the participants, for both phrases, the sequences of the first three meanings were the same-worried, anxious and tired-while the fourth to sixth meanings were differed between phrases.

CONCLUSION

The DT-X and DT-K were both effective screening tools. However, in this study, the DT-X had a larger AUC than the DT-K.

RELEVANCE TO CLINICAL PRACTICE

This study may be useful for enabling better measurement of distress in Chinese patients and improving the indigenisation of the DT.

Fatigue in Chronic Respiratory Diseases: Theoretical Framework and Implications For Real-Life Performance and Rehabilitation

Fatigue is a primary disabling symptom in chronic respiratory diseases (CRD) with major clinical implications. However, fatigue is not yet sufficiently explored and is still poorly understood in CRD, making this symptom underdiagnosed and undertreated in these populations. Fatigue is a dynamic phenomenon, particularly in such evolving diseases punctuated by acute events which can, alone or in combination, modulate the degree of fatigue experienced by the patients. This review supports a comprehensive inter-disciplinary approach of CRD-related fatigue and emphasizes the need to consider both its performance and perceived components. Most studies in CRD evaluated perceived fatigue as a trait characteristic using multidimensional scales, providing precious information about its prevalence and clinical impact. However, these scales are not adapted to understand the complex dynamics of fatigue in real-life settings and should be augmented with ecological assessment of fatigue. The state level of fatigue must also be considered during physical tasks as severe fatigue can emerge rapidly during exercise. CRD patients exhibit alterations in both peripheral and central nervous systems and these abnormalities can be exacerbated during exercise. Laboratory tests are necessary to provide mechanistic insights into how and why fatigue develops during exercise in CRD. A better knowledge of the neurophysiological mechanisms underlying perceived and performance fatigability and their influence on real-life performance will enable the development of new individualized countermeasures. This review aims first to shed light on the terminology of fatigue and then critically considers the contemporary models of fatigue and their relevance in the particular context of CRD. This article then briefly reports the prevalence and clinical consequences of fatigue in CRD and discusses the strengths and weaknesses of various fatigue scales. This review also provides several arguments to select the ideal test of performance fatigability in CRD and to translate the mechanistic laboratory findings into the clinical practice and real-world performance. Finally, this article discusses the dose-response relationship to training and the feasibility and validity of using the fatigue produced during exercise training sessions in CRD to optimize exercise training efficiency. Methodological concerns, examples of applications in selected diseases and avenues for future research are also provided.

Impact of distress screening algorithm for psycho-oncological needs in neurosurgical patients

Background

Cerebral tumors are associated with high rates of anxiety, depression and reduced health related quality of life. Nevertheless psychooncological screening instruments are neither implemented nor well defined in the daily routine of neurosurgical departments. Therefore, we tried (1) to identify a suitable screening algorithm for neurosurgical patients, (2) to define clinical risk factors for increased distress and (3) to analyze the optimal screening time point.

Results

Between October 2013 and January 2015 472 elective neurosurgical in-patients (median age 55.85 years) of the neurosurgical departments of the University Hospitals Duesseldorf and Muenster were prospectively included into this study. Regarding their diagnosis 244 (51.7%) patients were identified with malignant lesions and 228 (48.3%) patients with benign lesions. Increased distress was diagnosed in 63.1% of all patients via DT, in 13.6% via HADS and 27.8% via PO-Bado. Combining the cut-off criteria with the problem list increased sensitivity (90%) and specificity (70%) of the DT assessment. Regarding risk factors pre-existing psychiatric disorders, ataractic medication and a decreased clinical performance status were associated with increased distress.

Patients and methods

Patients with diagnosis of an intracranial lesion with elective surgical indication were screened for psychological distress via three assessment-instruments the Hospital Anxiety and Depression Scale (HADS), the Distress Thermometer (DT), and the Basic Documentation for Psycho-Oncology (PO-Bado). Screening results were correlated with clinical and demographic data.

Conclusion

Postoperative distress screening for neurosurgical patients is important independent from the neurosurgical diagnosis. The DT represents a suitable, non time-consuming instrument for daily routine in a neurosurgical department.

Systematic Review: Depression and Anxiety Prevalence in Bladder Cancer Patients

Background:

Depression affects more than 300 million people of all ages worldwide. In patients with cancer the reported prevalence is up to 24%.

Objective:

To systematically review the literature to report the prevalence of depression and anxiety among patients with bladder cancer (BC).

Methods:

Web of Science, MEDLINE/PubMed, and The Cochrane Library were searched between January and March 2018 using the terms “bladder carcinoma OR bladder cancer AND depression OR anxiety”.

Results:

Thirteen studies encompassing 1659 patients with BC were included. Six studies assessed depression prior and after treatment at 1, 6 and 12 months. Three were conducted in the US, one each in Turkey, Sweden/Egypt and China. Four studies showed a reduction of depression after radical cystectomy (RC) at 1, 6 and 12 months, respectively. Contrary, two studies showed no significant difference in depression between baseline and follow-up. Four studies investigated anxiety; they reported a slight reduction in anxiety score compared to baseline. Seven additional studies reported the prevalence of depression and anxiety (five studies) among patients with BC at a specific time-point. Studies were conducted in Sweden (2), Italy, Greece, US, China and Spain. Pretreatment depression rates ranged from 5.7 to 23.1% and post-treatment from 4.7 to 78%. Post-treatment anxiety rates ranged from 12.5 to 71.3%.

Conclusions:

The prevalence of reported depression and anxiety among BC patients is high with large geographic heterogeneity. Gender and geriatric specific screening and management for anxiety and depression should be implemented to alleviate suffering.

Lung Cancer Stigma across the Social Network: Patient and Caregiver Perspectives

OBJECTIVE

To examine the personal experiences of people with lung cancer and their caregivers and how stigma is manifested throughout a patient's social network.

METHODS

A qualitative thematic analysis of interviews with 28 patients with lung cancer and their caregivers was conducted. Telephone interviews were conducted and transcribed verbatim. Data analysis was guided by contemporary stigma theory.

RESULTS

Patients and caregivers reported feeling high levels of felt stigma and concomitant psychological distress in response to the diagnosis of lung cancer. Three overarching themes emerged: the nexus of lung cancer and smoking, moralization, and attacking the link between lung cancer and smoking. Stigma was inevitably linked to smoking, and this formed the hub around which the other themes were organized. Caregivers reported feeling invisible and noted a lack of support systems for families and caregivers. In addition, there was evidence that caregivers experienced stigma by association as members of the patients' close networks. Both groups responded ambivalently to stigmatizing antismoking advertisements.

CONCLUSIONS

The qualitative analysis demonstrated the complex interplay of the social and personal domains in the experience and outcomes of stigma in lung cancer. There is a significant potential for caregivers of patients with lung cancer to experience exacerbations of psychosocial distress as a consequence of widely shared negative views about lung cancer and its prognosis. It remains for researchers and practitioners to incorporate such complexity in addressing stigma and psychosocial distress in both patients and caregivers.

Distress and Supportive Care Needs of Ethnically Diverse Older Adults With Advanced or Recurrent Cancer

OBJECTIVES

To assess the prevalence of supportive care needs (SCNs) and distress and to describe relationships among these and patient characteristics for ethnically diverse older adults with advanced or recurrent cancer.

SAMPLE & SETTING

Cross-sectional survey in five outpatient oncology clinics in an urban academic medical center involving 100 participants receiving cancer care in an economically challenged community.

METHODS & VARIABLES

The supportive care framework for cancer care guided this study, and participants completed the SCN Survey Short Form 34 and the Distress Thermometer. Study variables are cancer diagnosis, gender, helping to raise children, number of comorbid diseases, race or ethnicity, treatment status, and zip code.

RESULTS

Clinically meaningful distress was found in about a third of patients. Distress was not affected by race or ethnicity. Many ethnically diverse older patients with advanced or recurrent cancer report distress and SCNs; those with high distress are more likely to report multiple SCNs.

IMPLICATIONS FOR NURSING

Nursing assessment of patient SCNs and distress is integral to establishing individualized patient-centered care plans and to delivering optimal care.

A simple filter model to guide the allocation of healthcare resources for improving the treatment of depression among cancer patients

Background

Depression is highly prevalent yet often poorly detected and treated among cancer patients. In light of the move towards evidence-based healthcare policy, we have developed a simple tool that can assist policy makers, organisations and researchers to logically think through the steps involved in improving patient outcomes, and to help guide decisions about where to allocate resources.

Methods

The model assumes that a series of filters operate to determine outcomes and cost-effectiveness associated with depression care for cancer patients, including: detection of depression, provider response to detection, patient acceptance of treatment, and effectiveness of treatment provided. To illustrate the utility of the model, hypothetical data for baseline and four scenarios in which filter outcomes were improved by 15% were entered into the model.

Results

The model provides outcomes including: number of people successfully treated, total costs per scenario, and the incremental cost-effectiveness ratio per scenario compared to baseline. The hypothetical data entered into the model illustrate the relative effectiveness (in terms of the number of additional incremental successes) and relative cost-effectiveness (in terms of cost per successful outcome and total cost) of making changes at each step or filter.

Conclusions

The model provides a readily accessible tool to assist decision makers to think through the steps involved in improving depression outcomes for cancer patents. It provides transparent guidance about how to best allocate resources, and highlights areas where more reliable data are needed. The filter model presents an opportunity to improve on current practice by ensuring that a logical approach, which takes into account the available evidence, is applied to decision making.

Screening for distress in patients with primary brain tumor using distress thermometer: a systematic review and meta-analysis

BACKGROUND

Patients with primary brain tumors are reported to have an elevated level of distress prevalence, due to the functional sequelae and the unfavorable prognosis, but the estimated prevalence of this disorder varies among studies. The Distress Thermometer (DT) is widely used distress screening tools to identify patients suffering from elevated psychosocial distress. The objective of this meta-analysis is to get a summarized estimate of distress prevalence in adult primary brain tumor patients screened by the DT instrument to identify distress in brain tumor patients.

METHOD

We searched studies published in PubMed, PsycINFO, and Cochrane library through August 2017 and checked related reviews and meta-analyses for eligible studies. Studies were eligible if they were published in the peer-reviewed literature and evaluated distress level by Distress Thermometer. The prevalence of distress symptoms in patients with the intracranial tumor was estimated by study-level characteristics using stratified meta-analysis. The prevalence of distress level or symptoms during the follow-up examination at different time points was detected by secondary analysis of the longitudinal studies included.

RESULTS

Twelve studies including a total of 2145 brain tumor patients were included in this analysis. Eight used a cross-sectional design and four were longitudinal. The pooled prevalence of distress was 38.2% (95% confidence interval (CI) 28.7%-47.7%) for the overall sample. The pooled prevalence of distress DT ≥4 was 41.1% (642/1686, 95% CI 28.6%-53.5%) and the pooled prevalence of distress by DT ≥6 was 29.7% (137/459, 95% CI 19.5%-39.9%). The distress symptom did not decrease in follow-up studies (Relative Increase Ratio:1.02, 95% CI, (0.78, 1.35)). A huge heterogeneity in different studies was detected, and different screening scales were not compared.

CONCLUSION

The high prevalence of distress becomes an enormous challenge for primary brain tumor patients. Routine screening and evaluation of distress in brain tumor patients may assist medical workers to develop proper interventions, which may lead to better quality of life and oncology management.

Assessing psychological distress in cancer patients: The use of distress thermometer in an outpatient cancer/hematology treatment center

The purpose of this study is to assess the feasibility of the distress thermometer (DT) and the accompanying problem checklist (PC) as a screening tool for psychological distress and the sources of those distress at an outpatient cancer treatment center in Central California. Forty-three patients completed the DT and the PC. Based on a recommended DT cutoff score of 4, patients were classified as "distressed" (>4) and "not-distressed" (<4). Respondents ranged in age from 34 to 87 years (mean = 60.44, SD = 12.05), the majority of whom were female (55.8%). The most common types of cancer diagnosis were breast cancer, followed by blood abnormality (i.e., blood disorders), lung, and bladder cancer. Based on the recommended DT cutoff score, 51% of patients were identified as significantly distressed. Results showed significant difference on DT score between the distressed and not-distressed groups, t(41) = -4.25, p < .001. The most commonly reported sources of distress were in the practical, emotional, and physical domains of the PC list. Routine distress screening can significantly help improve identification of distress and the sources of the distress in cancer patients and enable healthcare professionals to facilitate appropriate psychosocial support and referrals. Implications for practice and research are discussed.

Distress During Radiation Therapy: Assessment Among Patients With Breast or Prostate Cancer

BACKGROUND

Distress is regarded as the sixth vital sign in cancer care, but few studies describe distress in patients undergoing radiation therapy.

OBJECTIVES

The purpose of this study was to assess distress levels among patients with breast or prostate cancer undergoing radiation therapy and investigate which problems contribute to patients' distress levels.

METHODS

A retrospective medical record review was conducted for 217 patients with breast or prostate cancer at a midwestern community cancer center. Demographic data, distress scores, and problems or concerns from the patient-completed Distress Thermometer and associated Problem List were collected. Descriptive and bivariate statistics were calculated.

FINDINGS

The average distress of patients with breast cancer was significantly higher than that of patients with prostate cancer, and patients with breast cancer reported more problems than those with prostate cancer.

Emotional Problems, Quality of Life, and Symptom Burden in Patients With Lung Cancer

OBJECTIVES

Lung cancer is associated with a greater symptom burden than other cancers, yet little is known about the prevalence of emotional problems and how emotional problems may be related to the physical symptom burden and quality of life in newly diagnosed patients with lung cancer. This study aimed to identify the patient and disease characteristics of patients with lung cancer experiencing emotional problems and to examine how emotional problems relate to quality of life and symptom burden.

PATIENTS AND METHODS

A total of 2205 newly diagnosed patients with lung cancer completed questionnaires on emotional problems, quality of life, and symptom burden.

RESULTS

Emotional problems at diagnosis were associated with younger age, female gender, current cigarette smoking, current employment, advanced lung cancer disease, surgical or chemotherapy treatment, and a lower Eastern Cooperative Oncology Group performance score. Additionally, strong associations were found between greater severity of emotional problems, lower quality of life, and greater symptom burden.

CONCLUSION

Certain characteristics place patients with lung cancer at greater risk for emotional problems, which are associated with a reduced quality of life and greater symptom burden. Assessment of the presence of emotional problems at the time of lung cancer diagnosis provides the opportunity to offer tailored strategies for managing negative mood, and for improving the quality of life and symptom burden management of patients with lung cancer.

Pilot Study of a Communication Coaching Telephone Intervention for Lung Cancer Caregivers

BACKGROUND

Family caregivers are a key communication source for nurses, and there is a need to provide communication skill building for caregivers.

OBJECTIVE

A pilot study was conducted to determine feasibility and use of a communication coaching telephone intervention aimed at improving caregiver confidence in communication and reducing psychological distress.

METHODS

A printed communication guide for caregivers and a 1-time communication coaching call delivered by a research nurse were provided to caregivers. Recruitment and attrition, implementation and content of coaching calls, caregiver outcomes, and satisfaction with intervention were analyzed.

RESULTS

Twenty caregivers were recruited across 4 cohorts-diagnosis, treatment, survivorship, and end of life-with recruitment greater than 70%. Caregiver calls averaged 37 minutes, and most caregivers reported communication challenges with family members. Caregiver action plans revealed a need to develop communication skills to ask for help and share information. Caregivers reported satisfaction with the print guide, and 90% of caregivers followed through with their action plan, with 80% reporting that the action plan worked. Caregiver confidence in communication with healthcare providers was improved, except for caregivers of cancer survivors.

CONCLUSIONS

Recruitment and attrition rates demonstrate feasibility of the intervention. Caregivers reported that the communication coaching telephone intervention was considered valuable and they were able to implement a communication action plan with others.

IMPLICATIONS FOR PRACTICE

Lessons were learned about intervention content, namely, that nurses can help caregivers learn communication strategies for asking for help, sharing cancer information, and initiating self-care.

Factors Associated with Emotional Distress in Children and Adolescents during Early Treatment for Cancer

PURPOSE

Children and adolescents diagnosed with cancer experience emotional distress, such as sadness, worrying, and irritability. However, there is little information about the psychological well-being of parents at the time of their child's diagnosis. We sought to identify factors that were associated with emotional distress in cancer patients as a basis for developing innovative psychological interventions.

MATERIALS AND METHODS

A retrospective chart review was performed on patients newly diagnosed with cancer at a single center in Korea from 2014 to 2016. Eighty-five patients and their mothers completed psychological inventories. To determine factors associated with emotional distress in patients, we assessed the psychological inventory results using multiple linear regression after performing correlation analysis.

RESULTS

The maternal Beck Depression Inventory-II (BDI-II) score was positively correlated with total problem scores and externalizing scores in patients aged less than 7 years. In patients aged 7-12 years, there was no significant association between the patient's emotional distress and other variables. In contrast, the maternal BDI-II score was the strongest factor associated with patient depression in adolescents.

CONCLUSION

We suggest that the most important factor affecting emotional distress in children and adolescents with cancer is maternal depression, especially in patients aged 1-6 years and aged 13-17 years. Understanding the factors associated with emotional distress of cancer patients allows us to develop early psychiatric interventions for patients and their parents at the initial psychological crisis.

Integration of a Palliative Care Intervention into Community Practice for Lung Cancer: A Study Protocol and Lessons Learned with Implementation

BACKGROUND

A notable gap in the evidence base for outpatient palliative care (PC) for cancer is that most trials were conducted in specialized oncology or academic centers with limited translation and further evaluation in "real-world" settings. Health systems are desperate for guidance regarding the most effective and sustainable PC service models.

OBJECTIVE

Describe the study protocol to evaluate the dissemination of a previously tested nurse-led PC intervention (PCI) for patients with lung cancer and their family caregiver in community-based settings, lessons learned in adapting and implementing the PCI, and implications for future dissemination-translational efforts Design: Two-group, prospective sequential, quasi-experimental design with Phase 1 (Usual care) followed by Phase 2 (Intervention) setting/subjects. Three Kaiser Permanente Southern California sites. Patients with stage 2-4 nonsmall cell lung cancer and their caregiver.

MEASUREMENTS

Standard measures of quality of life (QOL; FACT-L, FACIT- SP12, City of Hope Family QOL), symptom burden, distress, and caregiver preparedness and perceived burden.

RESULTS

Adaptations were made to the PCI (comprehensive patient/caregiver assessment, interdisciplinary care planning, and patient/caregiver education) to harmonize with existing workflows, minimize burden to patients, caregivers, and the PC team, and maximize chances of sustainability. Implementation facilitators include external competitive pressures, internal readiness, and adaptability of the PCI. Barriers include the changing lung cancer therapeutic landscape and perceived need for PC support by patients and providers, insufficient staffing, and people-dependent processes.

CONCLUSIONS

Efforts to disseminate and implement previously tested PC models into real-world community practices need to be more realistic and consider the local context.

IT-based Psychosocial Distress Screening in Patients with Sarcoma and Parental Caregivers via Disease-specific Online Social Media Communities

BACKGROUND

Psychosocial distress can be frequently observed in patients with sarcoma, depicting a relevant clinical problem. However, prospective data collection on psychosocial distress in patients with rare tumors is often time-consuming. In this context, social media such as Facebook can serve as a potential platform to expand research. The aim of this study was to assess the feasibility of psychosocial distress screening in patients with osteosarcoma and Ewing's sarcoma via social media.

MATERIALS AND METHODS

For this study an online questionnaire including general information and self-assessment distress measurement tools for patients and parents was created. The link to the questionnaire was then posted on the main page of the two largest disease-specific Facebook communities on osteosarcoma and Ewing's sarcoma.

RESULTS

Within 2 months, 28 patients and 58 parents of patients were enrolled. All patients with osteosarcoma and Ewing's sarcoma, as well as the majority of parental caregivers of such patients, showed relevant psychosocial distress levels.

CONCLUSION

Crowdsourcing via disease-specific patient communities on Facebook is feasible and provides great potential for acquisition of medical data of rare diseases.

Prevalence and prognostic implications of psychological distress in patients with gastric cancer

Background

The aim of this study was to investigate the prevalence and prognostic significance of psychological distress in gastric cancer patients.

Methods

The study population included 229 gastric cancer patients visiting Yonsei Cancer Center between November 2009 and March 2011. The distress was measured by available tools including the Modified Distress Thermometer (MDT), Hospital Anxiety and Depression Scale (HADS), and Center for Epidemiologic Studies–Depression Scale (CES-D). Patients with psychological distress were defined as those who scored above the cut-off values in both the MDT and either one of the HADS or CES-D.

Results

The median age of patients was 56 (range, 20 to 86) and 97 (42.4%) patients were with stage IV disease status at enrollment. The overall prevalence of psychological distress was 33.6% (95% CI: 27.5–39.8%) in 229 gastric cancer patients. In multiple logistic regression analysis, lower education level (odds ratio [OR] 2.39; 95% confidence interval [CI] 1.11–5.17, P = 0.026) and higher disease stage (OR 2.72; 95% CI 1.47–5.03, P = 0.001) were associated with psychological distress. In stage I-III disease, patients with psychological distress had worse disease-free survival (DFS) (5-year DFS rate: 60% vs 76%, P = 0.49) compared with those without psychological distress. In stage IV disease (n = 97), patients with psychological distress showed poorer overall survival than those without psychological distress (median OS (Overall Survival): 12.2 vs. 13.8 months, P = 0.019).

Conclusion

Psychological distress is common in patients with all stages of gastric cancer and is associated with worse outcomes.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-017-3260-2) contains supplementary material, which is available to authorized users.

Communication Coaching: A Case Study of Family Caregiver Burden

BACKGROUND

Problematic communication among providers, patients, and their family members can affect the quality of patient care, causing stress to all parties involved and decreased opportunities for collaborative decision making.
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OBJECTIVES

The purpose of this article is to present one case from a pilot study of a family caregiver intervention focused on communication. 
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METHODS

The nurse-delivered communication intervention includes a written communication guide for family caregivers, as well as a one-time nurse communication coaching call. The call is aimed at identifying caregiver communication concerns, providing communication education, and role playing problematic communication.
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FINDINGS

Psychological distress and caregiver confidence in communication were improved for the caregiver. Data presented from the case study demonstrate the need for family caregiver communication support and training and the potential benefits of such training.