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Zhao R, Ma X, Zhang J. Maximizing Postoperative Success in NSCLC: The Critical Role of Multidisciplinary Collaboration. Ann Surg Oncol 2024:10.1245/s10434-024-16234-4. [PMID: 39277545 DOI: 10.1245/s10434-024-16234-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 09/04/2024] [Indexed: 09/17/2024]
Affiliation(s)
- Rongrui Zhao
- Gansu University of Chinese Medicine, First Clinical Medical College, Lanzhou, Gansu, China
| | - Xinyue Ma
- Gansu University of Chinese Medicine, First Clinical Medical College, Lanzhou, Gansu, China
| | - Jiacui Zhang
- Pulmonary and Critical Care Medicine, Gansu Provincial People's Hospital, Lanzhou, Gansu, China.
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Bognár SA, Teutsch B, Bunduc S, Veres DS, Szabó B, Fogarasi B, Zahariev OJ, Vörhendi N, Almog O, Hadani Y, Gergő D, Mihály E, Erőss B, Bunduc S, Márta K, Hegyi P. Psychological intervention improves quality of life in patients with early-stage cancer: a systematic review and meta-analysis of randomized clinical trials. Sci Rep 2024; 14:13233. [PMID: 38853187 PMCID: PMC11162999 DOI: 10.1038/s41598-024-63431-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/29/2024] [Indexed: 06/11/2024] Open
Abstract
The effectiveness of psychological interventions (PI) for malignant diseases is controversial. We aimed to investigate the effect of PI on survival and quality of life (QoL) in patients with cancer. We performed a systematic search of MEDLINE, Cochrane, and Embase databases to identify randomized controlled trials comparing PI to standard care (PROSPERO registration number CRD42021282327). Outcomes were overall survival (OS), recurrence-free survival (RFS), and different domains of QoL. Subgroup analysis was performed based on the provider-, type-, environment-, duration of intervention; cancer stage, and type. Pooled hazard ratios (HR) and standardized mean difference (SMD) with 95% confidence intervals (CI) were calculated using a random-effects model. The OS and RFS did not differ significantly between the two groups (OS:HR = 0.97; CI 0.87-1.08; RFS:HR = 0.99; CI 0.84-1.16). However, there was significant improvement in the intervention group in all the analyzed domains of QoL; in the global (SMD = 0.65; CI 0.35-0.94), emotional (SMD = 0.64; CI 0.33-0.95), social (SMD = 0.32; CI 0.13-0.51) and physical (SMD = 0.33; CI 0.05-0.60) domains. The effect of PI on QoL was generally positive immediately, 12 and 24 weeks after intervention, but the effect decreased over time and was no longer found significant at 48 weeks. The results were better in the breast cancer group and early stages of cancer. PIs do not prolong survival, but they significantly improve the QoL of cancer patients. PI should be added as standard of care 3-4 times a year, at least for patients with early-stage cancer.
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Affiliation(s)
- Sára Anna Bognár
- Institute of Pancreatic Diseases, Semmelweis University, 1083, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, 1085, Budapest, Hungary
| | - Brigitta Teutsch
- Centre for Translational Medicine, Semmelweis University, 1085, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7623, Pecs, Hungary
| | - Stefania Bunduc
- Centre for Translational Medicine, Semmelweis University, 1085, Budapest, Hungary
| | - Dániel Sándor Veres
- Centre for Translational Medicine, Semmelweis University, 1085, Budapest, Hungary
- Department of Biophysics and Radiation Biology, Semmelweis University, 1085, Budapest, Hungary
| | - Bence Szabó
- Centre for Translational Medicine, Semmelweis University, 1085, Budapest, Hungary
| | - Beatrix Fogarasi
- Institute of Pancreatic Diseases, Semmelweis University, 1083, Budapest, Hungary
| | - Olga Júlia Zahariev
- Institute of Pancreatic Diseases, Semmelweis University, 1083, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, 1085, Budapest, Hungary
| | - Nóra Vörhendi
- Institute for Translational Medicine, Medical School, University of Pécs, 7623, Pecs, Hungary
- Department of Internal Medicine, Siófok City Hospital and Outpatient Clinic, 8601, Siófok, Hungary
| | - Omer Almog
- Centre for Translational Medicine, Semmelweis University, 1085, Budapest, Hungary
| | - Yael Hadani
- Centre for Translational Medicine, Semmelweis University, 1085, Budapest, Hungary
| | - Dorottya Gergő
- Centre for Translational Medicine, Semmelweis University, 1085, Budapest, Hungary
- Department of Pharmacognosy, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary
| | - Emese Mihály
- Department of Internal Medicine and Hematology, Medical School, Semmelweis University, 1088, Budapest, Hungary
| | - Bálint Erőss
- Institute of Pancreatic Diseases, Semmelweis University, 1083, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, 1085, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7623, Pecs, Hungary
| | - Stefania Bunduc
- Centre for Translational Medicine, Semmelweis University, 1085, Budapest, Hungary
- Center for Digestive Diseases and Liver Transplant, Fundeni Clinical Institute, 022328, Bucharest, Romania
| | - Katalin Márta
- Institute of Pancreatic Diseases, Semmelweis University, 1083, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, 1085, Budapest, Hungary
- Translational Pancreatology Research Group, Interdisciplinary Centre of Excellence for Research Development and Innovation University of Szeged, 6725, Szeged, Hungary
| | - Péter Hegyi
- Institute of Pancreatic Diseases, Semmelweis University, 1083, Budapest, Hungary.
- Centre for Translational Medicine, Semmelweis University, 1085, Budapest, Hungary.
- Institute for Translational Medicine, Medical School, University of Pécs, 7623, Pecs, Hungary.
- Translational Pancreatology Research Group, Interdisciplinary Centre of Excellence for Research Development and Innovation University of Szeged, 6725, Szeged, Hungary.
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Vita G, Compri B, Matcham F, Barbui C, Ostuzzi G. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev 2023; 3:CD011006. [PMID: 36999619 PMCID: PMC10065046 DOI: 10.1002/14651858.cd011006.pub4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND Major depression and other depressive conditions are common in people with cancer. These conditions are not easily detectable in clinical practice, due to the overlap between medical and psychiatric symptoms, as described by diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). Moreover, it is particularly challenging to distinguish between pathological and normal reactions to such a severe illness. Depressive symptoms, even in subthreshold manifestations, have a negative impact in terms of quality of life, compliance with anticancer treatment, suicide risk and possibly the mortality rate for the cancer itself. Randomised controlled trials (RCTs) on the efficacy, tolerability and acceptability of antidepressants in this population are few and often report conflicting results. OBJECTIVES To evaluate the efficacy, tolerability and acceptability of antidepressants for treating depressive symptoms in adults (aged 18 years or older) with cancer (any site and stage). SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was November 2022. SELECTION CRITERIA We included RCTs comparing antidepressants versus placebo, or antidepressants versus other antidepressants, in adults (aged 18 years or above) with any primary diagnosis of cancer and depression (including major depressive disorder, adjustment disorder, dysthymic disorder or depressive symptoms in the absence of a formal diagnosis). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome was 1. efficacy as a continuous outcome. Our secondary outcomes were 2. efficacy as a dichotomous outcome, 3. Social adjustment, 4. health-related quality of life and 5. dropouts. We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We identified 14 studies (1364 participants), 10 of which contributed to the meta-analysis for the primary outcome. Six of these compared antidepressants and placebo, three compared two antidepressants, and one three-armed study compared two antidepressants and placebo. In this update, we included four additional studies, three of which contributed data for the primary outcome. For acute-phase treatment response (six to 12 weeks), antidepressants may reduce depressive symptoms when compared with placebo, even though the evidence is very uncertain. This was true when depressive symptoms were measured as a continuous outcome (standardised mean difference (SMD) -0.52, 95% confidence interval (CI) -0.92 to -0.12; 7 studies, 511 participants; very low-certainty evidence) and when measured as a proportion of people who had depression at the end of the study (risk ratio (RR) 0.74, 95% CI 0.57 to 0.96; 5 studies, 662 participants; very low-certainty evidence). No studies reported data on follow-up response (more than 12 weeks). In head-to-head comparisons, we retrieved data for selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants (TCAs) and for mirtazapine versus TCAs. There was no difference between the various classes of antidepressants (continuous outcome: SSRI versus TCA: SMD -0.08, 95% CI -0.34 to 0.18; 3 studies, 237 participants; very low-certainty evidence; mirtazapine versus TCA: SMD -4.80, 95% CI -9.70 to 0.10; 1 study, 25 participants). There was a potential beneficial effect of antidepressants versus placebo for the secondary efficacy outcomes (continuous outcome, response at one to four weeks; very low-certainty evidence). There were no differences for these outcomes when comparing two different classes of antidepressants, even though the evidence was very uncertain. In terms of dropouts due to any cause, we found no difference between antidepressants compared with placebo (RR 0.85, 95% CI 0.52 to 1.38; 9 studies, 889 participants; very low-certainty evidence), and between SSRIs and TCAs (RR 0.83, 95% CI 0.53 to 1.22; 3 studies, 237 participants). We downgraded the certainty of the evidence because of the heterogeneous quality of the studies, imprecision arising from small sample sizes and wide CIs, and inconsistency due to statistical or clinical heterogeneity. AUTHORS' CONCLUSIONS Despite the impact of depression on people with cancer, the available studies were few and of low quality. This review found a potential beneficial effect of antidepressants against placebo in depressed participants with cancer. However, the certainty of evidence is very low and, on the basis of these results, it is difficult to draw clear implications for practice. The use of antidepressants in people with cancer should be considered on an individual basis and, considering the lack of head-to-head data, the choice of which drug to prescribe may be based on the data on antidepressant efficacy in the general population of people with major depression, also taking into account that data on people with other serious medical conditions suggest a positive safety profile for the SSRIs. Furthermore, this update shows that the usage of the newly US Food and Drug Administration-approved antidepressant esketamine in its intravenous formulation might represent a potential treatment for this specific population of people, since it can be used both as an anaesthetic and an antidepressant. However, data are too inconclusive and further studies are needed. We conclude that to better inform clinical practice, there is an urgent need for large, simple, randomised, pragmatic trials comparing commonly used antidepressants versus placebo in people with cancer who have depressive symptoms, with or without a formal diagnosis of a depressive disorder.
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Affiliation(s)
- Giovanni Vita
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Beatrice Compri
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Faith Matcham
- School of Psychology, University of Sussex, Brighton, UK
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Anderson R, Cooper M, Steffen EM. Cancer patients' experiences of moments of relational depth during psychological therapy: a qualitative study. J Psychosoc Oncol 2023; 41:704-720. [PMID: 36876598 DOI: 10.1080/07347332.2023.2184741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Research into psychological interventions for cancer patients has focused on the effectiveness of different treatment methods. Investigating common factors across treatments, such as qualities within the therapeutic relationship, has been neglected. This study explores cancer patients' experiences of moments of profound contact and engagement with their therapist, including any perceived impact. METHODS Semi-structured interviews were conducted with ten cancer patients. Eight participants reported having experienced moments of relational depth. Their transcripts were analyzed using thematic analysis. FINDINGS Five themes were identified: "Being physically and psychically vulnerable," "Being rescued from the waves," "Experiencing the calm after the storm," "More than a feeling," and "The therapist as 'a stranger and not a stranger'." CONCLUSION Both novice and experienced practitioners should be aware of the potential power of moments of relational depth for cancer patients: to normalize patients' increased vulnerability and emotionality, and to manage breaks and endings with relational sensitivity.
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Fraile-Martinez O, Alvarez-Mon MA, Garcia-Montero C, Pekarek L, Guijarro LG, Lahera G, Saez MA, Monserrat J, Motogo D, Quintero J, Alvarez-Mon M, Ortega MA. Understanding the basis of major depressive disorder in oncological patients: Biological links, clinical management, challenges, and lifestyle medicine. Front Oncol 2022; 12:956923. [PMID: 36185233 PMCID: PMC9524231 DOI: 10.3389/fonc.2022.956923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
In recent years, the incidence of different types of cancer and patient survival have been rising, as well as their prevalence. The increase in survival in recent years exposes the patients to a set of stressful factors such as more rigorous follow-up and more aggressive therapeutic regimens that, added to the diagnosis of the disease itself, cause an increase in the incidence of depressive disorders. These alterations have important consequences for the patients, reducing their average survival and quality of life, and for these reasons, special emphasis has been placed on developing numerous screening tests and early recognition of depressive symptoms. Despite that cancer and major depressive disorder are complex and heterogeneous entities, they also share many critical pathophysiological mechanisms, aiding to explain this complex relationship from a biological perspective. Moreover, a growing body of evidence is supporting the relevant role of lifestyle habits in the prevention and management of both depression and cancer. Therefore, the present study aims to perform a thorough review of the intricate relationship between depression and cancer, with a special focus on its biological links, clinical management, challenges, and the central role of lifestyle medicine as adjunctive and preventive approaches to improve the quality of life of these patients.
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Affiliation(s)
- Oscar Fraile-Martinez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Miguel A. Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
- *Correspondence: Miguel A. Alvarez-Mon, ;
| | - Cielo Garcia-Montero
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Leonel Pekarek
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Oncology Service, Guadalajara University Hospital, Guadalajara, Spain
| | - Luis G. Guijarro
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Unit of Biochemistry and Molecular Biology, Department of System Biology, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas (CIBEREHD), University of Alcalá, Alcala de Henares, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Psychiatry Service, Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias Centro de Investigación Biomédica en Red en el Área temática de Salud Mental (CIBERSAM), Alcalá de Henares, Spain
| | - Miguel A. Saez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Pathological Anatomy Service, Central University Hospital of Defence-UAH Madrid, Alcala de Henares, Spain
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Domitila Motogo
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
| | - Javier Quintero
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
- Department of Legal Medicine and Psychiatry, Complutense University, Madrid, Spain
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas (CIBEREHD), University Hospital Príncipe de Asturias, Alcala de Henares, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Cancer Registry and Pathology Department, Principe de Asturias University Hospital, Alcala de Henares, Spain
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Effectiveness of mindfulness-based supportive psychotherapy on posttraumatic growth, resilience, and self-compassion in cancer patients : A pilot study. Wien Klin Wochenschr 2022; 134:593-601. [PMID: 35849181 DOI: 10.1007/s00508-022-02057-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 06/22/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effectiveness of mindfulness-based supportive psychotherapy on posttraumatic growth, resilience, and self-compassion of the cancer patients. METHODS This quasi-experimental study was conducted as a pre-test, post-test, and follow-up inquiry with a control group. A total of 30 patients who met the inclusion criteria were selected through the convenience sampling method out of all patients referred to ALA Cancer Prevention and Control Center (MACSA) in Isfahan city, Iran. They were randomly assigned to the experimental and control groups. The experimental group received mindfulness-based supportive psychotherapy (SP) for 6 sessions of 90-min, while the control group only received treatment as usual (TAU). Finally, both groups were re-evaluated through the post-test and follow-up stages after 3 months. The research instruments included the Post-Traumatic Growth Inventory, the Connor-Davidson Resilience Scale, and Neff's Self-Compassion Scale. Collected data were analyzed using the repeated measures analyses of variance (ANOVA). RESULTS The results showed that the group supportive psychotherapy significantly increased posttraumatic growth (p < 0.05) and resilience (p < 0.05), and improved self-compassion (p < 0.05) in the experimental group over the post-test phase. At the post-intervention phase, the effect sizes were Cohen's d = 0.72, d = 0.68, and d = 0.63 for post-traumatic growth, resilience, and self-compassion, respectively. Changes were constantly implemented in the follow-up phase as well. CONCLUSION According to the results of the present study, mindfulness-based supportive psychotherapy could be used along with usual medical treatment in order to improve post-traumatic growth, resilience, and self-compassion in cancer patients.
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Shao S, Zhuang X, Zhang L, Qiao T. Antidepressants Fluoxetine Mediates Endoplasmic Reticulum Stress and Autophagy of Non-Small Cell Lung Cancer Cells Through the ATF4-AKT-mTOR Signaling Pathway. Front Pharmacol 2022; 13:904701. [PMID: 35620287 PMCID: PMC9127500 DOI: 10.3389/fphar.2022.904701] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/08/2022] [Indexed: 12/30/2022] Open
Abstract
Fluoxetine, one of the latest clinical antidepressants, is reported to have the anti-proliferative effect on cancer cells via immune-related pathways. However, the mechanism is still not known. This study mainly focused on the discovery of the molecular basis of the inhibitory effect of fluoxetine in lung cancer. The specific anti-proliferation effect and autophagy induced by fluoxetine on lung cancer cell were shown in CCK8 and immunofluorescence. The RNA sequence hinted that the endoplasmic reticulum (ER) stress-related protein and mTOR pathway were enriched after fluoxetine treatment. Western blot results revealed that the ER stress pathway was activated by fluoxetine, including PERK, ATF4, and CHOP, while the AKT/mTOR pathway was inhibited. In addition, the transfection of ATF4 siRNA further discovered that ER stress participated in the inhibition of AKT/mTOR pathway and the induction of anti-proliferation and autophagy in the fluoxetine-treated cells. More importantly, fluoxetine was demonstrated to play cytotoxic activity in cancer cells without affecting normal cells. Our results showed that fluoxetine triggered the ATF4-AKT-mTOR signaling pathway to induce cell cycle arrest and autophagy restraining cancer cells’ growth in lung cancer. This study found fluoxetine unaffected the proliferation of normal lung epithelial cells, providing safe clinical therapeutic strategies for lung cancer patients with depression.
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Affiliation(s)
- Shali Shao
- Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xibing Zhuang
- Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Lin Zhang
- Department of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai, China
| | - Tiankui Qiao
- Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China
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Housman B, Flores R, Lee DS. Narrative review of anxiety and depression in patients with esophageal cancer: underappreciated and undertreated. J Thorac Dis 2021; 13:3160-3170. [PMID: 34164206 PMCID: PMC8182527 DOI: 10.21037/jtd-20-3529] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Depression and anxiety are emotional disorders that commonly affect patients with esophageal cancer. As a result of its high morbidity, mortality, and complication rates, this population is at particularly high risk for developing or exacerbating affective disorders; even when compared to patients with other forms of cancer. Many of the medical conditions and social behaviors that predispose patients to this disease are also independently associated with affective disorders, and likely compound their effects. Unfortunately, in the existing literature, there is wide variability in study design and diagnostic criteria. There is no standard method of evaluation, many studies are limited to written surveys, and widespread mental health screening is not included as a part of routine care. As a result, the prevalence of these illnesses remains elusive. Additionally, psychiatric and psychosocial illness can affect compliance with surveillance and treatment, and gaps in knowledge may ultimately influence patient outcomes and survival. This review will discuss the existing literature on depression and anxiety in patients with esophageal cancer. It will highlight current methods of psychological evaluation, the prevalence of affective disorders in this population, and their effects on treatment, compliance, and outcomes. It will also discuss possible screening tools, treatments and interventions for these comorbid illnesses that may improve oncologic outcomes as well as quality of life.
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Affiliation(s)
- Brian Housman
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Dong-Seok Lee
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
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Exploring the problems faced by patients living with advanced cancer in Bengaluru, India. Heliyon 2021; 7:e06686. [PMID: 33898822 PMCID: PMC8056401 DOI: 10.1016/j.heliyon.2021.e06686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/18/2021] [Accepted: 03/30/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose Cancer is a key influence on psychosocial and emotional distress among patients. Problems that advanced cancer patients in the western world face have been widely explored, but these findings may not be applicable in the non-western world due to the cultural differences. Exploring the problems of advanced cancer patients will help professionals plan appropriate therapeutic interventions to take care of the patients' physical, emotional, social and practical needs. Hence, this study aims to explore the psychosocial and emotional problems of advanced cancer patients in India. Methods Data were collected from 10 advanced cancer patients from Bengaluru, using purposive sampling and semi-structured interviews. The interviews were audio-recorded and transcribed. Themes were generated using thematic analysis. Results The prevalent themes were financial instability, hopelessness, family anguish, self-blame, helplessness, anger, stress, and suicidal thoughts. Conclusion This research has highlighted that advanced cancer patients have several issues, indicating the importance of using a holistic approach while handling this vulnerable population by focusing more on the patient rather than the disease.
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Kampling H, Baumeister H, Bengel J, Mittag O. Prevention of depression in adults with long-term physical conditions. Cochrane Database Syst Rev 2021; 3:CD011246. [PMID: 33667319 PMCID: PMC8092431 DOI: 10.1002/14651858.cd011246.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Major depression is one of the world's leading causes of disability in adults with long-term physical conditions compared to those without physical illness. This co-morbidity is associated with a negative prognosis in terms of increased morbidity and mortality rates, increased healthcare costs, decreased adherence to treatment regimens, and a substantial decline in quality of life. Therefore, preventing the onset of depressive episodes in adults with long-term physical conditions should be a global healthcare aim. In this review, primary or tertiary (in cases of preventing recurrences in those with a history of depression) prevention are the focus. While primary prevention aims at preventing the onset of depression, tertiary prevention comprises both preventing recurrences and prohibiting relapses. Tertiary prevention aims to address a depressive episode that might still be present, is about to subside, or has recently resolved. We included tertiary prevention in the case where the focus was preventing the onset of depression in those with a history of depression (preventing recurrences) but excluded it if it specifically focused on maintaining an condition or implementing rehabilitation services (relapse prevention). Secondary prevention of depression seeks to prevent the progression of depressive symptoms by early detection and treatment and may therefore be considered a 'treatment,' rather than prevention. We therefore exclude the whole spectrum of secondary prevention. OBJECTIVES To assess the effectiveness, acceptability and tolerability of psychological or pharmacological interventions, in comparison to control conditions, in preventing depression in adults with long-term physical conditions; either before first ever onset of depressive symptoms (i.e. primary prevention) or before first onset of depressive symptoms in patients with a history of depression (i.e. tertiary prevention). SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register, CENTRAL, MEDLINE, Embase, PsycINFO and two trials registries, up to 6 February 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) of preventive psychological or pharmacological interventions, specifically targeting incidence of depression in comparison to treatment as usual (TAU), waiting list, attention/psychological placebo, or placebo. Participants had to be age 18 years or older, with at least one long-term physical condition, and no diagnosis of major depression at baseline (primary prevention). In addition, we included studies comprising mixed samples of patients with and without a history of depression, which explored tertiary prevention of recurrent depression. We excluded other tertiary prevention studies. We also excluded secondary preventive interventions. Primary outcomes included incidence of depression, tolerability, and acceptability. Secondary outcomes included severity of depression, cost-effectiveness and cost-utility. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 11 RCTs, with one trial on psychological interventions, and 10 trials on pharmacological interventions. Data analyses on the psychological intervention (problem-solving therapy compared to TAU) included 194 participants with age-related macular degeneration. Data analyses on pharmacological interventions included 837 participants comparing citalopram (one trial), escitalopram (three trials), a mixed sample of fluoxetine/nortriptyline (one trial), melatonin (one trial), milnacipran (one trial), and sertraline (three trials), each to placebo. Included types of long-term physical conditions were acute coronary syndrome (one trial), breast cancer (one trial), head and neck cancer (two trials), stroke (five trials), and traumatic brain injury (one trial). Psychological interventions Very low-certainty evidence of one study suggests that problem solving therapy may be slightly more effective than TAU in preventing the incidence of depression, immediately post-intervention (odds ratio (OR) 0.43, 95% confidence interval (CI) 0.20 to 0.95; 194 participants). However, there may be little to no difference between groups at six months follow-up (OR 0.71, 95% CI 0.36 to 1.38; 190 participants; one study; very low-certainty evidence). No data were available regarding incidence of depression after six months. Regarding acceptability (drop-outs due to any cause), slightly fewer drop-outs occurred in the TAU group immediately post-intervention (OR 5.21, 95% CI 1.11 to 24.40; 206 participants; low-certainty evidence). After six months, however, the groups did not differ (OR 1.67, 95% CI 0.58 to 4.77; 206 participants; low-certainty evidence). This study did not measure tolerability. Pharmacological interventions Post-intervention, compared to placebo, antidepressants may be beneficial in preventing depression in adults with different types of long-term physical conditions, but the evidence is very uncertain (OR 0.31, 95% CI 0.20 to 0.49; 814 participants; nine studies; I2 =0%; very low-certainty evidence). There may be little to no difference between groups both immediately and at six months follow-up (OR 0.44, 95% CI 0.08 to 2.46; 23 participants; one study; very low-certainty evidence) as well as at six to 12 months follow-up (OR 0.81, 95% CI 0.23 to 2.82; 233 participants; three studies; I2 = 49%; very low-certainty evidence). There was very low-certainty evidence from five studies regarding the tolerability of the pharmacological intervention. A total of 669 adverse events were observed in 316 participants from the pharmacological intervention group, and 610 adverse events from 311 participants in the placebo group. There was very low-certainty evidence that drop-outs due to adverse events may be less frequent in the placebo group (OR 2.05, 95% CI 1.07 to 3.89; 561 participants; five studies; I2 = 0%). There was also very low-certainty evidence that drop-outs due to any cause may not differ between groups either post-intervention (OR 1.13, 95% CI 0.73 to 1.73; 962 participants; nine studies; I2 = 28%), or at six to 12 months (OR 1.13, 95% CI 0.69 to 1.86; 327 participants; three studies; I2 = 0%). AUTHORS' CONCLUSIONS Based on evidence of very low certainty, our results may indicate the benefit of pharmacological interventions, during or directly after preventive treatment. Few trials examined short-term outcomes up to six months, nor the follow-up effects at six to 12 months, with studies suffering from great numbers of drop-outs and inconclusive results. Generalisation of results is limited as study populations and treatment regimes were very heterogeneous. Based on the results of this review, we conclude that for adults with long-term physical conditions, there is only very uncertain evidence regarding the implementation of any primary preventive interventions (psychological/pharmacological) for depression.
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Affiliation(s)
- Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, University Clinic of Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany
- Section of Health Care Research and Rehabilitation Research, Center for Medical Biometry and Statistics, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Oskar Mittag
- Section of Health Care Research and Rehabilitation Research, Center for Medical Biometry and Statistics, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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11
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Fordham B, Sugavanam T, Edwards K, Hemming K, Howick J, Copsey B, Lee H, Kaidesoja M, Kirtley S, Hopewell S, das Nair R, Howard R, Stallard P, Hamer-Hunt J, Cooper Z, Lamb SE. Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis. Health Technol Assess 2021; 25:1-378. [PMID: 33629950 PMCID: PMC7957459 DOI: 10.3310/hta25090] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cognitive-behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive-behavioural therapy systematic reviews suggested that cognitive-behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials. OBJECTIVES This project was undertaken to map the quality and gaps in the cognitive-behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive-behavioural therapy. DATA SOURCES The overview was designed with cognitive-behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019. REVIEW METHODS Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive-behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive-behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality. RESULTS A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive-behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive-behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.05 to 0.50, I2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval -0.28 to 0.88, I2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.28 to 0.74, I2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions. LIMITATIONS Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them. CONCLUSION Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive-behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes. FUTURE WORK Future research should focus on how the modest effect sizes seen with cognitive-behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality. STUDY REGISTRATION This study is registered as PROSPERO CRD42017078690. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Beth Fordham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Thavapriya Sugavanam
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Katherine Edwards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Bethan Copsey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Hopin Lee
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Milla Kaidesoja
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Shona Kirtley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Roshan das Nair
- Department of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | | | | | - Zafra Cooper
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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12
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Fordham B, Sugavanam T, Edwards K, Stallard P, Howard R, das Nair R, Copsey B, Lee H, Howick J, Hemming K, Lamb SE. The evidence for cognitive behavioural therapy in any condition, population or context: a meta-review of systematic reviews and panoramic meta-analysis. Psychol Med 2021; 51:21-29. [PMID: 33455594 PMCID: PMC7856415 DOI: 10.1017/s0033291720005292] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 12/14/2022]
Abstract
The majority of psychological treatment research is dedicated to investigating the effectiveness of cognitive behavioural therapy (CBT) across different conditions, population and contexts. We aimed to summarise the current systematic review evidence and evaluate the consistency of CBT's effect across different conditions. We included reviews of CBT randomised controlled trials in any: population, condition, format, context, with any type of comparator and published in English. We searched DARE, Cochrane, MEDLINE, EMBASE, PsycINFO, CINAHL, CDAS, and OpenGrey between 1992 and January 2019. Reviews were quality assessed, their data extracted and summarised. The effects upon health-related quality of life (HRQoL) were pooled, within-condition groups. If the across-condition heterogeneity was I2 < 75%, we pooled effects using a random-effect panoramic meta-analysis. We summarised 494 reviews (221 128 participants), representing 14/20 physical and 13/20 mental conditions (World Health Organisation's International Classification of Diseases). Most reviews were lower-quality (351/494), investigated face-to-face CBT (397/494), and in adults (378/494). Few reviews included trials conducted in Asia, South America or Africa (45/494). CBT produced a modest benefit across-conditions on HRQoL (standardised mean difference 0.23; 95% confidence intervals 0.14-0.33, I2 = 32%). The effect's associated prediction interval -0.05 to 0.50 suggested CBT will remain effective in conditions for which we do not currently have available evidence. While there remain some gaps in the completeness of the evidence base, we need to recognise the consistent evidence for the general benefit which CBT offers.
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Affiliation(s)
- Beth Fordham
- Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Science (NDORMS) University of Oxford, Oxford, UK
| | | | - Katherine Edwards
- Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | | | - Robert Howard
- Institute of Mental Health, University College London, London, UK
| | - Roshan das Nair
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Hopin Lee
- Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Science (NDORMS) University of Oxford, Oxford, UK
| | - Jeremy Howick
- Department of Philosophy, University of Oxford, Oxford, UK
| | - Karla Hemming
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Sarah E. Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
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13
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Serfaty M, King M, Nazareth I, Moorey S, Aspden T, Tookman A, Mannix K, Gola A, Davis S, Wood J, Jones L. Manualised cognitive-behavioural therapy in treating depression in advanced cancer: the CanTalk RCT. Health Technol Assess 2020; 23:1-106. [PMID: 31097078 DOI: 10.3310/hta23190] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND With a prevalence of up to 16.5%, depression is one of the commonest mental disorders in people with advanced cancer. Depression reduces the quality of life (QoL) of patients and those close to them. The National Institute for Health and Care Excellence (NICE) guidelines recommend treating depression using antidepressants and/or psychological treatments, such as cognitive-behavioural therapy (CBT). Although CBT has been shown to be effective for people with cancer, it is unclear whether or not this is the case for people with advanced cancer and depression. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of treatment as usual (TAU) plus manualised CBT, delivered by high-level Improving Access to Psychological Therapy (IAPT) practitioners, versus TAU for people with advanced cancer and depression, measured at baseline, 6, 12, 18 and 24 weeks. DESIGN Parallel-group, single-blind, randomised trial, stratified by whether or not an antidepressant was prescribed, comparing TAU with CBT plus TAU. SETTING Recruitment took place in oncology, hospice and primary care settings. CBT was delivered in IAPT centres or/and over the telephone. PARTICIPANTS Patients (N = 230; n = 115 in each arm) with advanced cancer and depression. Inclusion criteria were a diagnosis of cancer not amenable to cure, a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis of depressive disorder using the Mini-International Neuropsychiatric Interview, a sufficient understanding of English and eligibility for treatment in an IAPT centre. Exclusion criteria were an estimated survival of < 4 months, being at high risk of suicide and receiving, or having received in the last 2 months, a psychological intervention recommended by NICE for treating depression. INTERVENTIONS (1) Up to 12 sessions of manualised individual CBT plus TAU delivered within 16 weeks and (2) TAU. OUTCOME MEASURES The primary outcome was the Beck Depression Inventory, version 2 (BDI-II) score at 6, 12, 18 and 24 weeks. Secondary outcomes included scores on the Patient Health Questionnaire-9, the Eastern Cooperative Oncology Group Performance Status, satisfaction with care, EuroQol-5 Dimensions and the Client Services Receipt Inventory, at 12 and 24 weeks. RESULTS A total of 80% of treatments (185/230) were analysed: CBT (plus TAU) (n = 93) and TAU (n = 92) for the BDI-II score at all time points using multilevel modelling. CBT was not clinically effective [treatment effect -0.84, 95% confidence interval (CI) -2.76 to 1.08; p = 0.39], nor was there any benefit for other measures. A subgroup analysis of those widowed, divorced or separated showed a significant effect of CBT on the BDI-II (treatment effect -7.21, 95% CI -11.15 to -3.28; p < 0.001). Economic analysis revealed that CBT has higher costs but produces more quality-adjusted life-years (QALYs) than TAU. The mean service costs for participants (not including the costs of the interventions) were similar across the two groups. There were no differences in EQ-5D median scores at baseline, nor was there any advantage of CBT over TAU at 12 weeks or 24 weeks. There was no statistically significant improvement in QALYs at 24 weeks. LIMITATIONS Although all participants satisfied a diagnosis of depression, for some, this was of less than moderate severity at baseline, which could have attenuated treatment effects. Only 64% (74/115) took up CBT, comparable to the general uptake through IAPT. CONCLUSIONS Cognitive-behavioural therapy (delivered through IAPT) does not achieve any clinical benefit in advanced cancer patients with depression. The benefit of CBT for people widowed, divorced or separated is consistent with other studies. Alternative treatment options for people with advanced cancer warrant evaluation. Screening and referring those widowed, divorced or separated to IAPT for CBT may be beneficial. Whether or not improvements in this subgroup are due to non-specific therapeutic effects needs investigation. TRIAL REGISTRATION Current Controlled Trials ISRCTN07622709. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 19. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Marc Serfaty
- Division of Psychiatry, University College London, London, UK.,Priory Hospital North London, London, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK.,Research Department of Primary Care & Population Health, University College London, London, UK
| | - Irwin Nazareth
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Stirling Moorey
- South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Trefor Aspden
- Division of Psychiatry, University College London, London, UK
| | - Adrian Tookman
- Marie Curie Hospice, Royal Free Hampstead NHS Trust, London, UK
| | - Kathryn Mannix
- Palliative Care Service, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anna Gola
- Research Department of Primary Care & Population Health, University College London, London, UK.,Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Sarah Davis
- Division of Psychiatry, University College London, London, UK.,Palliative Care Service, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John Wood
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Louise Jones
- Division of Psychiatry, University College London, London, UK.,Marie Curie Hospice, Royal Free Hampstead NHS Trust, London, UK
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14
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Li Z, Wei D, Zhu C, Zhang Q. Effect of a patient education and rehabilitation program on anxiety, depression and quality of life in muscle invasive bladder cancer patients treated with adjuvant chemotherapy. Medicine (Baltimore) 2019; 98:e17437. [PMID: 31689748 PMCID: PMC6946406 DOI: 10.1097/md.0000000000017437] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study aimed to investigate the effect of a patient education and rehabilitation program (PERP) on anxiety, depression, and quality of life in muscle invasive bladder cancer (MIBC) patients underwent adjuvant chemotherapy.One hundred and thirty MIBC patients about to receive adjuvant chemotherapy with 4-cycle gemcitabine and cisplatin (GC) regimen (16 weeks) were consecutively enrolled and randomly allocated into PERP group and control group as 1:1 ratio. Hospital Anxiety and Depression Scale (HADS) anxiety and depression scores and Quality of Life Questionnaire (QLQ-C30) scores were assessed before treatment (W0) and after treatment (W16).After 16-week treatment, PERP group exhibited decreased HADS anxiety score (P = .036), ΔHADS anxiety score (W16-W0) (P < .001) and percentage of anxiety patients (P = .019) compared to control group. And PERP group presented with numerically reduced HADS depression score but without statistical significance (P = .076) compared to control group, while lower ΔHADS depression score (W16-W0) (P = .014) and percentage of depression patients (P = .015) compared to control group. As to quality of life, QLQ-C30 global health status score (P = .032), Δglobal health status score (W16-W0) (P = .003) and Δfunctional score (W16-W0) (P = .005) were higher in PERP group compared to control group. However, no difference of QLQ-C30 functional score (P = .103), QLQ-C30 symptom score (P = .808) or Δsymptom score (W16-W0) (P = .680) was observed between two groups.PERP relieves anxiety, depression and improves quality of life in MIBC patients underwent adjuvant chemotherapy.
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Affiliation(s)
| | - Dan Wei
- Department of Urology Surgery
| | | | - Qing Zhang
- Department of Thoracic Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
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15
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Bulotiene G, Pociute K. Interventions for Reducing Suicide Risk in Cancer Patients: A Literature Review. EUROPES JOURNAL OF PSYCHOLOGY 2019; 15:637-649. [PMID: 33680150 PMCID: PMC7909181 DOI: 10.5964/ejop.v15i3.1741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/20/2018] [Indexed: 01/26/2023]
Abstract
The suicide risk of people diagnosed with cancer is two times higher than the general population. The number of cases of diagnosed cancer is estimated to rise by 70% over the next two decades. Evidence-based prevention strategies are necessary to protect this vulnerable group of individuals. The purpose of this review was to find out the risk factors of suicide and which types of interventions can serve as prevention strategies. Psychosocial interventions, pharmacotherapy and physical activity can play a preventive role in reducing psychosocial and physical risk factors, such as mental disorders, poor social support, poor performance status and pain. Further research is needed to develop effective suicide prevention strategies for cancer patients.
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Affiliation(s)
- Giedre Bulotiene
- Department of Physical Medicine and Rehabilitation, National Cancer Institute, Vilnius, Lithuania
| | - Kamile Pociute
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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16
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Hirayama T, Ogawa Y, Yanai Y, Suzuki SI, Shimizu K. Behavioral activation therapy for depression and anxiety in cancer patients: a case series study. Biopsychosoc Med 2019; 13:9. [PMID: 31168316 PMCID: PMC6487522 DOI: 10.1186/s13030-019-0151-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background Behavioral activation therapy (BAT) directly addresses activities that individuals value most highly, and may be easily applicable to cancer patients. However, there is no established evidence of the use of BAT in this population. In this study, we examined the possibility of a BAT program for depression and anxiety in cancer patients. Case presentation We retrospectively reviewed the medical records of cancer patients with each of the following characteristics: 1) were outpatients or inpatients visiting the psycho-oncology division of the National Cancer Center Hospital in Japan; 2) met criteria for Major Depressive Disorder or Adjustment Disorders; and 3) participated in a BAT program. The primary outcome was the program completion percentage. Secondary outcomes were self-reported depression severity (Patient Health Questionnaire-9 (PHQ-9) score), anxiety disorder status (Generalized Anxiety Disorder-7 (GAD-7) score), and clinical improvement (Clinical Global Impression-Improvement (CGI-I) score) after the program. We analyzed both depression and anxiety by the matched paired t-test. Ten patients participated in the program, and nine completed it. One dropped out due to cognitive impairment secondary to brain metastasis. Both the PHQ-9 scores (pre: 14.4 (SD, 6.1); post: 5.1 (SD, 5.8)) and the GAD-7 scores (pre: 11.9 (SD, 4.9); post: 4.7 (SD, 5.5)) significantly improved after the program (PHQ-9: P = 0.0014; GAD-7: P = 0.0004). CGI-I scores ranged from 1 to 3, and all subjects except the patient who dropped out improved clinically. Among the ten patients, three distinctive cases could be observed as follows. Case 1; a 45-year-old housewife with breast cancer who did not agree to take antidepressants because of concerns about the side effects achieved remission without antidepressants and began to live an active life. Case 4; a 66-year-old housewife was so shocked after endometrial cancer diagnosis that she was absent-minded and her compliance with the assigned homework was poor, therefore, her depression did not improve much. Case 9; a 62-year-old man with laryngeal cancer who had recurrent anxiety. Increased business activity, on which he put great value, gradually allowed him to be able to live his life actively without concerns. Conclusions This study suggests that BAT would be effective for the depression and anxiety of cancer patients.
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Affiliation(s)
- Takatoshi Hirayama
- 1Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Yuko Ogawa
- 2Faculty of Human Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa-city, Saitama, Tokyo 359-1192 Japan
| | - Yuko Yanai
- 1Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Shin-Ichi Suzuki
- 2Faculty of Human Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa-city, Saitama, Tokyo 359-1192 Japan
| | - Ken Shimizu
- 1Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
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17
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Almada AL, Casquinha P, Cotovio V, Santos MJHD, Caixeiro A. The Potential Role of Psychosocial Rehabilitation in Palliative Care. J R Coll Physicians Edinb 2018; 48:311-317. [DOI: 10.4997/jrcpe.2018.405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Palliative care is an approach to incurable and/or severe disease with limited prognosis, aiming to relieve the suffering and improve the quality of life of patients and their families. The existence of psychopathology is common in patients undergoing palliative care, and psychiatric comorbidities, such as depression and anxiety, are frequent and often underdiagnosed. This work constitutes a review of the literature and a reflection on the potential role of psychosocial rehabilitation in mental health in palliative care. Psychosocial rehabilitation may play a role in the mental health of patients undergoing palliative care, contributing to the minimisation of symptoms, support in daily life activities, the improvement of quality of life and the preparation for death.
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Affiliation(s)
- AL Almada
- Psychiatric resident (5th year), Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - P Casquinha
- Psychiatrist, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - V Cotovio
- Psychiatrist and Psychotherapist, Clinical Director of the Psychiatric Hospital, Casa de Saúde do Telhal, Sintra, Portugal
| | - MJ Heitor dos Santos
- Psychiatrist, Instituto de Medicina Preventiva e Saúde Pública, Universidade de Lisboa, Portugal
- Psychiatrist, Instituto de Saúde Ambiental Faculdade de Medicina, Universidade de Lisboa, Portugal
- Head of the Psychiatry and Mental Health Department of Hospital Beatriz Ângelo, Loures, Portugal
| | - A Caixeiro
- Psychiatrist, Head of the Rehabilitation Unit in Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
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18
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Abstract
Medical progress, the improvement of general living conditions, and an increase in life expectancy have led to an increase in the general prevalence of oncologic disease. More importantly, more and more patients survive cancer or live with the disease for long periods of time. While the battle for survivorship is continuously being fought, improving patients' quality of life has come to the fore. Psychosocial issues may modulate the course of the disease, but mainly have a deep impact on patients' physical and mental wellbeing. Psycho-oncology has risen as a relatively new interdisciplinary field with the aim of addressing these issues and providing support for patients confronting numerous challenges throughout the different stages of the disease. In this article, we provide an overview of the current knowledge of body-mind interactions in cancer and an outline of the broad spectrum of psycho-oncologic care, with a special focus on the treatment of pain, fatigue, sexual issues, and fear of progression.
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Skelton WP, Parekh H, Starr JS, Trevino J, Cioffi J, Hughes S, George TJ. Clinical Factors as a Component of the Personalized Treatment Approach to Advanced Pancreatic Cancer: a Systematic Literature Review. J Gastrointest Cancer 2018; 49:1-8. [PMID: 29110227 DOI: 10.1007/s12029-017-0021-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Pancreatic cancer is often diagnosed at late stages, where disease is either locally advanced unresectable or metastatic. Despite advances, long-term survival is relatively non-existent. DISCUSSION This review article discusses clinical factors commonly encountered in practice that should be incorporated into the decision-making process to optimize patient outcomes, including performance status, nutrition and cachexia, pain, psychological distress, medical comorbidities, advanced age, and treatment selection. CONCLUSION Identification and optimization of these clinical factors could make a meaningful impact on the patient's quality of life.
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Affiliation(s)
- William Paul Skelton
- Division of Hematology and Oncology, Department of Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610, USA.
| | - Hiral Parekh
- Division of Hematology and Oncology, Department of Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610, USA
| | - Jason S Starr
- Division of Hematology and Oncology, Department of Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610, USA
| | - Jose Trevino
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jessica Cioffi
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Steven Hughes
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Thomas J George
- Division of Hematology and Oncology, Department of Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610, USA.
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20
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Vartolomei L, Ferro M, Mirone V, Shariat SF, Vartolomei MD. Systematic Review: Depression and Anxiety Prevalence in Bladder Cancer Patients. Bladder Cancer 2018; 4:319-326. [PMID: 30112443 PMCID: PMC6087432 DOI: 10.3233/blc-180181] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Depression affects more than 300 million people of all ages worldwide. In patients with cancer the reported prevalence is up to 24%. Objective: To systematically review the literature to report the prevalence of depression and anxiety among patients with bladder cancer (BC). Methods: Web of Science, MEDLINE/PubMed, and The Cochrane Library were searched between January and March 2018 using the terms “bladder carcinoma OR bladder cancer AND depression OR anxiety”. Results: Thirteen studies encompassing 1659 patients with BC were included. Six studies assessed depression prior and after treatment at 1, 6 and 12 months. Three were conducted in the US, one each in Turkey, Sweden/Egypt and China. Four studies showed a reduction of depression after radical cystectomy (RC) at 1, 6 and 12 months, respectively. Contrary, two studies showed no significant difference in depression between baseline and follow-up. Four studies investigated anxiety; they reported a slight reduction in anxiety score compared to baseline. Seven additional studies reported the prevalence of depression and anxiety (five studies) among patients with BC at a specific time-point. Studies were conducted in Sweden (2), Italy, Greece, US, China and Spain. Pretreatment depression rates ranged from 5.7 to 23.1% and post-treatment from 4.7 to 78%. Post-treatment anxiety rates ranged from 12.5 to 71.3%. Conclusions: The prevalence of reported depression and anxiety among BC patients is high with large geographic heterogeneity. Gender and geriatric specific screening and management for anxiety and depression should be implemented to alleviate suffering.
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Affiliation(s)
- Liliana Vartolomei
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Clinical Psychology, University "Dimitrie Cantemir", Tirgu Mures, Romania
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples, Naples, Italy
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Mihai Dorin Vartolomei
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania
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Rodin G, Lo C, Rydall A, Shnall J, Malfitano C, Chiu A, Panday T, Watt S, An E, Nissim R, Li M, Zimmermann C, Hales S. Managing Cancer and Living Meaningfully (CALM): A Randomized Controlled Trial of a Psychological Intervention for Patients With Advanced Cancer. J Clin Oncol 2018; 36:2422-2432. [PMID: 29958037 PMCID: PMC6085180 DOI: 10.1200/jco.2017.77.1097] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Purpose Individuals with advanced cancer experience substantial distress in response to disease burden and impending mortality. Managing Cancer And Living Meaningfully (CALM) is a novel, brief, manualized psychotherapeutic intervention intended to treat and prevent depression and end-of-life distress in patients with advanced cancer. We conducted a randomized controlled trial to compare CALM with usual care (UC) in this population. Methods Patients with advanced cancer were recruited from outpatient oncology clinics at a comprehensive cancer center into an unblinded randomized controlled trial. Permuted block randomization stratified by Patient Health Questionnaire-9 depression score allocated participants to CALM plus UC or to UC alone. Assessments of depressive symptoms (primary outcome), death-related distress, and other secondary outcomes were conducted at baseline, 3 months (primary end point), and 6 months (trial end point). Analyses were by intention to treat. Analysis of covariance was used to test for outcome differences between groups at follow-up, controlling for baseline. Mixed-model results are reported. Results Participants (n = 305) were recruited between February 3, 2012, and March 4, 2016, and randomly assigned to CALM (n = 151) or UC (n = 154). CALM participants reported less-severe depressive symptoms than UC participants at 3 months (Δ = 1.09; P = .04; Cohen's d = 0.23; 95% CI, 0.04 to 2.13) and at 6 months (Δ = 1.29; P = .02; d = 0.29; 95% CI, 0.24 to 2.35). Significant findings for greater end-of-life preparation at 6 months also favored CALM versus UC. No adverse effects were identified. Conclusion Findings suggest that CALM is an effective intervention that provides a systematic approach to alleviating depressive symptoms in patients with advanced cancer and addresses the predictable challenges these patients face.
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Affiliation(s)
- Gary Rodin
- All authors: Princess Margaret Cancer Centre; Gary Rodin, Christopher Lo, Rinat Nissim, Madeline Li, Camilla Zimmermann, and Sarah Hales, University of Toronto; Toronto, Ontario, Canada
| | - Christopher Lo
- All authors: Princess Margaret Cancer Centre; Gary Rodin, Christopher Lo, Rinat Nissim, Madeline Li, Camilla Zimmermann, and Sarah Hales, University of Toronto; Toronto, Ontario, Canada
| | - Anne Rydall
- All authors: Princess Margaret Cancer Centre; Gary Rodin, Christopher Lo, Rinat Nissim, Madeline Li, Camilla Zimmermann, and Sarah Hales, University of Toronto; Toronto, Ontario, Canada
| | - Joanna Shnall
- All authors: Princess Margaret Cancer Centre; Gary Rodin, Christopher Lo, Rinat Nissim, Madeline Li, Camilla Zimmermann, and Sarah Hales, University of Toronto; Toronto, Ontario, Canada
| | - Carmine Malfitano
- All authors: Princess Margaret Cancer Centre; Gary Rodin, Christopher Lo, Rinat Nissim, Madeline Li, Camilla Zimmermann, and Sarah Hales, University of Toronto; Toronto, Ontario, Canada
| | - Aubrey Chiu
- All authors: Princess Margaret Cancer Centre; Gary Rodin, Christopher Lo, Rinat Nissim, Madeline Li, Camilla Zimmermann, and Sarah Hales, University of Toronto; Toronto, Ontario, Canada
| | - Tania Panday
- All authors: Princess Margaret Cancer Centre; Gary Rodin, Christopher Lo, Rinat Nissim, Madeline Li, Camilla Zimmermann, and Sarah Hales, University of Toronto; Toronto, Ontario, Canada
| | - Sarah Watt
- All authors: Princess Margaret Cancer Centre; Gary Rodin, Christopher Lo, Rinat Nissim, Madeline Li, Camilla Zimmermann, and Sarah Hales, University of Toronto; Toronto, Ontario, Canada
| | - Ekaterina An
- All authors: Princess Margaret Cancer Centre; Gary Rodin, Christopher Lo, Rinat Nissim, Madeline Li, Camilla Zimmermann, and Sarah Hales, University of Toronto; Toronto, Ontario, Canada
| | - Rinat Nissim
- All authors: Princess Margaret Cancer Centre; Gary Rodin, Christopher Lo, Rinat Nissim, Madeline Li, Camilla Zimmermann, and Sarah Hales, University of Toronto; Toronto, Ontario, Canada
| | - Madeline Li
- All authors: Princess Margaret Cancer Centre; Gary Rodin, Christopher Lo, Rinat Nissim, Madeline Li, Camilla Zimmermann, and Sarah Hales, University of Toronto; Toronto, Ontario, Canada
| | - Camilla Zimmermann
- All authors: Princess Margaret Cancer Centre; Gary Rodin, Christopher Lo, Rinat Nissim, Madeline Li, Camilla Zimmermann, and Sarah Hales, University of Toronto; Toronto, Ontario, Canada
| | - Sarah Hales
- All authors: Princess Margaret Cancer Centre; Gary Rodin, Christopher Lo, Rinat Nissim, Madeline Li, Camilla Zimmermann, and Sarah Hales, University of Toronto; Toronto, Ontario, Canada
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22
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Ostuzzi G, Matcham F, Dauchy S, Barbui C, Hotopf M. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev 2018; 4:CD011006. [PMID: 29683474 PMCID: PMC6494588 DOI: 10.1002/14651858.cd011006.pub3] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Major depression and other depressive conditions are common in people with cancer. These conditions are not easily detectable in clinical practice, due to the overlap between medical and psychiatric symptoms, as described by diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). Moreover, it is particularly challenging to distinguish between pathological and normal reactions to such a severe illness. Depressive symptoms, even in subthreshold manifestations, have been shown to have a negative impact in terms of quality of life, compliance with anti-cancer treatment, suicide risk and likely even the mortality rate for the cancer itself. Randomised controlled trials (RCTs) on the efficacy, tolerability and acceptability of antidepressants in this population are few and often report conflicting results. OBJECTIVES To assess the efficacy, tolerability and acceptability of antidepressants for treating depressive symptoms in adults (aged 18 years or older) with cancer (any site and stage). SEARCH METHODS We searched the following electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL 2017, Issue 6), MEDLINE Ovid (1946 to June week 4 2017), Embase Ovid (1980 to 2017 week 27) and PsycINFO Ovid (1987 to July week 4 2017). We additionally handsearched the trial databases of the most relevant national, international and pharmaceutical company trial registers and drug-approving agencies for published, unpublished and ongoing controlled trials. SELECTION CRITERIA We included RCTs comparing antidepressants versus placebo, or antidepressants versus other antidepressants, in adults (aged 18 years or above) with any primary diagnosis of cancer and depression (including major depressive disorder, adjustment disorder, dysthymic disorder or depressive symptoms in the absence of a formal diagnosis). DATA COLLECTION AND ANALYSIS Two review authors independently checked eligibility and extracted data using a form specifically designed for the aims of this review. The two authors compared the data extracted and then entered data into Review Manager 5 using a double-entry procedure. Information extracted included study and participant characteristics, intervention details, outcome measures for each time point of interest, cost analysis and sponsorship by a drug company. We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We retrieved a total of 10 studies (885 participants), seven of which contributed to the meta-analysis for the primary outcome. Four of these compared antidepressants and placebo, two compared two antidepressants, and one three-armed study compared two antidepressants and placebo. In this update we included one additional unpublished study. These new data contributed to the secondary analysis, while the results of the primary analysis remained unchanged.For acute-phase treatment response (6 to 12 weeks), we found no difference between antidepressants as a class and placebo on symptoms of depression measured both as a continuous outcome (standardised mean difference (SMD) -0.45, 95% confidence interval (CI) -1.01 to 0.11, five RCTs, 266 participants; very low certainty evidence) and as a proportion of people who had depression at the end of the study (risk ratio (RR) 0.82, 95% CI 0.62 to 1.08, five RCTs, 417 participants; very low certainty evidence). No trials reported data on follow-up response (more than 12 weeks). In head-to-head comparisons we only retrieved data for selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants, showing no difference between these two classes (SMD -0.08, 95% CI -0.34 to 0.18, three RCTs, 237 participants; very low certainty evidence). No clear evidence of a beneficial effect of antidepressants versus either placebo or other antidepressants emerged from our analyses of the secondary efficacy outcomes (dichotomous outcome, response at 6 to 12 weeks, very low certainty evidence). In terms of dropouts due to any cause, we found no difference between antidepressants as a class compared with placebo (RR 0.85, 95% CI 0.52 to 1.38, seven RCTs, 479 participants; very low certainty evidence), and between SSRIs and tricyclic antidepressants (RR 0.83, 95% CI 0.53 to 1.30, three RCTs, 237 participants). We downgraded the certainty (quality) of the evidence because the included studies were at an unclear or high risk of bias due to poor reporting, imprecision arising from small sample sizes and wide confidence intervals, and inconsistency due to statistical or clinical heterogeneity. AUTHORS' CONCLUSIONS Despite the impact of depression on people with cancer, the available studies were very few and of low quality. This review found very low certainty evidence for the effects of these drugs compared with placebo. On the basis of these results, clear implications for practice cannot be deduced. The use of antidepressants in people with cancer should be considered on an individual basis and, considering the lack of head-to-head data, the choice of which agent to prescribe may be based on the data on antidepressant efficacy in the general population of individuals with major depression, also taking into account that data on medically ill patients suggest a positive safety profile for the SSRIs. To better inform clinical practice, there is an urgent need for large, simple, randomised, pragmatic trials comparing commonly used antidepressants versus placebo in people with cancer who have depressive symptoms, with or without a formal diagnosis of a depressive disorder.
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Affiliation(s)
- Giovanni Ostuzzi
- University of VeronaDepartment of Neuroscience, Biomedicine and Movement Sciences, Section of PsychiatryPoliclinico "GB Rossi"Piazzale L.A. Scuro, 10VeronaItaly37134
| | - Faith Matcham
- The Institute of Psychiatry, King's College LondonDepartment of Psychological MedicineWeston Education CentreLondonUKSE5 9RJ
| | - Sarah Dauchy
- Gustave RoussyChef du Département Interdisciplinaire de Soins de Support114 rue Edouard VaillantVillejuifParisFrance94805
| | - Corrado Barbui
- University of VeronaDepartment of Neuroscience, Biomedicine and Movement Sciences, Section of PsychiatryVeronaItaly
| | - Matthew Hotopf
- The Institute of Psychiatry, King's College LondonDepartment of Psychological MedicineWeston Education CentreLondonUKSE5 9RJ
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23
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Thronicke A, Kröz M, Merkle A, Matthes H, Herbstreit C, Schad F. Psychosocial, Cognitive, and Physical Impact of Elaborate Consultations and Life Review in Female Patients with Non-Metastasized Breast Cancer. Complement Med Res 2018; 25:92-101. [DOI: 10.1159/000486672] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Elaborate consultations and life review (ECLR) has been regularly applied in patients of various cancer entities and stages within Anthroposophic-integrative oncology concepts. However, a lack of systematic research in this field has been detected. To close this gap of knowledge, we evaluated the impact of ECLR in patients with non-metastasized breast cancer before, during, and after primary oncological treatment. Methods: Patient-reported outcome measures were evaluated by analyzing European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ-C30) in patients with non-metastasized breast cancer who had received either oncological standard therapy alone or in combination with ECLR. Results: 95 female patients were eligible for questionnaire analysis (median age 58 years). Adjusted multivariable linear regression analysis revealed that ECLR was associated with significant improvements in medium-term global health/quality of life and emotional, social, and cognitive functioning. Furthermore, ECLR was associated with significant reductions of short-term appetite loss burden, pain, and short- and medium-term financial difficulties. Subgroup analyses revealed significant improvements in pivotal quality-of-life aspects including fatigue (p = 0.002) in chemotherapy-treated patients after ECLR. Conclusions: 12 months of surveillance of breast cancer patients reveals medium-term recovery of the global health status/quality of life and cognitive and psychosocial well-being associated with ECLR. In addition, our data indicate a possible association between ECLR and reduced short-term fatigue burden, which has to be re-confirmed prospectively in a larger study cohort. As long-term cancer survivors develop psychological symptoms similar to patients with chronic diseases, prospective studies should evaluate the impact of ECLR on the psychosocial well-being in these patients.
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Sanson-Fisher RW, Noble NE, Searles AM, Deeming S, Smits RE, Oldmeadow CJ, Bryant J. A simple filter model to guide the allocation of healthcare resources for improving the treatment of depression among cancer patients. BMC Cancer 2018; 18:125. [PMID: 29402237 PMCID: PMC5800015 DOI: 10.1186/s12885-018-4009-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/18/2018] [Indexed: 11/29/2022] Open
Abstract
Background Depression is highly prevalent yet often poorly detected and treated among cancer patients. In light of the move towards evidence-based healthcare policy, we have developed a simple tool that can assist policy makers, organisations and researchers to logically think through the steps involved in improving patient outcomes, and to help guide decisions about where to allocate resources. Methods The model assumes that a series of filters operate to determine outcomes and cost-effectiveness associated with depression care for cancer patients, including: detection of depression, provider response to detection, patient acceptance of treatment, and effectiveness of treatment provided. To illustrate the utility of the model, hypothetical data for baseline and four scenarios in which filter outcomes were improved by 15% were entered into the model. Results The model provides outcomes including: number of people successfully treated, total costs per scenario, and the incremental cost-effectiveness ratio per scenario compared to baseline. The hypothetical data entered into the model illustrate the relative effectiveness (in terms of the number of additional incremental successes) and relative cost-effectiveness (in terms of cost per successful outcome and total cost) of making changes at each step or filter. Conclusions The model provides a readily accessible tool to assist decision makers to think through the steps involved in improving depression outcomes for cancer patents. It provides transparent guidance about how to best allocate resources, and highlights areas where more reliable data are needed. The filter model presents an opportunity to improve on current practice by ensuring that a logical approach, which takes into account the available evidence, is applied to decision making.
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Affiliation(s)
- Robert W Sanson-Fisher
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Natasha E Noble
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia. .,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Andrew M Searles
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Simon Deeming
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rochelle E Smits
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Christopher J Oldmeadow
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, NSW, Australia
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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25
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Grossman CH, Brooker J, Michael N, Kissane D. Death anxiety interventions in patients with advanced cancer: A systematic review. Palliat Med 2018; 32:172-184. [PMID: 28786328 DOI: 10.1177/0269216317722123] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Death anxiety is a common issue in adult patients with advanced cancer and can have a large impact on quality of life and end-of-life care. Interventions are available to assist but are scarcely used in everyday practice. AIM To assess quantitative studies on interventions for adult patients with advanced cancer suffering from death anxiety. DATA SOURCES MEDLINE, PsycINFO, Embase and CINAHL were searched to identify quantitative or mixed studies on death anxiety or relatable existential intervention studies in advanced cancer patients published from 1990 to December 2016. Two reviewers independently screened titles and abstracts and assessed relevant studies for eligibility. Data were then extracted from included studies for analysis. RESULTS Nine unique quantitative studies were identified, including five randomised controlled trials, involving a total overall of 1179 advanced cancer patients. All studies were psychotherapeutic in nature and centred on existential themes such as meaning, dignity, relationships and spiritual well-being. The therapies investigated shared overlapping themes but varied in duration, therapist experience, training required and burden on patient. Heterogeneity of studies and measures prevented determination of an overall effect size. CONCLUSION Interventions were identified for this clinical scenario of death anxiety in patients with advanced cancer. Therapies of short duration incorporating spiritual well-being and those evoking a sense of meaning were claimed to be the most beneficial, despite lacking rigorous statistical analysis. More high-quality studies with tailored outcome measures are required to fully evaluate the most effective interventions for death anxiety in patients with advanced cancer.
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Affiliation(s)
- Christopher H Grossman
- 1 Palliative Care Research Department, Cabrini Institute, Cabrini Health, Melbourne, VIC, Australia.,2 Palliative Care Service, Cabrini Health, Prahran, VIC, Australia
| | - Joanne Brooker
- 3 Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.,4 Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Malvern, VIC, Australia
| | - Natasha Michael
- 1 Palliative Care Research Department, Cabrini Institute, Cabrini Health, Melbourne, VIC, Australia.,2 Palliative Care Service, Cabrini Health, Prahran, VIC, Australia.,5 School of Medicine, Sydney, University of Notre Dame, Sydney, NSW, Australia.,6 Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - David Kissane
- 1 Palliative Care Research Department, Cabrini Institute, Cabrini Health, Melbourne, VIC, Australia.,3 Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.,4 Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Malvern, VIC, Australia.,7 Supportive and Palliative Care Unit, Monash Health, Clayton, VIC, Australia
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Caruso R, Nanni MG, Riba MB, Sabato S, Grassi L. The burden of psychosocial morbidity related to cancer: patient and family issues. Int Rev Psychiatry 2017; 29:389-402. [PMID: 28753076 DOI: 10.1080/09540261.2017.1288090] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
With cancer incidence increasing over time, attention to the burden of related psychiatric and psychosocial consequences of the disease and treatment is a major topic for both cancer patients and their caregivers. Among cancer patients, psychiatric (e.g. adjustment, anxiety, depressive disorders) and neuropsychiatric disorders (e.g. cognitive disorders secondary to treatment, delirium) have been shown to affect an average of 30-35% patients, with differences according to stage and type of cancer. Also other psychosocial syndromes (e.g. demoralization, health anxiety, irritable mood) not taken into account in usual nosological systems should be considered for their impact on the patient's quality-of-life. Also, it has been repeatedly reported that psychological distress reverberates substantially throughout the nuclear family, and that a family approach is necessary in cancer care, with the caregiver-patient dyad as a unit to be the focus and direction of assessment and intervention. In this review the most significant psychosocial disorders causing burden for cancer patients and their caregivers are examined, and the main methods of assessment for more proper referral and treatment are summarized.
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Affiliation(s)
- Rosangela Caruso
- a Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences , University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatric Unit , Program of Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Behavior , S. Anna University Hospital and Health Authority , Ferrara , Italy
| | - Mara Giulia Nanni
- a Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences , University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatric Unit , Program of Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Behavior , S. Anna University Hospital and Health Authority , Ferrara , Italy
| | - Michelle B Riba
- c Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA.,d University of Michigan Comprehensive Cancer Center , Ann Arbor , MI , USA.,e Psycho-oncology Program , University of Michigan Comprehensive Cancer Center , Ann Arbor , MI , USA
| | - Silvana Sabato
- a Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences , University of Ferrara , Ferrara , Italy
| | - Luigi Grassi
- a Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences , University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatric Unit , Program of Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Behavior , S. Anna University Hospital and Health Authority , Ferrara , Italy
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Caruso R, GiuliaNanni M, Riba MB, Sabato S, Grassi L. Depressive Spectrum Disorders in Cancer: Diagnostic Issues and Intervention. A Critical Review. Curr Psychiatry Rep 2017; 19:33. [PMID: 28488207 PMCID: PMC5423924 DOI: 10.1007/s11920-017-0785-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Depressive spectrum disorders, including major depression, persistent depression, minor and sub-syndromal depression, and other forms of depressive conditions, such as demoralization, are among the most common psychiatric consequences of cancer patients, affecting up to 60% of patients. In spite of the negative effects and the burden for cancer patients and their families, these disorders often remain under-recognized and undertreated. The present review aims at summarizing the relevant data concerning the diagnostic challenges within the depressive spectrum disorders among cancer patients. Also, the most relevant data relative to integrated intervention, including psychopharmacological and psychosocial treatment, for depression in cancer patients are critically evaluated. It is mandatory that health care professionals working in oncology (e.g., oncologists, surgeons, radiation oncologists, primary care physicians, nurses, social workers, psychologists) receive training in the diagnosis and integrated management of the different types of disorder within the spectrum of clinical depression.
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Affiliation(s)
- Rosangela Caruso
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Disorders, S. Anna University Hospital and Health Authorities, Ferrara, Italy
| | - Maria GiuliaNanni
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Disorders, S. Anna University Hospital and Health Authorities, Ferrara, Italy
| | - Michelle B Riba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
- Psycho-oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Silvana Sabato
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy.
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Disorders, S. Anna University Hospital and Health Authorities, Ferrara, Italy.
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Okuyama T, Akechi T, Mackenzie L, Furukawa TA. Psychotherapy for depression among advanced, incurable cancer patients: A systematic review and meta-analysis. Cancer Treat Rev 2017; 56:16-27. [DOI: 10.1016/j.ctrv.2017.03.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
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Mukherjee A, Mazumder K, Kaushal V, Ghoshal S. Effect of Supportive Psychotherapy on Mental Health Status and Quality of Life of Female Cancer Patients Receiving Chemotherapy for Recurrent Disease. Indian J Palliat Care 2017; 23:399-402. [PMID: 29123345 PMCID: PMC5661341 DOI: 10.4103/ijpc.ijpc_73_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Context: Cancer patients receiving chemotherapy for their recurrent disease often report the presence of anxiety and depression. Aims: In the study, we intended to find out the mental health status and overall quality of life (QOL) of such patients and to identify the effect of supportive psychotherapy. Subjects and Methods: Forty cancer patients undergoing second or subsequent line chemotherapy(CCT) were selected for psychotherapy session. Pre- and post-psychotherapy evaluation of anxiety and depression was determined by hospital anxiety depression scale. The QOL was measured before and after psychotherapy sessions by using WHO QOL-BREF scale. Statistical Analysis Used: Statistical analysis was done by paired t-test, using SPSS V.20. Results: Among 40 patients, 17 patients had breast cancer, and the remaining had ovarian cancer. All breast cancer and 19 ovarian cancer patients were receiving 2nd line CCT. Four ovarian cancer patients were undergoing 3rd line CCT. Results indicated that mean scores (± standard deviation) of anxiety 13.95 (±4) and depression 15.5 (±4.4) both exceeded the cut-off score of 11 and mean score of QOL physical health 29.77 (±10.1), psychological health 31.3 (±10.1), social relationship 35.1 (±9.6), and environmental condition 25.9 (±9.9) was below cut-off score of 60. After psychotherapy, there was significant reduction in anxiety (P < 0.01), depression (P < 0.01) and improvement on QOL physical heath (P = 0.02), psychological health (P < 0.01), environmental condition (P < 0.01), and social relationship (P < 0.01). Conclusions: Supportive psychotherapy helps to reduce the level of anxiety, depression, and increase the QOL. Therefore, psychotherapeutic intervention should be encouraged along with chemotherapy to promote positive mental health and to obtain full benefit of their physical treatment.
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Affiliation(s)
- Anindita Mukherjee
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Koustav Mazumder
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikrant Kaushal
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushmita Ghoshal
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Soetrisno, Sulistyowati S, Ardhianto A, Hadi S. The effect of logotherapy on the expressions of cortisol, HSP70, Beck Depression Inventory (BDI), and pain scales in advanced cervical cancer patients. Health Care Women Int 2016; 38:91-99. [DOI: 10.1080/07399332.2016.1237952] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Soetrisno
- Department of Obstetrics and Gynecology, Dr. Moewardi Hospital/Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Sri Sulistyowati
- Department of Obstetrics and Gynecology, Dr. Moewardi Hospital/Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Adhitya Ardhianto
- Department of Obstetrics and Gynecology, Dr. Moewardi Hospital/Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Syamsul Hadi
- Department of Psychiatry, Dr. Moewardi Hospital/Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
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Giese-Davis J, Brandelli Y, Kronenwetter C, Golant M, Cordova M, Twirbutt S, Chang V, Kraemer HC, Spiegel D. Illustrating the Multi-Faceted Dimensions of Group Therapy and Support for Cancer Patients. Healthcare (Basel) 2016; 4:healthcare4030048. [PMID: 27490581 PMCID: PMC5041049 DOI: 10.3390/healthcare4030048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/07/2016] [Accepted: 07/26/2016] [Indexed: 12/27/2022] Open
Abstract
In cancer support groups, choice of therapy model, leadership style, and format can impact patients’ experiences and outcomes. Methodologies that illustrate the complexity of patients’ group experiences might aid in choosing group style, or testing therapeutic mechanisms. We used this naturalistic study as a beginning step to explore methods for comparing cancer group contexts by first modifying a group-experience survey to be cancer-specific (Group Experience Questionnaire (GEQ)). Hypothesizing that therapist-led (TL) would differ from non-therapist-led (NTL), we explored the GEQ’s multiple dimensions. A total of 292 patients attending three types of groups completed it: 2 TL groups differing in therapy style ((1) Supportive-Expressive (SET); (2) The Wellness Community (TWC/CSC)); (3) a NTL group. Participants rated the importance of “Expressing True Feelings” and “Discussing Sexual Concerns” higher in TL than NTL groups and “Discussing Sexual Concerns” higher in SET than other groups. They rated “Developing a New Attitude” higher in TWC/CSC compared to NTL. In addition, we depict the constellation of group qualities using radar-charts to assist visualization. These charts facilitate a quick look at a therapy model’s strengths and weaknesses. Using a measure like the GEQ and this visualization technique could enable health-service decision making about choice of therapy model to offer.
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Affiliation(s)
- Janine Giese-Davis
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd., Stanford, CA 94305, USA.
- Department of Oncology, University of Calgary, 2202 2nd St. S.W., Calgary, AB T2S 3C1, Canada.
- Department of Psychosocial Resources, Tom Baker Cancer Centre, 2202 2nd St. S.W., Calgary, AB T2S 3C1, Canada.
| | - Yvonne Brandelli
- Department of Oncology, University of Calgary, 2202 2nd St. S.W., Calgary, AB T2S 3C1, Canada.
- Department of Psychosocial Resources, Tom Baker Cancer Centre, 2202 2nd St. S.W., Calgary, AB T2S 3C1, Canada.
| | - Carol Kronenwetter
- California Pacific Medical Center, Breast Health Center, 3698 California Street, San Francisco, CA 94118, USA.
| | - Mitch Golant
- The Wellness Community/Cancer Support Community, Research & Training Institute, Cancer Support Community, 4100 Chamounix Drive, Philadelphia, PA 19131, USA.
| | - Matthew Cordova
- Veterans Administration Medical Center Martinez, 150 Muir Rd., Martinez, CA 94553, USA.
- Pacific Graduate School of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304-1337, USA.
| | - Suzanne Twirbutt
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd., Stanford, CA 94305, USA.
| | - Vickie Chang
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd., Stanford, CA 94305, USA.
| | - Helena C Kraemer
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd., Stanford, CA 94305, USA.
| | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd., Stanford, CA 94305, USA.
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Hasegawa T, Goto N, Matsumoto N, Sasaki Y, Ishiguro T, Kuzuya N, Sugiyama Y. Prevalence of unmet needs and correlated factors in advanced-stage cancer patients receiving rehabilitation. Support Care Cancer 2016; 24:4761-7. [PMID: 27344328 DOI: 10.1007/s00520-016-3327-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Although rehabilitation for patients with cancer is currently being provided throughout all phases of the disease, including the advanced stage, much remains unknown about the needs of such patients. The aims of this study were to identify the supportive care and unmet needs of cancer patients receiving rehabilitation interventions and to investigate the factors associated with those unmet needs. METHODS A total of 45 patients with cancer receiving rehabilitation interventions participated in this study between June 2013 and December 2015. Measures included the Japanese version of the Short-Form Supportive Care Needs Survey Questionnaire (SCNS-SF34), the Functional Independence Measure (FIM), the Hospital Anxiety and Depression Scale (HADS), and various other medico-social factors. RESULTS The mean age of the cancer patients was 66.6 years, the mean (±standard deviation) FIM score was 111.8 (±16.1), and the mean HADS score was 13.9 (±8.2). The patients had a mean of 17.4 (±10.3) unmet needs. The top ten unmet needs related to rehabilitation intervention included seven psychological needs, two health system and information needs, and one physical and daily living need. Multiple regression analysis revealed that psychological distress (HADS ≥11), marital status, and sex were significantly associated with physical and daily living needs. CONCLUSIONS These results suggest that psychosocial factors are important in understanding the supportive care and unmet needs of cancer patients receiving rehabilitation interventions.
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Affiliation(s)
- Takaaki Hasegawa
- Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan. .,Palliative Care Center, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan.
| | - Naoya Goto
- Department of Rehabilitation, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan
| | - Naoto Matsumoto
- Department of Rehabilitation, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan
| | - Yusuke Sasaki
- Department of Rehabilitation, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan
| | - Takashi Ishiguro
- Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan.,Palliative Care Center, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan
| | - Nanori Kuzuya
- Palliative Care Center, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan
| | - Yasuyuki Sugiyama
- Palliative Care Center, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan
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Shin E, Seo K, Lee S, Jang J, Jung Y, Kim M, Yeon J. Massage with or without aromatherapy for symptom relief in people with cancer. Cochrane Database Syst Rev 2016; 2016:CD009873. [PMID: 27258432 PMCID: PMC10406396 DOI: 10.1002/14651858.cd009873.pub3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Massage and aromatherapy massage are used to relieve cancer-related symptoms. A number of claims have been made for these treatments including reduction of pain, anxiety, depression, and stress. Other studies have not shown these benefits. OBJECTIVES To evaluate the effects of massage with or without aromatherapy on pain and other symptoms associated with cancer. SEARCH METHODS We searched the following databases and trials registries up to August 2015: the Cochrane Central Register of Controlled Trials (CENTRAL, 2015, Issue 7), MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), PubMed Cancer Subset, SADCCT, and the World Health Organization (WHO) ICTRP. We also searched clinical trial registries for ongoing studies. SELECTION CRITERIA Randomised controlled studies (RCTs) reporting the effects of aromatherapy or massage therapy, or both, in people with cancer of any age. We applied no language restrictions. Comparators were massage (using carrier oil only) versus no massage, massage with aromatherapy (using carrier oil plus essential oils) versus no massage, and massage with aromatherapy (using carrier oil plus essential oils) versus massage without aromatherapy (using carrier oil only). DATA COLLECTION AND ANALYSIS At least two review authors selected studies, assessed the risk of bias, and extracted data relating to pain and other symptoms associated with cancer, using standardised forms. We assessed the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and created two 'Summary of findings' tables. MAIN RESULTS We included 19 studies (21 reports) of very low quality evidence with a total of 1274 participants. We included 14 studies (16 reports) in a qualitative synthesis and five studies in a quantitative synthesis (meta-analysis). Thirteen studies (14 reports, 596 participants) compared massage with no massage. Six studies (seven reports, 561 participants) compared aromatherapy massage with no massage. Two studies (117 participants) compared massage with aromatherapy and massage without aromatherapy. Fourteen studies had a high risk of bias related to sample size and 15 studies had a low risk of bias for blinding the outcome assessment. We judged the studies to be at unclear risk of bias overall. Our primary outcomes were pain and psychological symptoms. Two studies reported physical distress, rash, and general malaise as adverse events. The remaining 17 studies did not report adverse events. We downgraded the GRADE quality of evidence for all outcomes to very low because of observed imprecision, indirectness, imbalance between groups in many studies, and limitations of study design. Massage versus no-massage groupsWe analysed results for pain and anxiety but the quality of evidence was very low as most studies were small and considered at an unclear or high risk of bias due to poor reporting. Short-term pain (Present Pain Intensity-Visual Analogue Scale) was greater for the massage group compared with the no-massage group (one RCT, n = 72, mean difference (MD) -1.60, 95% confidence interval (CI) -2.67 to -0.53). Data for anxiety (State-Trait Anxiety Inventory-state) relief showed no significant difference in anxiety between the groups (three RCTs, n = 98, combined MD -5.36, 95% CI -16.06 to 5.34). The subgroup analysis for anxiety revealed that the anxiety relief for children was greater for the massage group compared with the no-massage group (one RCT, n = 30, MD -14.70, 95% CI -19.33 to -10.07), but the size of this effect was considered not clinically significant. Furthermore, this review demonstrated no differences in effects of massage on depression, mood disturbance, psychological distress, nausea, fatigue, physical symptom distress, or quality of life when compared with no massage. Massage with aromatherapy versus no-massage groupsWe analysed results for pain, anxiety, symptoms relating to the breast, and quality of life but the quality of evidence was very low as studies were generally at a high risk of bias. There was some indication of benefit in the aromatherapy-massage group but this benefit is unlikely to translate into clinical benefit. The relief of medium- and long-term pain (medium-term: one RCT, n = 86, MD 5.30, 95% CI 1.52 to 9.08; long-term: one RCT, n = 86, MD 3.80, 95% CI 0.19 to 7.41), anxiety (two RCTs, n = 253, combined MD -4.50, 95% CI -7.70 to -1.30), and long-term symptoms relating to the breast in people with breast cancer (one RCT, n = 86, MD -9.80, 95% CI -19.13 to -0.47) was greater for the aromatherapy-massage group, but the results were considered not clinically significant. The medium-term quality of life score was lower (better) for the aromatherapy-massage group compared with the no-massage group (one RCT, n = 30, MD -2.00, 95% CI -3.46 to -0.54). Massage with aromatherapy versus massage without aromatherapy groupsFrom the limited evidence available, we were unable to assess the effect of adding aromatherapy to massage on the relief of pain, psychological symptoms including anxiety and depression, physical symptom distress, or quality of life. AUTHORS' CONCLUSIONS There was a lack of evidence on the clinical effectiveness of massage for symptom relief in people with cancer. Most studies were too small to be reliable and key outcomes were not reported. Any further studies of aromatherapy and massage will need to address these concerns.
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Affiliation(s)
- Ein‐Soon Shin
- Korean Academy of Medical Sciences (KAMS)KAMS Research Center, Research Agency for Clinical Practice Guidelines44‐3 Hangang‐ro, 2(i)Yongsan‐guSeoulKorea, South140‐706
| | - Kyung‐Hwa Seo
- Research Institute for Healthcare Policy, Korean Medical AssociationDepartment of Research302‐75, Ichon 1‐dongSeoulKorea, South140 721
- Ewha Woman's UniversityDepartment of Medical SciencesSeoulKorea, South
| | - Sun‐Hee Lee
- EWHA Woman's University School of MedicineDepartment of Preventive Medicine911‐1 Mok‐6‐dongSuite A‐409SeoulSeoulKorea, South158 710
| | - Ji‐Eun Jang
- Korean Academy of Medical Sciences (KAMS)KAMS Research Center, Research Agency for Clinical Practice Guidelines44‐3 Hangang‐ro, 2(i)Yongsan‐guSeoulKorea, South140‐706
| | - Yu‐Min Jung
- EWHA Woman's University School of MedicineDepartment of Preventive Medicine911‐1 Mok‐6‐dongSuite A‐409SeoulSeoulKorea, South158 710
| | - Min‐Ji Kim
- EWHA Woman's University School of MedicineDepartment of Preventive Medicine911‐1 Mok‐6‐dongSuite A‐409SeoulSeoulKorea, South158 710
| | - Ji‐Yun Yeon
- Korean Academy of Medical Sciences (KAMS)KAMS Research Center, Research Agency for Clinical Practice Guidelines44‐3 Hangang‐ro, 2(i)Yongsan‐guSeoulKorea, South140‐706
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Karyotaki E, Smit Y, Holdt Henningsen K, Huibers MJH, Robays J, de Beurs D, Cuijpers P. Combining pharmacotherapy and psychotherapy or monotherapy for major depression? A meta-analysis on the long-term effects. J Affect Disord 2016; 194:144-52. [PMID: 26826534 DOI: 10.1016/j.jad.2016.01.036] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The present meta-analysis aimed to examine to what extent combined pharmacotherapy with psychotherapy results in a different response to treatment compared to psychotherapy or pharmacotherapy alone in adults with major depression at six months or longer postrandomization. METHODS A systematic literature search resulted in 23 randomized controlled trials with 2184 participants. Combined treatment was compared to either psychotherapy or anti-depressant medication alone in both the acute phase and the maintenance phase. Odds ratios of a positive outcome were calculated for all comparisons. RESULTS In acute phase treatment, combined psychotherapy with antidepressants outperformed antidepressants alone at six months or longer postrandomization in patients with major depressive disorder (OR=2.93, 95%CI 2.15-3.99, p<0.001). Heterogeneity was zero (95%CI 0-57%, p>0.05). However, combined therapy resulted in equal response to treatment compared to psychotherapy alone at six months or longer postrandomization. As for the maintenance treatment, combined maintenance psychotherapy with antidepressants resulted in better-sustained treatment response compared to antidepressants at six months or longer postrandomization (OR=1.61, 95%CI 1.14-2.27, p<0.05). Heterogeneity was zero (95%CI 0-68%, p>0.05). CONCLUSIONS Combined therapy results in a superior enduring effect compared to antidepressants alone in patients with major depression. Psychotherapy is an adequate alternative for combined treatment in the acute phase as it is as effective as combined treatment in the long-term.
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Affiliation(s)
- E Karyotaki
- Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University and VU University medical centre, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University medical centre, Amsterdam, The Netherlands.
| | - Y Smit
- Independant researcher, The Netherlands
| | | | - M J H Huibers
- Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University and VU University medical centre, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University medical centre, Amsterdam, The Netherlands
| | - J Robays
- Belgian Health Care Knowledge Centre, KCE, Brussels, Belgium
| | - D de Beurs
- Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University and VU University medical centre, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University medical centre, Amsterdam, The Netherlands
| | - P Cuijpers
- Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University and VU University medical centre, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University medical centre, Amsterdam, The Netherlands
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[Dyspnea, itching and depression in palliative medicine]. Schmerz 2016; 30:193-208. [PMID: 26983746 DOI: 10.1007/s00482-016-0104-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Palliative medicine focuses on relieving burdening symptoms to improve quality of life. The most common symptoms are physical weakness, pain, loss of appetite, nausea as well as dyspnea, itching and depression. Frequently, good symptom control can be achieved using the most effective drug combination therapy or non-medicinal interventions. This article specifically addresses the physical symptoms dyspnea, itching and the psychological symptom depression.
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Serfaty M, King M, Nazareth I, Tookman A, Wood J, Gola A, Aspden T, Mannix K, Davis S, Moorey S, Jones L. The clinical and cost effectiveness of cognitive behavioural therapy plus treatment as usual for the treatment of depression in advanced cancer (CanTalk): study protocol for a randomised controlled trial. Trials 2016; 17:113. [PMID: 26926910 PMCID: PMC4772591 DOI: 10.1186/s13063-016-1223-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/09/2016] [Indexed: 01/02/2023] Open
Abstract
Background The prevalence of depressive disorder in adults with advanced cancer is around 20 %. Although cognitive behavioural therapy (CBT) is recommended for depression and may be beneficial in depressed people with cancer, its use for depression in those with advanced disease for whom cure is not likely has not been explored. Methods People aged 18 years and above with advanced cancer attending General Practitioner (GP), oncology or hospice outpatients from centres across England will be screened to establish a DSM-IV diagnosis of depression. Self-referral is also accepted. Eligible consenters will be randomised to a single blind, multicentre, randomised controlled trial of the addition to treatment as usual (TAU) of up to 12 one-hour weekly sessions of manualised CBT versus TAU alone. Sessions are delivered in primary care through Increasing Access to Psychological Care (IAPT) service, and the manual includes a focus on issues for people approaching the end of life. The main outcome is the Beck Depression Inventory-II (BDI-II). Subsidiary measures include the Patient Health Questionnaire, quality of life measure EQ-5D, Satisfaction with care, Eastern Cooperative Oncology Group-Performance Status and a modified Client Service Receipt Inventory. At 90 % power, we require 240 participants to enter the trial. Data will be analysed using multi-level (hierarchical) models for data collected at baseline, 6, 12, 18 and 24 weeks. Cost effectiveness analysis will incorporate costs related to the intervention to compare overall healthcare costs and QALYs between the treatment arms. We will conduct qualitative interviews after final follow-up on patient and therapist perspectives of the therapy. Discussion This trial will provide data on the clinical and cost effectiveness of CBT for people with advanced cancer and depression. We shall gain an understanding of the feasibility of delivering care to this group through IAPT. Our findings will provide evidence for policy-makers, commissioners and clinicians in cancer and palliative care, and in the community. Trial registration Controlled Trials ISRCTN07622709, registered 15 July 2011.
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Affiliation(s)
- Marc Serfaty
- Division of Psychiatry, UCL, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Michael King
- Division of Psychiatry, UCL, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Irwin Nazareth
- Research Department of Primary Care & Population Health, UCL Royal Free Site, Rowland Hill Street, London, NW3 2PF, UK.
| | - Adrian Tookman
- Marie Curie Hospice, 11 Lyndhurst Gardens, London, NW3 5NS, UK. .,Palliative Medicine, Royal Free Hampstead NHS Trust, London, UK.
| | - John Wood
- Research Department of Primary Care & Population Health, UCL Royal Free Site, Rowland Hill Street, London, NW3 2PF, UK.
| | - Anna Gola
- Marie Curie Palliative Care Research Department, UCL, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Trefor Aspden
- Division of Psychiatry, UCL, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Kathryn Mannix
- Palliative Medicine, Newcastle upon Tyne Hospital NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN, UK.
| | - Sarah Davis
- Marie Curie Palliative Care Research Department, UCL, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Stirling Moorey
- Psychotherapy and CBT, South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK.
| | - Louise Jones
- Marie Curie Palliative Care Research Department, UCL, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
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Lo C, Hales S, Chiu A, Panday T, Malfitano C, Jung J, Rydall A, Li M, Nissim R, Zimmermann C, Rodin G. Managing Cancer And Living Meaningfully (CALM): randomised feasibility trial in patients with advanced cancer. BMJ Support Palliat Care 2016; 9:209-218. [DOI: 10.1136/bmjspcare-2015-000866] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 10/20/2015] [Accepted: 12/16/2015] [Indexed: 11/03/2022]
Abstract
BackgroundManaging Cancer And Living Meaningfully (CALM) is a brief individual psychotherapy for patients with advanced cancer. In an intervention-only phase 2a trial, CALM showed promising results, leading to the present 2b pilot, which introduces procedures for randomisation and improved rigour in preparation for a phase 3 randomised controlled trial (RCT).AimsTo test trial methodology and assess feasibility of a confirmatory RCT.DesignA parallel-arm RCT (intervention vs usual care) with 3 and 6-month follow-ups. Assessment of feasibility included rates of consent, randomisation, attrition, intervention non-compliance and usual care contamination. Primary outcome: depressive symptoms (Patient Health Questionnaire-9; PHQ-9). Secondary outcomes: major depressive disorder (MDD), generalised anxiety, death anxiety, spiritual well-being, attachment anxiety and avoidance, self-esteem, experiential avoidance, quality of life and post-traumatic growth. Bayesian conjugate analysis was used in this low-powered setting.Setting/participants60 adult patients with advanced cancer from the Princess Margaret Cancer Centre.ResultsRate of consent was 32%, randomisation 78%, attrition 25%, non-compliance 37% and contamination 17%. There was support for potential treatment effects on: PHQ-9, OR=1.48, 95% Credible Interval (CRI.95) (0.65, 3.38); MDD, OR=1.56, CRI.95 (0.50, 4.84); attachment anxiety, OR=1.72, CRI.95 (0.73, 4.03); and attachment avoidance, OR=1.58, CRI.95 (0.67, 3.71). There was no support for effects on the seven remaining secondary outcomes.ConclusionsA phase 3 CALM RCT is feasible and should aim to detect effect sizes of d=0.40, with greater attention to issues of compliance and contamination.Trial registration numberNCT02353546.
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Lo C, Hales S, Rydall A, Panday T, Chiu A, Malfitano C, Jung J, Li M, Nissim R, Zimmermann C, Rodin G. Managing Cancer And Living Meaningfully: study protocol for a randomized controlled trial. Trials 2015; 16:391. [PMID: 26335704 PMCID: PMC4557481 DOI: 10.1186/s13063-015-0811-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 06/18/2015] [Indexed: 11/23/2022] Open
Abstract
Background We have developed a novel and brief semi-structured psychotherapeutic intervention for patients with advanced or metastatic cancer, called Managing Cancer And Living Meaningfully. We describe here the methodology of a randomized controlled trial to test the efficacy of this treatment to alleviate distress and promote well-being in this population. Methods/Design The study is an unblinded randomized controlled trial with 2 conditions (intervention plus usual care versus usual care alone) and assessments at baseline, 3 and 6 months. The site is the Princess Margaret Cancer Centre, part of the University Health Network, in Toronto, Canada. Eligibility criteria include: ≥ 18 years of age; English fluency; no cognitive impairment; and diagnosis of advanced cancer. The 3–6 session intervention is manualized and allows for flexibility to meet individual patients’ needs. It is delivered over a 3–6 month period and provides reflective space for patients (and their primary caregivers) to address 4 main domains: symptom management and communication with health care providers; changes in self and relations with close others; sense of meaning and purpose; and the future and mortality. Usual care at the Princess Margaret Cancer Centre includes distress screening and referral as required to in-hospital psychosocial and palliative care services. The primary outcome is frequency of depressive symptoms and the primary endpoint is at 3 months. Secondary outcomes include diagnosis of major or minor depression, generalized anxiety, death anxiety, spiritual well-being, quality of life, demoralization, attachment security, posttraumatic growth, communication with partners, and satisfaction with clinical interactions. Discussion Managing Cancer And Living Meaningfully has the potential to relieve distress and promote psychological well-being in patients with advanced cancer and their primary caregivers. This trial is being conducted to determine its benefit and inform its dissemination. The intervention has cross-national relevance and training workshops have been held thus far with clinicians from North and South America, Europe, the Middle East, Asia and Africa. Trial Registration ClinicalTrials.gov NCT01506492 4 January 2012. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0811-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chris Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada. .,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada.
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada. .,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada.
| | - Anne Rydall
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Tania Panday
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Aubrey Chiu
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Carmine Malfitano
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Judy Jung
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada. .,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada.
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada. .,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada.
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada. .,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada. .,Department of Medicine, University of Toronto, Suite RFE 3-805, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada. .,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada.
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Ostuzzi G, Matcham F, Dauchy S, Barbui C, Hotopf M. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev 2015; 2015:CD011006. [PMID: 26029972 PMCID: PMC6457578 DOI: 10.1002/14651858.cd011006.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Major depression and other depressive conditions are common in people with cancer. These conditions are not easily detectable in clinical practice, due to the overlap between medical and psychiatric symptoms, as described by diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). Moreover, it is particularly challenging to distinguish between pathological and normal reactions to such a severe illness. Depressive symptoms, even in subthreshold manifestations, have been shown to have a negative impact in terms of quality of life, compliance with anti-cancer treatment, suicide risk and likely even the mortality rate for the cancer itself. Randomised controlled trials (RCTs) on the efficacy and tolerability of antidepressants in this population group are few and often report conflicting results. OBJECTIVES To assess the effects and acceptability of antidepressants for treating depressive symptoms in adults (18 years or older) with cancer (any site and stage). SEARCH METHODS We searched the following electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 3), MEDLINE Ovid (1946 to April week 3, 2014), EMBASE Ovid (1980 to 2014 week 17) and PsycINFO Ovid (1987 to April week 4, 2014). We additionally handsearched the trial databases of the most relevant national, international and pharmaceutical company trial registers and drug-approving agencies for published, unpublished and ongoing controlled trials. SELECTION CRITERIA We included RCTs allocating adults (18 years or above) with any primary diagnosis of cancer and depression (including major depressive disorder, adjustment disorder, dysthymic disorder or depressive symptoms in the absence of a formal diagnosis) comparing antidepressants versus placebo, or antidepressants versus other antidepressants. DATA COLLECTION AND ANALYSIS Two review authors independently checked eligibility and extracted data using a form specifically designed for the aims of this review. The two authors compared the data extracted and then entered data into RevMan 5 with a double-entry procedure. Information extracted included study and participant characteristics, intervention details, outcome measures for each time point of interest, cost analysis and sponsorship by a drug company. We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We retrieved a total of nine studies (861 participants), with seven studies contributing to the meta-analysis for the primary outcome. Four of these compared antidepressants and placebo, two compared two antidepressants and one-three armed study compared two antidepressants and a placebo arm. For the acute phase treatment response (6 to 12 weeks), we found very low quality evidence for the effect of antidepressants as a class on symptoms of depression compared with placebo when measured as a continuous outcome (standardised mean difference (SMD) -0.45, 95% confidence interval (CI) -1.01 to 0.11, five RCTs, 266 participants) or as a proportion of people who had depression (risk ratio (RR) 0.82, 95% CI 0.62 to 1.08, five RCTs, 417 participants). No trials reported data on the follow-up response (more than 12 weeks). In head-to-head comparisons we only retrieved data for selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants, providing very low quality evidence for the difference between these two classes (SMD -0.08, 95% CI -0.34 to 0.18, three RCTs, 237 participants). No clear evidence of an effect of antidepressants versus either placebo or other antidepressants emerged from the analyses of the secondary efficacy outcomes (dichotomous outcome, response at 6 to 12 weeks, very low quality evidence). We found very low quality evidence for the effect of antidepressants as a class in terms of dropouts due to any cause compared with placebo (RR 0.87, 95% CI 0.49 to 1.53, six RCTs, 455 participants), as well as between SSRIs and tricyclic antidepressants (RR 0.83, 95% CI 0.53 to 1.30, three RCTs, 237 participants). We downgraded the quality of the evidence because the included studies were at an unclear or high risk of bias due to poor reporting, imprecision arising from small sample sizes and wide confidence intervals, and inconsistency due to statistical or clinical heterogeneity. AUTHORS' CONCLUSIONS Despite the impact of depression on people with cancer, available studies were very few and of low quality. This review found very low quality evidence for the effects of these drugs compared with placebo. On the basis of these results clear implications for practice cannot be made. The use of antidepressants in people with cancer should be considered on an individual basis and, considering the lack of head-to-head data, the choice of which agent should be prescribed may be based on the data on antidepressant efficacy in the general population of individuals with major depression, also taking into account that data on medically ill patients suggest a positive safety profile for the SSRIs. Large, simple, randomised, pragmatic trials comparing commonly used antidepressants versus placebo in people with cancer with depressive symptoms, with or without a formal diagnosis of a depressive disorder, are urgently needed to better inform clinical practice.
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Affiliation(s)
- Giovanni Ostuzzi
- University of VeronaDepartment of Neuroscience, Biomedicine and Movement Sciences, Section of PsychiatryPoliclinico "GB Rossi"Piazzale L.A. Scuro, 10VeronaItaly37134
| | - Faith Matcham
- The Institute of Psychiatry, King's College LondonDepartment of Psychological MedicineWeston Education CentreLondonUKSE5 9RJ
| | - Sarah Dauchy
- Gustave RoussyChef du Département Interdisciplinaire de Soins de Support114 rue Edouard VaillantVillejuifParisFrance94805
| | - Corrado Barbui
- University of VeronaNeuroscience, Biomedicine and Movement Sciences, Section of PsychiatryVeronaItaly
| | - Matthew Hotopf
- The Institute of Psychiatry, King's College LondonDepartment of Psychological MedicineWeston Education CentreLondonUKSE5 9RJ
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Ostuzzi G, Matcham F, Dauchy S, Barbui C, Hotopf M. Antidepressants for the treatment of depression in people with cancer. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [PMID: 26029972 DOI: 10.1002/14651858.cd011006.pub2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Major depression and other depressive conditions are common in people with cancer. These conditions are not easily detectable in clinical practice, due to the overlap between medical and psychiatric symptoms, as described by diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). Moreover, it is particularly challenging to distinguish between pathological and normal reactions to such a severe illness. Depressive symptoms, even in subthreshold manifestations, have been shown to have a negative impact in terms of quality of life, compliance with anti-cancer treatment, suicide risk and likely even the mortality rate for the cancer itself. Randomised controlled trials (RCTs) on the efficacy and tolerability of antidepressants in this population group are few and often report conflicting results. OBJECTIVES To assess the effects and acceptability of antidepressants for treating depressive symptoms in adults (18 years or older) with cancer (any site and stage). SEARCH METHODS We searched the following electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 3), MEDLINE Ovid (1946 to April week 3, 2014), EMBASE Ovid (1980 to 2014 week 17) and PsycINFO Ovid (1987 to April week 4, 2014). We additionally handsearched the trial databases of the most relevant national, international and pharmaceutical company trial registers and drug-approving agencies for published, unpublished and ongoing controlled trials. SELECTION CRITERIA We included RCTs allocating adults (18 years or above) with any primary diagnosis of cancer and depression (including major depressive disorder, adjustment disorder, dysthymic disorder or depressive symptoms in the absence of a formal diagnosis) comparing antidepressants versus placebo, or antidepressants versus other antidepressants. DATA COLLECTION AND ANALYSIS Two review authors independently checked eligibility and extracted data using a form specifically designed for the aims of this review. The two authors compared the data extracted and then entered data into RevMan 5 with a double-entry procedure. Information extracted included study and participant characteristics, intervention details, outcome measures for each time point of interest, cost analysis and sponsorship by a drug company. We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We retrieved a total of nine studies (861 participants), with seven studies contributing to the meta-analysis for the primary outcome. Four of these compared antidepressants and placebo, two compared two antidepressants and one-three armed study compared two antidepressants and a placebo arm. For the acute phase treatment response (6 to 12 weeks), we found very low quality evidence for the effect of antidepressants as a class on symptoms of depression compared with placebo when measured as a continuous outcome (standardised mean difference (SMD) -0.45, 95% confidence interval (CI) -1.01 to 0.11, five RCTs, 266 participants) or as a proportion of people who had depression (risk ratio (RR) 0.82, 95% CI 0.62 to 1.08, five RCTs, 417 participants). No trials reported data on the follow-up response (more than 12 weeks). In head-to-head comparisons we only retrieved data for selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants, providing very low quality evidence for the difference between these two classes (SMD -0.08, 95% CI -0.34 to 0.18, three RCTs, 237 participants). No clear evidence of an effect of antidepressants versus either placebo or other antidepressants emerged from the analyses of the secondary efficacy outcomes (dichotomous outcome, response at 6 to 12 weeks, very low quality evidence). We found very low quality evidence for the effect of antidepressants as a class in terms of dropouts due to any cause compared with placebo (RR 0.87, 95% CI 0.49 to 1.53, six RCTs, 455 participants), as well as between SSRIs and tricyclic antidepressants (RR 0.83, 95% CI 0.53 to 1.30, three RCTs, 237 participants). We downgraded the quality of the evidence because the included studies were at an unclear or high risk of bias due to poor reporting, imprecision arising from small sample sizes and wide confidence intervals, and inconsistency due to statistical or clinical heterogeneity. AUTHORS' CONCLUSIONS Despite the impact of depression on people with cancer, available studies were very few and of low quality. This review found very low quality evidence for the effects of these drugs compared with placebo. On the basis of these results clear implications for practice cannot be made. The use of antidepressants in people with cancer should be considered on an individual basis and, considering the lack of head-to-head data, the choice of which agent should be prescribed may be based on the data on antidepressant efficacy in the general population of individuals with major depression, also taking into account that data on medically ill patients suggest a positive safety profile for the SSRIs. Large, simple, randomised, pragmatic trials comparing commonly used antidepressants versus placebo in people with cancer with depressive symptoms, with or without a formal diagnosis of a depressive disorder, are urgently needed to better inform clinical practice.
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Affiliation(s)
- Giovanni Ostuzzi
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico "GB Rossi", Piazzale L.A. Scuro, 10, Verona, Italy, 37134
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Schuurhuizen CSEW, Braamse AMJ, Beekman ATF, Bomhof-Roordink H, Bosmans JE, Cuijpers P, Hoogendoorn AW, Konings IRHM, van der Linden MHM, Neefjes ECW, Verheul HMW, Dekker J. Screening and treatment of psychological distress in patients with metastatic colorectal cancer: study protocol of the TES trial. BMC Cancer 2015; 15:302. [PMID: 25903799 PMCID: PMC4407474 DOI: 10.1186/s12885-015-1313-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/09/2015] [Indexed: 12/22/2022] Open
Abstract
Background/Introduction Psychological distress occurs frequently in patients with cancer. Psychological distress includes mild and severe forms of both anxious and depressive mood states. Literature indicates that effective management of psychological distress seems to require targeted selection of patients (T), followed by enhanced care (E), and the application of evidence based interventions. Besides, it is hypothesized that delivering care according to the stepped care (S) approach results in an affordable program. The aim of the current study is to evaluate the (cost)-effectiveness of the TES program compared to usual care in reducing psychological distress in patients with metastatic colorectal cancer (mCRC). Methods This study is designed as a cluster randomized trial with 2 treatment arms: TES program for screening and treatment of psychological distress versus usual care. Sixteen hospitals participate in this study, recruiting patients with mCRC. Outcomes are evaluated at the beginning of chemotherapy and after 3, 10, 24, and 48 weeks. Primary outcome is the difference in treatment effect over time in psychological distress, assessed with the Hospital Anxiety and Depression Scale. Secondary outcomes include quality of life, patient evaluation of care, recognition and management of psychological distress, and societal costs. Discussion We created optimal conditions for an effective screening and treatment program for psychological distress in patients with mCRC. This involves targeted selection of patients, followed by enhanced and stepped care. Our approach will be thoroughly evaluated in this study. We expect that our results will contribute to the continuing debate on the (cost-) effectiveness of screening for and treatment of psychological distress in patients with cancer. Trial Registration This trial is registered in the Netherlands Trial Register NTR4034
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Affiliation(s)
- Claudia S E W Schuurhuizen
- Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands. .,Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
| | - Annemarie M J Braamse
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
| | - Aartjan T F Beekman
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
| | - Hanna Bomhof-Roordink
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
| | - Judith E Bosmans
- VU University, Faculty of Health Science, Amsterdam, the Netherlands.
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University, Amsterdam, the Netherlands.
| | - Adriaan W Hoogendoorn
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
| | - Inge R H M Konings
- Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | | | - Elisabeth C W Neefjes
- Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - Henk M W Verheul
- Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - Joost Dekker
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands. .,Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, 1007MB, Amsterdam, the Netherlands.
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Kiffel J, Sher L. Prevention and management of depression and suicidal behavior in men with prostate cancer. Front Public Health 2015; 3:28. [PMID: 25745628 PMCID: PMC4333715 DOI: 10.3389/fpubh.2015.00028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/04/2015] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jeremy Kiffel
- Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - Leo Sher
- Icahn School of Medicine at Mount Sinai , New York, NY , USA ; James J. Peters Veterans' Administration Medical Center , Bronx, NY , USA
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Fulcher CD, Kim HJ, Smith PR, Sherner TL. Putting evidence into practice: evidence-based interventions for depression. Clin J Oncol Nurs 2014; 18 Suppl:26-37. [PMID: 25427607 DOI: 10.1188/14.cjon.s3.26-37] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression is a distressing emotion that occurs during various times of the cancer trajectory. Depression often goes unrecognized and untreated, which can significantly affect cost, quality of life, and treatment adherence. The Oncology Nursing Society's Putting Evidence Into Practice depression project team reviewed current literature to identify evidence-based interventions to reduce depression in people with cancer. Pharmacologic and nonpharmacologic interventions were evaluated, and opportunities for nurses to integrate recommendations into practice are offered in this article.
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Affiliation(s)
| | - Hee-Ju Kim
- College of Nursing, Catholic University of Korea, Seoul
| | - Patsy R Smith
- College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City
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Yeh ML, Chung YC, Hsu MYF, Hsu CC. Quantifying psychological distress among cancer patients in interventions and scales: a systematic review. Curr Pain Headache Rep 2014; 18:399. [PMID: 24500637 DOI: 10.1007/s11916-013-0399-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The management of cancer-related psychological distress has been addressed in numerous studies, which have examined both the development of interventions to alleviate psychological distress as well as scales for evaluating their efficacy. In this systematic review, we examine results from randomized controlled trials (RCTs) on the relative effectiveness of interventions in reducing cancer-related psychological distress and the scales employed to measure this distress. An electronic database search for RCTs of psychological interventions in cancer patients from October 2008 to July 2013 was conducted using PubMed, MEDLINE, and CINAHL. Data was independently extracted and assessed by two researchers. Nineteen RCTs on interventions for psychological distress were identified and analyzed, among which eight studies reported that the interventions had a positive effect and improved the symptoms of psychological distress, and in which seven main instruments were used to measure psychological distress. The most frequently employed interventions were exercise training, cognitive behavioral therapy, and complementary therapy, followed by meeting with a psychologist and a combination of keeping a written journal and peer counseling. The three most frequently employed scales were the Profile of Mood States-Short Form (POMS-SF), Distress Thermometer (DT), and Hospital Anxiety and Depression (HADS). The majority of cancer patients experience considerable psychological and emotional distress at some time during the course of the disease. Reports have shown that interventions such as exercise training, cognitive behavioral therapy, and complementary therapy can assist oncology personnel in alleviating this distress. Future studies should consider optimizing such interventions. The POMS-SF scale, which has frequently been employed to measure the effects of psychological distress, could be incorporated into elements of screening programs for measuring unfulfilled needs, desire for assistance, clinical response, and longitudinal outcomes.
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Affiliation(s)
- Mei-Ling Yeh
- School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Minte Road, Taipei, Taiwan, Republic of China,
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Hulbert-Williams NJ, Storey L, Wilson KG. Psychological interventions for patients with cancer: psychological flexibility and the potential utility of Acceptance and Commitment Therapy. Eur J Cancer Care (Engl) 2014; 24:15-27. [PMID: 25100576 DOI: 10.1111/ecc.12223] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2014] [Indexed: 11/28/2022]
Abstract
Cancer is an illness affecting patients' physical and psychosocial well-being: high numbers report problematic levels of distress at many points through diagnosis, treatment and survivorship. Conclusive evidence for the long-term benefits of psychological interventions is lacking and this may be because (1) they employ a too limited scope of underlying therapeutic model; or (2) that they are too focused on improving psychopathological outcomes. Acceptance and Commitment Therapy (ACT) may add components not emphasised elsewhere and may provide a more suitable model of adjustment and coping. Following a comprehensive literature search a theoretical and conceptual discussion of the potential for ACT-based oncology interventions is presented. Only a small number of studies have purposively studied the application of ACT within the cancer setting, but this nonetheless presents useful pilot data. The data demonstrate potential clinical- and cost-effectiveness for a range of patients, including those with psychological comorbidity. Within the context of wider cancer adjustment, ACT offers an intervention framework to appropriately build upon the strong empirical base already established for Mindfulness within this specific patient population. The evidence available suggests that the underlying framework of ACT offers an intervention model that is potentially more suited to the individualistic nature of cancer adjustment.
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Kampling H, Baumeister H, Jäckel WH, Mittag O. Prevention of depression in chronically physically ill adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011246] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hanna Kampling
- Medical Center - University of Freiburg; Center for Medical Biometry and Medical Informatics, Institute for Quality Management and Social Medicine; Engelbergerstr. 21 Freiburg Germany 79106
| | - Harald Baumeister
- University of Freiburg; Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology; Freiburg Germany 79085
| | - Wilfried H Jäckel
- Medical Center - University of Freiburg; Center for Medical Biometry and Medical Informatics, Institute for Quality Management and Social Medicine; Engelbergerstr. 21 Freiburg Germany 79106
| | - Oskar Mittag
- Medical Center - University of Freiburg; Center for Medical Biometry and Medical Informatics, Institute for Quality Management and Social Medicine; Engelbergerstr. 21 Freiburg Germany 79106
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Tao WW, Jiang P, Liu Y, Aungsuroch Y, Tao XM. Psycho-oncologic interventions to reduce distress in cancer patients: a meta-analysis of controlled clinical studies published in People's Republic of China. Psychooncology 2014; 24:269-78. [DOI: 10.1002/pon.3634] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 07/01/2014] [Accepted: 07/06/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Wei-Wei Tao
- School of Nursing; Dalian Medical University; Dalian China
| | - Ping Jiang
- School of Nursing; Dalian Medical University; Dalian China
| | - Ying Liu
- School of Nursing; Dalian Medical University; Dalian China
- Faculty of Nursing; Chulalongkorn University; Bangkok Thailand
| | | | - Xiao-Mei Tao
- Beijing Shijitan Hospital Affiliated to Capital Medical University; Beijing China
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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: 470] [Impact Index Per Article: 47.0] [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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Sikorskii A, Given CW, Siddiqi AEA, Champion V, McCorkle R, Spoelstra SL, Given BA. Testing the differential effects of symptom management interventions in cancer. Psychooncology 2014; 24:25-32. [PMID: 24737669 DOI: 10.1002/pon.3555] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 03/14/2014] [Accepted: 03/25/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to test for moderating effects of patient characteristics on self-management interventions developed to address symptoms during cancer treatment. Patient's age, education, and depressive symptomatology were considered as potential moderators. METHODS A secondary analysis of data of 782 patients from two randomized clinical trials was performed. Both trials enrolled patients with solid tumors undergoing chemotherapy. After completing baseline interviews, patients were randomized to a nurse-delivered intervention versus intervention delivered by a 'coach' in trial I and to a nurse-delivered intervention versus an intervention delivered by an automated voice response system in trial II. In each of the two trials, following a six-contact 8-week intervention, patients were interviewed at week 10 to assess the primary outcome of symptom severity. RESULTS Although nurse-delivered intervention proved no better than the coach or automated system in lowering symptom severity, important differences in the intervention by age were found in both trials. Patients aged ≤45 years responded better to the coach or automated system, whereas those aged ≥75 years favored the nurse. Education and depressive symptomatology did not modify the intervention effects in either of the two trials. Depressive symptomatology had a significant main effect on symptom severity at week 10 in both trials (p = 0.03 and p < 0.01, respectively). Education was not associated with symptom severity over and above age and depressive symptomatology. CONCLUSIONS Clinicians need to carefully consider the age of the population when using or testing interventions to manage symptoms among cancer patients.
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Affiliation(s)
- Alla Sikorskii
- Department of Statistics and Probability, Michigan State University, East Lansing, MI, USA
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Depressive disorder in the last phase of life in patients with cardiovascular disease, cancer, and COPD: data from a 20-year follow-up period in general practice. Br J Gen Pract 2014; 63:e303-8. [PMID: 23643227 DOI: 10.3399/bjgp13x667150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Depression is assumed to be common in chronically ill patients during their last phase of life and is associated with poorer outcomes. The prevalence of depression is widely varying in previous studies due to the use of different terminology, classification, and assessment methods. AIM To explore the reported incidence of depressive disorder, as registered in the last phase of life of patients who died from cardiovascular disease, cancer or COPD, in a sample of primary care patients. DESIGN AND SETTING A historic cohort study, using a 20-year period registration database of medical records in four Dutch general practices (a dynamic population based on the Continuous Morbidity Registration database). METHOD Medical history of the sample cohort was analysed for the diagnosis of a new episode of depressive disorder and descriptive statistics were used. RESULTS In total 982 patients were included, and 19 patients (1.9%) were diagnosed with a new depressive disorder in the last year of their life. The lifetime prevalence of depressive disorder in this sample was 8.2%. CONCLUSION The incidence of depressive disorder in the last phase of life is remarkably low in this study. These data were derived from actual patient care in general practice. Psychiatric diagnoses were made by GPs in the context of both patient needs and delivered care. A broader concept of depression in general practice is recommended to improve the diagnosis and treatment of mood disorders in patients in the last phase of life.
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