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Chevalier LL, Blackmon JE, Bober SL, Roman A, Chang G, Recklitis CJ. Evaluating sensitive symptoms in young adult cancer survivors: acceptability of suicidal ideation and sexual health items across administration modes. J Cancer Surviv 2024; 18:450-456. [PMID: 35904728 DOI: 10.1007/s11764-022-01237-5] [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: 05/05/2022] [Accepted: 07/15/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Patient-reported outcomes (PROs) are essential for assessing potential late effects experienced by young adult cancer survivors (YACS), but stigma and social desirability bias may limit their effectiveness for assessing sensitive topics (e.g., suicidal ideation, sexual health). This study compared two methods of item administration to determine the optimal method for obtaining sensitive information in YACS. METHODS Two hundred forty-four YACS (ages 18-40) were randomized to complete measures of suicidal ideation and sexual health (i.e., sensitive items) by paper survey or by telephone automated computer assisted structured interview (TACASI). Participants also provided information on acceptability of administration mode and sensitive items. RESULTS The proportion of participants reporting symptoms did not significantly vary between paper and TACASI administration: respectively, 10% vs. 12% reported suicidal ideation and 55% vs. 58% reported sexual health concerns. The majority (≥ 78%) of participants reported feeling comfortable answering sensitive items on paper and TACASI and there were no significant differences in acceptability based on administration mode. Although participants endorsing sensitive symptoms were significantly more likely to feel upset answering sensitive items, the majority (93%) of participants experiencing symptoms still felt they were important to ask. CONCLUSIONS Despite their potentially sensitive nature, questions about suicidal ideation and sexual health were highly acceptable to YACS across administration modes. Moreover, YACS almost universally endorse the importance of providers asking about these topics. IMPLICATIONS FOR CANCER SURVIVORS Findings should bolster provider confidence that screening for suicidal ideation and sexual health concerns can and should be integrated into clinical care for YACS using paper or technology-assisted methods.
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Affiliation(s)
- Lydia L Chevalier
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Jaime E Blackmon
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Sharon L Bober
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Anthony Roman
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- University of Massachusetts, Boston, MA, USA
| | - Grace Chang
- Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Brockton, MA, USA
| | - Christopher J Recklitis
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
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2
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Skaali T, Blomhoff R, Lindemann K, Smeland S, Bruheim K, Seland M, Thorsen L. Self-reported distress and problems after treatment for gynecological cancer - Correlation between a short screening tool and longer measures of anxiety/depression and health-related quality of life. Acta Obstet Gynecol Scand 2024; 103:387-395. [PMID: 37991142 PMCID: PMC10823398 DOI: 10.1111/aogs.14709] [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: 04/10/2023] [Revised: 09/16/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION The National Comprehensive Cancer Network (NCCN) distress thermometer and problem list (DTPL) is a brief self-report screening measure for use in follow-up cancer care. The aims of this study were to explore the correlations between scores on the DTPL and scores on longer measures of anxiety/depression and health-related quality of life among women treated for gynecological cancer, and to define a cutoff score on the DT representing high levels of psychological distress in this patient group. MATERIAL AND METHODS During outpatient visits, 144 women filled in the DTPL, the Hospital Anxiety and Depression Scale (HADS) and the RAND-36-Item Short Form Health Survey (RAND-36) between October 2019 and March 2020. We assessed the agreement between the DT-scores and the HADS scores, explored variables associated with high levels of distress on the DT, and studied the associations between DTPL-scores and scores of health-related quality of life (HRQoL) from RAND-36. RESULTS In receiver operating characteristic curve analysis between the distress score from the DT and a HADS total score ≥15 (defining high levels of anxiety/depression symptoms), the area under the curve was 0.81 (95% CI: 0.74-0.89). Using a cutoff of ≥5 on the DT (scale 0-10), we found a balanced level of sensitivity (81%) and specificity (71%) towards a HADS total score of ≥15. The scores of distress and problems reported on the DTPL correlated significantly with the majority of HRQoL function scales from RAND-36. CONCLUSIONS The NCCN DTPL can be used as a screening measure for self-reported distress and problems after treatment for gynecological cancer. A score of ≥5 on DT may indicate high level of anxiety/depression as measured by HADS. The tool may help identify patients in need of referral to supportive care and rehabilitation facilities.
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Affiliation(s)
- Tone Skaali
- Department of Clinical Service, Division of Cancer MedicineOslo University HospitalOsloNorway
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of MedicineUniversity of OsloOsloNorway
| | - Rune Blomhoff
- Department of Clinical Service, Division of Cancer MedicineOslo University HospitalOsloNorway
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of MedicineUniversity of OsloOsloNorway
| | - Kristina Lindemann
- Department of Gynecologic Cancer, Division of Cancer MedicineOslo University HospitalOsloNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
| | - Sigbjørn Smeland
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
- Division of Cancer MedicineOslo University HospitalOsloNorway
| | - Kjersti Bruheim
- Department of Oncology, Division of Cancer MedicineOslo University HospitalOsloNorway
| | - Mette Seland
- Department of Clinical Service, Division of Cancer MedicineOslo University HospitalOsloNorway
| | - Lene Thorsen
- Department of Clinical Service, Division of Cancer MedicineOslo University HospitalOsloNorway
- Department of Oncology, Division of Cancer Medicine, National Advisory Unit on Late Effects after Cancer TreatmentOslo University HospitalOsloNorway
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Salsman JM, McLouth LE, Tooze JA, Little-Greene D, Cohn M, Kehoe MS, Moskowitz JT. An eHealth, Positive Emotion Skills Intervention for Enhancing Psychological Well-Being in Young Adult Cancer Survivors: Results from a Multi-Site, Pilot Feasibility Trial. Int J Behav Med 2023; 30:639-650. [PMID: 36890329 PMCID: PMC10485177 DOI: 10.1007/s12529-023-10162-5] [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] [Accepted: 02/01/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Young adult (YA) cancer survivors experience clinically significant distress and have limited access to psychosocial support. Given growing evidence for unique adaptive benefits of positive emotion in the context of health-related and other life stress, we developed an eHealth positive emotion skills intervention for post-treatment survivors called EMPOWER (Enhancing Management of Psychological Outcomes With Emotion Regulation) and evaluated feasibility and proof of concept for reducing distress and enhancing well-being. METHOD In this single-arm pilot feasibility trial, post-treatment YA cancer survivors (ages 18-39) participated in the EMPOWER intervention which included 8 skills (e.g., gratitude, mindfulness, acts of kindness). Participants completed surveys at baseline (pre-intervention), 8 weeks (post-intervention), and 12 weeks (1-month follow-up). Primary outcomes included feasibility (assessed by participation percentage) and acceptability (would recommend EMPOWER skills to a friend). Secondary outcomes included psychological well-being (mental health, positive affect, life satisfaction, meaning/purpose, general self-efficacy) and distress (depression, anxiety, anger). RESULTS We assessed 220 YAs for eligibility; 77% declined. Of those screened, 44 (88%) were eligible and consented, 33 began the intervention, and 26 (79%) completed the intervention. Overall retention was 61% at 12 weeks. Average acceptability ratings were high (8.8/10). Participants (M = 30.8 years, SD = 6.6) were 77% women, 18% racial/ethnic minorities, and 34% breast cancer survivors. At 12 weeks, EMPOWER was associated with improved mental health, positive affect, life satisfaction, meaning/purpose, and general self-efficacy (ps < .05, ds = .45 to .63) and decreased anger (p < .05, d = - 0.41). CONCLUSION EMPOWER demonstrated evidence of feasibility and acceptability as well as proof of concept for enhancing well-being and reducing distress. Self-guided, eHealth interventions show promise for addressing YA cancer survivors' needs and warrant additional research to optimize survivorship care. TRIAL REGISTRATION ClinicalTrials .gov NCT02832154, https://clinicaltrials.gov/ct2/show/NCT02832154.
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Affiliation(s)
- John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine & Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Laurie E McLouth
- Department of Behavioral Science and Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine & Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Denisha Little-Greene
- Health Care Education, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Mia Sorkin Kehoe
- Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Guleria B, Viswanath S, Soneji D, Kapoor R, Guleria P, Suresh P, Kumar M, Patel A, Swamy S. Cancer in the Adolescent and Young Adults (AYA) and Children: A Comprehensive Analysis of the Epidemiology and Psychosocial Morbidity in the Indian Population. South Asian J Cancer 2021; 11:73-81. [PMID: 35833048 PMCID: PMC9273329 DOI: 10.1055/s-0041-1735482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims
Adolescent and young adults (AYAs), children with cancer, and their guardians have unique psychosocial morbidities adversely effecting quality of life (QOL). This is measurable using patented tools. We analyzed epidemiological and clinicopathological patterns of solid organ cancers in this subgroup. We also assessed psychosocial morbidity and changes in QOL faced by them.
Methods
All patients aged 2 to 39 years, newly diagnosed with cancer from April 2017 to March 2019 were included. Clinical history, diagnosis, staging, treatment, outcomes, and follow-up were recorded. The National Comprehensive Cancer Network (NCCN) distress thermometer and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C-30) were used to assess psychosocial morbidity of AYAs, children ≥ 12 years, and parents of children < 12 years. Pediatric Quality of Life Inventory (Peds QL) version 3.0 was used for children < 12 years. Data was analyzed using descriptive statistics.
Results
A total of 571 patients (512 AYAs, 59 children) were enrolled. Median age was 30 years with male predominance (58.1%). Most cases (98.6%) were absent from school or work. Carcinoma breast was the most common in females (29.3%) and non-Hodgkin lymphoma in males (12.6%). 91.06% had overall NCCN distress score ≥ 4. Also, 73.81 and 79.49% had “quite a bit” or “very much” responses on functional and symptom scales, respectively, in EORTC QLQ C-30 questionnaire. Peds QL version 3.0 revealed total score ranging from 276 to 523 for each patient.
Conclusion
AYAs and children with cancer are extremely vulnerable to psychological stress and morbidity. Use of well-established tools help in assessing their mental status and timely psychiatric referral can be initiated.
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Affiliation(s)
- Bhupesh Guleria
- Department of Medical Oncology, Malignant Diseases Treatment Center, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - S. Viswanath
- Department of Medical Oncology, Malignant Diseases Treatment Center, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
| | - Dharmesh Soneji
- Department of Medical Oncology, Malignant Diseases Treatment Center, Army Hospital Research and Referral, New Delhi, India
| | - Rajan Kapoor
- Department of Hematology, Command Hospital (Eastern Command), Kolkata, West Bengal, India
| | - Prerna Guleria
- Department of Pathology, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - P. Suresh
- Department of Medical Oncology, Malignant Diseases Treatment Center, Army Hospital Research and Referral, New Delhi, India
| | - Manish Kumar
- Department of Medical Oncology, Malignant Diseases Treatment Center, Army Hospital Research and Referral, New Delhi, India
| | - Amol Patel
- Department of Medical Oncology, INHS ASVINI, Mumbai, Maharashtra, India
| | - Shivshankar Swamy
- Department of Medical Oncology, Malignant Diseases Treatment Center, Army Hospital Research and Referral, New Delhi, India
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5
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Recklitis CJ, Blackmon JE, Chevalier LL, Chang G. Validating the Patient-Reported Outcomes Measurement Information System Short Form v1.0-Anxiety 8a in a sample of young adult cancer survivors: Comparison with a structured clinical diagnostic interview. Cancer 2021; 127:3691-3697. [PMID: 34196978 DOI: 10.1002/cncr.33683] [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: 01/20/2021] [Revised: 04/16/2021] [Accepted: 05/15/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The objective of this study was to validate the Patient-Reported Outcomes Measurement Information System Short Form v1.0-Anxiety 8a (PROMIS-A-SF) against a structured diagnostic interview in order to determine its accuracy and the most appropriate cutoff score for identifying anxiety disorders in young adult cancer survivors (YACSs). METHODS Two hundred forty-nine YACSs aged 18 to 40 years (50% male) completed the PROMIS-A-SF and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). The SCID was used to determine whether participants met the criteria for an anxiety diagnosis. Receiving operator characteristic analyses were performed to determine the concordance of the PROMIS-A-SF and the SCID as well as cutoff scores with sensitivity (≥0.85) and specificity (≥0.75) appropriate for an anxiety screening measure. RESULTS The PROMIS-A-SF was determined to have good overall discrimination in comparison with the SCID (area under the curve, 0.84). A PROMIS-A-SF t-score cutoff ≥ 53.2 (total predictive value, 67.9%) came closest to meeting the study criteria with a sensitivity of 88%, but the specificity was only 65%. In a hypothetical screening example, this cutoff led to moderate levels of missed cases (14%) and a significant proportion of clinical referrals that were unnecessary by SCID criteria (35%). Of the survivors referred for services according to these criteria, less than one-third (29%) would have a SCID anxiety diagnosis. CONCLUSIONS The PROMIS-A-SF demonstrated moderately strong concordance with anxiety disorders measured by the SCID, but cutoff scores did not meet study criteria for clinical screening. Although it may not be appropriate as a standalone screener, the PROMIS-A-SF may be useful for assessing anxiety in YACSs when it is incorporated into clinical practice or when it is combined with other measures.
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Affiliation(s)
- Christopher J Recklitis
- Perini Family Survivor's Center, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jaime E Blackmon
- Perini Family Survivor's Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lydia L Chevalier
- Perini Family Survivor's Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Grace Chang
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, VA Boston Healthcare System, Brockton, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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6
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Ernst J, Friedrich M, Vehling S, Koch U, Mehnert-Theuerkauf A. Cancer-Related Distress: How Often Does It Co-occur With a Mental Disorder? - Results of a Secondary Analysis. Front Psychol 2021; 12:660588. [PMID: 34248754 PMCID: PMC8260981 DOI: 10.3389/fpsyg.2021.660588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/01/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives The Distress Thermometer (DT) is a validated and widely used screening tool to identify clinically relevant distress in cancer patients. It is unclear, to which extend subjectively perceived distress measured by the DT is related to objective burden (mental disorder). We therefore examine the co-occurrence of a mental disorder for different DT thresholds and explore the diagnostic properties of the DT in detecting a mental disorder. Methods In this multicenter cross-sectional study, we included 4,020 patients with mixed cancer diagnoses. After selection of relevant cases, weighting procedure and imputation of missing data we evaluated the data of N = 3,212 patients. We used the DT to assess perceived distress and the standardized Composite International Diagnostic Interview for Oncology (CIDI-O) to assess the 4-week prevalence of mental disorders. The association between distress and any mental disorder (MD) is calculated using Pearson correlations. Relative risks for MD in patients with/without distress and the co-occurrence of distress and MD were calculated with Poisson regression. To assess the operating characteristics between distress and MD, we present the area under the curve (AUC). Results 22.9% of the participants had a cut-off DT level of ≥5 and were affected by MD. Each level of distress co-occurs with MD. The proportion of patients diagnosed with MD was not greater than the proportion of patients without MD until distress levels of DT = 6 were reached. The correlation between DT and MD was r = 0.27. The ROC-analysis shows the area under curve (AUC) = 0.67, which is classified as unsatisfactory. With increasing distress severity, patients are not more likely to have a mental disorder. Conclusion Our results suggests viewing and treating cancer-related distress as a relatively distinct psychological entity. Cancer-related distress may be associated with an increased risk for a mental disorder and vice versa, but the overlap of both concepts is very moderate.
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Affiliation(s)
- Jochen Ernst
- Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany
| | - Sigrun Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany
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Patterson P, D'Agostino NM, McDonald FEJ, Church TD, Costa DSJ, Rae CS, Siegel SE, Hu J, Bibby H, Stark DP. Screening for distress and needs: Findings from a multinational validation of the Adolescent and Young Adult Psycho-Oncology Screening Tool with newly diagnosed patients. Psychooncology 2021; 30:1849-1858. [PMID: 34160847 PMCID: PMC9291177 DOI: 10.1002/pon.5757] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Adolescents and young adults (AYAs) diagnosed with cancer commonly experience elevated psychological distress and need appropriate detection and management of the psychosocial impact of their illness and treatment. This paper describes the multinational validation of the Distress Thermometer (DT) for AYAs recently diagnosed with cancer and the relationship between distress and patient concerns on the AYA-Needs Assessment (AYA-NA). METHODS AYA patients (N = 288; 15-29 years, Mage = 21.5 years, SDage = 3.8) from Australia (n = 111), Canada (n = 67), the UK (n = 85) and the USA (n = 25) completed the DT, AYA-NA, Hospital Anxiety Depression Scale (HADS) and demographic measures within 3 months of diagnosis. Using the HADS as a criterion, receiver operating characteristics analysis was used to determine the optimal cut-off score and meet the acceptable level of 0.70 for sensitivity and specificity. Correlations between the DT and HADS scores, prevalence of distress and AYA-NA scores were reported. RESULTS The DT correlated strongly with the HADS-Total, providing construct validity evidence (r = 0.65, p < 0.001). A score of 5 resulted in the best clinical screening cut-off on the DT (sensitivity = 82%, specificity = 75%, Youden Index = 0.57). Forty-two percent of AYAs scored at or above 5. 'Loss of meaning or purpose' was the AYA-NA item most likely to differentiate distressed AYAs. CONCLUSIONS The DT is a valid distress screening instrument for AYAs with cancer. The AYA-POST (DT and AYA-NA) provides clinicians with a critical tool to assess the psychosocial well-being of this group, allowing for the provision of personalised support and care responsive to individuals' specific needs and concerns.
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Affiliation(s)
- Pandora Patterson
- Canteen Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Norma M D'Agostino
- Department of Supportive Care, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Fiona E J McDonald
- Canteen Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Terry David Church
- Regulatory and Quality Sciences, School of Pharmacy, University of Southern California, Los Angeles, California, USA
| | - Daniel S J Costa
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Pain Management Research Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Charlene S Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Stuart E Siegel
- Kenneth J. Norris, Jr. Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - James Hu
- Kenneth J. Norris, Jr. Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Helen Bibby
- Canteen Australia, Sydney, New South Wales, Australia
| | - Dan P Stark
- Division of Oncology, Leeds Institute of Medical Research, School of Medicine, The University of Leeds, Leeds, UK
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8
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Pépin AJ, Lippé S, Drouin S, Krajinovic M, Laverdière C, Michon B, Robaey P, Rondeau É, Sinnett D, Sultan S. Screening for distress in pediatric cancer survivors: A systematic comparison of one-step and two-step strategies to minimize detection errors. J Psychosoc Oncol 2021; 40:441-456. [PMID: 33939599 DOI: 10.1080/07347332.2021.1906377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Childhood cancer survivors should be routinely screened for psychological distress. However, existing screening tools promoted by cancer care institutions, such as the Distress Thermometer (DT) generate high rates of errors. The aim of this study is to help refining strategies of screening psychological distress in this population by exploring two-step methods combining the DT on step #1 with one question on step #2. PROCEDURE Data from 255 survivors of childhood acute lymphoblastic leukemia aged 13-40 years were analyzed (38% 13-18 years, 62% 19+ years, 53% females). We used the DT on step #1 and the individual emotion items from the Pediatric Quality of Life Questionnaire (PedsQL) on step #2, to detect distress, depression and anxiety as measured by standard instruments. We compared sensitivity, specificity, negative and positive predictive values, Youden index, and clinical utility indices, in newly developed two-step strategies. RESULTS The best two-step strategies to screen anxious-depressive distress were DT ≥ 2 on step #1, with the item of Sadness on step #2, and DT ≥ 2 combined with the item of Concerns. Two-step strategies outperformed the DT alone on the correct identification of distressed survivors. However, two-step strategies did not outperform the DT used alone on the correct detection of no distressed survivors. Results were similar when predicting depression or anxiety alone. CONCLUSION Completing the DT with one single question on emotions from the PedsQL may minimize the number of participants falsely identified as distressed, which could be particularly pertinent in resource-limited clinics.
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Affiliation(s)
- Annie-Jade Pépin
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Sarah Lippé
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Simon Drouin
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Maja Krajinovic
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Caroline Laverdière
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Bruno Michon
- Laval University Health Center (Laval UHC) Québec, Québec, Québec, Canada
| | - Philippe Robaey
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Émélie Rondeau
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Serge Sultan
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
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9
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Validation of the Greek version of the distress thermometer compared to the clinical interview for depression. BMC Psychiatry 2020; 20:527. [PMID: 33158431 PMCID: PMC7648283 DOI: 10.1186/s12888-020-02926-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/22/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The Distress Thermometer (DT) is worldwide the most commonly used instrument for quick screening of emotional burden in patients with cancer. In order to validate the Greek version of the DT in the Greek population we aimed to explore the capacity of the DT to identify patients with comorbid depressive diagnosis. METHODS We analyzed the routinely collected clinical data from 152 patients with cancer who had been evaluated by the consultation-liaison psychiatric service and had received a diagnosis of either depressive disorder or no psychiatric diagnosis. The score of the DT accompanied by the list of problems in the Problem List, the depression status, and the clinical and demographic characteristics entered the data sheet. RESULTS The ROC analysis revealed that the DT achieved a significant discrimination with an area under the curve of 0.79. At a cut-off point of 4, the DT identified 85% of the patients with an ICD-10 depressive diagnosis (sensitivity) and 60% of the patients without a psychiatric diagnosis (specificity). The positive predictive value was 44%, the negative predictive value 92% and the diagnostic odd ratio 8.88. Fatigue and emotional difficulties were the most commonly reported problems by the patients. CONCLUSION The Greek version of the DT has a sufficient overall accuracy in classifying patients regarding the existence of depressive disorders, in the oncology setting. Therefore, it can be considered as a valid initial screening tool for depression in patients with cancer; patients scoring ≥4 should be assessed by a more thorough mental evaluation.
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10
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Lindner OC, Boon IS, Joffe J, Stark D. Evaluation of the "Shared Community Follow-up" after a germ cell tumour-A novel initiative for remote cancer follow-up enhanced by online patient-reported outcome measures. Eur J Cancer Care (Engl) 2020; 29:e13264. [PMID: 32495464 DOI: 10.1111/ecc.13264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 03/11/2020] [Accepted: 04/30/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Replying to germ cell tumour patients' needs, we implemented "Shared Community Follow-up"-a collaborative initiative, enabling remote delivery of specialist cancer care across large geographical areas. Blood, radiological investigations and patient-reported outcome measures (PROMs) are completed remotely and integrated within the electronic patient records for specialist review without patients requiring appointments. We describe the service evaluation estimating the feasibility, safety and acceptability of this initiative versus traditional Standard Follow-up. METHODS This cross-sectional evaluation estimated feasibility (uptake, adherence) and safety (via missed appointments, timeliness, cancellations) using routinely collected service process data. An acceptability questionnaire, evaluating patient satisfaction, was administered to 91 patients. RESULTS The new service is feasible. Across 2 years (2014-2016), uptake increased 54% (N = 123 to N = 270) and only 4.8% (N = 13) of patients were non-adherent. Fewer missed/cancelled investigations (N = 39, 5.9% vs. N = 566, 85.5%), timelier investigations (seven vs. 14 timely investigations) and equal relapse detection suggest its safety. PROMs replaced 3 appointments/patient. Patients were as satisfied with both services (3.4/4 vs. 3.6/4). CONCLUSION New follow-up services, with investigations completed remotely and shared between community providers and cancer centres, offer an alternative to traditional appointments with advantages for patients and the National Health Service.
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Affiliation(s)
- Oana C Lindner
- Patient-Centred Outcomes Research Group, Leeds Institute of Medical Research at St. James's University Hospital, School of Medicine, University of Leeds, Leeds, UK
| | - Ian S Boon
- Leeds Institute for Medical Research at St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Johnathan Joffe
- Leeds Institute for Medical Research at St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Dan Stark
- Patient-Centred Outcomes Research Group, Leeds Institute of Medical Research at St. James's University Hospital, School of Medicine, University of Leeds, Leeds, UK.,Leeds Institute for Medical Research at St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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11
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Leclerc AA, Lippé S, Bertout L, Chapados P, Boulet-Craig A, Drouin S, Krajinovic M, Laverdière C, Michon B, Robaey P, Rondeau É, Sinnett D, Sultan S. Inconsistencies between measures of cognitive dysfunction in childhood acute lymphoblastic leukemia survivors: Description and understanding. Psychooncology 2020; 29:1201-1208. [PMID: 32391960 DOI: 10.1002/pon.5410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/24/2020] [Accepted: 05/05/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The frequency of cognitive difficulties in childhood cancer survivors varies according to the measurement strategy. The goal of this research is to (a) describe agreements and differences between measures of working memory and attention (b) identify contributors of these differences, such as emotional distress, affects, and fatigue. METHODS We used data available for 138 adults successfully treated for childhood acute lymphoblastic leukemia (ALL) (PETALE cohort). Working memory and attention were assessed using subtests from the WAIS-IV and self-reported questionnaires (BRIEF-SR and CAARS-S:L). Potential contributors included emotional distress, anxiety, depression (BSI-18), affects (PANAS), and fatigue (PedsQL-MFS). We explored measurement agreements and differences using diagnostic indices and multivariate regression models. RESULTS The frequencies of working memory and attention deficits were higher when using cognitive tests (15%-21%) than with self-reports (10%-11%). Self-reported questionnaires showed high specificity (median 0.87) and low sensitivity (median 0.10), suggesting they did not reliably identify positive cases on cognitive tests. We identified negative affectivity as a possible contributor to inconsistencies between self-report and test results. CONCLUSIONS When measuring working memory and attention in childhood ALL survivors, cognitive test results and self-reports should not be considered equivalent. At best, self-report may be used for screening (high specificity), but not to assess prevalence in large samples. Self-reported difficulties are also probably influenced by the negative mood in this population.
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Affiliation(s)
- Andrée-Anne Leclerc
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Sarah Lippé
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Laurence Bertout
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Pascale Chapados
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Aubrée Boulet-Craig
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Simon Drouin
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Maja Krajinovic
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Montréal, Québec, Canada
| | - Caroline Laverdière
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Montréal, Québec, Canada
| | - Bruno Michon
- Department of Hematology-Oncology, Quebec University Health Center (QUHC), Montréal, Québec, Canada
| | - Philippe Robaey
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Émélie Rondeau
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Daniel Sinnett
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Montréal, Québec, Canada
| | - Serge Sultan
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Montréal, Québec, Canada
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12
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Rae CS, Tsangaris E, Klassen AF, Breakey V, D'Agostino N. Comparison of Patient-Reported Outcome Measures for Use as Performance Metrics in Adolescent and Young Adult Psychosocial Cancer Care. J Adolesc Young Adult Oncol 2020; 9:262-270. [DOI: 10.1089/jayao.2019.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Charlene S. Rae
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Elena Tsangaris
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anne F. Klassen
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Vicky Breakey
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Norma D'Agostino
- Department of Supportive Care, Princess Margaret Cancer Center, Toronto, Canada
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13
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De R, Zabih V, Kurdyak P, Sutradhar R, Nathan PC, McBride ML, Gupta S. Psychiatric Disorders in Adolescent and Young Adult-Onset Cancer Survivors: A Systematic Review and Meta-Analysis. J Adolesc Young Adult Oncol 2020. [DOI: 10.1089/jayao.2019.0097 16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Riddhita De
- Child Health and Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Veda Zabih
- Child Health and Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health CAMH, Mental Health Policy Research, Toronto, Canada
- Institute of Clinical and Evaluative Sciences, Mental Health and Addiction, Toronto, Canada
| | - Rinku Sutradhar
- Institute of Clinical and Evaluative Sciences, Cancer, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Paul C. Nathan
- Child Health and Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
- Institute of Clinical and Evaluative Sciences, Cancer, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Mary L. McBride
- Cancer Control Research, BC Cancer Research Centre, Vancouver, Canada
| | - Sumit Gupta
- Child Health and Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
- Institute of Clinical and Evaluative Sciences, Cancer, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
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14
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De R, Zabih V, Kurdyak P, Sutradhar R, Nathan PC, McBride ML, Gupta S. Psychiatric Disorders in Adolescent and Young Adult-Onset Cancer Survivors: A Systematic Review and Meta-Analysis. J Adolesc Young Adult Oncol 2020; 9:12-22. [DOI: 10.1089/jayao.2019.0097] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Riddhita De
- Child Health and Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Veda Zabih
- Child Health and Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health CAMH, Mental Health Policy Research, Toronto, Canada
- Institute of Clinical and Evaluative Sciences, Mental Health and Addiction, Toronto, Canada
| | - Rinku Sutradhar
- Institute of Clinical and Evaluative Sciences, Cancer, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Paul C. Nathan
- Child Health and Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
- Institute of Clinical and Evaluative Sciences, Cancer, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Mary L. McBride
- Cancer Control Research, BC Cancer Research Centre, Vancouver, Canada
| | - Sumit Gupta
- Child Health and Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
- Institute of Clinical and Evaluative Sciences, Cancer, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
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15
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Recklitis CJ, Blackmon JE, Chang G. Screening young adult cancer survivors with the PROMIS Depression Short Form (PROMIS-D-SF): Comparison with a structured clinical diagnostic interview. Cancer 2020; 126:1568-1575. [PMID: 31913510 DOI: 10.1002/cncr.32689] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND The current study was conducted to evaluate the Patient-Reported Outcomes Measurement Information System Depression Short Form (PROMIS-D-SF) as a screening measure for young adult cancer survivors (YACS) compared with a structured diagnostic interview. METHODS A total of 249 YACS (aged 18-40 years) completed the PROMIS-D-SF and Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (SCID). Based on the SCID, participants were classified as having: 1) an SCID depression diagnosis; 2) depression symptoms without an SCID diagnosis; or 3) no depression symptoms. Receiver operating characteristic analyses evaluated PROMIS-D-SF and SCID concordance and the sensitivity and specificity of PROMIS-D-SF cutoff t -scores. RESULTS The PROMIS-D-SF had overall good agreement with the SCID for both depression diagnosis (area under the curve, 0.89) and the presence of depressive symptoms (area under the curve, 0.83). A PROMIS-D-SF cutoff t-score of ≥53.2 came closest to meeting study criteria for detecting a SCID depression diagnosis (sensitivity ≥0.85 and specificity ≥0.75), with a sensitivity of 0.81 and a specificity of 0.74. For identifying survivors with depression symptoms, a t-score cutoff value of 49.4 was found to have slightly superior sensitivity (0.84) and inferior specificity (0.64). In hypothetical screening examples, these cutoff scores led to moderate levels of missed cases (15%-19%) and a high percentage of clinical referrals that were unnecessary by SCID criteria (56%-70%). CONCLUSIONS The PROMIS-D-SF demonstrated moderately strong concordance with depressive diagnoses and symptoms measured by the SCID, but cutoff t-scores did not meet study criteria for clinical screening. The PROMIS-D-SF may be useful for assessing depression in YACS, but the limitations in its sensitivity and specificity identified in the current study are likely to limit its usefulness as a stand-alone screening instrument in this population.
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Affiliation(s)
- Christopher J Recklitis
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jaime E Blackmon
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System, Brockton, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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16
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Abdelrahman A, Kumstel S, Zhang X, Liebig M, Wendt EHU, Eichberg J, Palme R, Thum T, Vollmar B, Zechner D. A novel multi-parametric analysis of non-invasive methods to assess animal distress during chronic pancreatitis. Sci Rep 2019; 9:14084. [PMID: 31575986 PMCID: PMC6773730 DOI: 10.1038/s41598-019-50682-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 09/17/2019] [Indexed: 02/06/2023] Open
Abstract
Ethical responsibility, legal requirements and the need to improve the quality of research create a growing interest in the welfare of laboratory animals. Judging the welfare of animals requires readout parameters, which are valid and sensitive as well as specific to assess distress after different interventions. In the present study, we evaluated the sensitivity and specificity of different non-invasive parameters (body weight change, faecal corticosterone metabolites concentration, burrowing and nesting activity) by receiver operating characteristic curves and judged the merit of a multi-parametric analysis by logistic regression. Chronic pancreatitis as well as laparotomy caused significant changes in all parameters. However, the accuracy of these parameters was different between the two animal models. In both animal models, the multi-parametric analysis relying on all the readout parameters had the highest accuracy when predicting distress. This multi-parametric analysis revealed that C57BL/6 mice during the course of chronic pancreatitis often experienced less distress than mice after laparotomy. Interestingly these data also suggest that distress does not steadily increase during chronic pancreatitis. In conclusion, combining these non-invasive methods for severity assessment represents a reliable approach to evaluate animal distress in models such as chronic pancreatitis.
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Affiliation(s)
- Ahmed Abdelrahman
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, Rostock, Germany.
| | - Simone Kumstel
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, Rostock, Germany
| | - Xianbin Zhang
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, Rostock, Germany
| | - Marie Liebig
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, Rostock, Germany
| | - Edgar Heinz Uwe Wendt
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, Rostock, Germany
| | - Johanna Eichberg
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, Rostock, Germany
| | - Rupert Palme
- Unit of Physiology, Pathophysiology and Experimental Endocrinology, Department of Biomedical Sciences, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany
| | - Brigitte Vollmar
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, Rostock, Germany
| | - Dietmar Zechner
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, Rostock, Germany.
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17
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Geue K, Göbel P, Leuteritz K, Nowe E, Sender A, Stöbel-Richter Y, Friedrich M. Anxiety and depression in young adult German cancer patients: Time course and associated factors. Psychooncology 2019; 28:2083-2090. [PMID: 31397041 DOI: 10.1002/pon.5197] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 07/17/2019] [Accepted: 08/05/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Cancer in young adulthood is a nonnormative and critical life event. The experience of having cancer can have a strong impact on the mental health of young adults. This study investigated anxiety and depression in young adult cancer patients, examining changes over time and determining associated factors. METHODS Young cancer patients (18-39 years at time of diagnosis, diagnosis less than 4 years) were examined. Anxiety and depression were measured at two time points (t2 = 12 months after t1) using the Hospital Anxiety and Depression Scale (HADS). Regression analyses were conducted to determine whether sociodemographic, medical, and/or psychosocial factors (social support, adjustment to the illness, unmet supportive care needs) were associated with patients' anxiety and depression. RESULTS Five hundred fourteen young cancer patients (mean age 29.6 years, 75.1% women) completed both questionnaires. A higher proportion showed elevated levels of anxiety (t1: 42.2%; t2: 45.3%) than of depression (t1: 16.9%; t2: 17.7%), and no significant changes in anxiety and depression levels over time were observed. Psychosocial factors explained a major proportion of the variances for anxiety and depression levels at both time points (adjusted R2 between.50 and.59). Furthermore, significant associations were found for anxiety (t1) with gender (women↑); anxiety (t2) and depression (t2) with sick leave (sick leave yes↑); depression (t2) with time since diagnosis (longer time↑). CONCLUSION Psychological distress among adolescents and young adults (AYA) manifests particularly as anxiety. Strong associations between anxiety/depression and psychosocial factors, as well as the stability of psychological distress over time, clearly illustrate the need for psycho-oncological care in this patient group.
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Affiliation(s)
- Kristina Geue
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Philipp Göbel
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Katja Leuteritz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Erik Nowe
- Medical Clinic II, Clinic for Diabetology and Kardiology, Hospital St. Elisabeth and St. Barbara, Halle (Saale), Germany
| | - Annekathrin Sender
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Yve Stöbel-Richter
- Faculty of Managerial and Cultural Studies, University of Zittau/Goerlitz, Goerlitz, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
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18
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Rae C, Klassen AF, Tsangaris E, Breakey V, D'Agostino N. Distress Screening in Adolescents and Young Adults with Cancer: Development of Cut-Points for the Cancer Distress Scales-Adolescent and Young Adults. J Adolesc Young Adult Oncol 2019; 8:560-565. [PMID: 31219363 DOI: 10.1089/jayao.2019.0032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Distress is an important issue facing adolescent and young adults (AYA) with cancer due to their stage of development. Metrics are necessary to help improve psychosocial outcomes in this population. This study determined cut-points for the newly developed Cancer Distress Scales (CDS)-AYA. Methods: The CDS-AYA is a new patient-reported outcomes measure that comprises five independently functioning scales, including the following: Impact of Cancer (12 items), Physical (12 items), Emotional (11 items), Cognitive (8 items), and Cancer Worry (5 items). Canadian AYA with cancer 15-39 years of age completed the CDS-AYA and the Hospital Anxiety and Depression Scale (HADS), as part of the CDS-AYA field test. Only patients who had completed responses to the CDS-AYA and HADS were included in these analyses. Receiver operating characteristic (ROC) curve analysis was used to generate cut-points for five CDS-AYA scales based on distress defined by the HADS anxiety and HADS depression scale. Results: In total 453 of 515 respondents had complete data for the CDS-AYA and HADS were included in analyses. Area under the curve (AUC) in the ROC analyses ranged from 0.75 to 0.85. The CDS-AYA Emotional scale had the greatest AUC. The cutoff value for the Emotional scale was 27 based on the HADS anxiety scores (78.3% and 78.9%). Conclusions: The five CDS-AYA scales had fair to good accuracy when classifying the none/low and moderate/severe distress categories based on HADS anxiety and depression scales. For screening purposes, it is recommended that the Emotional scale or Impact of Cancer scale be utilized.
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Affiliation(s)
- Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Elena Tsangaris
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vicky Breakey
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Norma D'Agostino
- Department of Supportive Care, Princess Margaret Cancer Center, Toronto, Ontario, Canada
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19
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Reed-Berendt R, Shafran R, Langdon D, Christie D, Hough R, Coughtrey A. Experiences of Low Mood in Young People With Cancer: A Qualitative Study. J Pediatr Oncol Nurs 2019; 36:424-435. [DOI: 10.1177/1043454219844232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Young people with cancer are at increased risk of psychological difficulty; yet there is little research on their experiences of low mood or depressive symptoms to help inform treatment interventions. This qualitative study explored experiences and opinions of low mood or depression in young people with cancer, how their mood related to developmental challenges, strategies used to cope, and how services could improve support. Nineteen young people diagnosed and treated for cancer completed semistructured interviews. Transcripts were thematically analyzed using the framework approach, and analysis produced eight themes, organized into three domains: “A Harder Time of Life,” “Interpersonal Impact of Cancer,” and “Learning to Understand and Describe Low Mood,” Participants interviewed experienced low mood during cancer and predominantly felt “low mood” was a helpful term to describe their emotions. There were similarities and variations in their reported mood compared with clinical depression. The developmental challenges of being a young person with cancer negatively affected their mood. Participants used a variety of different coping strategies to manage these challenges. Young people were clear that they would like others to help them understand negative emotions experienced through cancer are normal to feel and support for low mood to be accessible and available.
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Affiliation(s)
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | | | | | - Anna Coughtrey
- UCL Great Ormond Street Institute of Child Health, London, UK
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20
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Chow C, Liptak C, Chordas C, Manley P, Recklitis C. Adolescent and Young Adult Brain Tumor Survivors Report Increased Anxiety Even Years After Successful Treatment for Relapse. J Adolesc Young Adult Oncol 2019; 8:90-93. [DOI: 10.1089/jayao.2018.0053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Candice Chow
- Department of Psychosocial Oncology and Palliative Care and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Cori Liptak
- Department of Psychosocial Oncology and Palliative Care and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Christine Chordas
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Peter Manley
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Christopher Recklitis
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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21
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Anestin AS, Lippé S, Robaey P, Bertout L, Drouin S, Krajinovic M, Michon B, Rondeau É, Samoilenko M, Laverdière C, Sinnett D, Sultan S. Psychological risk in long-term survivors of childhood acute lymphoblastic leukemia and its association with functional health status: A PETALE cohort study. Pediatr Blood Cancer 2018; 65:e27356. [PMID: 30084222 DOI: 10.1002/pbc.27356] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recent research has suggested that long-term pediatric cancer survivors were at risk of important physical and psychological morbidities. To date, we do not know to what extent functional health status contributes to psychological risk and which domains are most important. The aim of this study was to systematically explore which functional domain could explain anxiety, depression, and distress symptoms. PROCEDURE We used data available for 105 adolescents and 182 adults successfully treated for childhood acute lymphoblastic leukemia at two Canadian sites part of the PETALE cohort. Participants were ≥5 years postdiagnosis, aged 22 ± 6 years, 52% female, and 49% acute lymphoblastic leukemia high-risk status. The contribution of health functional status (15D/16D questionnaires) to self-reported anxiety, depression, and distress (Beck scales and distress thermometer) was evaluated using adjusted logistic regression models. RESULTS Prevalence rates found for mild-severe anxiety, depression, and distress were 14%, 21%, and 30% among adolescents and 27%, 20%, and 19% among adults. Frequent health domains associated with psychological risk were sleeping and breathing in adolescents, and vitality/fatigue, discomfort/symptoms, mental function, and sleeping in adults. Mental function was systematically associated with psychological risk across age groups (median OR = 10.00, 95% CI 3.01-33.71). Exploratory mediation bootstrapping analyses suggested that the effect on psychological risk of overall health status and mental function problems was partly explained by social/work/school functioning. CONCLUSION The results identified important functional health domains that could be targeted for interventions preventing psychological risk: vitality/fatigue, discomfort/symptoms, sleeping, and mental function issues. Health domains probably affect mood partly by limiting social/work/school functioning.
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Affiliation(s)
- Annélie S Anestin
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Sarah Lippé
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Philippe Robaey
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Laurence Bertout
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Simon Drouin
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Maja Krajinovic
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Bruno Michon
- Quebec University Health Center (QUHC), Montréal, Québec, Canada
| | - Émélie Rondeau
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Mariia Samoilenko
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Université du Québec à Montréal (UQAM), Montréal, Québec, Canada
| | - Caroline Laverdière
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Serge Sultan
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
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22
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Normative values for the distress thermometer (DT) and the emotion thermometers (ET), derived from a German general population sample. Qual Life Res 2018; 28:277-282. [PMID: 30284181 DOI: 10.1007/s11136-018-2014-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The distress thermometer (DT) and the emotion thermometers (ET) are short screening instruments for use in oncological practice. The aim of this study was to provide normative values and to analyze the correlational structure of the ET. METHODS A representative sample of the adult German general population (N = 2437) completed the ET, the PHQ-4, the FACIT-fatigue scale, and the demoralization scale. RESULTS The percentages of people above the cutoff (≥ 4) and the mean scores of the five ET scales were as follows: distress: 39.0%, M = 3.15 ± 2.62, anxiety: 12.3%, M = 1.36 ± 1.93, depression: 16.1%, M = 1.65 ± 2.11, anger: 24.5%, M = 2.33 ± 2.16, and need for help: 10.7%, M = 1.18 ± 1.90. Women reported significantly higher levels of burden than men, with effect sizes between 0.07 (anger) and 0.36 (anxiety). All ET dimensions were interrelated (r between 0.44 and 0.69) and significantly correlated with the other scales (r between 0.36 and 0.68). CONCLUSIONS The normative scores can help qualify assessments of groups of patients. The new four dimensions of the ET provide relevant additional information that is not already covered by the DT.
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van der Geest I, van Dorp W, Pluijm S, van den Heuvel-Eibrink M. The distress thermometer provides a simple screening tool for selecting distressed childhood cancer survivors. Acta Paediatr 2018; 107:871-874. [PMID: 29385290 DOI: 10.1111/apa.14251] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 11/02/2017] [Accepted: 01/25/2018] [Indexed: 11/27/2022]
Abstract
AIM We investigated the value of the distress thermometer, a one-item screening tool, in childhood cancer survivors. METHODS The participants were 286 childhood cancer survivors who visited an outpatient clinic at Erasmus MC University-Sophia Children's Hospital, Rotterdam, The Netherlands, for the first time from 2001 to 2008 and completed the distress thermometer and Hospital Anxiety and Depression Scale (HADS). Higher scores reflected more distress. A HADS score ≥15 was used as the cut-off point for emotional distress. We calculated the correlation between the HADS and distress thermometer, the relationship between the HADS anxiety and the HADS depression ratings, and the distress score and the sensitivity and specificity for different cut-off scores of the distress thermometer. RESULTS A moderate correlation was found between the HADS score and the distress thermometer (r: 0.56, p < 0.01, interclass correlation 0.40, p < 0.01). In total, 39% of the variability of distress, as measured by the distress thermometer, could be explained by the HADS anxiety and HADS depression ratings. A cut-off score of at least three on the distress thermometer resulted in a sensitivity of 92% and specificity of 79%. CONCLUSION The distress thermometer provided a rapid screening tool for identifying distressed childhood cancer survivors who needed further psychological support.
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Affiliation(s)
- I.M.M. van der Geest
- Department of Paediatric Oncology/Haematology; Erasmus MC University-Sophia Children's Hospital; Rotterdam The Netherlands
- Princess Màxima Center for Paediatric Oncology; Utrecht The Netherlands
| | - W. van Dorp
- Department of Paediatric Oncology/Haematology; Erasmus MC University-Sophia Children's Hospital; Rotterdam The Netherlands
- Department of Obstetrics and Gynaecology; Division of Reproductive Medicine; Erasmus MC University-Medical Center; Rotterdam The Netherlands
| | - S.M.F. Pluijm
- Department of Paediatric Oncology/Haematology; Erasmus MC University-Sophia Children's Hospital; Rotterdam The Netherlands
- Princess Màxima Center for Paediatric Oncology; Utrecht The Netherlands
| | - M.M. van den Heuvel-Eibrink
- Department of Paediatric Oncology/Haematology; Erasmus MC University-Sophia Children's Hospital; Rotterdam The Netherlands
- Princess Màxima Center for Paediatric Oncology; Utrecht The Netherlands
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24
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Geue K, Brähler E, Faller H, Härter M, Schulz H, Weis J, Koch U, Wittchen HU, Mehnert A. Prevalence of mental disorders and psychosocial distress in German adolescent and young adult cancer patients (AYA). Psychooncology 2018; 27:1802-1809. [DOI: 10.1002/pon.4730] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Kristina Geue
- Department of Medical Psychology and Medical Sociology; University Medical Center Leipzig; Leipzig Germany
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology; University Medical Center Leipzig; Leipzig Germany
- Department of Psychosomatic Medicine and Psychotherapy; Universal Medical Center Mainz; Mainz Germany
| | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken; University of Würzburg; Würzburg Germany
| | - Martin Härter
- Department and Outpatient Clinic of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Holger Schulz
- Department and Outpatient Clinic of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Joachim Weis
- Department of Psychooncology, Tumor Biology Center; University Medical Center Freiburg; Freiburg Germany
| | - Uwe Koch
- Department and Outpatient Clinic of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Deanery, University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy; Technical University Dresden; Dresden Germany
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology; University Medical Center Leipzig; Leipzig Germany
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25
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Rosenberg AR, Bradford MC, Bona K, Shaffer ML, Wolfe J, Baker KS, Lau N, Yi-Frazier J. Hope, distress, and later quality of life among adolescent and young adults with cancer. J Psychosoc Oncol 2017; 36:137-144. [PMID: 28934026 DOI: 10.1080/07347332.2017.1382646] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We aimed to explore the predictive value of screening for distress alone, hope alone, or a combination of both. In a multicenter prospective study, 37 English-speaking adolescents and young adults with cancer and 40 parents completed validated instruments at diagnosis ("baseline") and 3-6 months later ("follow-up"). Correlated regression models described associations. Within each instrument, baseline and follow-up scores were associated. However, only a composite hope/distress score predicted all three patient-centered outcomes. Multidimensional screens incorporating positive and negative psychosocial constructs may predict patient-centered outcomes better than isolated, single-construct instruments.
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Affiliation(s)
- Abby R Rosenberg
- a Seattle Children's Hospital, Center for Clinical and Translational Research , Seattle , Washington , USA.,b Fred Hutchinson Cancer Research Center, Clinical Research Division , Seattle , Washington , USA.,c Seattle Children's Hospital, Treuman Katz Center for Pediatric Bioethics , Seattle , Washington , USA.,d Department of Pediatrics , University of Washington , Seattle , Washington , USA
| | - Miranda C Bradford
- a Seattle Children's Hospital, Center for Clinical and Translational Research , Seattle , Washington , USA
| | - Kira Bona
- e Department of Medicine , Boston Children's Hospital , Boston , Massachusetts , USA.,f Department of Pediatric Oncology , Dana-Farber Cancer Institute , Boston , Massachusetts , USA.,g Department of Pediatric Oncology , Harvard Medical School , Boston , Massachusetts , USA
| | - Michele L Shaffer
- a Seattle Children's Hospital, Center for Clinical and Translational Research , Seattle , Washington , USA.,d Department of Pediatrics , University of Washington , Seattle , Washington , USA
| | - Joanne Wolfe
- e Department of Medicine , Boston Children's Hospital , Boston , Massachusetts , USA.,g Department of Pediatric Oncology , Harvard Medical School , Boston , Massachusetts , USA.,h Department of Psychosocial Oncology and Palliative Care , Dana-Farber Cancer Institute , Boston , Massachusetts , USA
| | - K Scott Baker
- a Seattle Children's Hospital, Center for Clinical and Translational Research , Seattle , Washington , USA.,b Fred Hutchinson Cancer Research Center, Clinical Research Division , Seattle , Washington , USA.,d Department of Pediatrics , University of Washington , Seattle , Washington , USA
| | - Nancy Lau
- a Seattle Children's Hospital, Center for Clinical and Translational Research , Seattle , Washington , USA.,d Department of Pediatrics , University of Washington , Seattle , Washington , USA
| | - Joyce Yi-Frazier
- a Seattle Children's Hospital, Center for Clinical and Translational Research , Seattle , Washington , USA.,d Department of Pediatrics , University of Washington , Seattle , Washington , USA
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Abstract
Most cancer survivors adjust well to life after cancer but some experience persisting negative mood, such as cancer-related fears, posttraumatic stress, anxiety, or depression. Mood fluctuations may not reach criteria for a clinical diagnosis but subclinical symptoms can interfere with quality of life. Women, adolescents, and young adults are particularly at risk for mood disturbances. Behavioral interventions, such as cognitive behavioral therapy and pharmacologic treatments, can effectively treat these distressing emotions. Much of the research on managing emotional needs after cancer has been completed with breast cancer survivors and more work is needed with diverse groups of survivors.
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Affiliation(s)
- Jean C Yi
- Biobehavioral Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-220, Seattle, WA 98109, USA
| | - Karen L Syrjala
- Biobehavioral Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-220, Seattle, WA 98109, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, 1959 NE Pacific Street, Seattle, WA 98195, USA.
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27
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Denlinger CS, Ligibel JA, Are M, Baker KS, Broderick G, Demark-Wahnefried W, Friedman DL, Goldman M, Jones LW, King A, Ku GH, Kvale E, Langbaum TS, McCabe MS, Melisko M, Montoya JG, Mooney K, Morgan MA, Moslehi JJ, O'Connor T, Overholser L, Paskett ED, Peppercorn J, Rodriguez MA, Ruddy KJ, Sanft T, Silverman P, Smith S, Syrjala KL, Urba SG, Wakabayashi MT, Zee P, McMillian NR, Freedman-Cass DA. NCCN Guidelines Insights: Survivorship, Version 1.2016. J Natl Compr Canc Netw 2017; 14:715-24. [PMID: 27283164 DOI: 10.6004/jnccn.2016.0073] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common consequences of cancer and cancer treatment. They are intended to aid health care professionals who work with survivors of adult-onset cancer in the posttreatment period, including those in general oncology, specialty cancer survivor clinics, and primary care practices. Guidance is also provided to help promote physical activity, weight management, and proper immunizations in survivors. This article summarizes the NCCN Survivorship panel's discussions for the 2016 update of the guidelines regarding the management of anxiety, depression, posttraumatic stress disorder-related symptoms, and emotional distress in survivors.
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Affiliation(s)
| | | | | | - K Scott Baker
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | - Mindy Goldman
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Allison King
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | - Elizabeth Kvale
- University of Alabama at Birmingham Comprehensive Cancer Center
| | | | | | | | | | - Kathi Mooney
- Huntsman Cancer Institute at the University of Utah
| | | | | | | | | | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute
| | | | | | | | - Tara Sanft
- Yale Cancer Center/Smilow Cancer Hospital
| | - Paula Silverman
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Susan G Urba
- University of Michigan Comprehensive Cancer Center
| | | | - Phyllis Zee
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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Mental disorder screening on cancer patients before and after radiotherapy and at the 1-month follow-up. Support Care Cancer 2017; 26:813-821. [DOI: 10.1007/s00520-017-3894-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
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29
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Barr RD, Bleyer WA. New horizons on the landscape of AYA oncology. Pediatr Blood Cancer 2017; 64. [PMID: 28741306 DOI: 10.1002/pbc.26291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Ronald D Barr
- Departments of Pediatrics, Pathology and Medicine, McMaster University and McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - W Archie Bleyer
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
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30
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Differences in distress severity among oncology patients treated by a consultation–liaison service. A five-year survey in Germany. THE EUROPEAN JOURNAL OF PSYCHIATRY 2017. [DOI: 10.1016/j.ejpsy.2017.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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31
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Provision of integrated psychosocial services for cancer survivors post-treatment. Lancet Oncol 2017; 18:e39-e50. [PMID: 28049576 DOI: 10.1016/s1470-2045(16)30659-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 12/25/2022]
Abstract
Meeting the psychosocial needs of patients with cancer has been recognised as a priority within oncology care for several decades. Many approaches that address these needs have been developed and described; however, until recently much of this work had focused on patients during treatment and end-of-life care. With continued improvement in therapies, the population of cancer survivors who can expect to live for 5 or more years after cancer diagnosis has increased dramatically, as have associated concerns about how to meet their medical, psychosocial, and health behaviour needs after treatment. Guidelines and models for general survivorship care routinely address psychosocial needs, and similar guidelines for psychosocial care of patients with cancer are being extended to address the needs of survivors. In this Series paper, we summarise the existing recommendations for the provision of routine psychosocial care to survivors, as well as the challenges present in providing this care. We make specific recommendations for the integration of psychosocial services into survivorship care.
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Chiou YJ, Lee CY, Li SH, Chong MY, Lee Y, Wang LJ. Screening for Psychologic Distress in Taiwanese Cancer Inpatients Using the National Comprehensive Cancer Network Distress Thermometer: The Effects of Patients' Sex and Chemotherapy Experience. PSYCHOSOMATICS 2017; 58:496-505. [PMID: 28549574 DOI: 10.1016/j.psym.2017.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 03/29/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients with cancer often experience distress, and early detection and management of psychologic distress are vital for improving patients' outcomes. OBJECTIVE This study investigates the validity and determines the optimal cutoff score-for clinically significant distress-for the Taiwanese Distress Thermometer (DT). METHODS This study consisted of 768 inpatients diagnosed with cancer in a general hospital in southern Taiwan. The condition of psychologic distress was assessed in these patients using the DT and Chinese Health Questionnaire-12. We applied a receiver operating characteristic curve analysis to evaluate the discriminative validity of the DT, adopting the Chinese Health Questionnaire-12 score of ≥4 as having psychologic distress. We also used a logistic regression model to determine the associated factors of the concordant screening results of both the DT and the Chinese Health Questionnaire-12. RESULTS The DT demonstrated an acceptable validity of discriminating between patients with psychologic distress and those without (area under curve = 0.787). We found a DT score of 4 to be the best cutoff value, with a 72.2% of sensitivity, a specificity of 80.0%, and an accuracy of 79.2%. The concurrence between the DT and the Chinese Health Questionnaire-12 was related to patients' sex and chemotherapy treatment experience. CONCLUSION Our findings show that the DT has acceptable psychometric properties for identifying psychologic distress in patients with cancer. However, the optimal cutoff point of the DT may vary with patients' characteristics.
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Affiliation(s)
- Yu-Jie Chiou
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Yi Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shau-Hsuan Li
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mian-Yoon Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Pépin AJ, Lippé S, Krajinovic M, Laverdière C, Michon B, Sinnett D, Sultan S. How to interpret high levels of distress when using the Distress Thermometer in the long-term follow-up clinic? A study with Acute Lymphoblastic Leukemia survivors. Pediatr Hematol Oncol 2017; 34:133-137. [PMID: 28922050 DOI: 10.1080/08880018.2017.1338805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Recent guidelines recommend to assess emotional distress in pediatric oncology during treatment and in after care. One tool used to do this is the distress thermometer (DT), a simple tool which has almost exclusively been studied in its screening abilities. Given its increased used as a measure of distress per se, it is necessary to document its concurrent validity. The goal of this study was to identify clinical domains (eg, depression, anxiety) and individual symptoms associated with pediatric cancer survivors' rating on the DT. PARTICIPANTS To do so we used data collected from 84 young (≤18 years old), and 120 older (>18 years old) survivors who were treated for pediatric leukemia. METHODS Participants responded to self-report questionnaires as part of a research visit. RESULTS Results from stepwise regressions show that in the younger group, high scores on the thermometer were associated with higher negative affectivity only. In adults, high scores were associated with higher anxiety, higher negative affectivity, and lower positive affectivity. When exploring associations with individual items, we found that the main emotional tone reflected by the thermometer score was anxiety. CONCLUSIONS Interpreting ratings on the thermometer should probably focus on anxiety in childhood cancer survivors. This widely used tool also does not measure the same domains in young versus older survivors, so that age groups should be considered separately in future work.
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Affiliation(s)
- A J Pépin
- a CHU Sainte-Justine , Montréal , Québec , Canada.,b Department of Psychology , Université de Montréal , Montréal , Québec , Canada
| | - S Lippé
- a CHU Sainte-Justine , Montréal , Québec , Canada.,b Department of Psychology , Université de Montréal , Montréal , Québec , Canada
| | - M Krajinovic
- a CHU Sainte-Justine , Montréal , Québec , Canada.,c Department of Pediatrics , Université de Montréal , Montreal , Québec , Canada
| | - C Laverdière
- a CHU Sainte-Justine , Montréal , Québec , Canada.,c Department of Pediatrics , Université de Montréal , Montreal , Québec , Canada
| | - B Michon
- d CHUL Québec , Québec , Québec , Canada
| | - D Sinnett
- a CHU Sainte-Justine , Montréal , Québec , Canada.,c Department of Pediatrics , Université de Montréal , Montreal , Québec , Canada
| | - S Sultan
- a CHU Sainte-Justine , Montréal , Québec , Canada.,b Department of Psychology , Université de Montréal , Montréal , Québec , Canada.,c Department of Pediatrics , Université de Montréal , Montreal , Québec , Canada
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Recklitis CJ, Blackmon JE, Chang G. Validity of the Brief Symptom Inventory-18 (BSI-18) for identifying depression and anxiety in young adult cancer survivors: Comparison with a Structured Clinical Diagnostic Interview. Psychol Assess 2017; 29:1189-1200. [PMID: 28080106 DOI: 10.1037/pas0000427] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The Brief Symptom Inventory-18 (BSI-18) is widely used to assess psychological symptoms in cancer survivors, but the validity of conventional BSI-18 cut-off scores in this population has been questioned. This study assessed the accuracy of the BSI-18 for identifying significant anxiety and depression in young adult cancer survivors (YACS), by comparing it with a "gold standard" diagnostic interview measure. Two hundred fifty YACS, age 18-40 completed the BSI-18 and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; SCID) interview assessing anxiety and depressive disorders. BSI-18 results were compared with SCID criteria using receiver operating characteristics (ROC) analyses. Forty four participants (17.7%) met criteria for ≥1 SCID diagnoses, and an additional 20 (8.0%) met criteria for clinically significant SCID symptoms without a diagnosis. General concordance between the BSI-18 GSI scale and SCID diagnosis was good (AUC = 0.848), but the 2 most widely used BSI-18 case rules failed to identify a majority of survivors with SCID diagnoses, and no alternative BSI-18 cut-off scores met study criteria for clinical screening. Analyses aimed at identifying survivors with significant SCID symptoms or a SCID diagnosis had similar results, as did analyses examining depression and anxiety separately. The BSI-18 shows good overall concordance with a psychiatric interview, but recommended cut-off scores fail to identify a majority of YACS with psychiatric diagnosis. Clinicians should not rely on the BSI-18 alone as a screening measure for YACS. Alternative BSI-18 scoring algorithms optimized for detecting psychiatric symptoms in YACS may be an important step to address this limitation. (PsycINFO Database Record
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Affiliation(s)
| | | | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System
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35
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Shim EJ, Hahm BJ, Yu ES, Kim HK, Cho SJ, Chang SM, Yang JC, Kim JH. Development and validation of the National Cancer Center Psychological Symptom Inventory. Psychooncology 2016; 26:1036-1043. [PMID: 27605487 DOI: 10.1002/pon.4277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/30/2016] [Accepted: 09/03/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To report the development and validation of the National Cancer Center Psychological Symptom Inventory (NCC-PSI). METHODS Psychometric properties of the NCC-PSI were examined by using multicenter surveys involving 400 patients with cancer in 5 cancer-treatment hospitals throughout Korea. Related measures including the Mini-International Neuropsychiatric Interview were administered. RESULTS Convergent validity was supported by NCC-PSI's significant associations with related measures. Known-group validity was proven with higher scores of helplessness/hopelessness and anxious preoccupation on the Mini-Mental Adjustment to Cancer in the depression and anxiety diagnosis group, defined by the NCC-PSI. Cutoff scores for insomnia, anxiety, and depression were identified. Overall, the screening performance of the NCC-PSI was comparable to that of the distress thermometer and Patient Health Questionnare-2. CONCLUSIONS The NCC-PSI represents a meaningful effort to develop a distress screening tool that addresses specific psychological symptoms common in cancer, which are tailored to the local oncology care system with varying degrees of psychosocial care resources.
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Affiliation(s)
- Eun-Jung Shim
- Department of Psychology, Pusan National University, Pusan, South Korea
| | - Bong-Jin Hahm
- Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Eun-Seung Yu
- Mental Health Clinic, National Cancer Center, Goyang-si, South Korea
| | - Ha Kyoung Kim
- Department of Psychiatry, Incheon Medical Center, Incheon, South Korea
| | - Seong Jin Cho
- Department of Psychiatry, Korea Cancer Center Hospital, Seoul, South Korea
| | - Sung Man Chang
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, South Korea
| | - Jong-Chul Yang
- Department of Psychiatry, Chonbuk National University Hospital, Jeonju-si, South Korea
| | - Jong-Heun Kim
- Mental Health Clinic, National Cancer Center, Goyang-si, South Korea
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Predictor Variables and Screening Protocol for Depressive and Anxiety Disorders in Cancer Outpatients. PLoS One 2016; 11:e0149421. [PMID: 26954671 PMCID: PMC4783052 DOI: 10.1371/journal.pone.0149421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 01/16/2016] [Indexed: 12/13/2022] Open
Abstract
Background Cancer patients are at increased risk of persistent depressive and anxiety symptoms and disorders compared to the general population. However, these issues are not always identified, which may worsen the prognosis and increase morbidity and mortality. Therefore, the objectives of this study are to identify predictor variables (demographic and clinical) for the development of mood and anxiety disorders in cancer outpatients and to propose a probabilistic screening protocol considering these variables and certain standardized screening instruments. Methods A total of 1,385 adults, of both genders, receiving outpatient cancer care were evaluated using a questionnaire and screening instruments. Thereafter, 400 of these subjects responded to the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-IV) by telephone to confirm or rule out the presence of a Current Major Depressive Episode (CMDE) or Anxiety Disorder (AD). Results Of the patients surveyed, 64% met the criteria for CMDE and 41% for AD. Female gender was found to be a risk factor for both disorders, and the presence of previous psychiatric history and marital status (divorced and widowed) were risk factors for anxiety disorders. When scoring above the recommended cutoff score, the screening instruments also indicated a risk of the studied disorders. Based on these findings, a screening protocol and nomograms were created for the quantification, combination and probabilistic estimate of risk, with accuracy indicators >0.68. Conclusion The prevalence rates for the disorders under study are extremely high in cancer patients. The use of the proposed protocol and nomogram can facilitate rapid and wide screening, thus refining triage and supporting the establishment of criteria for referral to mental health professionals, so that patients can be properly diagnosed and treated.
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Chiou YJ, Chiu NM, Wang LJ, Li SH, Lee CY, Wu MK, Chen CC, Wu YS, Lee Y. Prevalence and related factors of psychological distress among cancer inpatients using routine Distress Thermometer and Chinese Health Questionnaire screening. Neuropsychiatr Dis Treat 2016; 12:2765-2773. [PMID: 27822049 PMCID: PMC5087777 DOI: 10.2147/ndt.s118667] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Clinical practice guidelines suggest routine screening for distress among cancer patients for immediate early psychiatric care. However, previous studies focusing on routine screening for psychological distress among cancer inpatients in Taiwan are scant. Thus, the aim of this study was to evaluate the prevalence and related factors of psychological distress and mental illness among cancer inpatients in Taiwan. PATIENTS AND METHODS This study was conducted as a retrospective chart review in a general hospital in southern Taiwan. Cancer inpatients were regularly screened by nursing staff using the Distress Thermometer and the 12-item Chinese Health Questionnaire. Positive screening results on either instrument were followed by a non-commanded referral to psychiatrists for clinical psychiatric diagnosis and treatment. RESULTS Of the 810 participants in this study, 179 (22.1%) were recognized as having psychological distress. Younger age (odds ratio [OR] =1.82), having head and neck cancer (OR =2.43), and having not received chemotherapy (OR =1.58) were significantly related to psychological distress. Among the 56 patients (31.3%) with psychological distress who were referred to psychiatrists, the most common mental illness was adjustment disorder (n=22, 39.2%), followed by major depressive disorder (n=13, 23.2%), depressive disorder not otherwise specified (n=6, 10.7%), and anxiety disorder not otherwise specified (n=4, 7.1%). CONCLUSION Our study indicated that cancer inpatients with psychological distress were more likely to be younger in age, have head and neck cancer, and have not received chemotherapy. The most common psychiatric disorder was adjustment disorder. Early detection of psychological distress and prompt psychiatric consultation and management are very important for cancer inpatients.
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Affiliation(s)
| | | | | | - Shau-Hsuan Li
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
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