Interest in a psycho-educational group intervention among out-patients with malignant melanoma in relation to their need: which patients are likely to participate?

Patients' Desire for Psychological Support When Receiving a Cancer Diagnostic

BACKGROUND

Factors related to the desire of receiving psychological help in cancer patients are not well known. The aim of this study is to assess the prevalence of patients who would ask for psychological assistance in the first weeks following diagnosis, and to identify their psychosocial and disease-related profile.

METHOD

This cross-sectional study assessed 229 consecutive cancer outpatients at a visit with their oncologist to be informed about the treatment they will receive. Disease-related and medical characteristics were assessed, and patients were asked about their mood states, levels of self-efficacy, and difficulties coping with the disease. Finally, patients were asked about their desire to receive psychological assistance.

RESULTS

Only 20% of patients expressed a desire for psychological help. These patients were lower in age and had previous history of mood disorders and reported higher discouragement and coping difficulties. These variables explained 30.6% of variance.

CONCLUSIONS

Although psycho-oncologists can provide helpful interventions, the percentage of patients interested in receiving psychological assistance in this study is low. Although further studies are needed, results from this study suggest methods that could easily be used by oncologists and nurses to identify patients who would like to receive psychological support.

[The need for psychosocial support and patients' desire for psychosocial support in female cancer patients - predictors and correlates]

The need for psychosocial support and patients' desire for psychosocial support in female cancer patients - predictors and correlates Objectives: The aims of the present study were to determine the need for psychosocial support of cancer patients, the subjective request for support and to examine the relationship between the need for psychosocial counselling, psychological distress and quality of life. Methods: 112 patients (consecutive) answered questionnaires about mental stress (GAD-2 and PHQ-2), quality of life (SF-8) as well as the Hornheide Screening Instrument (HSI) during their hospital stay (T1), two weeks (T2) and three months after their discharge (T3). Results: The need for psychosocial support goes down from 65.2 % (T1) to 39.3 % (T3). The psychological distress was in a positive (GAD-2 - HSI T1: r = 0.44, p < 0.01; PHQ-2 - HSI T1: r = 0.54, p < 0.01), the quality of life in a negative relationship to the need for support (SF-8 PCS - HSI T1: r = -0.45, p < 0.01; SF-8 MCS - HSI T1: r = -0.56, p < 0.01). The match between the need for support and the subjective desire to be cared for by psychologists was low (conversation persons not needing support: T1: 17.1 %, T2: 3.8 %, T3: 5.5 %; conversation persons needing support: T1: 13.7 %, T2: 18.4 %, T3: 18.2 %). Conclusions: The divergence between the assessed need for support and the subjective desire for consultations leads to the conclusion that both methods, screening and asking for desire of counseling, should be adopted in combination to provide adequate psychooncological support.

Perceived social support and associations with health-related quality of life in young versus older adult patients with haematological malignancies

Background

This study compared the perceived social support of young and older adult cancer patients, examining possible influencing factors as well as associations with health-related quality of life.

Methods

A total of 179 young patients (18–39 years) and 200 older adult patients (> 70 years) with haematological malignancies completed questionnaires on their perceived social support (ISSS-8, scales: Positive Support and Detrimental Interactions, range 0–16) and health-related quality of life (EORTC QLQ-C30). Tests for mean differences, correlations and regression analyses to determine associated variables of social support were performed.

Results

No difference was reported between young (M = 13.40, SD = 2.81) and older adult patients (M = 13.04, SD = 3.82; p = .313) for Positive Support. However, young patients (M = 4.16, SD = 3.10) reported having had more Detrimental Interactions than older patients did (M = 1.63, SD = 2.42; p < .001, Cohen’s d = .910). Comparison of the EORTC QLQ-C30 Function scales showed poorer outcomes for young patients on Emotional, Cognitive and Social Functions and a higher outcome on Physical Function compared with older adult patients. Regression analyses indicated that age (young vs. older adult patients) significantly explained proportions of variance in all models, with young age having a negative impact on Emotional, Cognitive and Social Functions and a positive impact on Physical and Role Functions compared with old age. Significant associations between Detrimental Interactions and all the scales examined except Cognitive Function were found.

Conclusions

The difference in negative perceptions of social support in young vs. older adult patients and its impact on health-related quality of life emphasises the necessity of differentiating between positive and negative social support. Negative interactions should be addressed through psychosocial care, particularly with young cancer patients.

Comprehensive evaluation of interventions: eight vital parameters

BACKGROUND

It is critically important to determine the effectiveness of an intervention before it can be translated into clinical practice. However, the future implementation and sustainability of the intervention may be diminished if other intervention parameters are not assessed. This requires obtaining feedback from intervention recipients so interventions will be perceived as appealing, relevant, meaningful and beneficial to them; otherwise recipients may be unlikely to perform them over time, resulting in unsuccessful health outcomes.

AIM

To propose the addition of two intervention parameters to the existing six-parameter model and provide examples from recent research of how each parameter can be tested.

DISCUSSION

Definitions of the eight parameters are provided and methods for analysing each of them explained. While some studies show necessity, fidelity and cost have unique distinguishing characteristics, other studies indicate feasibility, acceptability and safety have common features, and efficacy and effectiveness are closely associated.

CONCLUSION

Researchers frequently examine one or two parameters, but few simultaneously apply the six-parameter model. This model is also missing two vital parameters - efficacy and cost.

IMPLICATIONS FOR PRACTICE

Comprehensive and systematic evaluation of all eight intervention parameters is recommended before researchers begin randomised controlled trials and translate them into practice.

Unmet supportive care needs, health status and minimum costs in survivors of malignant melanoma

We explored the relationship between unmet care needs, health status, health utility and costs in people treated for melanoma via a cross-sectional follow-up survey (N = 455) 3 months to 5 years after complete resection of stage I-III cutaneous malignant melanoma. 51% (n = 232) had unmet care needs. This group had higher mean resource use, estimated conservatively (£28 vs. £10 per person) and worse overall health. Mean health-related utility index (AQoL6D) was 0.763 (95% CI 0.74; 0.79) in those with self-reported unmet need vs. 0.903 (0.89; 0.92) in those with no unmet need. Melanoma survivors with unmet need had worse outcomes in terms of anxiety (HADS 6.86 vs. 4.29), depression (HADS 4.29 vs. 2.01), overall quality of life (QoL: FACT-M 84.2 vs. 96.5). Higher resource use was associated with younger age (r_s  = -.29, p < .001), older school-leaving age (r_s  = .21, p < .001), reduced health utility (r_s  = -.14, p = .005), higher anxiety (r_s  = .22, p < .001), higher depression (r_s  = .16, p = .001) and lower QoL (overall r_s  = -.24, p < .001; melanoma QoL r_s  = -.20, p < .001; surgery QoL r_s  = -.19, p < .001). Lower health outcomes indicate increased service use, suggesting that interventions to address unmet need and improve health outcomes may reduce health costs. Integrated clinical and economic evaluations of interventions that target unmet need in melanoma survivors are required.

Psychosocial Care Needs of Melanoma Survivors: Are They Being Met?

Patients who have survived malignant melanoma for more than five years may lack the opportunity to talk about their burden. As a consequence their psychosocial care needs remain undetected and available supportive interventions may not be utilised. Therefore, the psychosocial burden of this patient group needs to be assessed using specific screening instruments. The aim of this study was to investigate the psychosocial burden of long-term melanoma survivors, their psychosocial care needs and the determinants of these needs. We wanted to find out if the use of professional support corresponds to the care needs defined by experts. Using the cancer registry of Rhineland-Palatinate, melanoma patients diagnosed at least 5 years before the survey were contacted by physicians. N = 689 former patients completed the Hornheide Questionnaire (short form HQ-S) to identify psychosocial support need (scale cut off ≥ 16 or item-based cut-off score) and the potential psychosocial determinants of these needs. Additionally, they were asked about their utilisation of the professional support system. More than one third (36%) of them was in need for professional psychosocial support. The highest burden scores concerned worry about tumour progression. Younger age (< 50), higher general fatigue, higher symptom burden, lower general health, negative social interactions and unfulfilled information needs were significant predictors of the need for psychosocial intervention. Related to the percentage of survivors identified as 'in need', the professional support system was underused. Further studies should investigate whether using the HQ-S to routinely identify burdened melanoma patients could lead to better fulfilment of their intervention needs, ultimately enhancing health-related quality of life.

Course of distress, anxiety, and depression in hematological cancer patients: Association between gender and grade of neoplasm

OBJECTIVE

The aim of our study was to explore the impact of gender and hematological cancer grade on distress, anxiety, and depression in patients receiving chemotherapy.

METHODS

A prospective study was done in a cohort of 104 patients with hematological cancer. We employed the (1) Distress Thermometer (DT) and the Problem List (PL) and (2) the Hospital Anxiety and Depression Scale (HADS) for assessments at baseline (T1), the halfway timepoint (T2), and completion of chemotherapy (T3).

RESULTS

The proportion of patients experiencing significant distress (DT ≥ 4) decreased from the first to the last timepoint; the proportion experiencing anxiety and depression (as assessed by HADS) also decreased. Specifically, 50% of participants reported significant distress levels, 47.1% anxiety, and 26% depression at T1. At T2, the proportion of patients experiencing distress was reduced by 60.8%, by 76% for anxiety, and by 48.5% for depression; at T3, the reduction was close to 80% for all assessments compared with T1. Emotional and physical problems were most commonly reported. Significant reductions were discovered for distress and problem-related distress levels over time, and a significant interaction was found between gender and practical and physical problems (p < 0.05).

SIGNIFICANCE OF RESULTS

Our findings suggest that female patients reported more distress, anxiety, and depression than male patients. Gender differences were related to problem-related distress but not to grade of neoplasm. We observed that, over the course of chemotherapy, the distress levels of patients with hematological cancer decrease over time.

Factors affecting participation in group intervention in patients after adjuvant treatment for early-study breast cancer

BACKGROUND AND PURPOSE

According to studies of patients with cancer, support groups can help in three areas: 1) improve mood; 2) introduce new, adaptive ways of handling potentially difficult situations; and 3) impart strategies for managing stress. Nevertheless, the decrease in the quality of life of cancer patients or survivors does not always translate into their utilization of available psychosocial services. The aim of the current study was to explore the factors affecting the decision of patients with breast cancer to participate in group intervention based on an enhancing-resilience approach.

METHODS

One hundred eighty-nine patients who were diagnosed with early-stage breast cancer at a tertiary hospital and had completed adjuvant therapy at least three months previously were asked to enroll in the study with or without group intervention. One hundred and one (53.4%) completed the battery of psychological questionnaires, of whom 56 agreed to participate in the intervention. Sociodemographic and medical data were collected for all 189 subjects from the medical files.

RESULTS

No significant differences in sociodemographic or medical data were found between intervention-group participants (N = 56) and non-participants (N = 133). Group participants reported significantly higher levels of psychological pathology. Subjects who completed the questionnaires but did not participate in the intervention reported significantly higher levels of positive cognitive emotion regulation and flexibility than participants.

CONCLUSION

Low participation in group interventions may be more strongly associated with psychological characteristics than sociodemographic and medical factors. It seems that patients know to perceive whether their personal resources are inadequate for facing a life-threatening illness. Like individual therapy, group interventions should be more sensitive to perceived individual needs and to the art of tailoring suitable contents according individual needs.

[Psychooncological interventions - what do cancer patients aged 60 years or older wish for?]

OBJECTIVES

To determine the acceptance of psychooncological interventions and predictors of subjective needs in cancer patients over 60 years of age.

METHODS

We examined 292 in- and outpatients (51% female, 51.7% aged over 60 years) from the Interdisciplinary Cancer Center of the University Hospital of Münster with a questionnaire designed to assess their wish to participate in various psychooncological interventions (FIPA) and with the Hospital Anxiety and Depression Scale (HADS-D).

RESULTS

73.5 % of those over 60 years and 87.9 % of those under 60 years professed a wish for at least one specific psychooncological intervention. Higher age, lower levels of anxiety and cancer relapse were negative predictors of the readiness to attend psychooncological interventions (9 % variance explained). As to specific interventions, those aged 60 years or older showed lower acceptance only for relaxation techniques.

CONCLUSIONS

Readiness to attend psychooncological interventions was high with only marginal differences between the age groups. Because objective features of the patient and the disease resulted only in a low predictability of the subjective need for psychooncological interventions, routine screening of cancer patients seems an important issue.

Needs, expectations and attendance among participants of a cancer wellness centre in Montreal, Quebec

INTRODUCTION

The purpose of this study was to examine the relationship between needs, expectations, and attendance patterns among users of a cancer wellness centre to better access future programming and improve attendance.

METHODS

We interviewed staff from 18 cancer wellness centers in Canada and the United States to assess if our attendance expectations were realistic. Then, from a total sample of non-users in 2008 (n  =  67) and infrequent users (n  =  67) at the Hope & Cope Wellness Centre in Montreal, we randomly selected individuals from each group who registered and never returned (n  =  16), and those who registered and returned 1-3 times (n  =  17). Telephone interviews were conducted using a brief questionnaire. We used a phenomenological approach to assess the meaning of attendance for the registrants.

RESULTS

Both groups of participants described similar reasons for not attending such as health complications, scheduling conflicts, child care, language issues, and parking restrictions. However, non-users focused specifically on functional aspects such as administrative issues and scheduling, and distance from the centre, while infrequent users expressed more emotional disappointments such as feeling more depressed and inability to engage with others.

DISCUSSION

Strategies are suggested to optimize service delivery for short-term attendees, including home-exercise programming, virtual support, outreach systems, and caregiving support. Information from other wellness centers in Canada and the United States revealed similar trends in attendance but also revealed a wide range of programs and systems of data recording.

IMPLICATIONS

The results of this study have implications for cancer survivors, for health care providers, for the development of strategies to address participation barriers, and for future research on understanding optimal use of wellness centers.