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Ernst M, Schwinn T, Hirschmiller J, Cleare S, Robb KA, Brähler E, Zwerenz R, Wiltink J, O'Connor RC, Beutel ME. To what extent are psychological variables considered in the study of risk and protective factors for suicidal thoughts and behaviours in individuals with cancer? A systematic review of 70 years of research. Clin Psychol Rev 2024; 109:102413. [PMID: 38518584 DOI: 10.1016/j.cpr.2024.102413] [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: 04/12/2023] [Revised: 11/29/2023] [Accepted: 03/08/2024] [Indexed: 03/24/2024]
Abstract
Psychological variables substantially shape the risk of suicidal thoughts and behaviours (STBs). However, it is unclear to what extent they are considered in individuals with cancer. We synthesized the quantitative research landscape concerning psychological risk/protective factors of STBs in the (psycho-) oncological context. This pre-registered review (PROSPERO-ID CRD42022331484) systematically searched the databases PubMed/Medline, CINAHL, PsycInfo, Cochrane Library, and Web of Science (as well as the grey literature and preprints). Risk of bias (RoB) was estimated using the ROBINS-I tool. Of 11,159 retrieved records, 319 studies were eligible for inclusion. Of those, 163 (51.1%) had investigated psychological factors (affective: n = 155; social: n = 65; cognitive: n = 63; personality/individual differences: n = 37; life events: n = 6), in a combined 3,561,741 participants. The most common STBs were suicidal ideation (n = 107) or death wishes (n = 20) rather than behaviour (suicide deaths: n = 26; attempts: n = 14). Most studies had a serious RoB. Thus, a large body of research investigated STBs in cancer patients/survivors, but it rarely aligned with the theoretical or clinical developments in suicide research. We propose a conceptual model of STBs in cancer delineating moderation and mediation effects to advance the integration of the fields, and to inform future research and practice.
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Affiliation(s)
- Mareike Ernst
- Department of Clinical Psychology, Psychotherapy and Psychoanalysis, Institute of Psychology, University of Klagenfurt, Klagenfurt am Wörthersee, Austria; Suicidal Behaviour Research Laboratory, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Tamara Schwinn
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Judith Hirschmiller
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Seonaid Cleare
- Suicidal Behaviour Research Laboratory, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Kathryn A Robb
- Cancer Behaviour Research Group, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Öztürk S, Hiçdurmaz D. A qualitative study on the perspectives and needs of oncology nurses about recognition and management of suicide risk in cancer patients. J Clin Nurs 2023; 32:749-763. [PMID: 35343003 DOI: 10.1111/jocn.16304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 11/28/2022]
Abstract
AIMS To determine the perspectives and needs of the oncology nurses in recognising and managing the risk of suicide in cancer patients. BACKGROUND Cancer patients are one of the groups with a high risk of suicide. The perspectives and needs of oncology nurses regarding their recognition and management of suicide risk in such patients need to be clarified. DESIGN AND METHODS This qualitative descriptive study used a sample of 33 oncology nurses that were sampled by maximum variation sampling from different oncology units and hospitals. Data were collected with in-depth interviews via a semi-structured interview form and analysed with content analysis. The COREQ guideline was followed for the reporting of the study. RESULTS Three main themes and eight subthemes were identified, namely 'An uncertain atmosphere: sensing the risk of suicide but not seeing the picture' (Subthemes: Inability to identify suicide risk, Unclear responsibilities and Distress as a result of uncertainty), 'Efforts to give meaning to and compensate losses of patients' (Subthemes: Attributions to cancer-related losses of patients and Interventions to alleviate distress related to loss) and 'Hindrances beyond the nurse' (Subthemes: Stigma towards psychosocial problems and getting help, Disagreement with the Physician and A lack of institutional culture on suicide prevention). CONCLUSIONS Our study revealed that oncology nurses have insufficient knowledge and skills and unclear roles in recognising and managing suicide risk. In addition, nurses have difficulty in helping patients due to the insufficient support of team members, stigmas of patients and their relatives towards getting help, patient workloads, and inadequate institutional support in risk management. Training programmes aiming to increase nurses' awareness, knowledge and skills should be developed and embedded into current in-service education programmes and undergraduate education curricula as part of professional improvement. RELEVANCE TO CLINICAL PRACTICE The results of the study can contribute to planning the content and scope of suicide prevention training peculiar to oncology nursing.
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Affiliation(s)
- Sevda Öztürk
- Department of Psychiatric Nursing, Hacettepe University Faculty of Nursing, Ankara, Turkey
| | - Duygu Hiçdurmaz
- Department of Psychiatric Nursing, Hacettepe University Faculty of Nursing, Ankara, Turkey
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Banerjee S, Sharma S, Thakur A, Sachdeva R, Sharma R, Nepali K, Liou JP. N-Heterocycle based Degraders (PROTACs) Manifesting Anticancer Efficacy: Recent Advances. Curr Drug Targets 2023; 24:1184-1208. [PMID: 37946353 DOI: 10.2174/0113894501273969231102095615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
Proteolysis Targeting Chimeras (PROTACs) technology has emerged as a promising strategy for the treatment of undruggable therapeutic targets. Researchers have invested a great effort in developing druggable PROTACs; however, the problems associated with PROTACs, including poor solubility, metabolic stability, cell permeability, and pharmacokinetic profile, restrict their clinical utility. Thus, there is a pressing need to expand the size of the armory of PROTACs which will escalate the chances of pinpointing new PROTACs with optimum pharmacokinetic and pharmacodynamics properties. N- heterocycle is a class of organic frameworks that have been widely explored to construct new and novel PROTACs. This review provides an overview of recent efforts of medicinal chemists to develop N-heterocycle-based PROTACs as effective cancer therapeutics. Specifically, the recent endeavors centred on the discovery of PROTACs have been delved into various classes based on the E3 ligase they target (MDM2, IAP, CRBN, and other E3 ligases). Mechanistic insights revealed during the biological assessment of recently furnished Nheterocyclic- based PROTACs constructed via the utilization of ligands for various E3 ligases have been discussed.
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Affiliation(s)
- Suddhasatwa Banerjee
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, 110031, Taiwan
| | - Sachin Sharma
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, 110031, Taiwan
| | - Amandeep Thakur
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, 110031, Taiwan
| | - Ritika Sachdeva
- College of Medicine, Taipei Medical University, Taipei, 110031, Taiwan
| | - Ram Sharma
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, 110031, Taiwan
| | - Kunal Nepali
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, 110031, Taiwan
- Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Jing Ping Liou
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, 110031, Taiwan
- Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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Contact with the health care system prior to suicide: A nationwide population-based analysis using linkage national death certificates and national health insurance data. J Psychiatr Res 2022; 149:226-232. [PMID: 35290817 DOI: 10.1016/j.jpsychires.2022.02.024] [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] [Received: 01/10/2022] [Revised: 02/16/2022] [Accepted: 02/28/2022] [Indexed: 11/21/2022]
Abstract
This study aimed to discover the proportion of people dying by suicide who had non-psychiatric medical contact alone or any mental health contact in the year, month, and week prior to suicide. Data on suicide deaths (n = 74,741) of all South Koreans from 2009 to 2013 were linked with National Health Insurance (NHI) data by social security number to identify health care contact during the 12 months prior to suicide. The NHI data includes records on inpatient or outpatient service and type of health care institutes which the decedents have contacted. Among the 74,741 individuals who died by suicide, the proportion of individuals who contacted non-psychiatric health care alone was 60.1%, 46.1%, and 35.5%; and the proportion of those who had any mental health contact was 27.9%, 18.0%, and 7.9% in the year, four weeks, and week before death, respectively. Psychiatric care visits in the year, four weeks and weeks prior to death occurred most frequently in psychiatric local clinics. Non-psychiatric care visits in the year and four weeks prior to death were most common in local clinics at the primary care level, but in the one week before death, non-psychiatric care visits were common in tertiary hospital departments. This study indicates that the majority of suicide cases are not diagnosed and managed preceding death despite high general medical contact rates. It implies that suicide prevention strategy should be applied to non-psychiatric medical settings in countries with high suicide rates like South Korea.
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Choi JW, Park EC, Kim TH, Han E. Mental Disorders and Suicide Risk among Cancer Patients: A Nationwide Cohort Study. Arch Suicide Res 2022; 26:44-55. [PMID: 32538322 DOI: 10.1080/13811118.2020.1779156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although cancer patients are known to experience mental disorders and face suicide risk, little is known about the relationship between mental illness and death by suicide in this group. As such, this study aims to examine the association between mental disorders and suicide risk among cancer patients. We used nationally representative cohort data, and included newly diagnosed cancer patients from 2004 to 2012 with whom we followed-up throughout 2013. We used the clinical diagnoses of all mental disorders as an independent variable and suicide death as a dependent variable to estimate the adjusted hazard ratio (AHR) of suicide deaths in patients with cancer using a Cox proportional hazard model. Among total cancer patients (n = 36,220), the 10,567 patients with mental disorders showed higher suicide risk than non-cancer patients (AHR, 1.53; 95% confidence interval [CI], 1.07-2.17), particularly in those who experienced mental disorders prior to cancer diagnosis (AHR, 2.24; 95% CI, 1.35-3.71). Suicide risk among cancer patients who had mood disorders (AHR, 2.23, 95% CI, 1.31-3.81) or anxiety and somatoform disorders (AHR, 1.61, 95% CI, 1.02-2.55) was higher than for those without mental disorders. Suicide risk of stomach (AHR, 3.32; 95% CI, 1.36-8.10) and liver (AHR, 7.57; 95% CI, 1.86-30.72) cancer patients who had mental disorders was higher than for patients without mental disorders. Cancer patients with mental disorders are at increased risk for suicide. During follow-ups after cancer diagnosis, early mental health support needs were provided to patients with mental disorders.
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Shahvand T, Sarafraz MR. Investigating the Mediatory Role of Hope and Shame in the Relationship between Caregiver Burden and Quality of Life of Patients with Cancer. South Asian J Cancer 2021; 9:174-179. [PMID: 34395330 PMCID: PMC8357453 DOI: 10.1055/s-0041-1723109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective
Patients suffering from cancer need to receive care from their family; however, their family caregivers do this without preparation or training, so their involvement in patients’ care results in a caregiving burden that may affect patient’s hope and quality of life (QOL).
Methods
This study examines the effect of caregiving burden on the QOL of cancer patients (
n
= 100) with the mediatory role of hope and shame. To achieve this, Persian versions of Zarit Burden Interview, the World Health Organization QOL, Herth Hope Index, and Guilt and Shame Proneness Scale were used. Meanwhile, path regression analysis was implemented to analyze the relationship between caregiving burden and QOL.
Results
The results implied a relation among caregiver burden, hope, and QOL of patients diagnosed with cancer. It was found that there is a direct and negative relationship between caregiver burden and hope. In addition, there was an indirect and positive relationship between caregiver burden and QOL. Hope and QOL also had a high correlation. Besides, it was shown that there was a negative relationship between the shame experienced by patients and their hope and QOL.
Conclusion
caregiver burden was proved to be influential and negatively affected the factor for the QOL. Besides, patients’ hope decreases while caregiving burden increases; this will in turn affect patients’ recovery and their physical, mental, and cognitive functions. This study provides a foundation for future research in this critical area for oncology.
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Affiliation(s)
- Touraj Shahvand
- Department of Clinical Psychology, Shiraz University, Shiraz, Iran
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Abstract
Cancer is one of the most common diseases and suicide is one of the causes of cancer patients' mortality. However, the suicide mortality rate in cancer patients has not been thoroughly investigated. The aim of this study was to perform a systematic review and a meta-analysis of suicide mortality risk in cancer patients. The authors systematically searched PubMed, Scopus, psycInfo, and Google Scholar databases using MESH keywords until July 2018; searching was limited to English. Random effects model was used for meta-analyzing the studies. Forest plot was calculated for the whole of the 22 studies and the subgroups. Publication bias was examined, and qualitative evaluation of the articles entered into the meta-analysis was also carried out. 22 studies were included in the meta-analysis. Pooled Standardized Mortality Ratio (SMR) for suicide mortality (SMR = 1.55; 95% and confidence interval (CI) CI = 1.37-1.74) in cancer patients were achieved. It has been shown (SMR = 1.67; 95% CI = 1.48-1.89 and p < 0.001) that cancer has increased suicidal rates in men and also in women (SMR = 1.34; 95% CI = 1.20-1.50 and p < 0.001). The following results were reported based on the subtypes of cancer; pooled SMR = 2.06; 95% CI = 1.32-3.23, and p < 0.001 in esophagus, stomach, pancreas and liver cancers; SMR = 1.57; 95% CI = 1.26-1.97, and p < 0.001 in colon and rectum cancers; SMR = 3.07; 95% CI = 2.20-4.28, and p < 0.001 in bronchus, trachea and lung cancers; SMR = 1.24; 95% CI = 1.03-1.48, and p = 0.020 in breast cancer; SMR = 1.71; 95% CI = 1.38-2.12, and p < 0.001 in prostate cancer. Overall, there is an evaluated suicide mortality rate in cancer patients. There was some evidence of publication bias. Our findings indicate that cancer increases the risk of suicide. Given the results and co-morbidities between suicide-induced cancer and other psychological disorders, the development of psychological interventions can be useful in reducing the risk of suicide in these patients.
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Aboumrad M, Shiner B, Riblet N, Mills PD, Watts BV. Factors contributing to cancer-related suicide: A study of root-cause analysis reports. Psychooncology 2018; 27:2237-2244. [DOI: 10.1002/pon.4815] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/04/2018] [Accepted: 06/08/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Maya Aboumrad
- The National Center for Patient Safety; White River Junction VT United States
| | - Brian Shiner
- Geisel School of Medicine at Dartmouth; Hanover NH United States
- The Dartmouth Institute for Health Policy and Clinical Practice; Lebanon NH United States
- Veterans Affairs Medical Center; White River Junction VT United States
| | - Natalie Riblet
- Geisel School of Medicine at Dartmouth; Hanover NH United States
- The Dartmouth Institute for Health Policy and Clinical Practice; Lebanon NH United States
- Veterans Affairs Medical Center; White River Junction VT United States
| | - Peter D. Mills
- Geisel School of Medicine at Dartmouth; Hanover NH United States
- Veterans Affairs Medical Center; White River Junction VT United States
| | - Bradley V. Watts
- The National Center for Patient Safety; White River Junction VT United States
- Geisel School of Medicine at Dartmouth; Hanover NH United States
- Veterans Affairs Medical Center; White River Junction VT United States
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Banyasz A, Wells-Di Gregorio SM. Cancer-related suicide: A biopsychosocial-existential approach to risk management. Psychooncology 2018; 27:2661-2664. [PMID: 29777570 DOI: 10.1002/pon.4768] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/18/2018] [Accepted: 05/08/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Alissa Banyasz
- Psychiatry and Behavioral Sciences, James Cancer Hospital, Martha Morehouse Medical Tower, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sharla M Wells-Di Gregorio
- Psychiatry and Behavioral Sciences, James Cancer Hospital, Martha Morehouse Medical Tower, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Santos MAD. [Cancer and suicide among the elderly: psychosocial determinants of risks, psychopathology and opportunities for prevention]. CIENCIA & SAUDE COLETIVA 2018; 22:3061-3075. [PMID: 28954157 DOI: 10.1590/1413-81232017229.05882016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 05/24/2016] [Indexed: 11/21/2022] Open
Abstract
Suicide is a serious public health problem worldwide. Increasing age is directly associated with the rising rates of cancer and physical and functional limitations are important factors regarded as being associated with suicidal behavior among the elderly. This study sought to conduct a critical review of the literature on the risk factors associated with suicide among elderly cancer patients published between 2000 and 2015. Psychosocial precipitants of risks and psychopathology in 20 selected articles were conducted. The studies consistently identified a number of factors that have been considered to be associated with suicidal behavior among the elderly diagnosed with cancer. These include physical and mental health constraints (particularly major depression), social isolation, and the manner in which these factors and others interact. Further research is needed given the importance of the issue and to examine whether further education for healthcare providers and their abilities in suicide risk assessment and management could have positive effects on reducing the suicide rates among elderly patients with cancer. Considerations for upcoming studies encourage the adoption of empirically supported interventions for individualized management of the elderly cancer patient.
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Affiliation(s)
- Manoel Antônio Dos Santos
- Departamento de Psicologia, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Vila Monte Alegre. 14040-900 Ribeirão Preto SP Brasil.
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Temprado Albalat MD, García Martínez P, Ballester Arnal R, Collado-Boira EJ. The relationship between resilience and quality of life in patients with a drainage enterostomy. J Health Psychol 2018; 25:1483-1497. [PMID: 29506431 DOI: 10.1177/1359105318761555] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Impact and adjustment to a drainage enterostomy are measured mainly through health indicators. To investigate the relationship between resilience and adaptation to the placement of a drainage enterostomy. Prospective observational study with a sample of 125 patients (64 men/36 women) with a temporary or permanent drainage enterostomy and a mean age of 66.72 years. High quality of life (mean, 80.5) and resilience (mean, 79.57) scores and a positive relationship between both were found. There seems to be a positive relationship with general quality of life and health-related quality of life. The logistic regression model shows that the main predictor as regards health-related quality of life is resilience.
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Affiliation(s)
| | | | - Rafa Ballester Arnal
- Department of Clinical Psychology, Jaume I University, Castellón de la Plana, Spain
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Davis MP, Lagman R, Parala A, Patel C, Sanford T, Fielding F, Brumbaugh A, Gross J, Rao A, Majeed S, Shinde S, Rybicki LA. Hope, Symptoms, and Palliative Care. Am J Hosp Palliat Care 2016; 34:223-232. [PMID: 26809826 DOI: 10.1177/1049909115627772] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Hope is important to patients with cancer. Identifying factors that influence hope is important. Anxiety, depression, fatigue, and pain are reported to impair hope. The objective of this study was to determine whether age, gender, marital status, duration of cancer, symptoms, or symptom burden measured by the sum of severity scores on the Edmonton Symptom Assessment Scale (ESAS) correlated with hope measured by the Herth Hope Index (HHI). METHODS Patients with advanced cancer in a palliative care unit participated. Demographics including age, gender, marital status, cancer site, and duration of cancer were collected. Individuals completed the ESAS and HHI. Spearman correlation and linear regression were used to assess associations adjusting for gender (male vs female), age (< 65 vs ≥ 65 years), marital status (married or living with a partner vs other), and duration of cancer (≤ 12 vs > 12 months). RESULTS One hundred and ninety-seven were participated in the study, of which 55% were female with a mean age of 61 years (standard deviation 11). Hope was not associated with gender, age, marital status, or duration of cancer. In univariable analysis, hope inversely correlated with ESAS score (-0.28), lack of appetite (-0.22), shortness of breath (-0.17), depression (-0.39), anxiety (-0.32), and lack of well-being (-0.33); only depression was clinically relevant. In multivariable analysis, total symptom burden weakly correlated with hope; only depression remained clinically significant. DISCUSSION This study found correlation between symptom burden and hope was not clinically relevant but was so for depression. CONCLUSION Among 9 ESAS symptoms, only depression had a clinically relevant correlation with hope.
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Affiliation(s)
- Mellar P Davis
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ruth Lagman
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Armida Parala
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chirag Patel
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tanya Sanford
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Flannery Fielding
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anita Brumbaugh
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Gross
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Archana Rao
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sumreen Majeed
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shivani Shinde
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa A Rybicki
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Parvan K, Jabbarzadeh Tabrizi F, Rahmani A, Ghojazadeh M, Azadi A, Golchin M. The Relationship between Hope and Self-Esteem in Patients with Leukemia. J Caring Sci 2015; 4:217-23. [PMID: 26464838 DOI: 10.15171/jcs.2015.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 01/08/2015] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Patients with hematologic malignancies often experience many emotional reactions which are different based on patient's culture. Indeed culture determines the different ways that patients understand cancer. Accordingly, the aim of this study was to determine the relationship of self-esteem and hope among Iranian cancer patients. METHODS This descriptive-correlational study was undertaken among 85 leukemic patients admitted to Shahid Ghazi hospital in East-Azerbaijan province, Iran. They were selected using consecutive sampling method. Persian form of Hearth Hope Index and Coppersmith Self-Esteem Inventory were used to identify patients' hope and self-esteem. The data were analyzed using SPSS version 13.0. RESULTS The overall scores of hope and self-esteem were 33.05 (5.24) and 94.61 (11.51), respectively. There was a positive correlation between hope and self-esteem (rs = 0.73, n = 85, P < 0.001). CONCLUSION Although culture determines the different ways that patients understand cancer, but it seems that the self-esteem and hope relationship could be similar in different cultures. The findings of this study indicate that nurses could be helpful through designing and implementing appropriate educational programs in order to enhance hope and self-esteem of leukemia patients.
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Affiliation(s)
- Kobra Parvan
- Department of Medic1Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iranal-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faranak Jabbarzadeh Tabrizi
- Department of Medical-Surgical Nursing, Hematology and Oncology Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azad Rahmani
- Department of Medical-Surgical Nursing, Hematology and Oncology Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Liver and Gastrointestinal, Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arman Azadi
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Mehri Golchin
- Department of Medical-Surgical Nursing, Hematology and Oncology Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Ahn MH, Park S, Lee HB, Ramsey CM, Na R, Kim SO, Kim JE, Yoon S, Hong JP. Suicide in cancer patients within the first year of diagnosis. Psychooncology 2014; 24:601-7. [DOI: 10.1002/pon.3705] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 07/19/2014] [Accepted: 09/16/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Myung Hee Ahn
- Department of Psychiatry, Asan Medical Center; Ulsan University College of Medicine; Seoul Korea
| | - Subin Park
- Department of Psychiatry; Seoul National Hospital; Seoul Korea
| | | | | | - Riji Na
- Department of Psychiatry, Asan Medical Center; Ulsan University College of Medicine; Seoul Korea
| | - Seon Ok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center; Ulsan University College of Medicine; Seoul Korea
| | - Jeong Eun Kim
- Department of Oncology, Asan Medical Center; Ulsan University College of Medicine; Seoul Korea
| | - Shinkyo Yoon
- Department of Oncology, Asan Medical Center; Ulsan University College of Medicine; Seoul Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Asan Medical Center; Ulsan University College of Medicine; Seoul Korea
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15
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Trevino KM, Abbott CH, Fisch MJ, Friedlander RJ, Duberstein PR, Prigerson HG. Patient-oncologist alliance as protection against suicidal ideation in young adults with advanced cancer. Cancer 2014; 120:2272-81. [PMID: 24888503 PMCID: PMC4356118 DOI: 10.1002/cncr.28740] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/10/2013] [Accepted: 07/30/2013] [Indexed: 11/05/2022]
Abstract
BACKGROUND Young adults with cancer are at an increased risk of suicidal ideation. To the authors' knowledge, the impact of the patient-oncologist alliance on suicidal ideation has not been examined to date. The current study examined the relationship between the patient-oncologist therapeutic alliance and suicidal ideation in young adults with advanced cancer. METHODS A total of 93 young adult patients (aged 20 years-40 years) with incurable, recurrent, or metastatic cancer were evaluated by trained interviewers. Suicidal ideation was assessed with the Yale Evaluation of Suicidality scale, dichotomized into a positive and negative score. Predictors included diagnoses of major depressive disorder and posttraumatic stress disorder, physical quality of life, social support, and use of mental health and supportive care services. The Human Connection Scale, dichotomized into a strong (upper third) and weak (lower two-thirds) therapeutic alliance, assessed the strength of the patients' perceived oncologist alliance. RESULTS Approximately 22.6% of patients screened positive for suicidal ideation. Patients with a strong therapeutic alliance were found to be at reduced risk of suicidal ideation after controlling for confounding influences of cancer diagnosis, Karnofsky performance status, number of physical symptoms, physical quality of life, major depressive disorder, posttraumatic stress disorder, and social support. A strong therapeutic alliance was also associated with a reduced risk of suicidal ideation after controlling for mental health discussions with health care providers and use of mental health interventions. CONCLUSIONS The patient-oncologist alliance was found to be a robust predictor of suicidal ideation and provided better protection against suicidal ideation than mental health interventions, including psychotropic medications. Oncologists may significantly influence patients' mental health and may benefit from training and guidance in building strong alliances with their young adult patients.
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Affiliation(s)
- Kelly M Trevino
- Center for Research on Patients and Families Facing Serious Illness, Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York
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16
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A correlational study of suicidal ideation with psychological distress, depression, and demoralization in patients with cancer. Support Care Cancer 2014; 22:3165-74. [PMID: 24935648 PMCID: PMC4218975 DOI: 10.1007/s00520-014-2290-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 05/15/2014] [Indexed: 11/02/2022]
Abstract
PURPOSE This study aims to study the effects of depression and demoralization on suicidal ideation and to determine the feasibility of the Distress Thermometer as a screening tool for patients with cancer who experience depression and demoralization, and thus to establish a model screening process for suicide prevention. METHODS Purposive sampling was used to invite inpatients and outpatients with lung cancer, leukemia, and lymphoma. Two hundred participants completed the questionnaire, which included the Distress Thermometer (DT), Patient Health Questionnaire-9 (PHQ-9), Demoralization Scale-Mandarin Version (DS-MV), and Beck Scale for Suicide Ideation. All data obtained were analyzed using SPSS 18.0 and SAS 9.3. RESULTS Tobit regression analysis showed that demoralization influenced suicidal ideation more than depression did (t = 2.84, p < 0.01). When PHQ-9 ≥ 10 and DS-MV ≥42 were used as criteria for the DT, receiver operating characteristic analysis revealed that the AUC values were 0.77-0.79, with optimal cutoff points for both of DT ≥5; sensitivity 76.9 and 80.6 %, respectively; and specificity of 73.9 and 72.2 %, respectively. CONCLUSIONS Demoralization had more influence on suicidal ideation than depression did. Therefore, attention should be paid to highly demoralized patients with cancer or high demoralization comorbid with depression for the purposes of suicide evaluation and prevention. The DT scale (with a cutoff of ≥5 points) has discriminative ability as a screening tool for demoralization or depression and can also be used in clinical settings for the preliminary screening of patients with cancer and high suicide risk.
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17
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Li HC, Hsiao YL, Tang CH, Miao NF. Nursing Inequalities in Elderly Suicides: An Empirical Study of Taiwan. INT J GERONTOL 2014. [DOI: 10.1016/j.ijge.2013.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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18
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Sakinofsky I. Preventing suicide among inpatients. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:131-40. [PMID: 24881161 PMCID: PMC4079240 DOI: 10.1177/070674371405900304] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Inpatient suicide comprises a proportionately small but clinically important fraction of suicide. This study is intended as a qualitative analysis of the comprehensive English literature, highlighting what is known and what can be done to prevent inpatient suicide. METHOD A systematic search was conducted on the Cochrane Library, PubMed, Embase, Web of Knowledge, and a personal database for articles on cohort series, preferably controlled, of inpatient suicide (not deliberate self-harm or attempted suicide, unless they also dealt specifically with suicide data). RESULTS A qualitative discussion is presented, based on the findings of the literature searched. CONCLUSIONS The bulk of inpatient suicides actually occur not on the ward but off premises, when the patient was on leave or had absconded. Peaks occur shortly after admission and discharge. It is possible to reduce suicide risk on the ward by having a safe environment, optimizing patient visibility, supervising patients appropriately, careful assessment, awareness of and respect for suicide risk, good teamwork and communication, and adequate clinical treatment.
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Duggleby W, Ghosh S, Cooper D, Dwernychuk L. Hope in newly diagnosed cancer patients. J Pain Symptom Manage 2013; 46:661-70. [PMID: 23535324 DOI: 10.1016/j.jpainsymman.2012.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 11/30/2012] [Accepted: 12/05/2012] [Indexed: 10/27/2022]
Abstract
CONTEXT Hope is important to cancer patients as it helps them deal with their diagnosis. Little is known about hope in newly diagnosed cancer patients. OBJECTIVES Based on the Transcending Possibilities conceptual model of hope, the purpose of this study was to examine the relationship of hope with pain, energy, and psychological and demographic characteristics in newly diagnosed adult oncology outpatients. METHODS Data from 310 New Patient Assessment Forms from cancer outpatients' health records were collected. Health records from the first six months of 2009 were reviewed and data were collected on hope, energy, pain, depression, anxiety, feeling overwhelmed, and demographic variables. A generalized linear modeling approach was used to study the relationship of hope scores with these variables. Hypothesized variables and variables that were significant at the P = 0.01 level from the univariate analysis were entered into the multivariate model, with hope scores as the dependent variable. RESULTS Hope scores were significantly negatively related to age (P = 0.02). More specifically, oncology patients who were 65 years of age or older had significantly less hope than those under the age of 65 years (P = 0.01). Gender (P = 0.009) also was a significant factor, with men having higher hope scores than women. No other variables were significant. CONCLUSION Older adults comprise the majority of persons in Canada with cancer. The lower hope scores found in this age group compared with their younger counterparts underscore the importance of further research. This study provides a foundation for future research in this important area for oncology patients.
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Affiliation(s)
- Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
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McCarthy JF, Szymanski BR, Karlin BE, Katz IR. Suicide mortality following nursing home discharge in the Department of Veterans Affairs health system. Am J Public Health 2013; 103:2261-6. [PMID: 24134359 DOI: 10.2105/ajph.2013.301292] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed suicide rates up to 6 months following discharge from US Department of Veterans Affairs (VA) nursing homes. METHODS In VA Minimum Data Set (MDS) records, we identified 281 066 live discharges from the 137 VA nursing homes during fiscal years 2002 to 2008. We used MDS and administrative data to assess resident age, gender, behaviors, pain, and indications of psychoses, bipolar disorder, dementia, and depression. We identified vital status and suicide mortality within 6 months of discharge through National Death Index searches. RESULTS Suicide rates within 6 months of discharge were 88.0 per 100 000 person-years for men and 89.4 overall. Standardized mortality ratios relative to age- and gender-matched individuals in the VA patient population were 2.3 for men (95% confidence interval [CI] = 1.9, 2.8) and 2.4 overall (95% CI = 2.0, 2.9). In multivariable proportional hazards regression analyses, resident characteristics, diagnoses, behaviors, and pain were not significantly associated with suicide risk. CONCLUSIONS Suicide risk was elevated following nursing home discharge. This underscores the importance of ongoing VA efforts to enhance discharge planning and timely postdischarge follow-up.
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Affiliation(s)
- John F McCarthy
- John F. McCarthy, Bradley E. Karlin, and Ira R. Katz are with the Department of Veterans Affairs (VA), Washington, DC. John F. McCarthy and Ira R. Katz are also with the VA Office of Mental Health Operations, Washington, DC. Bradley E. Karlin is also with VA Mental Health Services, Washington, DC. Benjamin R. Szymanski is with the Yale School of Public Health, New Haven, CT
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Mishara BL, Weisstub DN. Premises and evidence in the rhetoric of assisted suicide and euthanasia. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2013; 36:427-435. [PMID: 24145063 DOI: 10.1016/j.ijlp.2013.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In debates about euthanasia and assisted suicide, it is rare to find an article that begins with an expression of neutral interest and then proceeds to examine the various arguments and data before drawing conclusions based upon the results of a scholarly investigation. Although authors frequently give the impression of being impartial in their introduction, they invariably reach their prior conclusions. Positions tend to be clearly dichotomized: either one believes that the practice of euthanasia or assisted suicide is totally acceptable or completely unacceptable in a just and moral society. Where there is some admission of a gray zone of incertitude, authors attempt to persuade us that their beliefs (preferences) are the only sensible way to resolve outstanding dilemmas. The practice of vehemently promoting a "pro" or "con" position may be useful when societies must decide to either legalize certain practices or not. Although only a handful of countries have thus far accepted the legal practice of euthanasia or assisted suicide (Belgium, Luxembourg, The Netherlands, the U.S. states of Montana, Oregon, Vermont and Washington, and Switzerland), scholarly articles in recent trends mainly promote legalization, to the point of recommending expansion of the current practices. Is this a case of the philosophers being ahead of their time in promoting and rationalizing the wave of the future? Alternatively, does the small number of countries that have legalized these practices indicate a substantial gap between the beliefs and desires of common citizens and the universe of the 'abstracted realm'? For the time being, what we do know is that more countries and states are debating legalization of euthanasia or assisted suicide, the nature of laws and legal practices vary greatly and both ethical and empirical assessments of current practices are the subject of much controversy. This article presents an examination of the premises and evidence in the rhetoric of assisted suicide and euthanasia. Inasmuch as any analysis cannot be totally impartial, we do not contend that our analysis is without influence from our experiences and philosophical affinities. Notwithstanding this caveat, we venture to propose that our scrutiny of the arguments and empirical data may offer some guidance to individuals who are attempting to reach practical conclusions based upon the available evidence, whether empirical or rationalized.
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Affiliation(s)
- Brian L Mishara
- Centre for Research and Intervention on Suicide and Euthanasia, Université du Québec à Montréal, Canada.
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Shim EJ, Park JH. Suicidality and its associated factors in cancer patients: results of a multi-center study in Korea. Int J Psychiatry Med 2012; 43:381-403. [PMID: 23094469 DOI: 10.2190/pm.43.4.g] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The current study examined the prevalence and associated factors of suicidality among Korean cancer patients. Moreover, the association of multiple psychological morbidities with suicidality was investigated among cancer patients. METHODS A cross-sectional, multi-center survey of 400 cancer patients was administered in five cancer-treatment hospitals throughout South Korea. Study variables were assessed using standardized measures including the Mini International Neuropsychiatric Interview suicidality module, the Hospital Anxiety and Depression Scale, and the Impact of Event Scale-Revised. RESULTS 20.1% (80/399) of patients were positive cases of suicidality. Having no religion (p = .010), poor performance status (p = .000), and psychological comorbidity (p = .021) were significantly associated with the experience of suicidality in the multivariate analysis. Compared to "fully active" patients, patients who were capable of self-care but unable to perform any work activities had about a six times higher risk of suicidality (p = .000). Compared to patients with no psychological morbidity, the risk of suicidality was significantly higher among patients with comorbid anxiety and depression (p = .024), those experiencing comorbid depression and post-traumatic stress disorder (PTSD) (p = 0.051), and those experiencing comorbid anxiety, depression and PTSD (p = .001). CONCLUSIONS This study found that having no religion, impaired levels of overall functioning, and "multiple psychological morbidities" were associated with suicidality in Korean cancer patients. These findings suggest a need for careful monitoring of these factors and enhanced comprehensive care addressing both the physical and psychosocial functioning of patients with cancer in suicide prevention efforts.
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Shun SC, Hsiao FH, Lai YH. Relationship between hope and fatigue characteristics in newly diagnosed outpatients with cancer. Oncol Nurs Forum 2011; 38:E81-6. [PMID: 21356645 DOI: 10.1188/11.onf.e81-e86] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the relationship between hope and fatigue (intensity, duration, and interference) in newly diagnosed patients with cancer receiving chemotherapy. DESIGN Cross-sectional and correlational. SETTING Oncology outpatient clinics of two medical centers in northern Taiwan. SAMPLE 182 patients diagnosed with various types of solid tumors in the previous six months and receiving chemotherapy treatment. METHODS Questionnaires were used to assess patients' fatigue intensity, duration, and interference, as well as level of hope and related background information before drug administration at a chemotherapy visit. The relationship between fatigue characteristics and level of hope was verified using Pearson's correlation analysis. MAIN RESEARCH VARIABLES Hope, fatigue intensity, duration, and interference. FINDINGS Compared to fatigue intensity, interference and its duration have a stronger association with level of hope. Further analysis of the seven individual items of fatigue interference found that interference with mood status and relations with others is significantly associated with level of hope in newly diagnosed patients. CONCLUSIONS Fatigue duration and interference caused by fatigue, particularly in mood status and relations with others, are associated with the perception of hope in newly diagnosed patients. IMPLICATIONS FOR NURSING Clinical nurses should assess intensity of fatigue as well as its interference and duration to better support patients' perception of hope by reducing interference caused by fatigue.
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Affiliation(s)
- Shiow-Ching Shun
- Department of Nursing, College of Medicine, National Taiwan University, Taipei
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Spoletini I, Gianni W, Caltagirone C, Madaio R, Repetto L, Spalletta G. Suicide and cancer: Where do we go from here? Crit Rev Oncol Hematol 2011; 78:206-19. [DOI: 10.1016/j.critrevonc.2010.05.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 04/26/2010] [Accepted: 05/07/2010] [Indexed: 12/21/2022] Open
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Abstract
The psychosocial and psychiatric sequelae of cancer are highly prevalent, diverse, and challenging for clinicians to manage. A growing body of literature has generated methods for the reliable screening, assessment, and management of these sequelae, including the treatment of psychiatric disorders that may complicate the course of cancer. To meet the specific needs of this patient population, psycho-oncologists worldwide have begun to train more and more social workers, psychologists, and psychiatrists who can provide consultative services in support of the psychiatric care of cancer patients and their families at all stages of disease, including cancer survivorship. This review presents an overview of the history of psycho-oncology, common psychological responses to cancer, factors in adapting to cancer, epidemiology, the assessment and management of major psychiatric disorders in cancer patients, cancer-related fatigue, the cognitive effects of cancer and cancer treatment, issues related to the psychosocial care of families (including bereavement), and psychological issues for staff caring for cancer patients.
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