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Barata A, Dhawale T, Newcomb RA, Amonoo HL, Nelson AM, Yang D, Karpinski K, Holmbeck K, Farnam E, Frigault M, Johnson PC, El-Jawahri A. Quality of Life and Prognostic Awareness in Caregivers of Patients Receiving Chimeric Antigen Receptor T Cell Therapy. Transplant Cell Ther 2024; 30:452.e1-452.e11. [PMID: 38242441 DOI: 10.1016/j.jtct.2024.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/19/2023] [Accepted: 01/14/2024] [Indexed: 01/21/2024]
Abstract
Caregivers of patients undergoing chimeric antigen receptor T cell therapy (CAR-T) play a critical role during treatment, yet their experience remains largely unaddressed. We aimed to longitudinally describe quality of life (QoL) and psychological distress, as well as prognostic awareness, in caregivers and explore the association of prognosis awareness with baseline psychological distress. We conducted a longitudinal study of caregivers of patients undergoing CAR-T and examined QoL (CAReGiverOncology QoL questionnaire) and psychological distress (Hospital Anxiety and Depression Scale) prior to CAR-T (baseline) and at days 7, 30, 90, and 180 post-CAR-T. At baseline, caregivers and patients completed the Prognostic Awareness Impact Scale, which examines cognitive understanding of prognosis, emotional coping with prognosis, and adaptive response (ie, capacity to use prognostic awareness to inform life decisions). We enrolled 58% (69 of 120) of eligible caregivers. Caregivers reported QoL impairments that did not change over time (B = 0.09; P = .452). The rates of clinically significant depression and anxiety symptoms were 47.7% and 20.0%, respectively, at baseline, and 39.1% and 17.4% at 180 days. One-third (32%) of the caregivers and patients reported that their oncologist said the cancer is curable. Caregivers' greater emotional coping with prognosis was associated with fewer symptoms of anxiety (B = -.17; P < .001) and depression (B = -.02; P < .001). Cognitive understanding of prognosis and adaptive response were not associated with psychological distress. Caregivers reported QoL impairments throughout the study period. A substantial proportion of caregivers experienced psychological distress and reported misperceptions about the prognosis, highlighting the need for supportive care interventions.
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Affiliation(s)
- Anna Barata
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Tejaswini Dhawale
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard A Newcomb
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Hermioni L Amonoo
- Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ashley M Nelson
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Daniel Yang
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Kyle Karpinski
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Katherine Holmbeck
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Emelia Farnam
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Matt Frigault
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - P Connor Johnson
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
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Gray TF, Plotke R, Heuer L, Topping CE, Nipp RD, Wang AC, Gasca Banda J, Greer JA, Temel JS, El-Jawahri A. Perceptions of prognosis and end-of-life care outcomes in patients with advanced lung and gastrointestinal cancer. Palliat Med 2023; 37:740-748. [PMID: 36802979 DOI: 10.1177/02692163231155511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Many patients with advanced cancer have misperceptions of their prognosis, which may impact end-of-life decision-making. Data regarding associations between prognostic perceptions over time and end-of-life care outcomes are lacking. AIM To describe patients' perceptions of their prognosis with advanced cancer and examine associations between these perceptions and end-of-life care outcomes. DESIGN Secondary analysis of longitudinal data from a randomized controlled trial of a palliative care intervention for patients with newly diagnosed incurable cancer. SETTING/PARTICIPANTS Conducted at an outpatient cancer center in the northeastern United States and patients were within 8 weeks of a diagnosis with incurable lung or non-colorectal gastrointestinal cancer. RESULTS We enrolled 350 patients in the parent trial, of which 80.5% (281/350) died during the study period. Overall, 59.4% (164/276) of patients reported they were terminally ill, and 66.1% (154/233) reported that their cancer was likely curable at the assessment closest to death. Patient acknowledgment of terminal illness was only associated with lower risk of hospitalizations in the last 30 days of life (OR = 0.52, p = 0.025). Patients who reported their cancer as likely curable were less likely to utilize hospice (OR = 0.25, p = 0.002) or die at home (OR = 0.56, p = 0.043), and they were more likely to be hospitalized in the last 30 days of life (OR = 2.28, p = 0.011). CONCLUSIONS Patients' perceptions of their prognosis are associated with important end-of-life care outcomes. Interventions are needed to enhance patients' perceptions of their prognosis and optimize their end-of-life care.
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Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Rachel Plotke
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Lauren Heuer
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | - Ryan D Nipp
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Annie C Wang
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | - Joseph A Greer
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Jennifer S Temel
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital Cancer Center, Boston, MA, USA
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Dhawale TM, Johnson PC, Gaballa MR, Nelson AM, Lavoie MW, Boateng KY, Greydanus C, Frigault MJ, El-Jawahri A. Perception of prognosis, quality of life, and distress in patients receiving chimeric antigen receptor T-cell therapy. Cancer 2023; 129:441-449. [PMID: 36457279 DOI: 10.1002/cncr.34557] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/29/2022] [Accepted: 10/14/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Chimeric antigen receptor (CAR) T-cell is potentially curative therapy for patients with hematologic malignancies but can cause life-threatening toxicities. Data on perceptions of prognosis and psychological distress are lacking. METHODS The authors conducted a cross-sectional study of patients receiving CAR-T. Before hospitalization for CAR-T, patients completed assessments of quality of life (QOL) (Functional Assessment of Cancer Therapy-General), anxiety and depression symptoms (Hospital Anxiety and Depression Scale) and post-traumatic stress disorder symptoms (Post-Traumatic Stress Checklist). Patients also completed the Prognostic Awareness Impact Scale (PAIS), which measures three domains: cognitive understanding of prognosis, emotional coping with prognosis, and adaptive response. RESULTS A total of 71.8% (102 of 142) of eligible patients were enrolled. A total of 34% of patients reported that their oncologist said their cancer is curable and 64% reported there was >50% chance of cure. Overall, 26%, 30%, and 21% of patients reported clinically significant depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms, respectively. We found no association between patients' cognitive understanding of prognosis and QOL or mood. Higher emotional coping with prognosis was associated with better QOL (Β = 0.72; SE = 0.10; p = <.001) and lower depression (Β = -0.17; SE = 0.02; p = <.001), anxiety (Β = -0.21; SE = 0.02; p = <.001), and PTSD (Β = -0.43; SE = 0.06; p = <.001) symptoms. Higher adaptive response was associated with better QOL (Β = 0.19; SE = 0.09; p = .028) and lower depression (Β = -0.05; SE = 0.02; p = .023), anxiety (Β = -0.09; SE = 0.02; p = <.001), and PTSD (Β = -0.19; SE = 0.05; p = <.001) symptoms. CONCLUSIONS Patients undergoing CAR-T report overly optimistic perception of their prognosis and have high rates of psychological distress. Higher emotional coping with prognosis and adaptive response were associated with better QOL and less psychological distress, underscoring the need to develop interventions to promote coping with this treatment. PLAIN LANGUAGE SUMMARY Patients undergoing chimeric antigen receptor T-cell therapy experience report overly optimistic perceptions of their prognosis and have high rates of psychological distress. Notably, higher emotional coping with prognosis and adaptive response were associated with better quality of life and less psychological distress.
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Affiliation(s)
- Tejaswini M Dhawale
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - P Connor Johnson
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Mahmoud R Gaballa
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashley M Nelson
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mitchell W Lavoie
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kofi Y Boateng
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Claire Greydanus
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matthew J Frigault
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Ozdemir S, Lee JJ, Yang GM, Malhotra C, Teo I, Pham NT, Manalo MF, Hapuarachchi T, Mariam L, Rahman R, Finkelstein E. Awareness and Utilization of Palliative Care Among Advanced Cancer Patients in Asia. J Pain Symptom Manage 2022; 64:e195-e201. [PMID: 35705117 DOI: 10.1016/j.jpainsymman.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/09/2022] [Accepted: 06/03/2022] [Indexed: 11/16/2022]
Abstract
CONTEXT To date, little is known about palliative care (PC) awareness and utilization in low- and middle-income countries (LMICs) in Asia. OBJECTIVES This study aimed to investigate PC awareness and its predictors, utilization of PC services, and perceived utilization barriers among advanced cancer patients from select hospitals in Asian LMICs. METHODS This cross-sectional study analyzed data of 759 advanced cancer patients at major hospitals of four LMICs in Asia (i.e., Bangladesh, Philippines, Sri Lanka, and Vietnam). The predictors of PC awareness were investigated using multivariable logistic regression. RESULTS Overall PC awareness was 30.8% (n = 234). Patients with higher education (OR = 1.0; CI = 1.0,1.1), from upper-middle or high-income households (compared to low-income) (OR = 2.0; CI = 1.2,3.3), awareness of disease severity (OR = 1.5; CI = 1.0,2.2), and higher pain severity (OR = 1.1; CI = 1.0,1.2) had higher odds of PC awareness. Compared to patients who perceived themselves as being very informed about disease trajectory, those who were unsure (OR = 0.5; CI = 0.3,0.8) or uninformed (OR = 0.5; CI = 0.3,0.9) had lower odds of PC awareness. The PC utilization rate was 35.0% (n = 82) among those with PC awareness, and 47.8% (n = 66) among patients recommended PC by a healthcare professional (n = 138). The most cited PC utilization barriers were currently receiving anti-cancer treatment (n = 43; 33.9%), and having insufficient information about PC (n = 41; 32.3%). CONCLUSION The low awareness of PC services in these major hospitals in Asian LMICs highlights that more effort may be required to promote the awareness of PC in this region. The efforts should especially focus on those from disadvantaged groups to reduce the gap in PC awareness.
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Affiliation(s)
- Semra Ozdemir
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore.
| | - Jia Jia Lee
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore
| | - Grace Meijuan Yang
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Division of Palliative and Supportive Care (M.Y.), National Cancer Centre Singapore, Singapore
| | - Chetna Malhotra
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore
| | - Irene Teo
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore
| | | | | | | | - Lubna Mariam
- Department of Radiation Oncology (L.M.), National Institute of Cancer Research & Hospital, Dhaka, Bangladesh
| | - Rubayat Rahman
- Department of Palliative Medicine (R.R.), Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Eric Finkelstein
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore
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Yin Y, Lyu M, Chen Y, Zhang J, Li H, Li H, Xia G, Zhang J. Self-efficacy and positive coping mediate the relationship between social support and resilience in patients undergoing lung cancer treatment: A cross-sectional study. Front Psychol 2022; 13:953491. [PMID: 36211943 PMCID: PMC9539761 DOI: 10.3389/fpsyg.2022.953491] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe prognosis of patients undergoing lung cancer treatment might be influenced by mental health status. Resilience is one of the important predictors to reflect the mental health status. It has been shown that patients with higher levels of social support, self-care self-efficacy, and positive coping have greater resilience. This study aimed to determine the mediating role of self-efficacy and positive coping in the relationship between social support and psychological resilience in patients with lung cancer.MethodThis is a cross-sectional study that was conducted in in the oncology departments and thoracic surgical wards of four tertiary hospitals in Hunan Province, China, between November 2016 and November 2017. Three hundred and three patients who were undergoing treatment for lung cancer volunteered their participation in the study. Participants completed questionnaires, including the Chinese version of the Perceived Social Support Seale Scale, the Chinese version of Strategies Used by People to Promote Health Scale, and the Chinese version of the Connor-Davidson Resilience Scale.ResultsMediation analysis indicated that self-care self-efficacy and social support partially mediate the effect of social support on resilience. Direct paths from social support to self-efficacy, self-efficacy to positive coping, positive coping to psychological resilience, self-efficacy to psychological resilience, and social support to psychological resilience were significant (p < 0.001). The indirect paths from social support to self-efficacy and self-efficacy to psychological resilience were also significant. The chain mediation from social support to self-efficacy, self-efficacy to positive coping, and positive coping to resilience were significant.ConclusionSelf-efficacy and positive coping play an important role in the relationship between social support and resilience in patients receiving cancer treatment. Social support not only directly influenced psychological resilience but also indirectly influenced psychological resilience through self-efficacy and positive coping.
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Affiliation(s)
- Yizhen Yin
- Xiang Ya Nursing School, Central South University, Changsha, Hunan, China
| | - Mengmeng Lyu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiping Chen
- Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China
| | - Jie Zhang
- Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Hui Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huiyuan Li
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - Guili Xia
- Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China
- Guili Xia,
| | - Jingping Zhang
- Xiang Ya Nursing School, Central South University, Changsha, Hunan, China
- *Correspondence: Jingping Zhang,
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