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Zahid N, Enam SA, Mårtensson T, Azam I, Mushtaq N, Moochhala M, Kausar F, Hassan A, Kamran Bakhshi S, Javed F, Rehman L, Mughal MN, Altaf S, Kirmani S, Brown N. Factors associated with changes in the quality of life and family functioning scores of primary caregivers of children and young people with primary brain tumors in Karachi, Pakistan: a prospective cohort study. BMC Pediatr 2024; 24:389. [PMID: 38851708 PMCID: PMC11161978 DOI: 10.1186/s12887-024-04867-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/31/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND There are limited data available, particularly in low- and middle-income countries (LMICs), on the long-term quality of life (QoL) and family functioning of primary caregivers of children and young people (CYPs) affected by primary brain tumors (PBTs). This study aimed to assess the factors associated with the mean change in QoL and family functioning scores of primary caregivers of CYP patients with PBTs 12 months posttreatment. METHODS This prospective cohort study enrolled CYPs aged 5-21 years with newly diagnosed PBTs and their primary caregivers. The study was carried out between November 2020 and July 2023. The primary caregivers of CYPs were recruited from two major tertiary care centers in Karachi, Pakistan. The primary caregivers QoL were assessed by the Pediatric Quality of Life Inventory (PedsQL) Family Impact Module. The assessment was undertaken by a psychologist at the time of diagnosis and 12 months posttreatment. The data were analyzed with STATA version 12. RESULTS Forty-eight CYPs with newly diagnosed PBTs and their primary caregivers (46 mothers and 2 fathers) were enrolled. At 12 months posttreatment, 25 (52%) CYPs and their primary caregivers (mothers) were reassessed, and 23 (48%) were lost to follow-up. On multivariable analysis, a significant decrease in mothers' mean 12-month posttreatment QoL and family functioning scores was associated with CYP having posttreatment seizures (beta= -10.2; 95% CI: -18.4 to -2.0) and with the financial burden associated with the CYP's illness (beta= -0.3; 95% CI: -0.4 to -0.1). However, in those cases where CYP had higher posttreatment quality of life scores (beta = 0.4; 95% CI = 0.1, 0.6) and posttreatment higher verbal intelligence scores (beta = 0.1; 95% CI = 0.01, 0.3), the mothers' QoL and family functioning scores were significantly greater. CONCLUSION We found a significant decrease in QoL of mothers who had a high financial burden and whose CYP had posttreatment seizures. However, those whose CYPs had higher posttreatment verbal intelligence scores and quality of life scores had significantly greater QoL scores. Identification of the factors that influence primary caregivers QoL has the potential to aid in the development of targeted strategies to alleviate stressors and improve the overall quality of life for primary caregivers and their children who are at high risk.
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Affiliation(s)
- Nida Zahid
- Department of Surgery, Aga Khan University, Karachi, Pakistan.
- Global Health and Migration Unit Department of Women's and Children's Health, Uppsala University, Box 256, Uppsala, 751 05, Sweden.
| | - Syed Ather Enam
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Thomas Mårtensson
- Global Health and Migration Unit Department of Women's and Children's Health, Uppsala University, Box 256, Uppsala, 751 05, Sweden
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Naureen Mushtaq
- Department of Pediatric Oncology, Aga Khan University, Karachi, Pakistan
| | - Mariya Moochhala
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | - Faiza Kausar
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Aneesa Hassan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | | | - Farrukh Javed
- Department of Neurosurgery, Jinnah Post graduate Medical Centre, Karachi, Pakistan
| | - Lal Rehman
- Department of Neurosurgery, Jinnah Post graduate Medical Centre, Karachi, Pakistan
| | | | - Sadaf Altaf
- Department of Pediatric Oncology, Aga Khan University, Karachi, Pakistan
| | - Salman Kirmani
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Nick Brown
- Global Health and Migration Unit Department of Women's and Children's Health, Uppsala University, Box 256, Uppsala, 751 05, Sweden.
- Department of Pediatrics, Aga Khan University, Karachi, Pakistan.
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2
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Grange R, Rousset P, Williet N, Guesnon M, Milot L, Passot G, Phelip JM, Le Roy B, Glehen O, Kepenekian V. Metastatic Colorectal Cancer Treated with Combined Liver Resection, Cytoreductive Surgery, and Hyperthermic Intraperitoneal Chemotherapy (HIPEC): Predictive Factors for Early Recurrence. Ann Surg Oncol 2024; 31:2378-2390. [PMID: 38170409 DOI: 10.1245/s10434-023-14840-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Selection of colorectal cancer patients with concomitant peritoneal (PM) and liver metastases (LM) for radical treatment with cytoreductive surgery (CRS), including liver resection and hyperthermic intraperitoneal chemotherapy (HIPEC), needs improvement. This retrospective, monocentric study was designed to evaluate the predictive factors for early recurrence, disease-free survival (DFS), and overall survival (OS) in such patients treated in a referral center. METHODS Consecutive colorectal cancer patients with concomitant LM and PM treated with curative intent with perioperative systemic chemotherapy, simultaneous complete CRS, liver resection, and HIPEC in 2011-2022 were included. Clinical, radiological (before and after preoperative chemotherapy), surgical, and pathological data were investigated, along with long-term oncologic outcomes. A multivariate analysis was performed to identify predictive factors associated with early recurrence (diagnosed <6 months after surgery), DFS, and OS. RESULTS Of more than 61 patients included, 31 (47.1%) had pT4 and 27 (40.9%) had pN2 primary tumors. Before preoperative chemotherapy, the median number of LM was 2 (1-4). The median surgical PCI (peritoneal carcinomatosis index) was 3 (5-8.5). The median DFS and OS were 8.15 (95% confidence interval [CI] 5.5-10.1) and 34.1 months (95% CI 28.1-53.5), respectively. In multivariate analysis, pT4 (odds ratio [OR] = 4.14 [1.2-16.78], p = 0.032]) and pN2 (OR = 3.7 [1.08-13.86], p = 0.042) status were independently associated with an early recurrence, whereas retroperitoneal lymph node metastasis (hazard ratio [HR] = 39 [8.67-175.44], p < 0.001) was independently associated with poor OS. CONCLUSIONS In colorectal cancer patients with concomitant PM and LM, an advanced primary tumor (pT4 and/or pN2) was associated with a higher risk of early recurrence following a radical multimodal treatment, whereas RLN metastases was strongly detrimental for OS.
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Affiliation(s)
- Rémi Grange
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Pascal Rousset
- Department of Radiology, CHU Lyon Sud, Hospices Civils de Lyon, CICLY EMR 3738, Lyon 1 University, Pierre Bénite, France
| | - Nicolas Williet
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Mathias Guesnon
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France
- CICLY, EMR 3738, Lyon 1 University, Lyon, France
| | - Laurent Milot
- Department of Digestive and Oncologic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Guillaume Passot
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France
- CICLY, EMR 3738, Lyon 1 University, Lyon, France
| | - Jean-Marc Phelip
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Bertrand Le Roy
- Department of Digestive and Oncologic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Olivier Glehen
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France
- CICLY, EMR 3738, Lyon 1 University, Lyon, France
| | - Vahan Kepenekian
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France.
- CICLY, EMR 3738, Lyon 1 University, Lyon, France.
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Williamson M, Press DJ, Hansen SA, Tomar A, Jhuti GS, Revil C, Gururaj K. Population-level impact of adjuvant trastuzumab emtansine on the incidence of metastatic breast cancer: an epidemiological prediction model of women with HER2-positive early breast cancer and residual disease following neoadjuvant therapy. Breast Cancer 2024; 31:84-95. [PMID: 37907759 PMCID: PMC10764576 DOI: 10.1007/s12282-023-01514-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE Treating early-stage breast cancer (eBC) may delay or prevent subsequent metastatic breast cancer (mBC). In the phase 3 KATHERINE study, women with human epidermal growth factor receptor 2 (HER2)-positive eBC with residual disease following neoadjuvant therapy containing trastuzumab and a taxane experienced 50% reductions in disease recurrence or death when treated with adjuvant trastuzumab emtansine (T-DM1) vs adjuvant trastuzumab. We predicted the population-level impact of adjuvant T-DM1 on mBC occurrence in five European countries (EU5) and Canada from 2021-2030. METHODS An epidemiological prediction model using data from national cancer registries, observational studies, and clinical trials was developed. Assuming 80% population-level uptake of adjuvant treatment, KATHERINE data were extrapolated prospectively to model projections. Robustness was evaluated in alternative scenarios. RESULTS We projected an eligible population of 116,335 women in Canada and the EU5 who may be diagnosed with HER2-positive eBC and have residual disease following neoadjuvant therapy from 2021-2030. In EU5, the cumulative number of women projected to experience relapsed mBC over the 10-year study period was 36,009 vs 27,143 under adjuvant trastuzumab vs T-DM1, a difference of 8,866 women, equivalent to 25% fewer cases with the use of adjuvant T-DM1 in EU5 countries from 2021-2030. Findings were similar for Canada. CONCLUSION Our models predicted greater reductions in the occurrence of relapsed mBC with adjuvant T-DM1 vs trastuzumab in the indicated populations in EU5 and Canada. Introduction of T-DM1 has the potential to reduce population-level disease burden of HER2-positive mBC in the geographies studied.
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Affiliation(s)
- Mellissa Williamson
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA.
- Gilead Sciences, Inc., Foster City, CA, USA.
| | - David J Press
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
| | | | | | | | - Cedric Revil
- F. Hoffmann-La Roche AG, Basel, Switzerland
- Merck Sharp and Dohme, Zurich, Switzerland
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Kang SK, Kim DI, Im DW, Lee S, Choi JB, Jung YJ, Kim HY. A retrospective study of factors affecting contralateral central-neck lymph node metastasis in unilateral papillary thyroid carcinoma. Asian J Surg 2023; 46:3485-3490. [PMID: 36372709 DOI: 10.1016/j.asjsur.2022.10.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/06/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In 30-40% of papillary thyroid cancer patients, central neck lymph node metastasis occurs. As a result, prophylactic central neck lymph node dissection is performed. The extent of lymph node dissection and prophylactic central neck lymph node dissection is still debatable. The incidence of central neck lymph node metastasis and related factors were investigated in this study, and also the necessity of both central neck lymph node dissections. METHODS Between December 2017 and December 2019, 482 patients had thyroidectomy at Pusan National University Yangsan Hospital. A retrospective study of 186 patients who had a thyroidectomy with bilateral central neck lymph node dissection for unilateral thyroid carcinoma was done. RESULTS Ipsilateral and contralateral central neck lymph node metastasis were identified in 40.9% (76/186) and 19.3% (36/186), respectively. Male (p < 0.001), tumor size >1 cm (p = 0.047), extrathyroidal extension (p = 0.002), central neck lymph node metastases >5 (p < 0.001), lateral neck lymph node metastasis (p = 0.012), and ipsilateral central neck lymph node metastasis (p < 0.001) were associated with the contralateral central neck lymph node metastasis in univariate analysis. In a multivariate analysis, extrathyroidal extension (OR, 3.664), more than 5 central neck lymph node metastases (OR, 29.667), ipsilateral central neck lymph node metastasis (OR, 3.911), and male (OR, 5.890) were related to contralateral central neck lymph node metastasis. CONCLUSION Male, extrathyroidal extension, and ipsilateral central neck lymph node metastasis may be considered for contralateral prophylactic central neck lymph node dissection. In the future, it is thought that more research on the recurrence rate will be required.
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Affiliation(s)
- Seok Kyung Kang
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Dong-Il Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea.
| | - Dong Won Im
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Seungju Lee
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Jeong Bum Choi
- Department of Surgery, Pusan National University Hospital, Busan, South Korea
| | - Youn Joo Jung
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Hyun Yul Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
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Alwhaibi A, Alenazi M, Almadi B, Aljabali N, Alkhalifah S, Syed W, Alsaif R, Bablghaith SD, Al-Arifi MN. The Impact of Cancer Relapse and Poor Patient Outcomes on Health Care Providers Practicing in the Oncology Field. Cancer Control 2023; 30:10732748231170930. [PMID: 37122065 PMCID: PMC10134170 DOI: 10.1177/10732748231170930] [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: 05/02/2023] Open
Abstract
INTRODUCTION Devastating cancer-related events are not uncommon, and these events have weakened communication performance and induced stress among health care providers (HCPs), particularly physicians. This study aimed to investigate the perspective of HCPs emotionally affected by poor clinical outcomes due to the failure of cancer therapy. METHODS A cross-sectional, online survey was conducted over 3 months among HCPs practicing in the field of oncology in Saudi Arabia, comprising physicians, pharmacists, and nurses. Data were analyzed using Statistical Package for Social Sciences version 26.0. A P-value <.05 was considered statistically significant. RESULTS This study demonstrated a positive correlation between HCPs' length of experience and emotional impact of treatment failure, albeit this was not statistically significant (P = .071). Analysis of their perspective toward failure of cancer therapies revealed a significant impact of occupation and sex (P = .014 and P = .047, respectively). Moreover, occupation played a significant role in shaping the viewpoint of HCPs toward the need for conducing further research to test the appropriateness of treatment protocols on local patients (P = .022). Despite the emotional responses of HCPs to suboptimal clinical outcomes, factors such as work burnout, lack of concentration and patience, work or personal problems, and under appreciation were frequently identified as triggers of such outcomes. CONCLUSION Our results revealed that poor clinical outcomes observed among cancer patients are emotional triggers for HCPs practicing in the oncology field. The emotional response is often perceived negatively, and can potentially lead to a decline in the quality of care provided to these patients.
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Affiliation(s)
| | - Miteb Alenazi
- Pharmacy Department, Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia
| | - Bana Almadi
- Intern at the Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Nora Aljabali
- Intern at the Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sahar Alkhalifah
- Pharmacy Department, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Wajid Syed
- Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Reem Alsaif
- Pharmacy Department,, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Liu Y, Tian S, Ning B, Huang T, Li Y, Wei Y. Stress and cancer: The mechanisms of immune dysregulation and management. Front Immunol 2022; 13:1032294. [PMID: 36275706 PMCID: PMC9579304 DOI: 10.3389/fimmu.2022.1032294] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Advances in the understanding of psychoneuroimmunology in the past decade have emphasized the notion that stress and cancer are interlinked closely. Durable chronic stress accelerated tumorigenesis and progression, which is unfavorable for clinical outcomes of cancer patients. Available evidence has provided unprecedented knowledge about the role and mechanisms of chronic stress in carcinogenesis, the most well-known one is dysfunction of the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). With abnormal activation of neuroendocrine system, stress-related hormones contribute to increased oncogenes expression, exacerbated chronic inflammation and impaired immunologic function. In addition, accumulating studies have demonstrated that diverse stress interventions including pharmacological approaches, physical exercises and psychological relaxation have been administered to assist in mental disorders reduction and life quality improvement in cancer patients. In this review, we systematically summarize the connection and mechanisms in the stress-immune-cancer axis identified by animal and clinical studies, as well as conclude the effectiveness and deficiencies of existing stress management strategies.
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Affiliation(s)
- Yixin Liu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Sheng Tian
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Biao Ning
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Tianhe Huang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Yi Li
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Yongchang Wei
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
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Eckerling A, Ricon-Becker I, Sorski L, Sandbank E, Ben-Eliyahu S. Stress and cancer: mechanisms, significance and future directions. Nat Rev Cancer 2021; 21:767-785. [PMID: 34508247 DOI: 10.1038/s41568-021-00395-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 02/08/2023]
Abstract
The notion that stress and cancer are interlinked has dominated lay discourse for decades. More recent animal studies indicate that stress can substantially facilitate cancer progression through modulating most hallmarks of cancer, and molecular and systemic mechanisms mediating these effects have been elucidated. However, available clinical evidence for such deleterious effects is inconsistent, as epidemiological and stress-reducing clinical interventions have yielded mixed effects on cancer mortality. In this Review, we describe and discuss specific mediating mechanisms identified by preclinical research, and parallel clinical findings. We explain the discrepancy between preclinical and clinical outcomes, through pointing to experimental strengths leveraged by animal studies and through discussing methodological and conceptual obstacles that prevent clinical studies from reflecting the impacts of stress. We suggest approaches to circumvent such obstacles, based on targeting critical phases of cancer progression that are more likely to be stress-sensitive; pharmacologically limiting adrenergic-inflammatory responses triggered by medical procedures; and focusing on more vulnerable populations, employing personalized pharmacological and psychosocial approaches. Recent clinical trials support our hypothesis that psychological and/or pharmacological inhibition of excess adrenergic and/or inflammatory stress signalling, especially alongside cancer treatments, could save lives.
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Affiliation(s)
- Anabel Eckerling
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Itay Ricon-Becker
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Liat Sorski
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Elad Sandbank
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Shamgar Ben-Eliyahu
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.
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8
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Ozaki A, Murakami M, Nomura S, Sawano T, Tsubokura M, Ono K, Takebayashi Y, Tsukada M, Yamaoka K, Nakata Y, Ohira H. Overall health information exposure, its barriers and impacts on attitude toward healthcare among cancer patients. The long-term aftermath of the 2011 triple disaster in Fukushima, Japan: A single institution cross-sectional study. Health Informatics J 2021; 27:1460458221996420. [PMID: 33878956 DOI: 10.1177/1460458221996420] [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: 11/16/2022]
Abstract
Disasters can hinder access to health information among cancer patients. However, little is known regarding overall health information exposure (HIE), its barriers and its impacts on attitudes toward healthcare among cancer patients in the long-term aftermath of disasters. The aims of this study were threefold: assess the extent of HIE; identify associations between family composition and a non-engagement with HIE; and examine the effects of HIE on attitudes toward healthcare among local cancer patients-5 years after the 2011 triple disaster (earthquake, tsunami, and nuclear disaster) in Fukushima, Japan. We conducted self-administered surveys with all cancer and non-cancer surgery department outpatients at Minamisoma Municipal General Hospital (MMGH), Minamisoma City, from October 2016 to January 2017. In total, 404 patients (263 cancer patients and 141 non-cancer patients) voluntarily participated in the study. The results revealed that a regular level of HIE occurred among 90.5% of the cancer patients. In cancer patients, family composition was not significantly associated with HIE, and HIE was not associated with attitude toward healthcare. In conclusion, most cancer patients visiting the MMGH surgical department were regularly engaged in HIE.
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Affiliation(s)
- Akihiko Ozaki
- Minamisoma Municipal General Hospital, Japan.,Jyoban Hospital of Tokiwa Foundation, Japan
| | | | - Shuhei Nomura
- Minamisoma Municipal General Hospital, Japan.,The University of Tokyo, Japan.,Keio Univeristy, Japan
| | - Toyoaki Sawano
- Minamisoma Municipal General Hospital, Japan.,Sendai Open Hospital, Japan.,Fukushima Medical University, Japan
| | - Masaharu Tsubokura
- Minamisoma Municipal General Hospital, Japan.,Fukushima Medical University, Japan
| | - Kyoko Ono
- National Institute of Advanced Industrial Science and Technology, Japan
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Stewart RJ, Humphris GM, Donaldson J, Cruickshank S. Does Cancer Type Influence the Impact of Recurrence? A Review of the Experience of Patients With Breast or Prostate Cancer Recurrence. Front Psychol 2021; 12:635660. [PMID: 34267696 PMCID: PMC8276075 DOI: 10.3389/fpsyg.2021.635660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/04/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: Patients will experience a plethora of issues when faced with a recurrence of their cancer. It is unclear if cancer type is a significant factor in how recurrence is experienced by an individual. The aim of the current review is to explore the evidence base and summarise the experiences of patients specifically with a recurrence of breast or prostate cancer (the most common for women and men, respectively) and then provide a comparison of these experiences. These experiences include the physical, psychological and psychosocial issues that arise at this time. Methods: A systematic search was conducted of studies published between January 1994 and April 2019. Due to the mix of research designs used previously in the literature, this review was conducted in an integrative manner; allowing for inclusion of diverse research designs. Results were synthesised narratively, with data categorised according to physical, psychological, and psychosocial indices of quality of life. The review protocol was registered in the international database of prospective systematic reviews in health and social care- (CRD42019137381). Results: Fifteen breast cancer and six prostate cancer articles were identified, each reporting one relevant study. Patients reported several negative issues at the time of a breast or prostate cancer recurrence. Similarities were found between cancer types, with physical problems such as fatigue, psychological issues including anxiety and depressive symptoms, and psychosocial concerns such as issues with healthcare professionals common in both cancers. Certain findings were inconsistent across studies, with some experiences differing between studies rather than due to cancer type. Conclusions: Differences in the experience of recurrent cancer appear to be more heavily influenced by individual factors, rather than cancer type. Findings are confounded by gender; and should be considered preliminary. Effects of recurrence should be studied in samples where cancer type and gender are not confounded. Concerns are raised about available study quality and differing outcome measures in this interpretation. Care and support of the individual at the time of a cancer recurrence is a key focus. Future research suggestions with implications for clinical practise are included. Systematic Review Registration: PROSPERO 2019 CRD42019137381.
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Affiliation(s)
- Ross James Stewart
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | | | - Jayne Donaldson
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Susanne Cruickshank
- Royal Marsden National Health Service Foundation Trust, London, United Kingdom
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10
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Health-Related Quality of Life in Very Long-Term Cancer Survivors 14-24 Years Post-Diagnosis Compared to Population Controls: A Population-Based Study. Cancers (Basel) 2021; 13:cancers13112754. [PMID: 34206134 PMCID: PMC8199519 DOI: 10.3390/cancers13112754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 01/06/2023] Open
Abstract
Simple Summary Little is known about the health-related quality of life in very long-term cancer survivors 10 and more years post-diagnosis. Therefore, we compared the health-related quality of life of survivors of breast, colorectal, and prostate cancer (14–24 years post-diagnosis) with that of same-aged non-cancer controls, according to age, sex, and disease status (disease-free vs. stage IV, recurrence, metastasis, or second cancer). We found that the overall global health status/quality of life of cancer survivors more than a decade after diagnosis was slightly higher than that of population controls of the same age, but more symptoms and lower functioning were reported. Differences were small but statistically significant. Results differed by age, sex, and disease status. The findings point out the need for a comprehensive survivorship care program in order to monitor and treat potential late and long-term effects after the diagnosis and treatment of cancer. Survivorship care should be risk-adapted to survivors’ needs according to sociodemographic and clinical factors. Abstract (1) Background: Little is known about the health-related quality of life (HRQoL) in very long-term cancer survivors (VLTCS) 10 and more years post-diagnosis. The objective was to compare cancer survivors’ HRQoL 14–24 years post-diagnosis with that of same-aged non-cancer controls, stratified by age, sex, and disease status (disease-free vs. stage IV, recurrence, metastasis, or second cancer). (2) Methods: We recruited 2704 very long-term survivors of breast, colorectal and prostate cancer, and 1765 controls in German multi-regional population-based studies. The HRQoL was assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Differences in the HRQoL were estimated with multiple regression, controlling for age, sex (where appropriate), and education. (3) Results: The overall global health status/quality of life of VLTCS more than a decade after diagnosis was slightly higher than that of population controls of the same age, but more symptoms and lower functioning were reported. Differences were small but statistically significant. Results differed by age, sex, and disease status. (4) Conclusions: The findings point out the need for a comprehensive survivorship care program in order to monitor and treat potential late and long-term effects after the diagnosis and treatment of cancer. Survivorship care should be risk-adapted to survivors’ needs according to sociodemographic and clinical factors.
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Harbeck N, Schneeweiss A, Thuss-Patience P, Miller K, Garbe C, Griesinger F, Eberhardt WEE, Klussmann JP, Wollenberg B, Grimm MO, Zander T, Lüftner D. Neoadjuvant and adjuvant end-points in health technology assessment in oncology. Eur J Cancer 2021; 147:40-50. [PMID: 33611103 DOI: 10.1016/j.ejca.2021.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 11/26/2022]
Abstract
Health technology assessment (HTA) of clinical and economic value of a new intervention is an integral step in providing the access of patients to innovative cancer care and treatment. Overall survival (OS) is the preferred criterion for demonstrating the therapeutic efficacy in HTA given its direct clinical and patient relevance. However, with often long life expectancy of patients with early cancer, analysis of OS becomes less practical. Partially due to this reason, pathological complete response (pCR) and time-to-event end-points like disease-free survival are frequently incorporated into the pivotal clinical trials in the neoadjuvant and adjuvant settings. However, there exists a discrepancy between different national HTA bodies regarding the acknowledgement of patient relevance of these end-points. In this article, we analysed the perspectives of patients on different aspects of end-points used in clinical trials in early cancer. Gathered evidence strongly suggests that complete tumour eradication and reduced risk of recurrence provide important psychological benefits thus signifying that pCR and time-to-event end-points are directly relevant to patients. Additionally, we reviewed opinions on patient relevance of neoadjuvant and adjuvant therapy end-points adopted by HTA bodies during the recent evaluations. We found that improvements in end-points used in the adjuvant setting were commonly considered as valuable to patients. In contrast, opinions on patient relevance of neoadjuvant therapy end-points varied between the national HTA bodies. Universal acknowledgement of patient relevance of therapeutic end-points for early cancer by HTA bodies is necessary to balance the inequality in uptake of innovative therapies into national healthcare systems.
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Affiliation(s)
- Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center, University of Munich (LMU), 81377 Munich, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Division of Gynecologic Oncology, University Hospital and German Cancer Research Center, 69120 Heidelberg, Germany
| | - Peter Thuss-Patience
- Department of Hematology, Oncology and Tumor Immunology, Campus Virchow-Klinikum, Charité University Hospital Berlin, 12203 Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité University Hospital Berlin, 12203 Berlin, Germany
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius-Hospital, University Department Internal Medicine-Oncology, University of Oldenburg, 26121 Oldenburg, Germany
| | - Wilfried E E Eberhardt
- Department of Medical Oncology, West German Cancer Centre, Ruhrlandklinik, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Jens P Klussmann
- Department of Otolaryngology, Head and Neck Surgery, Medical Faculty, University Hospital Cologne, 50937 Cologne, Germany
| | - Barbara Wollenberg
- Department of Otolaryngology, Head and Neck Surgery, University Hospital MRI, Technical University Munich, 81675 Munich, Germany
| | - Marc-Oliver Grimm
- Department of Urology, Jena University Hospital, 07747 Jena, Germany
| | - Thomas Zander
- Department of Internal Medicine I, University Hospital Cologne, 50924 Cologne, Germany
| | - Diana Lüftner
- Department of Hematology, Oncology and Tumour Immunology, Charité Campus Benjamin Franklin, University Medicine Berlin, 12200 Berlin, Germany.
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12
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Tarnasky AM, Troy JD, LeBlanc TW. The patient experience of ABVD treatment in Hodgkin lymphoma: a retrospective cohort study of patient-reported distress. Support Care Cancer 2021; 29:4987-4996. [PMID: 33576877 DOI: 10.1007/s00520-021-06044-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/04/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Psychological distress is prevalent in Hodgkin lymphoma (HL). Many patients, regardless of prognosis, receive ABVD chemotherapy as first-line treatment, but few studies have specifically examined the nature of distress during this shared treatment experience. METHODS We conducted a retrospective study of patient-reported distress in HL patients receiving ABVD treatment at a single tertiary care facility. Distress was measured using the National Comprehensive Cancer Network Distress Thermometer and Problem List (PL). We used descriptive statistics and generalized estimating equations to assess the prevalence of distress and specific problem items during treatment and associations with patient- and disease-related factors. RESULTS We collected data from 50 patients comprising 467 unique encounters, with 369/467 (79.0%) reporting a distress thermometer score. Median distress score was 2 (IQR: 0-5), but actionable distress (distress thermometer ≥4) was noted for 118/369 (32.0%) encounters. Actionable distress was only related to having a prior cancer, which conferred lower odds of actionable distress (OR 0.23, 95% CI 0.07-0.74, p=0.01) Physical and emotional problems were reported for 287/369 (77.8%) and 125/369 (33.9%) visits, respectively. Female patients had greater odds of both physical (OR 3.17, 95% CI 1.32-7.66, p=0.01) and emotional (OR 3.31, 95% CI 1.25-8.73, p=0.02) problems. CONCLUSION ABVD treatment is associated with a high frequency of actionable distress, with physical and emotional problems acting as primary drivers. Female patients may be particularly vulnerable, while cancer survivors may be uniquely resilient. These findings demonstrate the need to thoroughly screen for and appropriately tailor distress management strategies for HL patients during treatment with ABVD.
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Affiliation(s)
| | - Jesse D Troy
- Division of Biostatistics, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, 27710, USA. .,Duke Cancer Institute, Box 2715, DUMC,, Durham, NC, 27710, USA.
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13
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Yang M, Zeng L, Yao WQ, Ke NW, Tan CL, Tian BL, Liu XB, Xiang B, Zhang Y. A comprehensive validation of the novel 8th edition of American Joint Committee on Cancer staging manual for the long-term survivals of patients with non-functional pancreatic neuroendocrine neoplasms. Medicine (Baltimore) 2020; 99:e22291. [PMID: 33181635 PMCID: PMC7668515 DOI: 10.1097/md.0000000000022291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Histologically, the World Health Organization has classified pancreatic neuroendocrine neoplasms (p-NENs) into well-differentiated pancreatic neuroendocrine tumors (G1/G2 p-NETs) and poorly-differentiated pancreatic neuroendocrine carcinoma (G3 p-NECs) based on tumor mitotic counts and Ki-67 index. Recently, the 8th edition of American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging manual has incorporated some major changes in 2017 that the TNM staging system for p-NENs should only be applied to well-differentiated G1/G2 p-NETs, while poorly-differentiated G3 p-NECs be classified according to the new system for pancreatic exocrine adenocarcinomas. However, this new manual for p-NENs has seldom been evaluated.Data of patients with both G1/G2 and G3 non-functional p-NENs (NF-p-NENs) from our institution was retrospectively collected and analyzed using 2 new AJCC 8th staging systems. We also made survival comparisons between the 8th and 7th edition system separately for different subgroups.For G1/G2 NF-p-NETs, there were 52 patients classified in AJCC 8th edition stage I, 40 in stage II, 41 in stage III and 19 in stage IV. As for G3 NF-p-NECs, 17, 19, 24, and 18 patients were respectively defined from AJCC 8th edition stage I to stage IV. In terms of the AJCC 7th staging system, the 230 patients with NF-p-NENs were totally distributed from stage I to stage IV (94, 63, 36, 37, respectively). For the survival analysis of both G1/G2 NF-p-NETs and G3 NF-p-NECs, the AJCC 7th edition system failed to discriminate the survival differences when compared stage III with stage II or stage IV (P > .05), while the 8th edition ones could perfectly allocate patients into 4 statistically different groups (P < .05). The HCIs of AJCC 8th stage for G1/G2 NF-p-NETs [HCI=0.658, 95% confidence interval (CI)=0.602-0.741] and stage for G3 NF-p-NECs (HCI=0.704, 95% CI=0.595-0.813) was both statistically larger than those of AJCC 7th stage for different grading NF-p-NENs [(HCI=0.578, 95% CI=0.557-0.649; P=.031), (HCI=0.546, 95% CI=0.531-0.636; P = .019); respectively], indicating a more accurate predictive ability for the survivals of NF-p-NENs.Our data suggested the 2 new AJCC 8th staging systems were superior to its 7th edition for patients with both G1/G2 NF-p-NETs and G3 NF-p-NECs.
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Affiliation(s)
| | | | | | - Neng-wen Ke
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, the People's Republic of China
| | - Chun-lu Tan
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, the People's Republic of China
| | - Bo-le Tian
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, the People's Republic of China
| | - Xu-bao Liu
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, the People's Republic of China
| | | | - Yi Zhang
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, the People's Republic of China
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Doege D, Thong MSY, Koch-Gallenkamp L, Jansen L, Bertram H, Eberle A, Holleczek B, Pritzkuleit R, Waldmann A, Zeissig SR, Brenner H, Arndt V. Age-specific prevalence and determinants of depression in long-term breast cancer survivors compared to female population controls. Cancer Med 2020; 9:8713-8721. [PMID: 33022889 PMCID: PMC7666751 DOI: 10.1002/cam4.3476] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/18/2020] [Accepted: 09/02/2020] [Indexed: 12/24/2022] Open
Abstract
Background Depression is more prevalent in breast cancer (BC) survivors than in the general population. However, little is known about depression in long‐term survivors. Study objectives were: (1) to compare the age‐specific prevalence of depressive symptoms (a) in BC survivors vs female population controls, (b) in disease‐free BC survivors vs BC survivors with self‐reported recurrence vs controls, and (2) to explore determinants of depression in BC survivors. Methods About 3010 BC survivors (stage I‐III, 5‐16 years post‐diagnosis), and 1005 population controls were recruited in German multi‐regional population‐based studies. Depression was assessed by the Geriatric Depression Scale‐15. Prevalence of mild/severe and severe depression only were estimated via logistic regression, controlling for age and education. Multinomial logistic regression was used to explore determinants of mild and severe depression. Results Compared with population controls, BC survivors were more likely to report mild/severe depression (30.4% vs 23.8%, p = .0003), adjusted for age and education. At all age groups <80 years, prevalence of both mild/severe and severe depression only was significantly higher in BC survivors, while BC survivors ≥80 years reported severe depression less frequently than controls. BC survivors with recurrence reported significantly higher prevalence of mild/severe depression than disease‐free survivors and controls, but prevalence in disease‐free survivors and controls was comparable. Age, income, living independently, recurrence, and BMI were significant determinants of mild depression in BC survivors. Age, education, employment, income, recurrence, and BMI were significant determinants of severe depression. Conclusions Long‐term BC survivors <80 years report significantly higher prevalence of depressive symptoms than controls, which might be explained by recurrence and individual factors. The findings suggest that depression in BC survivors is common, and even more after BC recurrence. Clinicians should routinize screening and normalize referral to psychological care.
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Affiliation(s)
- Daniela Doege
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melissa S Y Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | | | - Annika Waldmann
- Hamburg Cancer Registry, Hamburg, Germany.,Institute of Social Medicine and Epidemiology, University Lübeck, Lübeck, Germany
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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15
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Babbitt GA, Lynch ML, McCoy M, Fokoue EP, Hudson AO. Function and evolution of B-Raf loop dynamics relevant to cancer recurrence under drug inhibition. J Biomol Struct Dyn 2020; 40:468-483. [DOI: 10.1080/07391102.2020.1815578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Gregory A. Babbitt
- Thomas H. Gosnell School of Life Sciences, Rochester Institute of Technology, Rochester, New York, USA
| | - Miranda L. Lynch
- Hauptmann-Woodward Medical Research Institute, Buffalo, New York, USA
| | - Matthew McCoy
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, DC, USA
| | - Ernest P. Fokoue
- School of Mathematical Sciences, Rochester Institute of Technology, Rochester, New York, USA
| | - André O. Hudson
- Thomas H. Gosnell School of Life Sciences, Rochester Institute of Technology, Rochester, New York, USA
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16
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Distress and mental health care and medication use among survivors of multiple primary cancer diagnoses: Findings from the 2016 National Health Interview Survey. J Psychosom Res 2020; 134:110137. [PMID: 32417691 DOI: 10.1016/j.jpsychores.2020.110137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/09/2020] [Accepted: 05/07/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Over 1 million survivors of multiple primary cancer (MPC) diagnoses reside in the USA. Information regarding their physical and mental health status is limited. This study examined distress and mental health care use among MPC survivors relative to survivors of a single primary cancer (SPC) diagnosis. METHODS Using the 2016 National Health Information Survey, MPC survivors (n = 265), SPC survivors (n = 2103), and no cancer controls (NCC; n = 28,320) were identified. The MPC group was compared to the SPC and NCC groups with regard to multiple distress indices and use of mental health care and anxiety and depression medication. RESULTS Relative to the SPC group, the MPC group reported more Total Distress (M = 9.59 vs. 8.84; p < .001), and were more likely to report daily or weekly anxiety feelings (OR = 2.07; p < .001), meet criteria for serious psychological distress (OR = 1.49; p = .02) and have talked to a mental health professional (OR = 1.75; p = .01). Comparison of MPC and NweCC groups yielded similar results. The MPC group did not differ from the SPC or NCC groups in severity of anxiety or depression feelings, distress interference, or anxiety and depression medication use. CONCLUSIONS MPC survivors reported greater distress relative to SPC survivors. The clinical significance of this greater distress is unclear, however. While MPC survivors were more likely to have talked to a mental health professional, uptake of mental health care appeared to be suboptimal. MPC and SPC survivors might be considered distinct subgroups and increased attention devoted to potentially unique mental and physical health needs of MPC survivors.
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17
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Morzycki A, Corkum J, Joukhadar N, Samargandi O, Williams JG, Frank SG. The Impact of Delaying Breast Reconstruction on Patient Expectations and Health-Related Quality of Life: An Analysis Using the BREAST-Q. Plast Surg (Oakv) 2020; 28:46-56. [PMID: 32110645 DOI: 10.1177/2292550319880924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose An understanding of patient expectations predicts better health outcomes following breast reconstruction. No study to date has examined how patient expectations for breast reconstruction and preoperative health-related quality of life vary with time since breast cancer diagnosis. Methods Women consulting for breast reconstruction to a single surgeon's practice over a 13-month period were enrolled in this cross-sectional study. Patients were asked to prospectively complete the BREAST-Q expectations and preoperative reconstruction modules. A retrospective chart review was then performed on eligible patients, and patient demographics, cancer-related factors, and comorbidities were collected. BREAST-Q scores were transformed using the equivalent Rasch method. Multivariate linear regression models were constructed to assess the association between BREAST-Q scores and time since cancer diagnosis. Results Sixty-five patients met inclusion criteria for analysis and are characterized by a mean age of 53 ± 11 (34-79) years and a mean body mass index of 28 ± 6 (19-49). Most patients were treated by mastectomy (58%) or lumpectomy (23%). At the time of retrospective chart review, 29 (43%) patients had undergone reconstruction, most of which were delayed (59%). The mean latency from cancer diagnosis to reconstruction was 685 ± 867 days (range: 28-3322 days). Latency from cancer diagnosis to reconstruction was associated with a greater expectation of pain (β = 0.5; standard error [SE] = 0.005; 95% confidence interval [CI]: 0.003-0.027; P < .05), and a slower expectation for recovery (β = -0.5; SE = 0.004; 95% CI: -0.021 to -0.001; P < .05) after breast reconstruction. Latency from cancer diagnosis to reconstruction was associated with an increase in preoperative psychosocial well-being (β = 0.578; SE 0.009; 95% CI: 0.002-0.046; P < .05). Conclusion Delaying breast reconstruction may negatively impact patient expectations of postoperative pain and recovery. Educational interventions aimed at understanding and managing patient expectations in the preoperative period may improve health-related quality of life and patient-related outcomes following initial breast cancer surgery.
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Affiliation(s)
- Alexander Morzycki
- Division of Plastic and Reconstructive Surgery, University of Alberta, Alberta, Edmonton, Canada
| | - Joseph Corkum
- Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nadim Joukhadar
- Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Osama Samargandi
- Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason G Williams
- Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Simon G Frank
- Division of Plastic Surgery, University of Ottawa, Ottawa, Ontario, Canada
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18
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van Roessel S, Kasumova GG, Verheij J, Najarian RM, Maggino L, de Pastena M, Malleo G, Marchegiani G, Salvia R, Ng SC, de Geus SW, Lof S, Giovinazzo F, van Dam JL, Kent TS, Busch OR, van Eijck CH, Koerkamp BG, Abu Hilal M, Bassi C, Tseng JF, Besselink MG. International Validation of the Eighth Edition of the American Joint Committee on Cancer (AJCC) TNM Staging System in Patients With Resected Pancreatic Cancer. JAMA Surg 2018; 153:e183617. [PMID: 30285076 DOI: 10.1001/jamasurg.2018.3617] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Importance The recently released eighth edition of the American Joint Committee on Cancer TNM staging system for pancreatic cancer seeks to improve prognostic accuracy but lacks international validation. Objective To validate the eighth edition of the American Joint Committee on Cancer TNM staging system in an international cohort of patients with resected pancreatic ductal adenocarcinoma. Design, Setting, and Participants This international multicenter cohort study took place in 5 tertiary centers in Europe and the United States from 2000 to 2015. Patients who underwent pancreatoduodenectomy for nonmetastatic pancreatic ductal adenocarcinoma were eligible. Data analysis took place from December 2017 to April 2018. Exposures Patients were retrospectively staged according to the seventh and eighth editions of the TNM staging system. Main Outcomes and Measures Prognostic accuracy on survival rates, assessed by Kaplan-Meier and multivariate Cox proportional hazards analyses and concordance statistics. Results A total of 1525 consecutive patients were included (median [IQR] age, 66 (58-72) years; 802 (52.6%) male). Distribution among stages via the seventh edition was stage IA in 41 patients (2.7%), stage IB in 42 (2.8%), stage IIA in 200 (13.1%), stage IIB in 1229 (80.6%), and stage III in 12 (0.8%); this changed with use of the eighth edition to stage IA in 118 patients (7.7%), stage IB in 144 (9.4%), stage IIA in 22 (1.4%), stage IIB in 643 (42.2%), and stage III in 598 (39.2%). With the eighth edition, 774 patients (50.8%) migrated to a different stage; 183 (12.0%) were reclassified to a lower stage and 591 (38.8%) to a higher stage. Median overall survival for the entire cohort was 24.4 months (95% CI, 23.4-26.2 months). On Kaplan-Meier analysis, 5-year survival rates changed from 38.2% for patients in stage IA, 34.7% in IB, 35.3% in IIA, 16.5% in IIB, and 0% in stage III (log-rank P < .001) via classification with the seventh edition to 39.2% for patients in stage IA, 33.9% in IB, 27.6% in IIA, 21.0% in IIB, and 10.8% in stage III (log-rank P < .001) with the eighth edition. For patients who were node negative, the T stage was not associated with prognostication of survival in either edition. In the eighth edition, the N stage was associated with 5-year survival rates of 35.6% in N0, 20.8% in N1, and 10.9% in N2 (log-rank P < .001). The C statistic improved from 0.55 (95% CI, 0.53-0.57) for the seventh edition to 0.57 (95% CI, 0.55-0.60) for the eighth edition. Conclusions and Relevance The eighth edition of the TNM staging system demonstrated a more equal distribution among stages and a modestly increased prognostic accuracy in patients with resected pancreatic ductal adenocarcinoma compared with the seventh edition. The revised T stage remains poorly associated with survival, whereas the revised N stage is highly prognostic.
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Affiliation(s)
- Stijn van Roessel
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gyulnara G Kasumova
- Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Joanne Verheij
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Robert M Najarian
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Laura Maggino
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Matteo de Pastena
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Giuseppe Malleo
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Giovanni Marchegiani
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Roberto Salvia
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Sing Chau Ng
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Susanna W de Geus
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Sanne Lof
- Department of Surgery, Southampton University Hospital National Health Service Foundation Trust, Southampton, United Kingdom
| | - Francesco Giovinazzo
- Department of Surgery, Southampton University Hospital National Health Service Foundation Trust, Southampton, United Kingdom
| | - Jacob L van Dam
- Department of Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Tara S Kent
- Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Olivier R Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | - Mohammed Abu Hilal
- Department of Surgery, Southampton University Hospital National Health Service Foundation Trust, Southampton, United Kingdom
| | - Claudio Bassi
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Jennifer F Tseng
- Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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19
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Paredes AC, Pereira MG. Spirituality, Distress and Posttraumatic Growth in Breast Cancer Patients. JOURNAL OF RELIGION AND HEALTH 2018; 57:1606-1617. [PMID: 28725952 DOI: 10.1007/s10943-017-0452-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Breast cancer is the most common type of cancer for women and is associated with increased distress. Spirituality and posttraumatic growth (PTG) have been associated with illness adjustment, but the relationship between these variables is still not well understood. A sample of 100 breast cancer patients completed a demographic and clinical questionnaire, the Posttraumatic Growth Inventory, Spiritual and Religious Attitudes in Dealing with Illness, and the Hospital Anxiety and Depression Scale. Results showed an association between PTG, spirituality and distress. Women with a longer diagnosis and recurrence showed more distress. Younger age, recurrent cancer and spirituality predicted higher PTG. Patients' spirituality should be part of intervention with breast cancer patients since it seems to be related to greater growth and adjustment to the illness.
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Affiliation(s)
| | - M Graça Pereira
- School of Psychology, University of Minho, 4710-057, Braga, Portugal.
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Recurrent Cancer Is Associated With Dissatisfaction With Care—A Longitudinal Analysis Among Ovarian and Endometrial Cancer Patients. Int J Gynecol Cancer 2018; 28:614-622. [DOI: 10.1097/igc.0000000000001204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe primary aim of this study was to assess the longitudinal impact of a recurrence of gynecological cancer on satisfaction with information provision and care. The secondary aim was to assess the impact of a recurrence on illness perceptions, anxiety, and depression and health-related quality of life.MethodsThis study is a longitudinal analysis from the ROGY Care trial, conducted between 2011 and 2014, including patients with endometrial (n = 215) and ovarian (n = 149) cancer. Patients were invited to complete questionnaires directly after initial treatment and after 6, 12, and 24 months. Satisfaction with information provision and care, illness perceptions, anxiety, and depression were compared before and after the recurrence. Linear mixed-model analyses were conducted to assess the differences in outcomes of patients with a recurrence compared with patients without a recurrence.ResultsDuring 2-year follow-up, 25 patients with endometrial cancer (12%) and 64 patients with ovarian cancer (43%) had recurrent disease, of whom 9 endometrial and 26 ovarian cancer patients completed at least 1 questionnaire after their recurrence was determined. Patients reported lower satisfaction with care after the diagnosis of a recurrence (doctor interpersonal skills, exchange of information between caregivers, and general satisfaction with care) compared with patients without recurrence. In addition, patients reported lower health-related quality of life, more anxiety and depression, and more threatening illness perceptions after diagnosis of a recurrence.ConclusionsAfter diagnosis of recurrent disease, endometrial and ovarian cancer patients were less satisfied with care compared with patients without a recurrence. Our findings suggest that patients with recurrent cancer are in need of care that is better tailored to their needs.
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Abstract
We aimed to describe the quality of life (QOL) among parents of adolescent and young adult brain tumor survivors as well as parent, survivor, and diagnosis/treatment-related factors associated with adverse QOL. A cross-sectional study of 28 parents of adolescent and young adult brain tumor survivors (who were on average 10 y postdiagnosis) was used to assess QOL. Parent QOL was measured using the Patient-Reported Outcomes Measurement Information System Global Health measure. Factors associated with adverse parent QOL were explored using logistic regression including: parent, survivor, and diagnosis/treatment-related factors. Parent QOL was within the normal range; however, 40% scored below the clinical threshold of 0.5 SD below the mean for physical and mental health. Parent perceptions of greater family impact, survivor emotional/behavioral health problems, improved cognitive function, and recurrence were associated with adverse parent physical health. Parent anger/sorrow, uncertainty, survivor emotional/behavioral health problems, speech/language problems, and recurrence were associated with adverse parent mental health. Parental emotional resources and perceptions of improved survivor peer relationships were associated with greater parent physical and mental health. The impact of a brain tumor diagnosis and treatment on the QOL of parents may be significant. Interventions are needed to ensure that the needs of parents are met.
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Becherer BE, Kamali P, Paul MA, Wu W, Curiel DA, Rakhorst HA, Lee B, Lin SJ, Kansal KJ. Prevalence of psychiatric comorbidities among women undergoing free tissue autologous breast reconstruction. J Surg Oncol 2017; 116:803-810. [PMID: 28743179 DOI: 10.1002/jso.24755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 06/11/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Autologous breast reconstruction (BR) can be a stressful life event. Therefore, women undergoing mastectomy and autologous BR are required to have sufficient coping mechanisms. Although mental health problems are widespread, information regarding the prevalence of psychiatric diagnosis among these patients is scarce. METHODS Retrospective analysis was performed using data from a large tertiary teaching hospital and the Nationwide Inpatient Sample (NIS) database. Patients undergoing autologous BR after mastectomy were included and evaluated for psychiatric disorders. Prevalence of each disorder, timing of diagnosis (preoperative or postoperative), and data per age group were reviewed. RESULTS Between 2004 and 2014, 817 patients were included from the institutional database and 26 399 from the NIS database. Preoperatively, 15.3% of the patients were diagnosed with a psychiatric disorder within our institution and 17.6% nationwide (P < 0.001). Postoperatively, 20.5% of the institutional patients were diagnosed with a psychiatric disorder. No major differences in prevalence were seen between age groups. CONCLUSIONS Approximately, one in six patients were diagnosed with a psychiatric comorbidity preoperatively. Postoperatively, an additional 20.5% developed a psychiatric disorder. There was no difference in prevalence and timing of diagnosis between age groups.
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Affiliation(s)
- Babette E Becherer
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Parisa Kamali
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Marek A Paul
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Winona Wu
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniel A Curiel
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Hinne A Rakhorst
- Division of Plastic, Reconstructive and Hand Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.,Division of Plastic, Reconstructive and Hand Surgery, Enschede, The Netherlands
| | - Bernard Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kari J Kansal
- Division of Surgical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Lee MS, Tyson DM, Gonzalez BD, Small BJ, Lechner SC, Antoni MH, Vinard A, Krause M, Meade C, Jacobsen PB. Anxiety and depression in Spanish-speaking Latina cancer patients prior to starting chemotherapy. Psychooncology 2017; 27:333-338. [PMID: 28557067 DOI: 10.1002/pon.4462] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/07/2017] [Accepted: 05/22/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Anxiety and depression can substantially impact the life of a cancer patient, but literature on emotional distress in the Hispanic cancer population is sparse. Additionally, the influence of psychosocial variables including age, acculturation, and spiritual well-being on emotional distress in this population remains unclear. The purpose of the present report was to assess the prevalence of anxiety and depression in Spanish-speaking Latina cancer patients preparing to begin chemotherapy and to explore the predictors and correlates of these outcomes. METHODS Participants were 198 Spanish-speaking Latina cancer patients who completed measures of anxiety, depression, acculturation, and spiritual well-being prior to starting chemotherapy. RESULTS Prevalence of clinically significant anxious symptomatology was 52%, and prevalence of clinically significant depressive symptomatology was 27%. Longer time since diagnosis and less acculturation predicted more severe anxiety, while longer time since diagnosis, less acculturation, and older age predicted more severe depression (Ps < .05). In multivariable analyses, only time since diagnosis emerged as a significant predictor of anxiety and depression when accounting for the influence of other variables. Greater spiritual well-being was correlated with both less severe anxiety and less severe depression (Ps < .001). CONCLUSIONS The present findings document the high prevalence of emotional distress, particularly anxiety, in this patient population prior to chemotherapy initiation and identify several demographic and clinical factors associated with increased risk for heightened distress. Additionally, these findings suggest that interventions to address distress in this patient population would benefit from including components that seek to improve patients' spiritual well-being.
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Affiliation(s)
| | | | | | - Brent J Small
- University of South Florida, Tampa, FL, USA.,Moffitt Cancer Center, Tampa, FL, USA
| | - Suzanne C Lechner
- University of Miami, Coral Gables, FL, USA.,Sylvester Cancer Center, Miami, FL, USA
| | - Michael H Antoni
- University of Miami, Coral Gables, FL, USA.,Sylvester Cancer Center, Miami, FL, USA
| | - Andrea Vinard
- University of Miami, Coral Gables, FL, USA.,Sylvester Cancer Center, Miami, FL, USA
| | - Madeline Krause
- University of Miami, Coral Gables, FL, USA.,Sylvester Cancer Center, Miami, FL, USA
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Sohn IJ, Han JW, Hahn SM, Song DH, Lyu CJ, Cheon KA. Factors Associated with Emotional Distress in Children and Adolescents during Early Treatment for Cancer. Yonsei Med J 2017; 58:816-822. [PMID: 28540996 PMCID: PMC5447114 DOI: 10.3349/ymj.2017.58.4.816] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Children and adolescents diagnosed with cancer experience emotional distress, such as sadness, worrying, and irritability. However, there is little information about the psychological well-being of parents at the time of their child's diagnosis. We sought to identify factors that were associated with emotional distress in cancer patients as a basis for developing innovative psychological interventions. MATERIALS AND METHODS A retrospective chart review was performed on patients newly diagnosed with cancer at a single center in Korea from 2014 to 2016. Eighty-five patients and their mothers completed psychological inventories. To determine factors associated with emotional distress in patients, we assessed the psychological inventory results using multiple linear regression after performing correlation analysis. RESULTS The maternal Beck Depression Inventory-II (BDI-II) score was positively correlated with total problem scores and externalizing scores in patients aged less than 7 years. In patients aged 7-12 years, there was no significant association between the patient's emotional distress and other variables. In contrast, the maternal BDI-II score was the strongest factor associated with patient depression in adolescents. CONCLUSION We suggest that the most important factor affecting emotional distress in children and adolescents with cancer is maternal depression, especially in patients aged 1-6 years and aged 13-17 years. Understanding the factors associated with emotional distress of cancer patients allows us to develop early psychiatric interventions for patients and their parents at the initial psychological crisis.
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Affiliation(s)
- In Jung Sohn
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Woo Han
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Hahn
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ho Song
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chuhl Joo Lyu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
| | - Keun Ah Cheon
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Lutgendorf SK, Andersen BL. Biobehavioral approaches to cancer progression and survival: Mechanisms and interventions. ACTA ACUST UNITED AC 2016; 70:186-97. [PMID: 25730724 DOI: 10.1037/a0035730] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Over the last decade, there have been groundbreaking strides in our understanding of the multiple biological pathways by which psychosocial and behavioral factors can affect cancer progression. It is now clear that biobehavioral factors not only affect cellular immunity but both directly and indirectly modulate fundamental processes in cancer growth, including inflammation, angiogenesis, invasion, and metastasis. There is also an emerging understanding of how psychological and behavioral factors used in interventions can impact these physiological processes. This review outlines our current understanding of the physiological mechanisms by which psychological, social, and behavioral processes can affect cancer progression. The intervention literature is discussed, along with recommendations for future research to move the field of biobehavioral oncology forward.
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Morrison EJ, Flynn JM, Jones J, Byrd JC, Andersen BL. Individual differences in physical symptom burden and psychological responses in individuals with chronic lymphocytic leukemia. Ann Hematol 2016; 95:1989-1997. [PMID: 27539615 DOI: 10.1007/s00277-016-2790-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 08/06/2016] [Indexed: 10/21/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is an incurable illness, with some patients requiring no treatment until disease progression. Burden from physical symptoms has been associated with depression, anxiety, and stress in cancer patients. Additionally, patient factors, i.e., individual differences, have been associated with worse psychological outcomes. There are few psychological studies of CLL, with no examination of individual differences. A cross-sectional design studied the covariation of symptom burden with depressive and anxiety symptoms and cancer-specific stress, and tested patients' individual differences as predictors and as moderators. CLL patients (N = 112) receiving active surveillance participated. They were Caucasian (100 %) and predominately male (55 %) with a mean age of 61; most (62.5 %) had stage 0 disease. A composite measure of physical symptom burden (CLL symptoms, fatigue, pain, impaired functional status) was tested as a predictor of psychological responses. Individual differences in psychiatric history and social support were tested as moderators. Using multiple linear regression, greater symptom burden covaried with higher levels of depressive and anxiety symptoms and cancer stress (ps < .05). Those with a psychiatric history, low social support, and low relationship satisfaction with one's partner reported greater symptom burden and more psychological symptoms and stress (ps < .05). Findings suggest that CLL patients in surveillance with a psychiatric history and/or low social support are at risk for greater distress when coping with high symptom burden. These new data clarify the experience of CLL surveillance and identify characteristics of patients with heightened risk for symptom burden, stress, and anxiety or depressive symptoms.
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Affiliation(s)
- Eleshia J Morrison
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Joseph M Flynn
- Norton Cancer Institute, 234 E Gray St, Louisville, KY, 40202, USA
| | - Jeffrey Jones
- Division of Hematology, The Ohio State University, Starling Loving Hall, 320 W 10th Avenue, Columbus, OH, 43210, USA
| | - John C Byrd
- Division of Hematology, The Ohio State University, Starling Loving Hall, 320 W 10th Avenue, Columbus, OH, 43210, USA
| | - Barbara L Andersen
- Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH, 43210, USA
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Conley CC, Bishop BT, Andersen BL. Emotions and Emotion Regulation in Breast Cancer Survivorship. Healthcare (Basel) 2016; 4:healthcare4030056. [PMID: 27517969 PMCID: PMC5041057 DOI: 10.3390/healthcare4030056] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/19/2016] [Accepted: 08/04/2016] [Indexed: 01/10/2023] Open
Abstract
Emotional distress in cancer patients is an important outcome; however, emotional experience does not begin and end with emotion generation. Attempts to regulate emotions may lessen their potentially negative effects on physical and psychological well-being. Researchers have called for the study of emotion regulation (ER) in health psychology and psycho-oncology. Thus, this review has three aims. First, we discuss current understandings of emotion and ER across the cancer trajectory, including the principles of ER and methods for its assessment. Second, we present a model for examining the mediating effects of ER on psychosocial outcomes. Third, we “round out” the discussion with an example: new data on the role of ER in recurrent breast cancer. Taken together, these aims illustrate the impact of affective regulatory processes on cancer patients’ long-term outcomes. As survival rates increase, long-term follow-up studies are needed to characterize the dynamic, reciprocal effects of emotion and ER for cancer survivors. Further research on ER may help women with breast cancer better manage the challenges associated with diagnosis and treatment.
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Affiliation(s)
- Claire C Conley
- Department of Psychology, The Ohio State University, 225 Psychology Building, 1835 Neil Avenue, Columbus, OH 43210, USA.
| | - Brenden T Bishop
- Department of Psychology, The Ohio State University, 225 Psychology Building, 1835 Neil Avenue, Columbus, OH 43210, USA.
| | - Barbara L Andersen
- Department of Psychology, The Ohio State University, 225 Psychology Building, 1835 Neil Avenue, Columbus, OH 43210, USA.
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Westbrook TD, Maddocks K, Andersen BL. The relation of illness perceptions to stress, depression, and fatigue in patients with chronic lymphocytic leukaemia. Psychol Health 2016; 31:891-902. [PMID: 26982998 DOI: 10.1080/08870446.2016.1158259] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Chronic lymphocytic leukaemia (CLL) is the most prevalent adult leukaemia and is incurable. The course and treatment of CLL is unique and characterised by repeated cycles of treatment, stable disease and relapse. Utilising a Self-Regulatory Model framework, we examined the relationship between patients' illness perceptions and cancer-specific stress, depressive symptoms and fatigue. Our aim was to test illness perceptions as predictors of these outcomes when variance due to disease and treatment variables was controlled. DESIGN Data were collected on 147 patients with relapsed/refractory CLL as they entered a phase II clinical trial of an investigational medication at a university affiliated, National Cancer Institute designated comprehensive cancer center. MAIN OUTCOME MEASURES Cancer-specific stress, depressive symptoms and fatigue interference. RESULT . Hierarchical multiple regression was used. Consequences and emotional representation were related to all outcomes (ps < .01). Illness concern was related to cancer-specific stress (p < .01), and identity was related to fatigue interference (p < .01). All relationships were observed while controlling for number of previous CLL therapies received. CONCLUSION Illness perceptions are related to cancer-specific stress, depressive symptoms and fatigue interference in relapsed/refractory CLL. Interventions targeted at restructuring maladaptive illness perceptions may have clinical benefit in this population.
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Affiliation(s)
- Travis D Westbrook
- a Department of Psychology , The Ohio State University , Columbus , OH , USA
| | - Kami Maddocks
- b Division of Hematology , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - Barbara L Andersen
- a Department of Psychology , The Ohio State University , Columbus , OH , USA
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Ganz PA, Stanton AL. Living with Metastatic Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 862:243-54. [PMID: 26059940 DOI: 10.1007/978-3-319-16366-6_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Although prevalence estimates are imprecise, growing numbers of women in the United States are living longer with metastatic breast cancer, attributable at least in part to the availability of effective targeted therapies. Women living with metastatic disease are understudied, however, and substantial heterogeneity exists in both the clinical characteristics of metastatic tumors and the physical and psychological experience of patients living with the disease. Survivorship issues are complex for patients who are living with metastatic disease over extended periods of time, from years to decades. Newly diagnosed patients with stage IV disease are confronting cancer for the first time, while others have metastatic disease as a result of breast cancer recurrence. Many patients are able to live for years on stable medical regimens, and yet others live with a moving target of aggressive disease with arduous treatments and uneven response. The psychological common denominator is the experience of profound life threat and the accompanying uncertainty, for both the affected woman and her loved ones. Maintaining life balance in the face of metastatic disease, as well as managing pain, fatigue, and other physical and psychological symptoms are major challenges. Increasingly, the clinical approach to metastatic disease reflects the consensus that palliative and supportive care are essential from the point of diagnosis. To remedy the paucity of systematic research on women living with metastatic breast cancer for extended periods, we offer directions for research to understand the experience of metastatic breast cancer and to provide evidence-based inter-professional care.
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Affiliation(s)
- Patricia A Ganz
- UCLA Schools of Medicine and Public Health, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA,
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Wanat M, Boulton M, Watson E. Patients' experience with cancer recurrence: a meta-ethnography. Psychooncology 2015. [PMID: 26224137 DOI: 10.1002/pon.3908] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Recurrence is a difficult stage in the cancer journey as it brings to the fore the life-threatening nature of the illness. This meta-ethnography examines and synthesises the findings of qualitative research regarding patients' experience of cancer recurrence. METHODS A systematic search of the qualitative studies published between January 1994 to April 2014 was undertaken. Seventeen relevant papers were identified, and a meta-ethnography was conducted. RESULTS Six third-order concepts were developed to capture patients' experiences: experiencing emotional turmoil following diagnosis, which described the emotional impact of diagnosis and the influence of previous experiences on how the news were received; experiencing otherness, encompassing changed relationships; seeking support in the health care system, describing the extent of information needs and the importance of the relationship with health care professionals; adjusting to a new prognosis and uncertain future, highlighting the changes associated with uncertainty; finding strategies to deal with recurrence, describing ways of maintaining emotional well-being and regaining a sense of control over cancer; and facing mortality, describing the difficulties in facing death-related concerns and associated consequences. CONCLUSIONS This meta-ethnography clarifies the fundamental aspects of patients' experience of recurrence. It suggests that health care professionals can promote a positive experience of care and help lessen the psychosocial impact of recurrence by providing information in an approachable way and being sensitive to their changing needs. It also points to the importance of supporting patients in adopting strategies to regain a sense of control and to address their potential mortality and its impact on loved ones.
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Affiliation(s)
- Marta Wanat
- Clinical Health Care Department, Oxford Brookes University, Jack Straws Lane, Oxford, UK
| | - Mary Boulton
- Clinical Health Care Department, Oxford Brookes University, Jack Straws Lane, Oxford, UK
| | - Eila Watson
- Clinical Health Care Department, Oxford Brookes University, Jack Straws Lane, Oxford, UK
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Taylor-Ford M. Clinical considerations for working with patients with advanced cancer. J Clin Psychol Med Settings 2015; 21:201-13. [PMID: 24916664 DOI: 10.1007/s10880-014-9398-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Advanced cancer is a life-limiting condition, but improvements in medical care are contributing to longer survival among some patients. As a result, it is likely that mental health professionals will be called upon to assist more patients with advanced cancer. The present paper reviews the psychological literature and from it draws clinical considerations for working with individuals affected by advanced cancer. It begins with a brief description of advanced cancer and the medical attributes of an advanced cancer diagnosis, and then catalogues salient medical, psychological, existential, and interpersonal challenges faced by this patient population. The review concludes with recommendations for treatment planning including an overview of some of the more recently tested and widely available interventions. It is hoped that this review will serve as a resource for professionals working with patients affected by advanced cancer.
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Affiliation(s)
- Megan Taylor-Ford
- Department of Psychology, University of Southern California, SGM 501, 3620 South McClintock Ave., Los Angeles, CA, 90089-1061, USA,
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Villaron C, Marqueste T, Eisinger F, Cappiello MA, Therme P, Cury F. Activité physique et cancer du sein métastatique : qualité de vie, fatigue et estime de soi — étude pilote. ONCOLOGIE 2015. [DOI: 10.1007/s10269-014-2474-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Kim SH. An Ethnographic Research on Psychological Experiences of Mothers Caring for their Children with Recurent Cancer. ASIAN ONCOLOGY NURSING 2015. [DOI: 10.5388/aon.2015.15.2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Seong-Heui Kim
- Department of Nursing, Seoul National University Hospital, Seoul, Korea
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Schuler TA, Zaider TI, Li Y, Hichenberg S, Masterson M, Kissane DW. Typology of perceived family functioning in an American sample of patients with advanced cancer. J Pain Symptom Manage 2014; 48:281-8. [PMID: 24766739 PMCID: PMC5177448 DOI: 10.1016/j.jpainsymman.2013.09.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/03/2013] [Accepted: 09/10/2013] [Indexed: 11/19/2022]
Abstract
CONTEXT Poor family functioning affects psychosocial adjustment and the occurrence of morbidity following bereavement in the context of a family's coping with advanced cancer. Family functioning typologies assist with targeted family-centered assessment and intervention to offset these complications in the palliative care setting. OBJECTIVES Our objective was to identify the number and nature of potential types in an American palliative care patient sample. METHODS Data from patients with advanced cancer (N = 1809) screened for eligibility for a larger randomized clinical trial were used. Cluster analyses determined whether patients could be classified into clinically meaningful and coherent groups, based on similarities in their perceptions of family functioning across the cohesiveness, expressiveness, and conflict resolution subscales of the Family Relations Index. RESULTS Patients' reports of perceived family functioning yielded a model containing five meaningful family types. CONCLUSION Cohesiveness, expressiveness, and conflict resolution appear to be useful dimensions by which to classify patient perceptions of family functioning. "At risk" American families may include those we have called hostile, low-communicating, and less-involved. Such families may benefit from adjuvant family-centered psychosocial services, such as family therapy.
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Affiliation(s)
- Tammy A Schuler
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
| | - Talia I Zaider
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Shira Hichenberg
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Melissa Masterson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - David W Kissane
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA; School of Psychology and Psychiatry, Monash University, Clayton, Victoria, Australia
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Thornton LM, Cheavens JS, Heitzmann CA, Dorfman CS, Wu SM, Andersen BL. Test of mindfulness and hope components in a psychological intervention for women with cancer recurrence. J Consult Clin Psychol 2014; 82:1087-100. [PMID: 24884347 DOI: 10.1037/a0036959] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Psychological interventions can attenuate distress and enhance coping for those with an initial diagnosis of cancer, but there are few intervention options for individuals with cancer recurrence. To address this gap, we developed and tested a novel treatment combining Mindfulness, Hope Therapy, and biobehavioral components. METHOD An uncontrolled, repeated measures design was used. Women (N = 32) with recurrent breast or gynecologic cancers were provided 20 treatment sessions in individual (n = 12) or group (n = 20) formats. On average, participants were middle aged (M = 58) and Caucasian (81%). Independent variables (i.e., hope and mindfulness) and psychological outcomes (i.e., depression, negative mood, worry, and symptoms of generalized anxiety disorder) were assessed pre-treatment and 2, 4, and 7 months later. Session-by-session therapy process (positive and negative affect, quality-of-life) and mechanism (use of intervention-specific skills) measures were also included. RESULTS Distress, anxiety, and negative affect decreased, whereas positive affect and mental-health-related quality-of-life increased over the course of treatment, as demonstrated in mixed-effects models with the intent-to-treat sample. Both hope and mindfulness increased, and use of mindfulness skills was related to decreased anxiety. CONCLUSIONS This treatment was feasible to deliver and was acceptable to patients. The trial serves as preliminary evidence for a multi-component intervention tailored to treat difficulties specific to recurrent cancer. The blending of the components was novel as well as theoretically and practically consistent. A gap in the literature is addressed, providing directions for testing interventions designed for patients coping with the continuing stressors and challenges of cancer recurrence.
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Thornton LM, Levin AO, Dorfman CS, Godiwala N, Heitzmann C, Andersen BL. Emotions and social relationships for breast and gynecologic patients: a qualitative study of coping with recurrence. Psychooncology 2013; 23:382-9. [PMID: 24123502 DOI: 10.1002/pon.3429] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 09/05/2013] [Accepted: 09/16/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND In contrast to the large literature on patients' coping with an initial diagnosis of cancer, there have been few quantitative or qualitative studies of patients coping with recurrence. A qualitative study was undertaken to aid in the development of a tailored intervention for these patients. METHODS Individuals (N=35) receiving follow-up care for recurrent breast or gynecologic cancer at a university-affiliated cancer center participated in an individual or a group interview. Transcripts of interviews were analyzed using a coding format with two areas of emphasis. First, we focused on patients' emotions, as there is specificity between emotions and the corresponding ways in which individuals choose to manage them. Secondly, we considered the patients' social environments and relationships, as they too appear key in the adjustment to, and survival from, cancer. RESULTS Patients identified notable differences in their responses to an initial diagnosis of cancer and their current ones to recurrence, including the following: (i) depressive symptoms being problematic; (ii) with the passing years and the women's own aging, there is shrinkage in the size of social networks; and (iii) additional losses come from social support erosion, arising from a) intentional distancing by social contacts, b) friends and family not understanding that cancer recurrence is a chronic illness, and/or c) patients stemming their support requests across time. CONCLUSION The contribution of these findings to the selection of intervention strategies is discussed.
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Affiliation(s)
- Lisa M Thornton
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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Yanez B, Garcia SF, Victorson D, Salsman JM. Distress among young adult cancer survivors: a cohort study. Support Care Cancer 2013; 21:2403-8. [PMID: 23568764 DOI: 10.1007/s00520-013-1793-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 03/14/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Being diagnosed with cancer as a young adult can lead to significant psychological distress and impaired quality of life. Compared to children and older adults diagnosed with cancer, fewer studies have addressed psychological distress among young adult cancer survivors. This study sought to identify the prevalence of, and factors associated with, distress among young adult cancer survivors (ages 18-39). METHODS Young adult cancer survivors (N = 335, mean age = 31.8, women = 68.4%) were recruited from an online research panel and stratified by cohort (time postactive treatment: 0-12, 13-24, and 25-60 months). Participants completed measures assessing demographic and clinical characteristics, global impact of cancer, cancer-related education and work interruption, and cancer-specific distress using the impact of event scale (IES). RESULTS The mean score on the IES (M = 31.0, range = 0-75) was above the cut point of 20, suggesting clinically elevated distress. Analysis of covariance revealed significant main effects for cohort, global impact and cancer-related education/work interruption, and an interaction between cohort and cancer-related education/work interruption on distress. Although there was no significant effect of education/work interruption on distress for those in the 0-12 month cohort (p = .88), survivors in the 13-24 and 25-60 month cohorts reporting education/work interruption were significantly more distressed than those not reporting education/work interruption in the respective cohorts (p < .05). CONCLUSIONS Young adult cancer survivors face unique challenges. These data underscore the importance of attending to cancer-related distress beyond the completion of treatment and may help inform targeted interventions to prevent or reduce significant distress and related sequelae in this population.
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Affiliation(s)
- Betina Yanez
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th floor, Chicago, IL 60611, USA.
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The impact of caregiving on the psychological well-being of family caregivers and cancer patients. Semin Oncol Nurs 2013; 28:236-45. [PMID: 23107181 DOI: 10.1016/j.soncn.2012.09.006] [Citation(s) in RCA: 246] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To provide an overview of patient and caregiver emotional distress; examine the sources of their distress, review evidence-based interventions that can reduce distress, and provide guidelines for assessment and intervention. DATA SOURCES Peer-reviewed publications. CONCLUSION There is a significant, reciprocal relationship between patient and caregiver emotional distress. Sources of distress vary by phase of illness. Evidence-based interventions can reduce distress and anxiety, but often are not implemented in practice. IMPLICATIONS FOR NURSING PRACTICE Nurses need to assess patients and family caregivers for distress and intervene to reduce distress by fostering patient-caregiver teamwork, communication, and self-care; providing information; and referring to resources as needed.
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Spiegel D. Tranceformations: hypnosis in brain and body. Depress Anxiety 2013; 30:342-52. [PMID: 23423952 DOI: 10.1002/da.22046] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 11/27/2012] [Accepted: 12/01/2012] [Indexed: 01/30/2023] Open
Abstract
In this review, the role of hypnosis and related psychotherapeutic techniques are discussed in relation to the anxiety disorders. In particular, anxiety is addressed as a special form of mind/body problem involving reverberating interaction between mental and physical distress. The history of hypnosis as a therapeutic discipline is reviewed, after which neurobiological evidence of the effect of hypnosis on modulation of perception in the brain. Specific brain regions involved in hypnosis are reviewed, notably the dorsal anterior cingulate gyrus and the dorsolateral prefrontal cortex. The importance of hypnotizability as a trait, stable variability in hypnotic responsiveness, is discussed. Analogies between the hypnotic state and dissociative reactions to trauma are presented, and the uses of hypnosis in treating posttraumatic stress disorder, stressful situations, and phobias as well as outcome data are reviewed. Effects of hypnosis on control of somatic processes are discussed, and then effects of psychosocial support involving Supportive-Expressive Group Therapy and hypnosis on survival time for cancer patients are evaluated. The evidence indicates an important role for hypnosis in managing anxiety disorders and anxiety related to medical illness.
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Affiliation(s)
- David Spiegel
- Stanford University School of Medicine, Stanford, CA 94305-5718, USA.
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Postoperative Complications following Nodal Dissection and Their Association with Melanoma Recurrence. ISRN SURGERY 2013; 2013:382138. [PMID: 23533815 PMCID: PMC3600306 DOI: 10.1155/2013/382138] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 01/30/2013] [Indexed: 02/05/2023]
Abstract
Background. Although postoperative complications are common after lymph node dissection, its association with disease recurrence has not yet been fully investigated. Methods. A retrospective review of a prospectively maintained database was conducted, looking at all malignant melanoma patients with sentinel nodes positive disease requiring axillary or inguinal dissection between 2002 and 2011. Results. A total of 124 patients required nodal clearance from 317 patients with stage I/II malignant melanoma who had undergone sentinel lymph node biopsy. Of these, 104 patients met the inclusion criteria and were divided into inguinal lymph node dissections (ILND; n = 63) or axillary lymph node dissections (ALND; n = 41). Immunohistochemical deposits had higher detection rate in ALND (P = 0.01). The ILND patients had a higher recurrence rate (84.1% versus 63.4%; P = 0.02) and mortality (68.3% versus 48.8%; P = 0.05) without a significant difference in complications. In patients whom complications developed, 75% of the ILND group and 71.4% of the ALND group had disease recurrence, but without reaching a statistical value as an independent predictor of melanoma recurrence. Conclusion. Complications are common following ILND and ALND; however there is no significant difference in complications rates between the groups with some associations with recurrence without reaching a significant difference.
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Mehnert A, Lehmann C, Koch U. [Doctor-patient interaction: dealing with difficult situations]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:1134-43. [PMID: 22936481 DOI: 10.1007/s00103-012-1544-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Good doctor-patient communication has a positive impact on patient satisfaction, adherence to treatment, health outcomes and well-being, and it has been linked to reduced anxiety, increased recall, and improved understanding. During the diagnostic phase and the course of the illness, patients exhibit a range of mood changes. These include sadness and worry, frustration and anger, uncertainty, fear of disease recurrence, difficulties in inter-personal relationships, changing roles, and concerns about body image. Medical consultations can be influenced by different expectations concerning the doctor-patient interaction, by individual roles and beliefs, and by a different understanding of health and well-being influenced by cultural and other factors not necessarily associated with the medical situation. Responding to anger and other difficult emotions, dealing with family meetings, or communicating via interpreters are often experienced as demanding situations by health care professionals. This article provides an overview of the difficult doctor-patient interactions and illustrates basic communication skills in responding to challenging situations.
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Affiliation(s)
- A Mehnert
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52 - Gebäude W26, 20246, Hamburg, Deutschland.
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Cripe LD, Rawl SM, Schmidt KK, Tong Y, Monahan PO, Rand KL. Discussions of life expectancy moderate relationships between prognosis and anxiety or depression in men with advanced cancer. J Palliat Med 2012; 15:99-105. [PMID: 22268405 DOI: 10.1089/jpm.2011.0249] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Oncologists avoid prognostic discussions due to concerns about increasing patients' anxiety or depression. We sought to determine if perceived prognosis or extent of prognostic discussions predicted anxiety or depression and whether prognostic discussions moderated the relationship between prognosis and anxiety or depression. METHODS Men with advanced cancer and their oncologists estimated the likelihood of survival at 6 months and reported extent of prognostic discussions. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). RESULTS Men who died within 6 months reported higher scores on depression but not anxiety. Men who estimated a lower (10%-75%) likelihood of surviving at least 6 months were more depressed and anxious than men who estimated a higher (>90%) likelihood of survival. A similar relationship was seen with oncologists' prognostications. Men who reported having had full prognostic discussions with their oncologist had less depression compared with men who reported having had brief or no discussions. Men for whom the oncologists reported a full discussion had greater anxiety. The relationships between patient-perceived prognosis and depression or anxiety were moderated by extent of prognostic discussions as reported by the patient or oncologist, respectively. CONCLUSION Full prognostic discussions are associated with less depression among men who perceive a poor prognosis. Anxiety is increased in men if the oncologists report a full discussion. Oncologists should engage in prognostic discussions but assess for increased anxiety to facilitate coping with advanced cancer.
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Affiliation(s)
- Larry D Cripe
- Indiana University Simon Cancer Center, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.
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Creach KM, Siegel BA, Nussenbaum B, Grigsby PW. Radioactive iodine therapy decreases recurrence in thyroid papillary microcarcinoma. ISRN ENDOCRINOLOGY 2012; 2012:816386. [PMID: 22462017 PMCID: PMC3313572 DOI: 10.5402/2012/816386] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 11/24/2011] [Indexed: 11/23/2022]
Abstract
Background. The most appropriate therapy for papillary microcarcinoma (PMC) is controversial. Methods. We reviewed the therapy and outcome of 407 patients with PMC. Results. Three hundred-eighty patients underwent total thyroidectomy, and 349 patients received I-131 therapy. The median followup was 5.3 years. Forty patients developed recurrent disease. On univariate analysis, development of disease recurrence was correlated with histological tumor size > 0.8 cm (P = 0.0104), age < 45 years (P = 0.043), and no I-131 therapy (P < 0.0001). On multivariate analysis, histological tumor size > 0.8 cm, positive lymph nodes, and no I-131 therapy were significant. The 5-year RFS for patients treated with I-131 was 95.0% versus 78.6% (P < 0.0001) for patients not treated with I-131. Patients with lymph node metastasis who did not receive I-131 had a 5-year RFS of 42.9% versus 93.2% (P < 0.0001) for patients who received I-131. Conclusions. Recommend I-131 remnant ablation for patients with PMC, particularly patients with lymph node metastasis.
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Affiliation(s)
- Kimberly M Creach
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Mailstop no. 90-38-635, St. Louis, MO 63110, USA
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Tacón AM. Mindfulness: existential, loss, and grief factors in women with breast cancer. J Psychosoc Oncol 2012; 29:643-56. [PMID: 22035537 DOI: 10.1080/07347332.2011.615382] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Although a plethora of studies exist as to the efficacy of mindfulness-based interventions with cancer patients, existential, loss, and grief factors are absent. The primary purpose of this exploratory study was to add to the literature by exploring the pre-post effects of an 8-week mindfulness-based intervention on existential well-being, summed self-identified losses, and grief scores as well as assess mental adjustment to cancer; also, 6-month follow-up data as to intervention maintenance were obtained. Sixty-five women, all of whom had been diagnosed with breast cancer within the past 12 months, participated in this study. The data indicated significant improvements for existential well-being, number of self-identified losses, grief scores as well as three mental adjustment styles. Six-month follow-up revealed that of the 58 responding participants, 88% were maintaining mindfulness strategies at varying schedules on a weekly basis with mindfulness-based walking as the preferred strategy. This is the first known mindfulness-based intervention study to investigate existential, loss, and grief factors in those with cancer. Further investigations earnestly are needed in this area to provide full psychosocial care to those confronting cancer.
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Affiliation(s)
- A M Tacón
- Department of Health, Exercise and Sport Sciences, Texas Tech University, Lubbock, USA.
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Gregorio SWD, Carpenter KM, Dorfman CS, Yang HC, Simonelli LE, Carson WE. Impact of breast cancer recurrence and cancer-specific stress on spouse health and immune function. Brain Behav Immun 2012; 26:228-33. [PMID: 21807090 PMCID: PMC3250556 DOI: 10.1016/j.bbi.2011.07.237] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 07/15/2011] [Accepted: 07/17/2011] [Indexed: 12/01/2022] Open
Abstract
Spouses of cancer patients are at-risk for poor psychological and physical health as they cope with the complex nature of the disease and fears of losing their partner. Moreover, spouses often serve as patients' primary informal caregivers, a group that evidences poor outcomes across a variety of domains. The present study examines the relative contributions of cancer recurrence - a cancer-specific stressful event - and the subjective experience of cancer-specific stress (IES) in a sample of male spouses of breast cancer survivors. We hypothesized that stress would contribute to poorer physical health and compromised immune function. Spouses (recurrence; n=16) of patients who were coping with their first recurrence were matched to spouses of patients with no evidence of disease (disease-free; n=16). Self-reported physical health (physical symptoms and fatigue) and immune function [T-cell blastogenic response to the mitogens Concanavalin A (ConA) and phytohemagglutanin (PHA) and T3 monoclonal antibody (T3 Mab)] were included as outcomes. Results indicated that patient recurrence status was not a significant unique predictor of physical health or immune function; rather, among all spouses, cancer-specific stress symptoms were associated with increased physical symptoms and altered T-cell blastogenesis. These data suggest that the health implications of caregiving for spouses of cancer survivors is more strongly linked to their subjective experience of cancer as stressful, rather than simply the patients' disease status.
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Affiliation(s)
- Sharla Wells-Di Gregorio
- Department of Psychiatry, Center for Palliative Care, The Ohio State University, Columbus, OH 43210–1222, USA.
| | | | | | | | | | - William E. Carson
- Department of Surgery, College of Medicine and Comprehensive Cancer Center, The Ohio State University
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Karabeg R, Lukic D, Janjic Z, Jakirlic M, Dujso V, Bandic J, Babic N, Karabeg A, Guzvic V, Lazic P. The analysis of reasons for malignant skin tumors late diagnosis. Mater Sociomed 2012; 24:73-5. [PMID: 23678311 PMCID: PMC3633384 DOI: 10.5455/msm.2012.24.73-75] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 05/15/2012] [Indexed: 11/29/2022] Open
Abstract
Introduction: Timely diagnosis is a prerequisite for the successful treatment of malignant skin tumors. Late diagnosis leads a patient into a situation of losing valuable time and chance for cure. Material and methods: A prospective study was conducted from February 2006 until August 2011 which analyzed the reasons that led to establishing the diagnosis of malignant skin tumors in 220 patients. Patients were divided into two groups: Group A (102 patients), patients with diagnosed melanoma, and group B (118 patients) of patients suffering from basocellular (BCC) and planocellular cell (PCC) skin cancer. Parameters for comparison of analysis results were the reasons for coming to examination and reasons for not coming to the examination, because of which skin cancers were not diagnosed in time. Goal: To determine the factors that influences the establishment of late diagnosis and treatment of skin tumors. Results: It was confirmed that the prejudices of patients that tumors of the skin „should not be operated because it is dangerous“ is the main reason for late diagnosis. At the same time it is confirmed that the belief that it is unnecessary to operate congenital changes of the skin is the second most important reason for delayed diagnosis of malignant skin tumors.
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Affiliation(s)
- Reuf Karabeg
- Clinical Center University of Sarajevo, Bosnia and Herzegovina
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Dyadic effects of fear of recurrence on the quality of life of cancer survivors and their caregivers. Qual Life Res 2011; 21:517-25. [DOI: 10.1007/s11136-011-9953-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2011] [Indexed: 10/18/2022]
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Kelly KM, Shedlosky-Shoemaker R, Porter K, Desimone P, Andrykowski M. Cancer recurrence worry, risk perception, and informational-coping styles among Appalachian cancer survivors. J Psychosoc Oncol 2011; 29:1-18. [PMID: 21240722 DOI: 10.1080/07347332.2011.534014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite a growing literature on the psychosocial impact of the threat of cancer recurrence, underserved populations, such as those from the Appalachian region, have been understudied. To examine worry and perceived risk in cancer survivors, Appalachian and non-Appalachian cancer patients at an ambulatory oncology clinic in a university hospital were surveyed. Appalachians had significantly higher worry than non-Appalachians. Cancer type and lower need for cognition were associated with greater worry. Those with missing perceived risk data were generally older, less educated, and lower in monitoring, blunting, and health literacy. Additional resources are needed to assist Appalachians and those with cancers with poor prognoses (e.g., liver cancer, pancreatic cancer) to cope with worry associated with developing cancer again. More attention for cancer prevention is critical to improve quality of life in underserved populations where risk of cancer is greater.
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Affiliation(s)
- Kimberly M Kelly
- School of Pharmacy and Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, WV 26506, USA.
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Hjörleifsdóttir E, Óskarsson GK. Psychological distress in Icelandic patients with repeated recurrences of cancer. Int J Palliat Nurs 2010; 16:586-92. [DOI: 10.12968/ijpn.2010.16.12.586] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elísabet Hjörleifsdóttir
- Associate Professor, School of Health Sciences, University of Akureyri, 600 Akureyri, Iceland and a palliative care nurse at the hospice home care service in Akureyri
| | - Guðmundur Kr. Óskarsson
- Associate Professor, School of Business and Science, University of Akureyri, 600 Akureyri, Iceland
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