151
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Guo L, Du Y, Wang J. Network analysis reveals a stress-affected common gene module among seven stress-related diseases/systems which provides potential targets for mechanism research. Sci Rep 2015; 5:12939. [PMID: 26245528 PMCID: PMC4526881 DOI: 10.1038/srep12939] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/30/2015] [Indexed: 12/19/2022] Open
Abstract
Chronic stress (CS) was reported to associate with many complex diseases and stress-related diseases show strong comorbidity; however, molecular analyses have not been performed to date to evaluate common stress-induced biological processes across these diseases. We utilized networks constructed by genes from seven genetic databases of stress-related diseases or systems to explore the common mechanisms. Genes were connected based on the interaction information of proteins they encode. A common sub-network constructed by 561 overlapping genes and 8863 overlapping edges among seven networks was identified and it provides a common gene module among seven stress-related diseases/systems. This module is significantly overlapped with network that constructed by genes from the CS gene database. 36 genes with high connectivity (hub genes) were identified from seven networks as potential key genes in those diseases/systems, 33 of hub genes were included in the common module. Genes in the common module were enriched in 190 interactive gene ontology (GO) functional clusters which provide potential disease mechanism. In conclusion, by analyzing gene networks we revealed a stress-affected common gene module among seven stress-related diseases/systems which provides insight into the process of stress induction of disease and suggests potential gene and pathway candidates for further research.
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Affiliation(s)
- Liyuan Guo
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yang Du
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Jing Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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152
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Tian J, Jia L, Cheng Z. Relationships between patient knowledge and the severity of side effects, daily nutrient intake, psychological status, and performance status in lung cancer patients. Curr Oncol 2015; 22:e254-8. [PMID: 26300675 PMCID: PMC4530822 DOI: 10.3747/co.22.2366] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM We aimed to assess the relationships of patient education with the severity of treatment-induced side effects, daily calorie and protein intake, psychological status, and performance status in patients with lung cancer. METHODS The study patients were divided into an intervention (n = 62) and a control group (n = 110). The patients in the intervention group were provided with information about treatment, diet, and rehabilitation during chemotherapy. The patients in the control group were not specially provided with that information. RESULTS We observed significant differences between the intervention and control groups with respect to low daily protein intake (54.84% vs. 70.00%, p = 0.046), prevalence of depression (51.61% vs. 70.91%, p = 0.011), prevalence of severe side effects of treatment (14.52% vs. 37.27%, p = 0.002), and good performance status (75.81% vs. 55.45%, p = 0.008). CONCLUSIONS Our results suggest that educating patients about cancer treatment and rehabilitation can lead to increased protein intake, a lower prevalence of depression, lesser side effects from cancer treatments, and improved performance status.
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Affiliation(s)
- J. Tian
- Department of Epidemiology and Health Statistics, Fujian Medical University, Fuzhou, PRC
| | - L.N. Jia
- Department of Nursing, Fujian Health College, Fuzhou, PRC
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153
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Abstract
BACKGROUND Cancer survivors assume that stress plays an important role in cancer recurrence. However, the role of stress in the etiology of cancer recurrence remains unclear. OBJECTIVE A systematic review examining the causal role of exposure to stressors and/or stress response and cancer recurrence was conducted. METHODS The authors screened the scientific literature published from December 1979 through April 2012. Prospective studies and randomized control trials that examined the link between exposure to stressors and/or stress response and cancer recurrence were included in the review. RESULTS Fifteen studies examined exposures to stressors (life event questionnaires) and/or multiple indices of the stress response (mood, anxiety, depression, biological, and immune measures). The relationships between stressors and/or stress response and recurrence were observed as no relationship (80%), positive relationship (33%), and inverse relationship (27%). One of 3 randomized control trials reported a positive relationship between stress reduction and reduced risk of recurrence. CONCLUSIONS The scientific literature to date indicates no clear evidence for a causal relationship between stress (measured as stressor exposure and/or stress response) and cancer recurrence. Although additional high-quality research is needed to provide a more definitive answer, the evidence to date does not support this hypothesis. IMPLICATIONS FOR PRACTICE Although at present, there is no evidence indicating a causal relationship between stress and cancer recurrence, attending to the reduction in a cancer survivor's stress response can improve emotional well-being and quality of life.
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154
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Lu Q, You J, Man J, Loh A, Young L. Evaluating a culturally tailored peer-mentoring and education pilot intervention among Chinese breast cancer survivors using a mixed-methods approach. Oncol Nurs Forum 2015; 41:629-37. [PMID: 25355018 DOI: 10.1188/14.onf.629-637] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate a social support intervention that was culturally tailored for Chinese Americans who face many challenges because of cultural and linguistic barriers. DESIGN Intervention with a one-group pre- or post-test design, mixed methods, and a community-based participatory research (CBPR) approach. SETTING Southern California. SAMPLE 14 Chinese American breast cancer survivors post-treatment and eight breast cancer peer mentors. METHODS The intervention was a 10-week program to provide emotional and informational support through peer mentoring and education. Health outcomes were assessed before and after the intervention. Eight weekly process evaluations and two focus group interviews also were conducted. MAIN RESEARCH VARIABLES Depressive and anxiety symptoms. FINDINGS The program was associated with a decrease in depressive symptoms. Participants valued the program highly. Inductive analysis suggested possible mechanisms for effectiveness, such as reducing stigma, empowerment, and increased sense of belonging. CONCLUSIONS The peer-mentoring and education program has the potential to serve as a model intervention for ethnic minorities. Mixed methods and CBPR are valuable in evaluating pilot interventions with minorities. Focusing on relationships may be fruitful for designing novel interventions for cancer survivors from collectivistic cultures. IMPLICATIONS FOR NURSING Peer-mentoring and education programs can be integrated into communities and clinics to improve care for underserved minority cancer survivors and to reduce health disparities.
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Affiliation(s)
- Qian Lu
- Department of Psychology, University of Houston in Texas
| | - Jin You
- Department of Psychology, Wuhan University in China
| | - Jenny Man
- Department of Psychology, University of Houston
| | - Alice Loh
- Herald Cancer Association, San Gabriel, CA
| | - Lucy Young
- Herald Cancer Association, San Gabriel, CA
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155
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Chirico A, Lucidi F, Mallia L, D'Aiuto M, Merluzzi TV. Indicators of distress in newly diagnosed breast cancer patients. PeerJ 2015; 3:e1107. [PMID: 26244115 PMCID: PMC4517964 DOI: 10.7717/peerj.1107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 06/26/2015] [Indexed: 11/20/2022] Open
Abstract
Background. The diagnosis, treatment, and long-term management of cancer can present individuals with a multitude of stressors at various points in that trajectory. Psychosocial distress may appear early in the diagnostic process and have negative effects on compliance with treatment and subsequent quality of life. Purpose. The aim of the study was to determine early-phase predictors of distress before any medical treatment. Method. Consistent with the goals of the study, 123 newly diagnosed breast cancer patients (20 to 74 years old) completed multiple indicators of knowledge about breast cancer management and treatment, attitudes toward cancer, social support, coping efficacy, and distress. Results. SEM analysis confirmed the hypothesized model. Age was negatively associated with the patient’s knowledge (β = − 0.22), which, in turn, was positively associated with both attitudes toward breast cancer (β = 0.39) and coping self-efficacy (β = 0.36). Self-efficacy was then directly related to psychological distress (β = − 0.68). Conclusions. These findings establish indicators of distress in patients early in the cancer trajectory. From a practical perspective, our results have implications for screening for distress and for the development of early interventions that may be followed by healthcare professionals to reduce psychological distress.
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Affiliation(s)
- Andrea Chirico
- Breast Cancer Department, National Cancer Institute Fondazione "G.Pascale," Naples , Italy ; Department of Psychology of Developmental and Socialisation Processes, "Sapienza" University of Rome , Rome , Italy
| | - Fabio Lucidi
- Department of Psychology of Developmental and Socialisation Processes, "Sapienza" University of Rome , Rome , Italy
| | - Luca Mallia
- Department of Psychology of Developmental and Socialisation Processes, "Sapienza" University of Rome , Rome , Italy
| | - Massimiliano D'Aiuto
- Breast Cancer Department, National Cancer Institute Fondazione "G.Pascale," Naples , Italy
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蒋 姗, 李 萍. [Progress in Palliative Care Benefit of Elderly Patients with Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 18:462-8. [PMID: 26182873 PMCID: PMC6000248 DOI: 10.3779/j.issn.1009-3419.2015.07.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 03/26/2015] [Indexed: 01/15/2023]
Abstract
Lung cancer is the leading cause of death among all cancers in China. It also has the highest incidence when compared to other cancers. Almost half of all lung cancers occur over 70-year-old. Approximately 85% of all lung cancers are non-small cell lung cancer (NSCLC). The majority of patients are advanced lung cancer. Due to the unique alterations in physiology, elderly patients are at a greater risk of toxicity from chemotherapy. Palliative care as a special medical care is an important treatment for elderly patients with advanced NSCLC. Low-dose palliative radiotherapy can improve respiratory symptoms in elderly patients with NSCLC, with the tolerated side effects. Elderly patients with epidermal growth factor receptor (EGFR) mutation can benefit from gefitinib and have a good tolerate of erlotiib. Cryocare Surgical System has an increasing trend of application in the treatment of elderly patients with NSCLC. Chinese medicine has effects in improving clinical symptoms and reducing side effects of chemotherapy, it can also improve the quality of life in these patients. Psychosocial support therapy can alleviate the burden of patients with NSCLC to some extent, but needs to improve its systematicness. Assessment and the time of palliative care are two important factors which determine the outcome of patients. We introduce the progress in palliative care benefit of elderly NSCLC, in order to provide the basis for palliative care of elderly NSCLC.
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Affiliation(s)
- 姗彤 蒋
- />100142 北京,北京大学肿瘤医院暨北京市肿瘤防治研究所中西医结合暨老年肿瘤科Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Integration Medicine and Geriatric Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - 萍萍 李
- />100142 北京,北京大学肿瘤医院暨北京市肿瘤防治研究所中西医结合暨老年肿瘤科Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Integration Medicine and Geriatric Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China
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157
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Andersen BL, Dorfman CS. Evidence-based psychosocial treatment in the community: considerations for dissemination and implementation. Psychooncology 2015; 25:482-90. [PMID: 27092813 DOI: 10.1002/pon.3864] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 04/05/2015] [Accepted: 05/10/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND In psycho-oncology care, steps toward dissemination and implementation of evidence-based treatments (EBTs) have not been made. For this to change, factors associated with real-world dissemination and implementation must be identified. In the community, providers, their organizations, and patients are key stakeholders. METHOD A focused review of literatures in continuing education, dissemination, and implementation of mental health services is provided. RESULTS Early-career providers are most ready to implement as they have greater openness and more positive attitudes toward EBTs. Current continuing education practices to teach EBTs have limited effectiveness. Instruction using interactive strategies tailored to therapists' clinical needs and the provision of post-education consultation is needed. There is tension between EBT delivery with fidelity and the necessity for adaptation. EBT service provision is the key outcome of implementation, and documenting such is important to patients, providers, and organizations. CONCLUSION A multilevel conceptual framework, Setting, Therapist, Education, imPlementation, and Sustainability, is offered and provides directions for dissemination and sustainable implementation. Guidelines from the Commission on Cancer of the American College of Surgeons and the American Society of Clinical Oncology underscore the timeliness of the proposed framework to move EBTs from the research settings where they were developed to the practice settings where they are needed.
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158
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Vin-Raviv N, Akinyemiju TF, Galea S, Bovbjerg DH. Depression and Anxiety Disorders among Hospitalized Women with Breast Cancer. PLoS One 2015; 10:e0129169. [PMID: 26035180 PMCID: PMC4452789 DOI: 10.1371/journal.pone.0129169] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 05/05/2015] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To document the prevalence of depression and anxiety disorders, and their associations with mortality among hospitalized breast cancer patients. METHODS We examined the associations between breast cancer diagnosis and the diagnoses of anxiety or depression among 4,164 hospitalized breast cancer cases matched with 4,164 non-breast cancer controls using 2006-2009 inpatient data obtained from the Nationwide Inpatient Sample database. Conditional logistic regression models were used to compute odds ratios (ORs) and 95% confidence intervals (CI) for the associations between breast cancer diagnosis and diagnoses of anxiety or depression. We also used binary logistic regression models to examine the association between diagnoses of depression or anxiety, and in-hospital mortality among breast cancer patients. RESULTS We observed that breast cancer cases were less likely to have a diagnosis of depression (OR=0.63, 95% CI: 0.52-0.77), and less likely to have a diagnosis of anxiety (OR=0.68, 95% CI: 0.52-0.90) compared with controls. This association remained after controlling for race/ethnicity, residential income, insurance and residential region. Breast cancer patients with a depression diagnosis also had lower mortality (OR=0.69, 95% CI: 0.52-0.89) compared with those without a depression diagnosis, but there was no significant difference in mortality among those with and without anxiety diagnoses. CONCLUSION Diagnoses of depression and anxiety in breast cancer patients were less prevalent than expected based on our analysis of hospitalized breast cancer patients and matched non-breast cancer controls identified in the NIS dataset using ICD-9 diagnostic codes. Results suggest that under-diagnosis of mental health problems may be common among hospitalized women with a primary diagnosis of breast cancer. Future work may fruitfully explore reasons for, and consequences of, inappropriate identification of the mental health needs of breast cancer patients.
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Affiliation(s)
- Neomi Vin-Raviv
- Rocky Mountain Cancer Rehabilitation Institute, School of Sport and Exercise Science, University of Northern Colorado, Greeley, Colorado, United States of America
| | - Tomi F. Akinyemiju
- Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama, United States of America
- * E-mail:
| | - Sandro Galea
- Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Dana H. Bovbjerg
- Biobehavioral Oncology Program, Department of Psychiatry, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, United States of America
- Biobehavioral Oncology Program, Department of Psychology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, United States of America
- Biobehavioral Oncology Program, Department of Behavioral & Community Health Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, United States of America
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159
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Pat-Horenczyk R, Perry S, Hamama-Raz Y, Ziv Y, Schramm-Yavin S, Stemmer SM. Posttraumatic Growth in Breast Cancer Survivors: Constructive and Illusory Aspects. J Trauma Stress 2015; 28:214-22. [PMID: 26013468 DOI: 10.1002/jts.22014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study investigated the impact of a building-resilience intervention on coping and posttraumatic growth (PTG) in a convenience sample of 94 breast cancer survivors. PTG was divided into constructive and illusory components, based on the two-sided Janus face model (Maercker & Zoellner, 2004). We operationalized constructive PTG as an improvement in both PTG and coping, and illusory PTG as an improvement in PTG only. An 8-session group intervention was delivered to 49 women (mean age = 51.5 years, SD = 10.7) who completed self-report questionnaires at baseline and at 6 months follow-up; a control group of 45 women only completed questionnaires. More than half the participants (n = 53; 56.38%) reported increased PTG at 6 months (mean change = 0.56, SD = 0.48, η(2) = .58). The increase in both PTG and positive coping was significantly greater in the intervention group than the control group (B = 0.23 for PTG, and B = 0.35 for positive coping). Further, a higher proportion of constructive PTG (vs. illusory PTG) was reported by the participants in the intervention group (89.3%), as compared to the control group (56.3%; z = 2.57). The distinction between constructive and illusory PTG has clinical implications for interventions promoting coping and growth among cancer survivors.
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Affiliation(s)
- Ruth Pat-Horenczyk
- Israel Center for the Treatment of Psychotrauma, Herzog Hospital, Jerusalem, Israel.,School of Social Work and Social Welfare, Hebrew University of Jerusalem, Israel
| | - Shlomit Perry
- Psycho-Oncology Unit, Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Yuval Ziv
- Israel Center for the Treatment of Psychotrauma, Herzog Hospital, Jerusalem, Israel
| | - Sarit Schramm-Yavin
- Israel Center for the Treatment of Psychotrauma, Herzog Hospital, Jerusalem, Israel
| | - Salomon M Stemmer
- Psycho-Oncology Unit, Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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160
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De Feudis R, Lanciano T, Rinaldi S. Coping Strategies of Southern Italian Women Predict Distress Following Breast Cancer Surgery. EUROPES JOURNAL OF PSYCHOLOGY 2015; 11:280-94. [PMID: 27247657 PMCID: PMC4873111 DOI: 10.5964/ejop.v11i2.908] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/07/2015] [Indexed: 11/20/2022]
Abstract
The present study was aimed at investigating the role of coping strategies in predicting emotional distress following breast cancer, over and above the illness severity, operationalized in terms of the type of surgery performed. In order to achieve this goal, two groups of newly diagnosed breast cancer women were selected and compared on the basis of the type of surgical treatment received. A subsample of 30 women with quadrantectomy and sentinel lymph-node biopsy (SLNB) and a subsample of 31 patients with mastectomy and axillary dissection (MAD) filled in the Brief Cope scale and Hospital Anxiety and Depression Scale. Summarizing, results showed that emotional support, venting, and humor explained a statistically significant increment of variance in psychological distress indices. Implication for clinical practice and future research were discussed.
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Affiliation(s)
- Rossana De Feudis
- Psycho-Oncology, Breast Unit, "San Paolo" Hospital ASL BA, Bari, Italy
| | - Tiziana Lanciano
- Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy
| | - Stefano Rinaldi
- General Surgery Unit, Breast Unit, "San Paolo" Hospital of ASL BA, Bari, Italy
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161
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Jassim GA, Whitford DL, Hickey A, Carter B. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev 2015:CD008729. [PMID: 26017383 DOI: 10.1002/14651858.cd008729.pub2] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. OBJECTIVES To assess the effects of psychological interventions on psychological morbidities, quality of life and survival among women with non-metastatic breast cancer. SEARCH METHODS We searched the following databases up to 16 May 2013: the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL and PsycINFO; and reference lists of articles. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) search portal and ClinicalTrials.gov for ongoing trials in addition to handsearching. SELECTION CRITERIA Randomised controlled trials that assessed the effectiveness of psychological interventions for non-metastatic breast cancer in women. DATA COLLECTION AND ANALYSIS Two review authors independently appraised and extracted data from eligible trials. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcome. MAIN RESULTS Twenty-eight randomised controlled trials comprising 3940 participants were included. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. A wide range of interventions were evaluated, with 24 trials investigating a cognitive behavioural therapy and four trials investigating psychotherapy compared to control. Pooled standardised mean differences (SMD) from baseline indicated less depression (SMD -1.01, 95% confidence interval (CI) -1.83 to -0.18; P = 0.02; 7 studies, 637 participants, I(2) = 95%, low quality evidence), anxiety (SMD -0.48, 95% CI -0.76 to -0.21; P = 0.0006; 8 studies, 776 participants, I(2) = 64%, low quality evidence) and mood disturbance (SMD -0.28, 95% CI -0.43 to -0.13; P = 0.0003; 8 studies, 1536 participants, I(2) = 47%, moderate quality evidence) for the cognitive behavioural therapy group than the control group. For quality of life, only an individually-delivered cognitive behavioural intervention showed significantly better quality of life than the control with an SMD of 0.65 (95% CI 0.07 to 1.23; P = 0.03; 3 studies, 141 participants, I(2) = 41%, very low quality evidence). Pooled data from two group-delivered studies showed a non-significant overall survival benefit favouring cognitive behavioural therapy compared to control (pooled hazard ratio (HR) 0.76, 95% CI 0.25 to 2.32; P = 0.63; 530 participants, I(2) = 84%, low quality evidence). Four studies compared psychotherapy to control with one to two studies reporting on each outcome. The four studies were assessed as high risk of bias and provided limited evidence of the efficacy of psychotherapy. Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS A psychological intervention, namely cognitive behavioural therapy, produced favourable effects on some psychological outcomes, in particular anxiety, depression and mood disturbance. However, the evidence for survival improvement is still lacking. These findings are open to criticism because of the notable heterogeneity across the included studies and the shortcomings of the included studies.
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Affiliation(s)
- Ghufran A Jassim
- Department of Family & Community Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Adliya, Bahrain
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162
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Tsimopoulou I, Pasquali S, Howard R, Desai A, Gourevitch D, Tolosa I, Vohra R. Psychological Prehabilitation Before Cancer Surgery: A Systematic Review. Ann Surg Oncol 2015; 22:4117-23. [DOI: 10.1245/s10434-015-4550-z] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Indexed: 12/31/2022]
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163
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Vyssoki B, Gleiss A, Rockett IRH, Hackl M, Leitner B, Sonneck G, Kapusta ND. Suicide among 915,303 Austrian cancer patients: who is at risk? J Affect Disord 2015; 175:287-91. [PMID: 25661393 DOI: 10.1016/j.jad.2015.01.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether time since first diagnosis, site, and stage of cancer impacted suicide risk within a nationwide cohort of Austrian cancer patients. METHODS Data for this population-based study were derived from the Austrian National Cancer Registry and Austrian Statistics on Causes of Death. The study of population comprised 915,303 patients diagnosed with cancer between 1983 and 2000 and 14,532,682 person-years of follow-up. Standardized suicide mortality ratios (SMRs) were calculated by sex, time since first diagnosis, site, and stage of cancer. RESULTS A total of 2877 suicides were registered among all cancer patients over the observation period. Indicating excess suicide risk relative to the general Austrian population, the SMR for the patient cohort was 1.23 (95% CI: 1.19-1.28), and was higher for men (1.41; 95% CI: 1.35-1.47) than women (1.24; 95% CI: 1.15-1.34). This excess risk varied with time since first cancer diagnosis. SMRs peaked in year one after diagnosis (3.17; 95% CI: 2.96-3.40). An excess suicide risk was observed for patients with late locally advanced (SMR=1.59; 95% CI: 1.47-1.71) or metastasized cancer (SMR=4.07; 95% CI: 3.58-4.61), and cancers of the lung (SMR 3.86; 95% CI: 3.36-4.42) and central nervous system (SMR 2.81; 95% CI: 1.92-3.97). LIMITATIONS No data were available on psychiatric comorbidities, genetic variables, family characteristics, social factors, and community characteristics. CONCLUSIONS Our study shows that cancer patients have an excess risk for suicide, relative to the general population, which varies with time since first diagnosis, disease severity, and anatomical site. The diagnostic process needs to be sensitive and responsive to their mental health needs. Psychological care should be an integral component of cancer treatment programs.
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Affiliation(s)
- Benjamin Vyssoki
- Medical University of Vienna, Department of Psychiatry and Psychotherapy, CIinical Division for Social Psychiatry, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Andreas Gleiss
- Medical University of Vienna, Center for Medical Statistics, Informatics, and Intelligent Systems, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Ian R H Rockett
- West Virginia University, Department of Epidemiology, School of Public Health, and Injury Control Research Center, Morgantown, WV 26506-9190, USA
| | - Monika Hackl
- Bundesanstalt Statistik Austria, Guglgasse 13, 1110 Vienna, Austria
| | - Barbara Leitner
- Bundesanstalt Statistik Austria, Guglgasse 13, 1110 Vienna, Austria
| | - Gernot Sonneck
- Crisis intervention center, Lazarettgasse 14A, 1090 Vienna, Austria
| | - Nestor D Kapusta
- Medical University of Vienna, Department of Psychoanalysis and Psychotherapy, Suicide Research Group, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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164
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Horowitz M, Neeman E, Sharon E, Ben-Eliyahu S. Exploiting the critical perioperative period to improve long-term cancer outcomes. Nat Rev Clin Oncol 2015; 12:213-26. [PMID: 25601442 PMCID: PMC5497123 DOI: 10.1038/nrclinonc.2014.224] [Citation(s) in RCA: 333] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Evidence suggests that the perioperative period and the excision of the primary tumour can promote the development of metastases—the main cause of cancer-related mortality. This Review first presents the assertion that the perioperative timeframe is pivotal in determining long-term cancer outcomes, disproportionally to its short duration (days to weeks). We then analyse the various aspects of surgery, and their consequent paracrine and neuroendocrine responses, which could facilitate the metastatic process by directly affecting malignant tissues, and/or through indirect pathways, such as immunological perturbations. We address the influences of surgery-related anxiety and stress, nutritional status, anaesthetics and analgesics, hypothermia, blood transfusion, tissue damage, and levels of sex hormones, and point at some as probable deleterious factors. Through understanding these processes and reviewing empirical evidence, we provide suggestions for potential new perioperative approaches and interventions aimed at attenuating deleterious processes and ultimately improving treatment outcomes. Specifically, we highlight excess perioperative release of catecholamines and prostaglandins as key deleterious mediators of surgery, and we recommend blockade of these responses during the perioperative period, as well as other low-risk, low-cost interventions. The measures described in this Review could transform the perioperative timeframe from a prominent facilitator of metastatic progression, to a window of opportunity for arresting and/or eliminating residual disease, potentially improving long-term survival rates in patients with cancer.
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Affiliation(s)
- Maya Horowitz
- School of Psychological Sciences, Sharet Building, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Elad Neeman
- School of Psychological Sciences, Sharet Building, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eran Sharon
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petach-Tikva 49100, Israel
| | - Shamgar Ben-Eliyahu
- School of Psychological Sciences, Sharet Building, Tel Aviv University, Tel Aviv 6997801, Israel
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Deshields TL, Heiland MF, Kracen AC, Dua P. Resilience in adults with cancer: development of a conceptual model. Psychooncology 2015; 25:11-8. [PMID: 25787828 DOI: 10.1002/pon.3800] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 02/03/2015] [Accepted: 02/12/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Resilience is a construct addressed in the psycho-oncology literature and is especially relevant to cancer survivorship. The purpose of this paper is to propose a model for resilience that is specific to adults diagnosed with cancer. METHODS To establish the proposed model, a brief review of the various definitions of resilience and of the resilience literature in oncology is provided. RESULTS The proposed model includes baseline attributes (personal and environmental) which impact how an individual responds to an adverse event, which in this paper is cancer-related. The survivor has an initial response that fits somewhere on the distress-resilience continuum; however, post-cancer experiences (and interventions) can modify the initial response through a process of recalibration. CONCLUSIONS The literature reviewed indicates that resilience is a common response to cancer diagnosis or treatment. The proposed model supports the view of resilience as both an outcome and a dynamic process. Given the process of recalibration, a discussion is provided of interventions that might facilitate resilience in adults with cancer.
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Affiliation(s)
- Teresa L Deshields
- Siteman Counseling Service, Siteman Cancer Center, St. Louis, MO, United States
| | - Mark F Heiland
- Siteman Counseling Service, Siteman Cancer Center, St. Louis, MO, United States
| | - Amanda C Kracen
- Siteman Counseling Service, Siteman Cancer Center, St. Louis, MO, United States
| | - Priya Dua
- National Agricultural Statistics Service, U.S. Department of Agriculture, St. Louis, MO, United States
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Brothers BM, Carpenter KM, Shelby RA, Thornton LM, Frierson GM, Patterson KL, Andersen BL. Dissemination of an evidence-based treatment for cancer patients: training is the necessary first step. Transl Behav Med 2015; 5:103-12. [PMID: 25729459 PMCID: PMC4332903 DOI: 10.1007/s13142-014-0273-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Evidence-based psychological treatments (EBTs) for cancer patients have not been disseminated in part due to lack of available training. The biobehavioral intervention (BBI) is an EBT designed to alleviate cancer stress and enhance coping. The current study evaluates a training program and uses the Theory of Planned Behavior (TpB) to analyze factors related to intentions to implement BBI. Mental health providers (n = 62) attended a training for BBI. Attendees' supervisors (n = 40) were later surveyed. Repeated measure ANOVAs assessed change over time in knowledge gains, attitudes towards EBTs/BBI, and self-efficacy. Linear multiple regression analyses assessed relationships between these factors and implementation intentions. BBI knowledge and attitude scores increased from pre- to post-training (ps < 0.01). Significant predictors in the final model were BBI-specific attitudes and self-efficacy (ps < 0.05). The BBI training program was an effective dissemination vehicle. Intervention-specific attitudes and self-efficacy were key factors in predicting providers' implementation intentions.
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Affiliation(s)
| | - Kristen M. Carpenter
- />Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH USA
| | - Rebecca A. Shelby
- />Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC USA
| | - Lisa M. Thornton
- />Department of Psychology, The Ohio State University, Columbus, OH USA
| | | | - Kyle L. Patterson
- />Department of Psychology, The Ohio State University, Columbus, OH USA
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Wenzel L, Osann K, Hsieh S, Tucker JA, Monk BJ, Nelson EL. Psychosocial telephone counseling for survivors of cervical cancer: results of a randomized biobehavioral trial. J Clin Oncol 2015; 33:1171-9. [PMID: 25713429 DOI: 10.1200/jco.2014.57.4079] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Survivors of cervical cancer experience quality-of-life (QOL) disruptions that persist years after treatment. This study examines the effect of a psychosocial telephone counseling (PTC) intervention on QOL domains and associations with biomarkers. PATIENTS AND METHODS We conducted a randomized clinical trial in survivors of cervical cancer, who were ≥ 9 and less than 30 months from diagnosis (n = 204), to compare PTC to usual care (UC). PTC included five weekly sessions and a 1-month booster. Patient-reported outcomes (PROs) and biospecimens were collected at baseline and 4 and 9 months after enrollment. Changes in PROs over time and associations with longitudinal change in cytokines as categorical variables were analyzed using multivariable analysis of variance for repeated measures. RESULTS Participant mean age was 43 years; 40% of women were Hispanic, and 51% were non-Hispanic white. Adjusting for age and baseline scores, participants receiving PTC had significantly improved depression and improved gynecologic and cancer-specific concerns at 4 months compared with UC participants (all P < .05); significant differences in gynecologic and cancer-specific concerns (P < .05) were sustained at 9 months. Longitudinal change in overall QOL and anxiety did not reach statistical significance. Participants with decreasing interleukin (IL) -4, IL-5, IL-10, and IL-13 had significantly greater improvement in QOL than those with increasing cytokine levels. CONCLUSION This trial confirms that PTC benefits mood and QOL cancer-specific and gynecologic concerns for a multiethnic underserved population of survivors of cancer. The improvement in PROs with decreases in T-helper type 2 and counter-regulatory cytokines supports a potential biobehavioral pathway relevant to cancer survivorship.
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Affiliation(s)
- Lari Wenzel
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ.
| | - Kathryn Osann
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Susie Hsieh
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Jo A Tucker
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Bradley J Monk
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Edward L Nelson
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ
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Block KI, Block PB, Gyllenhaal C. Integrative therapies in cancer: modulating a broad spectrum of targets for cancer management. Integr Cancer Ther 2015; 14:113-8. [PMID: 25601968 DOI: 10.1177/1534735414567473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Integrative medicine is an approach to health and healing that "makes use of all appropriate therapeutic approaches, health care professionals, and disciplines to achieve optimal health and healing." A comprehensive integrative medicine intervention for cancer patients typically includes nutritional counseling, biobehavioral strategies, and promotion of physical activity, as well as dietary supplements including herbs, nutraceuticals, and phytochemicals. A broad-spectrum intervention of this type may contribute uniquely to improvement in cancer outcomes through its impact on a wide variety of relevant molecular targets, including effects on multiple cancer hallmarks. Hallmarks that may be particularly affected include genetic instability, tumor-promoting inflammation, deregulated metabolism, and immune system evasion. Because of their susceptibility to manipulation by diet, exercise, and supplementation, these may be characterized as metabolic hallmarks. Research on the use of comprehensive integrative approaches can contribute to the development of systems of multitargeted treatment regimens and would help clarify the combined effect of these approaches on cancer outcomes.
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Affiliation(s)
- Keith I Block
- Block Center for Integrative Cancer Treatment, Skokie, IL, USA
| | - Penny B Block
- Block Center for Integrative Cancer Treatment, Skokie, IL, USA
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Eficácia das intervenções psicológicas em grupo dirigidas a mulheres com cancro da mama: uma revisão sistemática. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rpsp.2015.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Partridge AH, Jacobsen PB, Andersen BL. Challenges to Standardizing the Care for Adult Cancer Survivors: Highlighting ASCO's Fatigue and Anxiety and Depression Guidelines. Am Soc Clin Oncol Educ Book 2015:188-194. [PMID: 25993156 DOI: 10.14694/edbook_am.2015.35.188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There are over 14 million survivors of cancer living in the United States alone and tens of millions more worldwide, with this population expected to nearly double in the next decade. The successes of prevention, early detection, and better therapies have lead to an emerging understanding of the substantial medical and psychosocial issues for this growing population that must be tackled for individuals and from the health care system and societal perspectives.
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Affiliation(s)
- Ann H Partridge
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Moffitt Cancer Center, Tampa, FL; Department of Psychology, The Ohio State University, Columbus, OH
| | - Paul B Jacobsen
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Moffitt Cancer Center, Tampa, FL; Department of Psychology, The Ohio State University, Columbus, OH
| | - Barbara L Andersen
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Moffitt Cancer Center, Tampa, FL; Department of Psychology, The Ohio State University, Columbus, OH
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Garchinski CM, DiBiase AM, Wong RK, Sagar SM. Patient-centered care in cancer treatment programs: the future of integrative oncology through psychoeducation. Future Oncol 2014; 10:2603-14. [DOI: 10.2217/fon.14.186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The reciprocal relationship between the mind and body has been a neglected process for improving the psychosocial care of cancer patients. Emotions form an important link between the mind and body. They play a fundamental role in the cognitive functions of decision-making and symptom control. Recognizing this relationship is important for integrative oncology. We define psychoeducation as the teaching of self-evaluation and self-regulation of the mind–body process. A gap exists between research evidence and implementation into clinical practice. The patients’ search for self-empowerment through the pursuit of complementary therapies may be a surrogate for inadequate psychoeducation. Integrative oncology programs should implement psychoeducation that helps patients to improve both emotional and cognitive intelligence, enabling them to better negotiate cancer treatment systems.
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Affiliation(s)
| | - Ann-Marie DiBiase
- Faculty of Education, Brock University, St Catharines, Ontario, Canada
| | - Raimond K Wong
- Faculty of Medicine, Departments of Medicine & Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Stephen M Sagar
- Faculty of Medicine, Departments of Medicine & Oncology, McMaster University, Hamilton, Ontario, Canada
- Juravinski Cancer Centre, 3rd Floor, 699 Concession Street, Hamilton, Ontario L8V 5C2, Canada
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Heng HH, Bremer SW, Stevens JB, Horne SD, Liu G, Abdallah BY, Ye KJ, Ye CJ. Chromosomal instability (CIN): what it is and why it is crucial to cancer evolution. Cancer Metastasis Rev 2014; 32:325-40. [PMID: 23605440 DOI: 10.1007/s10555-013-9427-7] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Results of various cancer genome sequencing projects have "unexpectedly" challenged the framework of the current somatic gene mutation theory of cancer. The prevalence of diverse genetic heterogeneity observed in cancer questions the strategy of focusing on contributions of individual gene mutations. Much of the genetic heterogeneity in tumors is due to chromosomal instability (CIN), a predominant hallmark of cancer. Multiple molecular mechanisms have been attributed to CIN but unifying these often conflicting mechanisms into one general mechanism has been challenging. In this review, we discuss multiple aspects of CIN including its definitions, methods of measuring, and some common misconceptions. We then apply the genome-based evolutionary theory to propose a general mechanism for CIN to unify the diverse molecular causes. In this new evolutionary framework, CIN represents a system behavior of a stress response with adaptive advantages but also serves as a new potential cause of further destabilization of the genome. Following a brief review about the newly realized functions of chromosomes that defines system inheritance and creates new genomes, we discuss the ultimate importance of CIN in cancer evolution. Finally, a number of confusing issues regarding CIN are explained in light of the evolutionary function of CIN.
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Affiliation(s)
- Henry H Heng
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA,
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174
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Abstract
Central and sympathetic nervous systems govern functional activities of many organs. Solid tumors like organs are also innervated by sympathetic nerve fibers. Neurotransmitters released from sympathetic nerve fibers can modulate biological behaviors of tumor cells. Multiple physiologic processes of tumor development may be dominated by central and sympathetic nervous systems as well. Recent studies suggest that dysfunction of central and sympathetic nervous systems and disorder of the hormone network induced by psychological stress may influence malignant progression of cancer by inhibiting the functions of immune system, regulating metabolic reprogramming of tumor cells, and inducing interactions between tumor and stromal cells. Over-release of inflammatory cytokines by tumors may aggravate emotional disorder, triggering the vicious cycles in tumor microenvironment and host macroenvironment. It is reasonable to hypothesize that cancer progression may be controlled by central and sympathetic nervous systems. In this review, we will focus on the recent information about the impacts of central and sympathetic nervous systems on tumor invasion and metastasis.
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175
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Carlson LE, Beattie TL, Giese-Davis J, Faris P, Tamagawa R, Fick LJ, Degelman ES, Speca M. Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors. Cancer 2014; 121:476-84. [PMID: 25367403 DOI: 10.1002/cncr.29063] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 04/14/2014] [Accepted: 04/18/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Group psychosocial interventions including mindfulness-based cancer recovery (MBCR) and supportive-expressive group therapy (SET) can help breast cancer survivors decrease distress and influence cortisol levels. Although telomere length (TL) has been associated with breast cancer prognosis, the impact of these two interventions on TL has not been studied to date. METHODS The objective of the current study was to compare the effects of MBCR and SET with a minimal intervention control condition (a 1-day stress management seminar) on TL in distressed breast cancer survivors in a randomized controlled trial. MBCR focused on training in mindfulness meditation and gentle Hatha yoga whereas SET focused on emotional expression and group support. The primary outcome measure was relative TL, the telomere/single-copy gene ratio, assessed before and after each intervention. Secondary outcomes were self-reported mood and stress symptoms. RESULTS Eighty-eight distressed breast cancer survivors with a diagnosis of stage I to III cancer (using the American Joint Committee on Cancer (AJCC) TNM staging system) who had completed treatment at least 3 months prior participated. Using analyses of covariance on a per-protocol sample, there were no differences noted between the MBCR and SET groups with regard to the telomere/single-copy gene ratio, but a trend effect was observed between the combined intervention group and controls (F [1,84], 3.82; P = .054; η(2) = .043); TL in the intervention group was maintained whereas it was found to decrease for control participants. There were no associations noted between changes in TL and changes in mood or stress scores over time. CONCLUSIONS Psychosocial interventions providing stress reduction and emotional support resulted in trends toward TL maintenance in distressed breast cancer survivors, compared with decreases in usual care.
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Affiliation(s)
- Linda E Carlson
- Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada; Southern Alberta Cancer Research Institute, Health Research Innovation Centre, University of Calgary, Calgary, Alberta, Canada
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Telepak LC, Jensen SE, Dodd SM, Morgan LS, Pereira DB. Psychosocial factors and mortality in women with early stage endometrial cancer. Br J Health Psychol 2014; 19:737-50. [PMID: 24152380 PMCID: PMC4061273 DOI: 10.1111/bjhp.12070] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 03/09/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Psychosocial factors have previously been linked with survival and mortality in cancer populations. Little evidence is available about the relationship between these factors and outcomes in gynaecologic cancer populations, particularly endometrial cancer, the fourth most common cancer among women. This study examined the relationship between several psychosocial factors prior to surgical resection and risk of all-cause mortality in women with endometrial cancer. DESIGN The study utilized a non-experimental, longitudinal design. METHODS Participants were 87 women (Mage = 60.69 years, SDage = 9.12 years) who were diagnosed with T1N0-T3N2 endometrial cancer and subsequently underwent surgery. Participants provided psychosocial data immediately prior to surgery. Survival statuses 4-5 years post-diagnoses were abstracted via medical record review. Cox regression was employed for the survival analysis. RESULTS Of the 87 women in this sample, 21 women died during the 4- to 5-year follow-up. Adjusting for age, presence of regional disease and medical comorbidity severity (known biomedical prognostic factors), greater use of an active coping style prior to surgery was significantly associated with a lower probability of all-cause mortality, hazard ratio (HR) = 0.78, p = .04. Life stress, depressive symptoms, use of self-distraction coping, receipt of emotional support and endometrial cancer quality of life prior to surgery were not significantly associated with all-cause mortality 4-5 years following diagnosis. CONCLUSIONS Greater use of active coping prior to surgery for suspected endometrial cancer is associated with lower probability of all-cause mortality 4-5 years post-surgery. Future research should attempt to replicate these relationships in a larger and more representative sample and examine potential behavioural and neuroendocrine/immune mediators of this relationship. STATEMENT OF CONTRIBUTION What is already known on this subject? Psychosocial factors have previously been linked with clinical outcomes in a variety of cancer populations. With regards to gynecologic cancer, the majority of the research has been conducted in ovarian cancer and examines the protective role of social support in mortality outcomes. What does this study add? Demonstrates association between active coping during perioperative period and 5 year survival. Demonstrates psychosocial-survival relationship exists independent of biobehavioral factors.
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Affiliation(s)
- Laura C. Telepak
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Sally E. Jensen
- Division of Organ Transplantation, Departments of Medical Social Sciences and Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stacy M. Dodd
- Department of Behavioral Medicine, Palo Alto Health Care System, Palo Alto, California, USA
| | - Linda S. Morgan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, USA
| | - Deidre B. Pereira
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
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Andreotti C, Root JC, Ahles TA, McEwen BS, Compas BE. Cancer, coping, and cognition: a model for the role of stress reactivity in cancer-related cognitive decline. Psychooncology 2014; 24:617-23. [PMID: 25286084 DOI: 10.1002/pon.3683] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 07/15/2014] [Accepted: 08/20/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cognitive decline and accompanying neurological changes associated with non-CNS cancer diagnosis and treatment have been increasingly identified in a subset of patients. Initially believed to be because of neurotoxic effects of chemotherapy exposure, observation of cognitive decline in patients not treated with chemotherapy, cancer-diagnosed individuals prior to treatment, and patients receiving alternative treatment modalities (surgery, endocrine therapy, and radiation) has led to the investigation of additional potential etiologies and moderating factors. Stressful experiences have long been posited as a contributor to these cognitive changes. Through reciprocal connectivity with peripheral systems, the brain maintains a dynamic circuitry to adapt to stress (allostasis). However, overuse of this system leads to dysregulation and contributes to pathophysiology (allostatic load). At this time, little research has been conducted to systematically examine the role of allostatic load in cancer-related cognitive dysfunction. METHODS AND RESULTS Here, we integrate theories of stress biology, neuropsychology, and coping and propose a model through which individuals with a high level of allostatic load at diagnosis may be particularly vulnerable to the neurocognitive effects of cancer. CONCLUSIONS Opportunities for future research to test and extend proposed mechanisms are discussed in addition to points of prevention and intervention based on individual variation in stress reactivity and coping skills.
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Affiliation(s)
- Charissa Andreotti
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
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Abstract
Over the past two decades there has been a growing acceptance of 'integrative oncology', also known as complementary and alternative medicine (CAM), in cancer care and research at academic medical centres and medical schools. Proponents of integrative oncology argue that it is based in science and provides the 'best of both worlds' by combining science-based treatments and 'holistic' medicine. However, a close examination of the methodologies indicates that, from a standpoint of basic science, the vast majority of 'integrative' treatments are supported by little, if any, scientific evidence. What are the consequences of this integration? Is there any harm? Are there any potential benefits?
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Ryan R, Spathis A, Clow A, Fallon M, Booth S. The biological impact of living with chronic breathlessness – A role for the hypothalamic–pituitary–adrenal axis? Med Hypotheses 2014; 83:232-7. [DOI: 10.1016/j.mehy.2014.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
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Gene expression of peripheral blood cells reveals pathways downstream of glucocorticoid receptor antagonism and nab-paclitaxel treatment. Pharmacogenet Genomics 2014; 24:451-8. [PMID: 25000515 DOI: 10.1097/fpc.0000000000000077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Whereas paclitaxel treatment is associated with leukopenia, the mechanisms that underlie this effect are not well-characterized. In addition, despite the importance of glucocorticoid signaling in cancer treatment, the genomic effects of glucocorticoid receptor antagonism by mifepristone treatment in primary human cells have never been described. METHODS As part of a randomized phase 1 clinical trial, we used microarrays to profile gene expression in peripheral blood cells sampled from each of four patients at baseline, after placebo/nanoparticle albumin-bound paclitaxel (nab-paclitaxel) treatment (cycle 1), and after mifepristone/nab-paclitaxel treatment (cycle 2). RESULTS We found that 63 genes were differentially expressed following treatment with nab-paclitaxel, including multiple genes in the tubulin pathway. We also found 606 genes that were differentially expressed in response to mifepristone; genes downregulated by mifepristone overlapped significantly with those previously identified as being upregulated by dexamethasone. CONCLUSION These results provide insights into the mechanisms of paclitaxel and glucocorticoid receptor inhibition in peripheral blood cells.
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Clinical perspective: Linking psychosocial care to the disease continuum in patients with multiple myeloma. Palliat Support Care 2014; 13:829-38. [PMID: 24959656 DOI: 10.1017/s1478951514000649] [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: 11/07/2022]
Abstract
OBJECTIVE A model of psychosocial care specific for patients with multiple myeloma and their caregivers has not yet been proposed. We sought to develop a model of care that considers the specific profile of this disease. METHOD The authors, representing a multidisciplinary care team, met in December of 2012 to identify a model of psychosocial care for patients with multiple myeloma and their caregivers. This model was determined by consensus during the meeting and via total agreement following the meeting. The meeting was sponsored by Onyx Pharmaceuticals. RESULTS The need for targeted psychosocial care for the multiple myeloma patient and caregiver throughout the disease process is essential to ensure quality of life and optimal treatment outcomes. We propose herein the first known model of care for the treatment of multiple myeloma that engages both the patient and their caregivers. SIGNIFICANCE OF RESULTS Innovative partnerships between psychosocial providers and other entities such as pharmaceutical companies can maximize resources for comprehensive program development. This manuscript proposes a model of care that promotes active engagement in therapies for multiple myeloma while engaging the individual patient and their family caregivers. This treatment approach must be evidence based in terms of distress screening tools, comprehensive psychosocial assessments, and, most importantly, in the interventions and measurements of response that clinicians apply to this population.
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Andersen BL, DeRubeis RJ, Berman BS, Gruman J, Champion VL, Massie MJ, Holland JC, Partridge AH, Bak K, Somerfield MR, Rowland JH. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol 2014; 32:1605-19. [PMID: 24733793 PMCID: PMC4090422 DOI: 10.1200/jco.2013.52.4611] [Citation(s) in RCA: 463] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE A Pan-Canadian Practice Guideline on Screening, Assessment, and Care of Psychosocial Distress (Depression, Anxiety) in Adults With Cancer was identified for adaptation. METHODS American Society of Clinical Oncology (ASCO) has a policy and set of procedures for adapting clinical practice guidelines developed by other organizations. The guideline was reviewed for developmental rigor and content applicability. RESULTS On the basis of content review of the pan-Canadian guideline, the ASCO panel agreed that, in general, the recommendations were clear, thorough, based on the most relevant scientific evidence, and presented options that will be acceptable to patients. However, for some topics addressed in the pan-Canadian guideline, the ASCO panel formulated a set of adapted recommendations based on local context and practice beliefs of the ad hoc panel members. It is recommended that all patients with cancer be evaluated for symptoms of depression and anxiety at periodic times across the trajectory of care. Assessment should be performed using validated, published measures and procedures. Depending on levels of symptoms and supplementary information, differing treatment pathways are recommended. Failure to identify and treat anxiety and depression increases the risk for poor quality of life and potential disease-related morbidity and mortality. This guideline adaptation is part of a larger survivorship guideline series. CONCLUSION Although clinicians may not be able to prevent some of the chronic or late medical effects of cancer, they have a vital role in mitigating the negative emotional and behavioral sequelae. Recognizing and treating effectively those who manifest symptoms of anxiety or depression will reduce the human cost of cancer.
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Affiliation(s)
- Barbara L Andersen
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Robert J DeRubeis
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Barry S Berman
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Jessie Gruman
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Victoria L Champion
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Mary Jane Massie
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Jimmie C Holland
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Ann H Partridge
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Kate Bak
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Mark R Somerfield
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Julia H Rowland
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
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184
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Hryniuk W, Simpson R, McGowan A, Carter P. Patient perceptions of a comprehensive cancer navigation service. ACTA ACUST UNITED AC 2014; 21:69-76. [PMID: 24764695 DOI: 10.3747/co.21.1930] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Our aim was to determine the extent to which comprehensive navigation augments the provincial health system for meeting the needs of newly-diagnosed cancer patients (clients). We also assessed reactions of attending physicians to comprehensive navigation. METHODS Clients who completed navigation as an employee benefit or through membership in an insurance organization were polled to determine whether they needed help beyond that provided by the provincial health system and the extent to which that help was provided by navigation. Exit interviews were analyzed for perceptions of the clients about reactions by their attending physicians to navigation. RESULTS Of eligible clients, 72% responded. They reported needing help beyond that which the provincial system could provide in 64%-98% of specified areas. Navigation provided help in more than 90% of those cases. Almost all respondents (98%) appreciated having a designated oncology nurse navigator. Family doctors were perceived to be positive or neutral about navigation in 100% of exit interviews. Oncologists were positive or neutral in 92% (p < 0.001 for difference from family doctors). CONCLUSIONS In many areas, cancer patients need additional help beyond that which the provincial health system can provide. Comprehensive cancer navigation provides that help to a considerable extent. Clients perceived the reactions of attending physicians to comprehensive navigation to be generally supportive or neutral.
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185
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Axelsson CK, Ballegaard S, Karpatschof B, Schousen P. Pressure pain sensitivity as a marker for stress and pressure pain sensitivity-guided stress management in women with primary breast cancer. Scandinavian Journal of Clinical and Laboratory Investigation 2014; 74:399-407. [PMID: 24697620 DOI: 10.3109/00365513.2014.900187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To validate (1) Pressure Pain Sensitivity (PPS) as a marker for stress and (2) a PPS-guided intervention in women with primary Breast Cancer (BC). METHODS (1) A total of 58 women with BC were examined before and after 6 months of intervention. A control group of 165 women office employees was divided in a High Stress Group (HSG, n = 37) and a Low Stress Group (LSG, n = 128) to evaluate the association between PPS, questionnaire-related Quality of Life (QOL) and self-evaluated stress. (2) A PPS-guided stress management program (n = 40) was compared to a Psychosocial Group Intervention (PGI, n = 91) and no treatment (n = 86) with respect to a European Organization for Research and Treatment of Cancer (EORTC) questionnaire measured QOL. RESULTS (1) Resting PPS and changes in PPS during the intervention period correlated significantly to EORTC and Short Form 36 (SF 36) main scores: (all p < 0.05). Between BC, HSG and LSG there was a significant and positive correlation with respect to PPS, SF 36 main scores, depression, and clinical stress scores (all p < 0.05). However, the BC group scored significantly lower than both HSG and LSG (both p < 0.05) with respect to self-evaluated stress. (2) The PPS-guided intervention group improved EORTC main score, pain and nausea, when compared to the control groups (all p < 0.05). CONCLUSIONS PPS was positively associated with QOL, which was in contrast to self-evaluated stress. PPS-guided intervention improved QOL in women with breast cancer.
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Affiliation(s)
- Christen K Axelsson
- Department of Breast Surgery, Herlev Hospital, Herlev, University of Copenhagen , Denmark
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186
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Xia Y, Tong G, Feng R, Chai J, Cheng J, Wang D. Psychosocial and Behavioral Interventions and Cancer Patient Survival Again. Integr Cancer Ther 2014; 13:301-9. [DOI: 10.1177/1534735414523314] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hypotheses. Although there is evidence that psychosocial and behavioral interventions (PBIs) increase well-being, improve coping and adjustment, and reduce distress among cancer patients, findings regarding PBIs as a means for prolonging survival were not convincing. Conflicting findings resulted in tremendous controversies over the efficacy of PBIs. This study aims at estimating the pooled effects of PBIs on survival of cancer patients. Study Design and Methods. Randomized controlled trials (RCTs) testing the effects of any kind of PBIs on the survival of cancer patients included in MEDLINE, EMBASE, Cancer Lit, CINAHL, Cochrane Library, and reference lists of relevant articles were retrieved and reviewed by 2 independent researchers. Data items derived from the articles included time and duration of study, intervention types and doses, and numbers of patients dying and surviving 1, 2, 4, and 6 years after intervention. Estimation of the collective effects of the interventions used meta-analysis via Review Manager (version 5). Results. A total of 15 RCTs met inclusion criteria, involving 2041 subjects (1118 in intervention and 923 in control groups). Inclusive total mean Mantel-Haenszel risk ratios (RRs) ranged from 0.83 to 0.99, and 3 of these effect sizes were statistically nonsignificant. Yet when the RCTs with less than 30 hours of PBIs were excluded, all the RRs decreased to some extent, with the RR for the first 2 years being decreased to 0.69 (95% CI, 0.55-0.87) and 0.82 (95% CI, 0.71-0.95), respectively. Conclusion. PBIs with adequate intervention doses prolong survival at least for some cancer patients in the first 2 years after intervention, although longer term effects need to be determined via more studies.
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Affiliation(s)
- Yi Xia
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Guixian Tong
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Rui Feng
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Jing Chai
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Jing Cheng
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Debin Wang
- School of Health Services Management, Anhui Medical University, Hefei, China
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187
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Barrera I, Spiegel D. Review of psychotherapeutic interventions on depression in cancer patients and their impact on disease progression. Int Rev Psychiatry 2014; 26:31-43. [PMID: 24716499 DOI: 10.3109/09540261.2013.864259] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Depression, ranging from mild to severe, is the most frequently found psychological symptom among individuals with cancer. Depression in cancer patients has been known to mitigate emotional distress, quality of life, adherence to medical treatment, and overall health outcomes. Specifically, depression has been associated with impaired immune response and with poorer survival in patients with cancer. Various studies have found that psychotherapeutic interventions are effective in reducing symptoms of depression, which in turn could affect disease progression and mortality. This paper provides updated information on psychotherapeutic interventions geared towards cancer patients suffering from depressive disorders, and its impact on disease progression. PubMed, Cochrane Library database, PsycINFO and PsycARTICLES databases were searched from January 1980 through August 2013 using key words: psychotherapy, treatment, oncology, cancer, psycho-oncology, psychosocial issues, psychosocial stress, depression, mood disorder, and psychoneuroimmunology.
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Affiliation(s)
- Ingrid Barrera
- Department of Psychiatry and Behavioral Science, Miller School of Medicine, University of Miami , Miami, Florida , USA
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188
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Stephen J, Collie K, McLeod D, Rojubally A, Fergus K, Speca M, Turner J, Taylor-Brown J, Sellick S, Burrus K, Elramly M. Talking with text: communication in therapist-led, live chat cancer support groups. Soc Sci Med 2013; 104:178-86. [PMID: 24581076 DOI: 10.1016/j.socscimed.2013.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 08/15/2013] [Accepted: 12/02/2013] [Indexed: 11/26/2022]
Abstract
CancerChatCanada is a pan-Canadian initiative with a mandate to make professionally led cancer support groups available to more people in Canada. Although online support groups are becoming increasingly popular, little is known about therapist-led, synchronous groups using live chat. The purpose of this study was to generate a rich descriptive account of communication experiences in CancerChatCanada groups and to gain an understanding of processes associated with previously-reported benefits. We used interpretive description to analyze interview segments from 102 patients, survivors and family caregivers who participated in CancerChatCanada groups between 2007 and 2011. The analysis yielded four inter-related process themes (Reaching Out From Home, Feeling Safe, Emotional Release, and Talking With Text) and one outcome theme (Resonance and Kinship). The findings extend previous research about text-only online support groups and provide novel insights into features of facilitated, live chat communication that are valued by group members.
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Affiliation(s)
- Joanne Stephen
- BC Cancer Agency, Patient and Family Counselling Services, 13750 96th Ave, Surrey, BC V3T 0C7, Canada.
| | - Kate Collie
- Cross Cancer Institute, 11560 University Avenue, Edmonton, AB T6G 1Z2, Canada.
| | - Deborah McLeod
- QE II Health Sciences Centre, School of Nursing, Dalhousie University, Victoria 11-006, 1278 Tower Rd., Halifax, NS B3H 2Y9, Canada.
| | - Adina Rojubally
- BC Cancer Agency, Patient and Family Counselling Services, 13750 96th Ave, Surrey, BC V3T 0C7, Canada.
| | - Karen Fergus
- Sunnybrook Odette Cancer Center, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
| | - Michael Speca
- Tom Baker Cancer Centre, Department of Psychosocial Resources, Holy Cross Site, Phase I, 2202 - 2nd Street SW, Calgary, AB T2S 3C1, Canada.
| | - Jill Turner
- Cross Cancer Institute, 11560 University Avenue, Edmonton, AB T6G 1Z2, Canada.
| | - Jill Taylor-Brown
- Patient and Family Support Services, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, MB R3E 0V9, Canada.
| | - Scott Sellick
- Supportive Care, Thunderbay Regional Health Sciences Center, 980 Oliver Road, Thunder Bay, ON P7B 6V4, Canada.
| | - Kimberly Burrus
- BC Cancer Agency, Patient and Family Counselling Services, 13750 96th Ave, Surrey, BC V3T 0C7, Canada.
| | - Mai Elramly
- BC Cancer Agency, Patient and Family Counselling Services, 13750 96th Ave, Surrey, BC V3T 0C7, Canada.
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189
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Le C, Karnezis T, Achen MG, Stacker S, Sloan E. Lymphovascular and neural regulation of metastasis: shared tumour signalling pathways and novel therapeutic approaches. Best Pract Res Clin Anaesthesiol 2013; 27:409-25. [PMID: 24267548 PMCID: PMC4007214 DOI: 10.1016/j.bpa.2013.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 10/08/2013] [Indexed: 12/13/2022]
Abstract
The progression of cancer is supported by a wide variety of non-neoplastic cell types which make up the tumour stroma, including immune cells, endothelial cells, cancer-associated fibroblasts and nerve fibres. These host cells contribute molecular signals that enhance primary tumour growth and provide physical avenues for metastatic dissemination. This article provides an overview of the role of blood vessels, lymphatic vessels and nerve fibres in the tumour microenvironment and highlights the interconnected molecular signalling pathways that control their development and activation in cancer. Further, this article highlights the known pharmacological agents which target these pathways and discusses the potential therapeutic uses of drugs that target angiogenesis, lymphangiogenesis and stress-response pathways in the different stages of cancer care.
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Affiliation(s)
- C.P. Le
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia
| | - T. Karnezis
- Tumour Angiogenesis Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria 3002, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria 3010, Australia
| | - M. G. Achen
- Tumour Angiogenesis Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria 3002, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria 3010, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria 3050, Australia
| | - S.A. Stacker
- Tumour Angiogenesis Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria 3002, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria 3010, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria 3050, Australia
| | - E.K. Sloan
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia
- Department of Cancer Anaesthesia and Pain Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria 3002, Australia
- Cousins Center for PNI, Semel Institute for Neuroscience and Human Behavior, UCLA AIDS Institute and Jonsson Comprehensive Cancer Center, University of California Los Angeles, USA
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190
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Effects of psycho-behavioral interventions on immune functioning in cancer patients: a systematic review. J Cancer Res Clin Oncol 2013; 140:15-33. [DOI: 10.1007/s00432-013-1516-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/02/2013] [Indexed: 01/06/2023]
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191
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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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192
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Spiegel D. Minding the body: Psychotherapy and cancer survival. Br J Health Psychol 2013; 19:465-85. [DOI: 10.1111/bjhp.12061] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 06/24/2013] [Indexed: 01/02/2023]
Affiliation(s)
- David Spiegel
- Department of Psychiatry & Behavioral Sciences; Stanford University School of Medicine; Stanford California USA
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193
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Astin JA, Shapiro J, Shapiro D. Psychological control and morbidity/mortality in breast cancer patients: a 20-year follow-up study. Behav Med 2013; 39:7-10. [PMID: 23398270 DOI: 10.1080/08964289.2012.708683] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this paper was to examine the longitudinal effects of psychological sense of control and control-related coping strategies on breast cancer outcomes. Utilizing the California Cancer Registry, follow-up data on cancer recurrence and all-cause mortality were obtained for 54 of 58 women originally diagnosed with breast cancer in 1992 to 1994. Relationships between cancer outcomes and psychological control and mood at 4 and 8 months post-diagnosis were examined. Results of the study showed that a greater sense of control at 8 months was associated with less cancer recurrence, while higher desire for control at both 4 and 8 months was associated with greater likelihood of recurrence. Utilization of an accepting mode of control appeared to mitigate the negative effects of desire for control on recurrence. No significant relationships were observed between mood and mortality or recurrence. These findings suggest the potential value of examining psychological control and control-related coping on cancer outcomes in future epidemiological and clinical studies.
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194
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The benefits of psychosocial interventions for cancer patients undergoing radiotherapy. Health Qual Life Outcomes 2013; 11:121. [PMID: 23866850 PMCID: PMC3721996 DOI: 10.1186/1477-7525-11-121] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 07/08/2013] [Indexed: 01/04/2023] Open
Abstract
Background Many patients with cancer experience depression and anxiety, and an associated decrease in quality of life (QOL) during radiation therapy (RT). The main objective of the study was to determine the benefits of psychosocial interventions for cancer patients who received RT. Methods Patients with cancer (n = 178) who agreed to participate in the study were randomized to the intervention arm (n = 89) or the control arm (n = 89). Patients in the intervention group received psychosocial care during RT, whereas the control group received RT only. The benefits of the intervention were evaluated using the Zung Self-rating Depression Scale (SDS) to measure depression, the Self-rating Anxiety Scale (SAS) to assess anxiety, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) to survey health-related QOL. The association between intervention and survival was also assessed. Results Patients randomly assigned to the intervention arm showed significant improvements on symptoms of depression (p < 0.05) and anxiety (p < 0.05), health-related QOL (p < 0.05) (i.e. better global health status, and physical and emotional functioning, and less insomnia) when compared with controls. In the subset analysis, female patients, those that received high dose irradiation, and those that underwent adjuvant chemotherapy could benefit more from psychosocial intervention. There was no difference between the two groups in disease-free survival (DFS) (2-year DFS 79.8% in the intervention arm and 76.4% in the control arm; p = 0.527) and overall survival (OS) (2-year OS 83.1% in the intervention arm and 84.3% in the control arm; p = 0.925) Conclusions Psychosocial intervention is a cost-effective approach that can improve a patient’s mood and QOL both during and after RT. However, the intervention was not found to reduce the risk of cancer recurrence and death. Trial registration ChiCTR-TRC-12002438
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195
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Frenkel M, Cohen L. Effective communication about the use of complementary and integrative medicine in cancer care. J Altern Complement Med 2013; 20:12-8. [PMID: 23863085 DOI: 10.1089/acm.2012.0533] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Complementary and integrative medicine (CIM) is becoming an increasingly popular and visible component of oncology care. Many patients affected by cancer and their family members are looking for informed advice and desire communication with their physicians about CIM use. Patients affected by cancer come to discuss CIM use with intense emotions and are experiencing an existential crisis that cannot be ignored. Effective communication is crucial in establishing trust with these patients and their families. Communication is now recognized as a core clinical skill in medicine, including cancer care, and is important to the delivery of high-quality care. The quality of communication affects patient satisfaction, decision-making, patient distress and well-being, compliance, and even malpractice litigation. The communication process about CIM use requires a very sensitive approach that depends on effective communication skills, such as experience in listening, encouraging hope, and ability to convey empathy and compassion. This process can be divided into two parts: the "how" and the "what". The "how" relates to the change in clinician attitude, the process of gathering information, addressing patients' unmet needs and emotions, and dealing with uncertainty. The "what" relates to the process of information exchange while assisting patients in decisions about CIM use by using reliable information sources, leading to informed decision-making.
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Affiliation(s)
- Moshe Frenkel
- Integrative Medicine Program, The University of Texas M. D. Anderson Cancer Center , Houston, Texas
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196
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Heifetz LJ, Christensen SD, Devere-White RW, Meyers FJ. A model for rural oncology. J Oncol Pract 2013; 7:168-71. [PMID: 21886498 DOI: 10.1200/jop.2010.000167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2011] [Indexed: 12/26/2022] Open
Abstract
Small rural hospitals in the United States have had challenging issues developing sustainable oncology programs. This is a report on the development of a successful rural oncology program. In 2006, the Tahoe Forest Health System in Truckee, CA, a remote mountain resort town, started a cancer program that was focused on addressing patient and family fears that are common to all cancer patients but more frightening in the rural setting. Four years later, it is a thriving program with significant community support, a creative academic affiliation, and a central focus of the future of the hospital. The Tahoe Forest Cancer Center developed a sustainable model for high quality cancer care that overcomes geographic, cultural and financial barriers. This structure may serve as a model for national rural health care.
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Affiliation(s)
- Laurence J Heifetz
- Tahoe Forest Cancer Center, Truckee; University of California, Davis Cancer Center, Sacramento, CA
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197
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Laoutidis ZG, Mathiak K. Antidepressants in the treatment of depression/depressive symptoms in cancer patients: a systematic review and meta-analysis. BMC Psychiatry 2013; 13:140. [PMID: 23679841 PMCID: PMC3674917 DOI: 10.1186/1471-244x-13-140] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 04/09/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Over the past thirty years a number of studies have suggested that antidepressants can be effective in the treatment of depressive symptoms in patients with cancer. The aim of this paper was to review randomized controlled trials (RCTs) and to perform a meta-analysis in order to quantify their overall effect. METHODS Pubmed and the Cochrane libraries were searched for the time period between 1980 and 2010. RESULTS Nine RCTs were identified and reviewed. Six of them (with a total of 563 patients) fulfilled the criteria for meta-analysis, but exhibited an unclear risk for bias. The estimated effect size was 1.56 with 95% CI: 1.07- 2.28 (p= 0.021). There were no differences in discontinuation rates between antidepressants and placebo groups (RR= 0.86 with 95% CI 0.47- 1.56, p=0.62). CONCLUSIONS This meta-analysis suggests that antidepressants can be effective in treating depressive symptoms beside clinical depression. When considering the risk of side effects and interactions and the heterogeneity among the mostly small studies, a general recommendation cannot be made until well-controlled studies are conducted.
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Affiliation(s)
- Zacharias G Laoutidis
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH, University of Aachen, Bergische Landstrasse 2, 40629 Düsseldorf, Germany.
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH University of Aachen, Bergische Landstrasse 2, 40629 Düsseldorf, Germany,Jülich Aachen Research Alliance (JARA-BRAIN), Pauwelstrasse 30, Aachen, 52074, Germany,Institute of Neuroscience and Medicine (INM-1), Forschungszentrum Jülich GmbH, Aachen, Germany
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198
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Nekolaichuk CL, Turner J, Collie K, Cumming C, Stevenson A. Cancer patients' experiences of the early phase of individual counseling in an outpatient psycho-oncology setting. QUALITATIVE HEALTH RESEARCH 2013; 23:592-604. [PMID: 23264535 DOI: 10.1177/1049732312470567] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Distress is a common and substantive problem associated with the invasive nature of cancer. Psychosocial interventions can alleviate distress and enhance quality of life, with a wealth of research demonstrating benefits of group interventions. Less is known, however, about the value of individual psychological counseling for cancer patients. The goal of our study was to understand patients' experiences of attending an individual psycho-oncology counseling service in a comprehensive cancer center in Canada. We conducted six focus groups to ask patients about their perceived benefits of the early phase of counseling. The 23 participants were predominantly women living in urban areas who sought counseling for emotional and coping difficulties. Using inductive analysis, we identified four interrelated themes: distress and need for support, challenges to service access, service benefits, and the therapeutic encounter. The therapeutic encounter formed a core component of patients' experiences, highlighting the benefits of specific therapeutic interventions and processes.
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199
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Spiegel D. Tranceformations: hypnosis in brain and body. Depress Anxiety 2013; 30:342-52. [PMID: 23423952 DOI: 10.1002/da.22046] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 11/27/2012] [Accepted: 12/01/2012] [Indexed: 01/30/2023] Open
Abstract
In this review, the role of hypnosis and related psychotherapeutic techniques are discussed in relation to the anxiety disorders. In particular, anxiety is addressed as a special form of mind/body problem involving reverberating interaction between mental and physical distress. The history of hypnosis as a therapeutic discipline is reviewed, after which neurobiological evidence of the effect of hypnosis on modulation of perception in the brain. Specific brain regions involved in hypnosis are reviewed, notably the dorsal anterior cingulate gyrus and the dorsolateral prefrontal cortex. The importance of hypnotizability as a trait, stable variability in hypnotic responsiveness, is discussed. Analogies between the hypnotic state and dissociative reactions to trauma are presented, and the uses of hypnosis in treating posttraumatic stress disorder, stressful situations, and phobias as well as outcome data are reviewed. Effects of hypnosis on control of somatic processes are discussed, and then effects of psychosocial support involving Supportive-Expressive Group Therapy and hypnosis on survival time for cancer patients are evaluated. The evidence indicates an important role for hypnosis in managing anxiety disorders and anxiety related to medical illness.
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Affiliation(s)
- David Spiegel
- Stanford University School of Medicine, Stanford, CA 94305-5718, USA.
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The influence of glucocorticoid signaling on tumor progression. Brain Behav Immun 2013; 30 Suppl:S26-31. [PMID: 23164950 PMCID: PMC3987853 DOI: 10.1016/j.bbi.2012.10.022] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 10/22/2012] [Accepted: 10/26/2012] [Indexed: 02/07/2023] Open
Abstract
The diagnosis of cancer elicits a broad range of well-characterized stress-related biobehavioral responses. Recent studies also suggest that an individual's neuroendocrine stress response can influence tumor biology. One of the major physiological pathways altered by the response to unrelenting social stressors is the hypothalamic-pituitary-adrenal or HPA axis. Initially following acute stress exposure, an increased glucocorticoid response is observed; eventually, chronic stress exposure can lead to a blunting of the normal diurnal cortisol pattern. Interestingly, recent evidence also links high primary tumor glucocorticoid receptor expression (and associated increased glucocorticoid-mediated gene expression) to more rapid estrogen-independent breast cancer progression. Furthermore, animal models of human breast cancer suggest that glucocorticoids inhibit tumor cell apoptosis. These findings provide a conceptual basis for understanding the molecular mechanisms underlying the influence of the individual's stress response, and specifically glucocorticoid action, on breast cancer and other solid tumor biology. How this increased glucocorticoid signaling might contribute to cancer progression is the subject of this review.
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