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Danieli PP, Hoang N, Selvanayagam T, Yang A, Breetvelt E, Tabbers M, Cohen C, Aelvoet AS, Trost B, Ward T, Semotiuk K, Durno C, Aronson M, Cohen Z, Dekker E, Vorstman J. Autistic traits in youth with familial adenomatous polyposis: A Dutch-Canadian case-control study. Am J Med Genet B Neuropsychiatr Genet 2024:e32999. [PMID: 38967411 DOI: 10.1002/ajmg.b.32999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/25/2024] [Accepted: 06/10/2024] [Indexed: 07/06/2024]
Abstract
This study investigated the neurodevelopmental impact of pathogenic adenomatous polyposis coli (APC) gene variants in patients with familial adenomatous polyposis (FAP), a cancer predisposition syndrome. We hypothesized that certain pathogenic APC variants result in behavioral-cognitive challenges. We compared 66 FAP patients (cases) and 34 unaffected siblings (controls) to explore associations between APC variants and behavioral and cognitive challenges. Our findings indicate that FAP patients exhibited higher Social Responsiveness Scale (SRS) scores, suggesting a greater prevalence of autistic traits when compared to unaffected siblings (mean 53.8 vs. 47.4, Wilcoxon p = 0.018). The distribution of SRS scores in cases suggested a bimodal pattern, potentially linked to the location of the APC variant, with scores increasing from the 5' to 3' end of the gene (Pearson's r = 0.33, p = 0.022). While we observed a trend toward lower educational attainment in cases, this difference was not statistically significant. This study is the first to explore the connection between APC variant location and neurodevelopmental traits in FAP, expanding our understanding of the genotype-phenotype correlation. Our results emphasize the importance of clinical assessment for autistic traits in FAP patients, shedding light on the potential role of APC gene variants in these behavioral and cognitive challenges.
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Affiliation(s)
- Polina Perlman Danieli
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ny Hoang
- Department of Genetic Counselling, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Thanuja Selvanayagam
- Department of Genetic Counselling, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alvin Yang
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Familial Gastrointestinal Cancer Registry at the Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Elemi Breetvelt
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Merit Tabbers
- Department of Pediatrics, Emma Children's Hospital, Amsterdam, The Netherlands
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam Reproduction and Development and Amsterdam Gastroenterology Endocrinology Metabolism Research Institutes, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Christine Cohen
- Department of Gastroenterology and Hepatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology & Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Arthur S Aelvoet
- Department of Gastroenterology and Hepatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology & Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Brett Trost
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Thomas Ward
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- The Familial Gastrointestinal Cancer Registry at the Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Kara Semotiuk
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- The Familial Gastrointestinal Cancer Registry at the Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Carol Durno
- The Familial Gastrointestinal Cancer Registry at the Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Gastroenterology/Hepatology & Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Melyssa Aronson
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- The Familial Gastrointestinal Cancer Registry at the Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Zane Cohen
- The Familial Gastrointestinal Cancer Registry at the Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology & Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jacob Vorstman
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Developmental Psychopathology, The Hospital for Sick Children, Toronto, Ontario, Canada
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2
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Krok D, Telka E, Moroń M. Personal Resources and Total Pain: Exploring the Multiple Mediation of Fear of Recurrence, Meaning-Making, and Coping in Posttreatment Cancer Patients. Ann Behav Med 2024:kaae029. [PMID: 38850553 DOI: 10.1093/abm/kaae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND People with cancer who have completed treatment still experience negative effects, such as an increased risk of experiencing cancer-related pain. Psychological factors tend to influence cancer patients' ability to cope with pain in various dimensions. Although personal resources are an important factor in buffering total pain, still little is known about the intervening variables and underlying mechanisms. PURPOSE The current study examined the relationship between psychological flexibility, self-esteem, and total pain, while considering fear of recurrence, meaning-making, and coping as potential mediating factors. METHODS Adults (N = 304) who completed medical treatment (radiotherapy, chemotherapy, and combined therapy) participated in this study. They completed questionnaires measuring the aforementioned variables. Structural equation models were used to examine mediation effects. RESULTS Psychological flexibility, and partly self-esteem, were negatively related to the dimensions of total pain. However, to a large extent, these relationships were serially and parallelly mediated by fear of recurrence, meaning-making, and emotion-oriented coping. CONCLUSIONS Consistent with the meaning-making model, cognitive (meaning-making), and affective (fear of recurrence and emotional coping) factors may be potential mechanisms underlying the association between psychological flexibility, self-esteem, and total pain in posttreatment cancer patients. In this study, they tended to interact in the area of physiological and psychosocial experiences of cancer-related pain.
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Affiliation(s)
- Dariusz Krok
- Institute of Psychology, Faculty of Social Sciences, University of Opole, Opole, Poland
| | - Ewa Telka
- The Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Marcin Moroń
- Institute of Psychology, Faculty of Social Sciences, University of Silesia, Katowice, Poland
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Fujiyoshi K, Sudo T, Fujita F, Tanihara S, Ishida H, Shichijo S, Chino A, Nagasaski T, Takao A, Sasaki K, Akagi K, Matsubara T, Ueno H, Hirata K, Miyakura Y, Ishikawa T, Sunami E, Takahashi Y, Yamaguchi T, Tanakaya K, Tomita N, Ajioka Y. Marital status after colorectal surgery in familial adenomatous polyposis: a nationwide multicenter study in Japan. Int J Clin Oncol 2024:10.1007/s10147-024-02558-4. [PMID: 38819608 DOI: 10.1007/s10147-024-02558-4] [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: 02/04/2024] [Accepted: 05/17/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Patients with familial adenomatous polyposis (FAP) experience psychological and social challenges concerning future events such as marriage and childbirth alongside the medical risks of colorectal cancer (CRC) and FAP-related disease. We retrospectively investigated the rate of marriage and childbirth postoperatively in Japanese patients with FAP. METHODS We included 161 patients who had colorectal surgery and reported marital status from a national survey of 35 Japanese institutions. Participants were classified according to marital status: married before colectomy (80 patients), married after colectomy (13 patients), and unmarried (68 patients). RESULTS The marriage rate for all 161 patients (57.8%, standardized ratio 0.95, 95% confidence interval [CI] 0.76-1.14) was comparable to that in the general Japanese population (57.1%). The marriage rate among the 81 patients who were unmarried before colectomy was low (16.0%); however, the standardized marital ratio (0.75, 95% CI 0.34-1.15) was not significantly lower than that of the general population. In multivariable logistic regression, younger age (born after 1980, odds ratio [OR] 0.12, p < 0.001) and genetic testing (OR 4.06, p = 0.001) were associated with postoperative marriage. Seventy-one percent of patients with FAP who married after colectomy became pregnant and achieved delivery. CONCLUSIONS The marriage rate of patients with FAP was comparable to that of the general population whereas the rate after colectomy was low among patients with FAP. However, in patients with FAP, colorectal surgery itself may not lead to negative consequences in terms of fecundity.
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Affiliation(s)
- Kenji Fujiyoshi
- Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan.
| | - Tomoya Sudo
- Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
| | - Fumihiko Fujita
- Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Shinichi Tanihara
- Department of Public Health, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Hideyuki Ishida
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, 350-8550, Japan
| | - Satoki Shichijo
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Akiko Chino
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Toshiya Nagasaski
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Akinari Takao
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kazuhito Sasaki
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kiwamu Akagi
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Division of Molecular Diagnosis and Cancer Prevention, Saitama Cancer Center, 818 Komuro, Ina-machi, Kitaadachi-gun, Saitama, 362-0806, Japan
| | - Takaaki Matsubara
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Department of Surgery, Division of Lower Gastrointestinal Surgery, Hyogo College of Medicine, Nishinomiya, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hideki Ueno
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Keiji Hirata
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Department of Surgery I, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu-shi, Fukuoka, 807-8555, Japan
| | - Yasuyuki Miyakura
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Department of Surgery, Saitama Medical Center Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-0834, Japan
| | - Toshiaki Ishikawa
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Department of Clinical Oncology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Eiji Sunami
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-0004, Japan
| | - Yusuke Takahashi
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Department of Surgery, National Hospital Organization Osaka National Hospital, 2-1-1 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
| | - Tatsuro Yamaguchi
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Department of Clinical Genetics, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kohji Tanakaya
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Department of Surgery, Iwakuni Clinical Center, 1-1-1 Atago-cho, Iwakuni-shi, Yamaguchi, 740-8510, Japan
| | - Naohiro Tomita
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Cancer Treatment Center, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka-shi, Osaka, 560-8565, Japan
| | - Yoichi Ajioka
- Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Sanbancho KS Building, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, 757 Ichibancho, Asahimachi-dori, Chuo Ward, Niigata, 951-8510, Japan
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van de Wal D, den Hollander D, Desar IME, Gelderblom H, Oosten AW, Reyners AKL, Steeghs N, Husson O, van der Graaf WTA. Financial difficulties experienced by patients with gastrointestinal stromal tumours (GIST) in the Netherlands: data from a cross-sectional multicentre study. Support Care Cancer 2024; 32:279. [PMID: 38594390 PMCID: PMC11004045 DOI: 10.1007/s00520-024-08451-0] [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: 10/31/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE This study aims to (1) explore the prevalence of patient-reported financial difficulties among GIST patients, differentiating between those currently undergoing tyrosine kinase inhibitor (TKI) treatment and those who are not; (2) investigate associations between financial difficulties and sociodemographic and clinical characteristics, work, cancer-related concerns, anxiety and depression and (3) study the impact of financial difficulties on health-related quality of life. METHODS A cross-sectional study was conducted among Dutch GIST patients diagnosed between 2008 and 2018, who were invited to complete a one-time survey between September 2020 and June 2021. Patients completed nine items of the EORTC item bank regarding financial difficulties, seven work-related questions, the Hospital Anxiety and Depression Scale, Cancer Worry Scale and EORTC QLQ-C30. RESULTS In total, 328 GIST patients participated (response rate 63.0%), of which 110 (33.8%) were on TKI treatment. Patients currently treated with TKIs reported significantly more financial difficulties compared to patients not on TKIs (17.3% vs 8.7%, p = 0.03). The odds of experiencing financial difficulties was 18.9 (95% CI 1.7-214.7, p = 0.02) times higher in patients who were less able to work due to their GIST diagnosis. Patients who experienced financial difficulties had significantly lower global quality of life and functioning, and more frequently reported psychological symptoms as compared to patients who did not report financial difficulties. CONCLUSION Even in a country where the costs of TKIs and follow-up care are covered by health insurance, financial difficulties can be present in GIST patients, especially in patients on TKI treatment, and may negatively influence the quality of life.
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Affiliation(s)
- Deborah van de Wal
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dide den Hollander
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Astrid W Oosten
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Anna K L Reyners
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Olga Husson
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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Fukuda S, Watanabe K, Takahashi S, Yoshida T, Fujimori S, Komatsu T, Shimodaira Y, Matsuhashi T, Iijima K. Disproportionate cancer worries in ultra-short-segment Barrett's esophagus in Japan. DEN OPEN 2024; 4:e329. [PMID: 38223912 PMCID: PMC10787273 DOI: 10.1002/deo2.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
Objectives Although Barrett's esophagus (BE), especially ultra-short-segment BE (USSBE), is very frequently diagnosed in Japan, how subjects feel about receiving a diagnosis of BE is unclear. We therefore prospectively investigated cancer worry in subjects who received a BE diagnosis. Methods Self-administered questionnaires were sent to subjects who were diagnosed with BE at three health checkup institutes in Akita Prefecture, Japan. The cancer worry scale (CWS) was used to quantitatively assess the fear of developing cancer. The BE subjects were classified into USSBE <1 cm and non-USSBE ≥1 cm groups. Factors associated with the CWS were investigated using logistic regression analyses. Results A total of 325 (31%) subjects, comprising 229 USSBE and 96 non-USSBE patients were included in this study. Compared with the USSBE group, the non-USSBE group had a significantly higher frequency of a history of a BE diagnosis and perception of carcinogenesis. However, the CWS was similar between the USSBE and non-USSBE groups, with a median CWS of 12.5 (3.75) versus 12.7 (3.65). A multivariate logistic regression analysis revealed that while positive reflux symptoms were significantly associated with a positive CWS, the BE length was not significantly associated with it, with an odds ratio (95% confidence interval) of 1.3 (0.75-2.2). Conclusions A BE diagnosis promotes a similar level of worry about cancer among subjects, irrespective of the length of BE. In Japan, since USSBE poses a much lower cancer risk than non-USSBE, the former may frequently be associated with a disproportionate cancer worry relative to the latter. (UMIN000044010).
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Affiliation(s)
- Sho Fukuda
- Department of GastroenterologyAkita University Graduate School of MedicineAkitaJapan
| | - Kenta Watanabe
- Department of GastroenterologyAkita University Graduate School of MedicineAkitaJapan
| | - So Takahashi
- Department of GastroenterologyAkita University Graduate School of MedicineAkitaJapan
| | - Tatsuki Yoshida
- Department of GastroenterologyAkita University Graduate School of MedicineAkitaJapan
| | - Shusei Fujimori
- Department of GastroenterologyYokote Municipal HospitalAkitaJapan
| | - Taiga Komatsu
- Department of AnesthesiologyHonjo‐Daiichi HospitalAkitaJapan
| | - Yosuke Shimodaira
- Department of GastroenterologyAkita University Graduate School of MedicineAkitaJapan
| | - Tamotsu Matsuhashi
- Department of GastroenterologyAkita University Graduate School of MedicineAkitaJapan
| | - Katsunori Iijima
- Department of GastroenterologyAkita University Graduate School of MedicineAkitaJapan
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6
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Jelsig AM, Karstensen JG, Overeem Hansen TV. Progress report: Peutz-Jeghers syndrome. Fam Cancer 2024:10.1007/s10689-024-00362-7. [PMID: 38493229 DOI: 10.1007/s10689-024-00362-7] [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: 10/25/2023] [Accepted: 02/04/2024] [Indexed: 03/18/2024]
Abstract
Peutz-Jeghers syndrome is a rare, autosomal dominant polyposis syndrome. Presenting with a remarkable phenotype including development of characteristic gastrointestinal polyps, mucocutaneous pigmentations, and an increased risk of cancer, the syndrome has been subject to many studies concerning the natural course of disease. In most patients, pathogenic germline variants are detected in the STK11 gene including cases of mosaicism and structural variants. Yet, studies assessing the effect of surveillance, understanding of cancer development, as well as clinical studies evaluating chemoprevention are lacking. In addition, the impact of Peutz-Jeghers syndrome on mental health, education, and family planning are insufficiently addressed. In this progress report, we describe current knowledge, clinical phenotype, surveillance strategies, and future areas of research.
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Affiliation(s)
- Anne Marie Jelsig
- Department of Clinical Genetics, University Hospital of Copenhagen - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - John Gásdal Karstensen
- The Danish Polyposis Register, Gastro Unit and Department of Clinical Medicine, Amager and Hvidovre, Copenhagen University Hospital and University of Copenhagen-, Copenhagen, Denmark
| | - Thomas V Overeem Hansen
- Department of Clinical Genetics and Department of Clinical Medicine, University Hospital of Copenhagen, Rigshospitalet and Copenhagen University, Copenhagen, Denmark
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7
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Boelhouwer IG, van Vuuren T. The association of fatigue and cognitive complaints with work-related outcomes and cancer-related anxiety among employees 2-10 years after cancer diagnosis. J Health Psychol 2024:13591053241234748. [PMID: 38433650 DOI: 10.1177/13591053241234748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
This study investigated the association of fatigue and cognitive complaints among employees post-cancer diagnosis, with work-related outcomes, and moderation by cancer-related anxiety. A survey was carried out among workers 2-10 years after cancer diagnosis. Employees without cancer recurrence or metastases were selected (N = 566). Self-reported fatigue and cognitive complaints were classified into three groups. ANOVA's and regression analyses were used, controlling for age. Group 1 (cognitive complaints, n = 25, 4.4%), group 2 (fatigue, n = 205, 36.2%), and group 3 (cognitive complaints and fatigue, n = 211, 37.3%) were associated with higher burnout complaints and lower work engagement, and group 2 and 3 with lower work ability. Cancer-related anxiety positively moderated the association of group 3 with higher burnout complaints. Employees with both fatigue and cognitive complaints report less favorable work functioning. Cancer-related anxiety needs attention in the context of burnout complaints.
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Affiliation(s)
| | - Tinka van Vuuren
- Open Universiteit, the Netherlands
- Loyalis Knowledge & Consult, the Netherlands
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8
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van der Ende-van Loon MCM, Oude Nijhuis RAB, Curvers WL, Schoon EJ. Prevalence and associated factors of worry for cancer in patients with a Barrett's esophagus. Sci Rep 2024; 14:2878. [PMID: 38311635 PMCID: PMC10838905 DOI: 10.1038/s41598-024-53428-y] [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: 06/15/2023] [Accepted: 01/31/2024] [Indexed: 02/06/2024] Open
Abstract
Although the risk of cancer progression in a Barrett's esophagus (BE) is very low, worrying about cancer is known as an important factor affecting HRQoL. The aim of this study was to determine the proportion of BE patients with high levels of worry for cancer, to compare outcomes of patients endoscopically treated for BE neoplasia (DBE), non-dysplastic BE patients (NDBE) and patients with reflux symptoms, and to examine associated factors. We performed a cross sectional, exploratory, self-administered questionnaire study using the cancer worry scale, and the reflux disease questionnaire. A total of 192 DBE patients, 213 NDBE patients and 111 refractory reflux symptom patients were included from October 2019 until July 2021, 76.8% of BE participants were male and aged 66.9 years. High cancer worry was reported in 40.6% of the DBE patients and 36.2% of NDBE patient. Reflux patients scored statistically significant worse with 56.6% stated high cancer worry. Positive correlations were found between reflux symptoms and cancer worry in NDBE patients and reflux patients. In DBE patients' negative correlations were found between higher cancer worry and younger age as well as a family history of esophageal carcinoma. A clinically significant group of BE patients reported high cancer worry, which was associated with reflux symptoms in NDBE patients and a younger age and a (family) history of esophageal carcinoma diagnosis in BE patients treated for (early) neoplasia. Physicians should communicate about the actual cancer risk, which leads to greater patient understanding and therefore may have a positive impact on health outcomes.
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Affiliation(s)
- M C M van der Ende-van Loon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
- GROW: School for Oncology and Developmental Biology, Maastricht UMC, Maastricht, The Netherlands.
| | - R A B Oude Nijhuis
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - W L Curvers
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - E J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
- GROW: School for Oncology and Developmental Biology, Maastricht UMC, Maastricht, The Netherlands
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9
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Blankenship K, Chieffo S, Morris E, Slomp C, Batallones R, Prijoles E, Hill-Chapman C, Austin J. Development and evaluation of an educational resource for parents of children with 22q11.2 deletion syndrome about the psychiatric manifestations of the condition. J Genet Couns 2023. [PMID: 37658574 DOI: 10.1002/jgc4.1779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/03/2023]
Abstract
Parents of children with 22q11.2 deletion syndrome (22q11DS) report concern about the psychiatric manifestations of the condition, but typically receive little information about this in clinical encounters and instead find information about it elsewhere. We developed an educational booklet about the psychiatric manifestations of 22q11DS and assessed its utility among parents of children with the condition. First, six parents of individuals with 22q11DS completed cognitive interviews to review an established generic booklet about the genetics of psychiatric conditions-and to suggest 22q11DS-specific adaptations. We used these suggestions to develop a novel booklet specific to psychiatric conditions and 22q1DS. Then, before and 1-month after reading the novel 22q11DS-specific online booklet, 73 parents of children with 22q11DS (with/without psychiatric conditions) completed validated scales (measuring empowerment, stigma, intolerance of uncertainty), an adapted version of a scale measuring worry about their child developing psychiatric illness, and purpose-designed items assessing perceptions of understanding of 22q11DS and mental illness, confidence in recognizing early signs, etc. After reading the 22q11DS online booklet, participants' feelings of empowerment increased (p = 0.002), while feelings of worry about their child developing psychiatric illness decreased (p = 0.05), and they reported better understanding 22q11DS and mental illness, and increased confidence in recognizing early warning signs. There is potential benefit in broadly distributing this educational booklet to parents of children with 22q11DS.
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Affiliation(s)
- Kayla Blankenship
- University of South Carolina Genetic Counseling Program, Columbia, South Carolina, USA
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Stephanie Chieffo
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Morris
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Caitlin Slomp
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rolan Batallones
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eloise Prijoles
- Greenwood Genetic Center, Columbia, Columbia, South Carolina, USA
| | - Crystal Hill-Chapman
- University of South Carolina Genetic Counseling Program, Columbia, South Carolina, USA
- Department of Psychology, Francis Marion University, Florence, South Carolina, USA
| | - Jehannine Austin
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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10
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Omran M, Johansson H, Lundgren C, Silander G, Stenmark-Askmalm M, Loman N, Baan A, Adra J, Kuchinskaya E, Blomqvist L, Tham E, Bajalica-Lagercrantz S, Brandberg Y. Whole-body MRI surveillance in TP53 carriers is perceived as beneficial with no increase in cancer worry regardless of previous cancer: Data from the Swedish TP53 Study. Cancer 2023; 129:946-955. [PMID: 36601958 DOI: 10.1002/cncr.34631] [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: 10/13/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND To evaluate the psychosocial consequences of surveillance with whole-body MRI (WB-MRI) in individuals with the heritable TP53-related cancer (hTP53rc) syndrome, also known as the Li-Fraumeni syndrome, with regard to cancer worry, perceived benefits and risks to surveillance and overall health. PATIENTS AND METHODS Since 2016, the national Swedish TP53 Study (SWEP53) has offered surveillance with WB-MRI to all individuals with hTP53rc syndrome. Seventy-five individuals have been included in the study. Sixty consecutive participants fulfilled a base-line evaluation as well as an evaluation after 1 year with structured questionnaires including the Cancer Worry Scale (CWS), perceived benefits and risks of surveillance, and the 36-item Short Form Survey (SF-36). Individuals with or without previous personal cancer diagnosis were enrolled and results at baseline and after 1 year of surveillance were compared. For SF-36, a comparison with the normal population was also made. RESULTS Participants with previous cancer tend to worry more about cancer, but both individuals with and without cancer had a positive attitude toward surveillance with no differences regarding perceived benefits and barriers to surveillance. Participants with a previous cancer scored significantly lower on some of the SF-36 subscales, but between-group differences were found only for social functioning after 1 year. CONCLUSIONS Surveillance with WB-MRI is feasible from a psychosocial point of view both among TP53 carriers with as well as without a previous history of cancer and does not increase cancer worry in any of the groups. PLAIN LANGUAGE SUMMARY Individuals with heritable TP53-related cancer syndrome (also known as the Li-Fraumeni syndrome) have a high lifetime risk of developing cancer. These TP53 carriers are offered surveillance with whole-body MRI to detect cancer early. There are few reports of the psychosocial impact of surveillance. In this study, we wanted to evaluate cancer worry, benefits and barriers to participation, and perceived overall health. Our study shows no increase in cancer worry after 1 year of surveillance, regardless of previous cancer.
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Affiliation(s)
- Meis Omran
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Cancer Theme, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Lundgren
- Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Gustav Silander
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Marie Stenmark-Askmalm
- Division of Clinical Genetics, Department of Laboratory Medicine, Office for Medical Services, Skåne University Hospital, Lund, Sweden
| | - Niklas Loman
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Annika Baan
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jamila Adra
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Imaging and Physiology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Emma Tham
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Svetlana Bajalica-Lagercrantz
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Cancer Theme, Karolinska University Hospital Solna, Stockholm, Sweden.,Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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11
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Lof P, Engelhardt EG, van Gent MDJM, Mom CH, Rosier-van Dunné FMF, van Baal WM, Verhoeve HR, Hermsen BBJ, Verbruggen MB, Hemelaar M, van de Swaluw JMG, Knipscheer HC, Huirne JAF, Westenberg SM, van Driel WJ, Bleiker EMA, Amant F, Lok CAR. Psychological impact of referral to an oncology hospital on patients with an ovarian mass. Int J Gynecol Cancer 2022; 33:ijgc-2022-003753. [PMID: 36600495 DOI: 10.1136/ijgc-2022-003753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES In patients with an ovarian mass, a risk of malignancy assessment is used to decide whether referral to an oncology hospital is indicated. Risk assessment strategies do not perform optimally, resulting in either referral of patients with a benign mass or patients with a malignant mass not being referred. This process may affect the psychological well-being of patients. We evaluated cancer-specific distress during work-up for an ovarian mass, and patients' perceptions during work-up, referral, and treatment. METHODS Patients with an ovarian mass scheduled for surgery were enrolled. Using questionnaires we measured (1) cancer-specific distress using the cancer worry scale, (2) patients' preferences regarding referral (evaluated pre-operatively), and (3) patients' experiences with work-up and treatment (evaluated post-operatively). A cancer worry scale score of ≥14 was considered as clinically significant cancer-specific distress. RESULTS A total of 417 patients were included, of whom 220 (53%) were treated at a general hospital and 197 (47%) at an oncology hospital. Overall, 57% had a cancer worry scale score of ≥14 and this was higher in referred patients (69%) than in patients treated at a general hospital (43%). 53% of the patients stated that the cancer risk should not be higher than 25% to undergo surgery at a general hospital. 96% of all patients were satisfied with the overall work-up and treatment. No difference in satisfaction was observed between patients correctly (not) referred and patients incorrectly (not) referred. CONCLUSIONS Relatively many patients with an ovarian mass experienced high cancer-specific distress during work-up. Nevertheless, patients were satisfied with the treatment, regardless of the final diagnosis and the location of treatment. Moreover, patients preferred to be referred even if there was only a relatively low probability of having ovarian cancer. Patients' preferences should be taken into account when deciding on optimal cut-offs for risk assessment strategies.
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Affiliation(s)
- Pien Lof
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - Ellen G Engelhardt
- Division of Psychological Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mignon D J M van Gent
- Department of Gynecologic Oncology, Amsterdam University Medical Center, location Academic Medical Center, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - Constantijne H Mom
- Department of Gynecologic Oncology, Amsterdam University Medical Center, location Academic Medical Center, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | | | - Majoie Hemelaar
- Department of Gynecology, Dijklander Hospital, Hoorn and Purmerend, The Netherlands
| | | | - Haye C Knipscheer
- Department of Gynecology, Spaarne Hospital, Haarlem and Hoofddorp, The Netherlands
| | - Judith A F Huirne
- Department of Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Willemien J van Driel
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - Eveline M A Bleiker
- Division of Psychological Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frédéric Amant
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
- Department of Gynecologic Oncology, UZ Leuven, Leuven, Belgium
| | - Christianne A R Lok
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
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12
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Fear of Cancer Recurrence in Sarcoma Survivors: Results from the SURVSARC Study. Cancers (Basel) 2022; 14:cancers14246099. [PMID: 36551585 PMCID: PMC9776518 DOI: 10.3390/cancers14246099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Fear of cancer recurrence (FCR) is often reported as an unmet concern by cancer patients. The aim of our study was to investigate (1) the prevalence of FCR in sarcoma survivors; (2) the factors associated with a higher level of FCR; the relationship between (3) FCR and global health status and (4) FCR and use of follow-up care. METHODS A cross-sectional study was conducted among sarcoma survivors 2 to 10 years after diagnosis. Patients completed the Cancer Worry Scale (CWS), the global health status subscale of the EORTC QLQ-C30 and a custom-made questionnaire on follow-up care. RESULTS In total, 1047 patients were included (response rate 55%). The prevalence of high FCR was 45%. Factors associated with high FCR were female sex with 1.6 higher odds (95% CI 1.22-2.25; p = 0.001); having ≥1 comorbidities and receiving any treatment other than surgery alone with 1.5 (95% CI 1.07-2.05; p = 0.017) and 1.4 (95% CI 1.06-1.98; p = 0.020) higher odds, respectively. Patients on active follow-up had 1.7 higher odds (95% CI 1.20-2.61; p = 0.004) and patients with higher levels of FCR scored lower on the global health status scale (72 vs. 83 p ≤ 0.001). CONCLUSIONS Severe FCR is common in sarcoma survivors and high levels are related to a decreased global health status. FCR deserves more attention in sarcoma survivorship, and structured support programs should be developed to deliver interventions in a correct and time adequate environment.
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13
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van der Ende-van Loon MCM, Nieuwkerk PT, van Stiphout SHC, Scheffer RCH, de Ridder RJJ, Pouw RE, Alkhalaf A, Weusten BLAM, Curvers WL, Schoon EJ. Barrett Esophagus: Quality of life and factors associated with illness perception. United European Gastroenterol J 2022; 10:721-729. [PMID: 35795902 PMCID: PMC9486561 DOI: 10.1002/ueg2.12266] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background Health‐related Quality of life (HRQoL) in patients with Barrett's esophagus (BE), a premalignant condition, may be influenced by gastroesophageal reflux disease (GERD) symptoms and the risk of developing esophageal adenocarcinoma. Methods We aim to investigate HRQoL in non‐dysplastic Barrett Esophagus (NDBE) patients, identify factors associated with a negative illness perception of the diagnosis BE and compare outcomes between patients treated in a specialized BE center with non‐expert centers. In this multi‐center cross‐sectional study, HRQoL of NDBE patients were assessed using the Short Form 36, Hospital Anxiety and Depression Scale, Cancer worry Scale, and Reflux Disease Questionnaire. A multivariable, linear regression analysis was conducted to assess factors associated with illness perception (Illness perception scale) of the BE diagnosis. Outcome parameters of patients from expert centers were compared to non‐expert centers. Results A total of 859 NDBE patients (mean age 63.6% and 74.5% male), of which 640 from BE expert centers were included. BE patients scored similar or higher means (i.e. better) on generic HRQoL in comparison with a Dutch norm population. The multivariable regression model showed that cancer worry, GERD symptoms, signs of anxiety and depression, and female gender were associated with a negative illness perception of BE. GERD symptoms were reported in the minority (22.4%) of BE patients. Levels of anxiety symptoms were comparable to a Dutch norm population (mean 3.7 vs. 3.9 p 0.183) and lower for depression symptoms (mean 6.8 vs. 7.6 p < 0.001). Overall, there were no differences found on outcomes between expert centers and non‐expert centers. Conclusion NDBE patients scored similar or better on generic HRQoL, anxiety and depression than an age and gender matched norm population. The presence of cancer worry, gastrointestinal symptoms, anxiety and depression, and female gender are factors associated with a negative illness perception of the diagnosis BE.
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Affiliation(s)
| | - Pythia T Nieuwkerk
- Department of Medical Psychology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam Institute for Infection and Immunity and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | | | - Robert C H Scheffer
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - Rogier J J de Ridder
- Department of Gastroenterology and Hepatology, Maastricht UMC+, Maastricht, the Netherlands
| | - Roos E Pouw
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alaa Alkhalaf
- Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, the Netherlands
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands.,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wouter L Curvers
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
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14
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Pijnappel EN, Dijksterhuis WPM, Sprangers MAG, Augustinus S, de Vos-Geelen J, de Hingh IHJT, Molenaar IQ, Busch OR, Besselink MG, Wilmink JW, van Laarhoven HWM. The fear of cancer recurrence and progression in patients with pancreatic cancer. Support Care Cancer 2022; 30:4879-4887. [PMID: 35169873 PMCID: PMC9046341 DOI: 10.1007/s00520-022-06887-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/28/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE It is plausible that patients with pancreatic cancer experience fear of tumor recurrence or progression (FOP). The aim of this study was to compare FOP in patients with pancreatic cancer treated with surgical resection, palliative systemic treatment, or best supportive care (BSC) and analyze the association between quality of life (QoL) and FOP and the effect of FOP on overall survival (OS). METHODS This study included patients diagnosed with pancreatic cancer between 2015 and 2018, who participated in the Dutch Pancreatic Cancer Project (PACAP). The association between QoL and WOPS was assessed with logistic regression analyses. OS was evaluated using Kaplan-Meier curves with the log-rank tests and multivariable Cox proportional hazard analyses adjusted for clinical covariates and QoL. RESULTS Of 315 included patients, 111 patients underwent surgical resection, 138 received palliative systemic treatment, and 66 received BSC. Patients who underwent surgical resection had significantly lower WOPS scores (i.e., less FOP) at initial diagnosis compared to patients who received palliative systemic treatment or BSC only (P < 0.001). Better QoL was independently associated with the probability of having a low FOP in the BSC (OR 0.95, 95% CI 0.91-0.98) but not in the surgical resection (OR 0.97, 95% CI 0.94-1.01) and palliative systemic treatment groups (OR 0.97, 95% CI 0.94-1.00). The baseline WOPS score was not independently associated with OS in any of the subgroups. CONCLUSION Given the distress that FOP evokes, FOP should be explicitly addressed by health care providers when guiding pancreatic cancer patients through their treatment trajectory, especially those receiving palliative treatment or BSC.
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Affiliation(s)
- Esther N Pijnappel
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Willemieke P M Dijksterhuis
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, Utrecht, 3501 DB, The Netherlands
| | - Mirjam A G Sprangers
- Department of Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Simone Augustinus
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Judith de Vos-Geelen
- Department of Internal Medicine, Division of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht UMC+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
| | | | - Izaak Q Molenaar
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Johanna W Wilmink
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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15
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van de Wal D, Elie M, Le Cesne A, Fumagalli E, den Hollander D, Jones RL, Marquina G, Steeghs N, van der Graaf WTA, Husson O. Health-Related Quality of Life and Side Effects in Gastrointestinal Stromal Tumor (GIST) Patients Treated with Tyrosine Kinase Inhibitors: A Systematic Review of the Literature. Cancers (Basel) 2022; 14:cancers14071832. [PMID: 35406604 PMCID: PMC8997462 DOI: 10.3390/cancers14071832] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The introduction of tyrosine kinase inhibitors (TKIs) has revolutionized the treatment of gastrointestinal stromal tumors (GISTs), resulting in a substantial gain in median overall survival. Subsequently, health-related quality of life (HRQoL) has become more relevant. Here, we systematically review the available literature on HRQoL issues and side effects of different TKIs registered for the treatment of GIST. METHODS A search through five databases was performed. Full reports in English describing HRQoL outcomes and/or side effects in GIST patients on TKI therapy were included. RESULTS A total of 104 papers were included; 13 studies addressed HRQoL, and 96 studies investigated adverse events. HRQoL in patients treated with imatinib, regorafenib, and ripretinib remained stable, whereas most sunitinib-treated patients reported a decrease in HRQoL. Severe fatigue and fear of recurrence or progression were specifically assessed as HRQoL issues and had a negative impact on overall HRQoL as well as psychological and physical well-being. The majority of studies focused on physician-reported side effects. Nearly all GIST patients treated with a TKI experienced at least one adverse event, mostly mild to moderate. CONCLUSIONS Despite the fact that almost all patients treated with a TKI experienced side effects, this did not seem to affect overall HRQoL during TKI therapy. In daily practice, it are the side effects that hamper a patient's HRQoL resulting in treatment adjustments, suggesting that the reported side effects were underestimated by physicians, or the measures used to assess HRQoL do not capture all relevant issues that determine a GIST patient's HRQoL.
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Affiliation(s)
- Deborah van de Wal
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands; (D.v.d.W.); (N.S.); (W.T.A.v.d.G.)
| | - Mai Elie
- Department of Medical Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (M.E.); (D.d.H.)
| | - Axel Le Cesne
- Department of Medical Oncology, Gustave Roussy, 94805 Villejuif, France;
| | - Elena Fumagalli
- Department of Medical Oncology, IRCCS Foundation National Cancer Institute, 20133 Milan, Italy;
| | - Dide den Hollander
- Department of Medical Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (M.E.); (D.d.H.)
| | - Robin L. Jones
- Department of Clinical Oncology, The Royal Marsden Hospital and Institute of Cancer Research, London SM2 5 NG, UK;
| | - Gloria Marquina
- Department of Medical Oncology, Hospital Clinico San Carlos, 28040 Madrid, Spain;
| | - Neeltje Steeghs
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands; (D.v.d.W.); (N.S.); (W.T.A.v.d.G.)
- Department of Clinical Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands
| | - Winette T. A. van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands; (D.v.d.W.); (N.S.); (W.T.A.v.d.G.)
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Olga Husson
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands; (D.v.d.W.); (N.S.); (W.T.A.v.d.G.)
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Division of Clinical Studies, Institute of Cancer Research, London SM2 5NG, UK
- Correspondence: ; Tel.: +31-614-549-755
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16
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Hawranek C, Maxon J, Andersson A, Van Guelpen B, Hajdarevic S, Numan Hellquist B, Rosén A. Cancer Worry Distribution and Willingness to Undergo Colonoscopy at Three Levels of Hypothetical Cancer Risk—A Population-Based Survey in Sweden. Cancers (Basel) 2022; 14:cancers14040918. [PMID: 35205668 PMCID: PMC8870195 DOI: 10.3390/cancers14040918] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Cancer worry is a known health concern in cancer patients and people with a genetic predisposition to cancer. We measured how worried people, in general, are about developing cancer to describe levels in non-affected individuals. In total, 943 respondents completed a survey containing the Cancer Worry Scale (CWS) and hypothetical questions asking if they would attend a colonoscopy screening at a 5, 10, or 70 percent lifetime risk of developing bowel cancer. Unaffected individuals scored a mean of 9.46 on the six-item CWS. Women scored significantly higher than men (9.91 vs. 9.06). Women and parents had higher cancer worry than men and people without children when ruling out differences in education, age, and country of birth. People who worried more were also more inclined to undergo a colonoscopy screening, and intention increased with higher levels of hypothetical risk. These data may be helpful in future work on cancer worry and cancer prevention. Abstract Purpose: We describe levels of cancer worry in the general population as measured with the Cancer Worry Scale (CWS) and investigate the association with colonoscopy screening intentions in three colorectal cancer risk scenarios. Methods: The data were sourced through a population-based survey. Respondents (n = 943) completed an eight-item CWS and questions on colonoscopy screening interest at three hypothetical risk levels. Results: Respondents without a personal cancer history (n = 853) scored 9.46 on the six-item CWS (mean, SD 2.72). Mean scores were significantly higher in women (9.91, SD 2.89) as compared to men (9.06, SD 2.49, p < 0.001). Linear regression showed higher cancer worry in women and those with children when controlling for education, age group, and country of birth. High cancer worry (six-item CWS mean >12) was identified in 25% of women and in 17% of men. Among those, 71% would attend a colonoscopy screening compared to 52% of those with low cancer worry (p < 0.001, 5% CRC-risk). Conclusions: The distribution of cancer worry in a general population sample showed higher mean scores in women, and levels overlapped with earlier findings in cancer-affected samples. Respondents with high cancer worry were more inclined to undergo a colonoscopy screening, and intention increased with higher levels of hypothetical risk.
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Affiliation(s)
- Carolina Hawranek
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
- Correspondence: ; Tel.: +46-76-69-60-648
| | - Johan Maxon
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
| | - Andreas Andersson
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
| | - Bethany Van Guelpen
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
- Wallenberg Centre for Molecular Medicine, Umeå University, SE-901 87 Umeå, Sweden
| | - Senada Hajdarevic
- Department of Nursing, Umeå University, SE-901 87 Umeå, Sweden;
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, SE-901 87 Umeå, Sweden
| | - Barbro Numan Hellquist
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
| | - Anna Rosén
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
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17
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van Bommel MHD, Steenbeek MP, IntHout J, Hermens RPMG, Hoogerbrugge N, Harmsen MG, van Doorn HC, Mourits MJE, van Beurden M, Zweemer RP, Gaarenstroom KN, Slangen BFM, Brood-van Zanten MMA, Vos MC, Piek JM, van Lonkhuijzen LRCW, Apperloo MJA, Coppus SFPJ, Prins JB, Custers JAE, de Hullu JA. Cancer worry among BRCA1/2 pathogenic variant carriers choosing surgery to prevent tubal/ovarian cancer: course over time and associated factors. Support Care Cancer 2022; 30:3409-3418. [PMID: 34997316 PMCID: PMC8857097 DOI: 10.1007/s00520-021-06726-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/26/2021] [Indexed: 11/03/2022]
Abstract
Objective High cancer risks, as applicable to BRCA1 and BRCA2 pathogenic variant (PV) carriers, can induce significant cancer concerns. We examined the degree of cancer worry and the course of this worry among BRCA1/2-PV carriers undergoing surgery to prevent ovarian cancer, and identified factors associated with high cancer worry. Methods Cancer worry was evaluated as part of the multicentre, prospective TUBA-study (NCT02321228) in which BRCA1/2-PV carriers choose either novel risk-reducing salpingectomy with delayed oophorectomy or standard risk-reducing salpingo-oophorectomy. The Cancer Worry Scale was obtained before and 3 and 12 months after surgery. Cancer worry patterns were analysed using latent class growth analysis and associated factors were identified with regression analysis. Results Of all 577 BRCA1/2-PV carriers, 320 (57%) had high (≥ 14) cancer worry pre-surgery, and 54% had lower worry 12 months post-surgery than pre-surgery. Based on patterns over time, BRCA1/2-PV carriers could be classified into three groups: persistently low cancer worry (56%), persistently high cancer worry (6%), and fluctuating, mostly declining, cancer worry (37%). Factors associated with persistently high cancer concerns were age below 35 (BRCA1) or 40 (BRCA2), unemployment, previous breast cancer, lower education and a more recent BRCA1/2-PV diagnosis. Conclusions Some degree of cancer worry is considered normal, and most BRCA1/2-PV carriers have declining cancer worry after gynaecological risk-reducing surgery. However, a subset of these BRCA1/2-PV carriers has persisting major cancer concerns up to 1 year after surgery. They should be identified and potentially offered additional support. Clinical trial registration The TUBA-study is registered at ClinicalTrials.gov since December 11th, 2014. Registration number: NCT02321228. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06726-4.
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Affiliation(s)
- Majke H D van Bommel
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Miranda P Steenbeek
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Joanna IntHout
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marline G Harmsen
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Helena C van Doorn
- Department of Gynaecology, Erasmus MC Cancer Clinic, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Marian J E Mourits
- Department of Gynaecologic Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Marc van Beurden
- Center for Gynaecological Oncology Amsterdam (CGOA), Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Ronald P Zweemer
- Department of Gynaecological Oncology, UMC Utrecht Cancer Center, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Katja N Gaarenstroom
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Brigitte F M Slangen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, GROW-School for Oncology and Developmental Biology, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Monique M A Brood-van Zanten
- Center for Gynaecological Oncology Amsterdam (CGOA), Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Center for Gynaecological Oncology Amsterdam (CGOA), AmsterdamUMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M Caroline Vos
- Gynaecologic Oncologic Center South Location Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5000 LC, Tilburg, The Netherlands
| | - Jurgen M Piek
- Gynaecologic Oncologic Center South Location Catharina Hospital, Department of Obstetrics and Gynaecology and Catharina Cancer Institute, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Luc R C W van Lonkhuijzen
- Center for Gynaecological Oncology Amsterdam (CGOA), AmsterdamUMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mirjam J A Apperloo
- Department of Obstetrics and Gynaecology, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
| | - Sjors F P J Coppus
- Department of Obstetrics and Gynaecology, Maxima Medical Center, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud Institute F Or Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - José A E Custers
- Department of Medical Psychology, Radboud Institute F Or Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Joanne A de Hullu
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Assessing the fear of recurrence using the Cancer Worry Scale in a sample of Italian breast cancer survivors. Support Care Cancer 2021; 30:2829-2837. [PMID: 34845503 DOI: 10.1007/s00520-021-06718-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The fear of cancer recurrence (FCR) is one of the most reported problems by cancer survivors. A valid instrument to detect this issue could be useful to identify cancer survivors who are more vulnerable to developing FCR and related adverse outcomes (e.g., anxiety). The present study aimed to evaluate FCR in a sample of Italian breast cancer survivors using an Italian version of the 8-item Cancer Worry Scale (CWS) in order to establish a cut-off for the use in clinical settings. METHODS The participants were 119 breast cancer survivors (mean age 47.7 years) at least 1 year after their primary treatment. An exploratory factor analysis (EFA) of CWS, internal reliability of CWS, concurrent and divergent validity using a bivariate correlation between the key measures of the study (i.e., FCR, anxiety, depression, fatigue, and self-efficacy), and ROC analysis of CWS were performed. RESULTS Fit indices for the EFA were considered acceptable and showed a two-factor structure-labeled cancer worries and worries impact. The reliability of the two factors showed a Cronbach's alpha coefficient greater than 0.90. The CWS was positively related to anxiety, depression, fatigue, and negatively related to perceived self-efficacy. The best cut-off score was 24 versus 25, with a sensitivity of 74% and a specificity of 85%. CONCLUSIONS The CWS is a valid questionnaire to assess FCR among breast cancer survivors. The present study provides an overview of the relationship between CWS and the adverse outcomes related to FCR and coping strategies adopted to face it.
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Jansen SMA, van de Heuvel LM, Houweling AC, van Tintelen JP, de Man FS, Vonk Noordegraaf A, Jan Bogaard H. Uptake and Patient Perspectives on Additional Testing for Novel Disease-Associated Genes: Lessons from a PAH Cohort. Genes (Basel) 2021; 12:genes12101540. [PMID: 34680935 PMCID: PMC8536181 DOI: 10.3390/genes12101540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Pulmonary arterial hypertension (PAH) has an identifiable genetic cause in 5% of all PAH cases. Due to health benefits conferred by the early detection of PAH and the recent identification of additional PAH-associated genes, we decided to offer (extended) genetic testing to all incident and prevalent idiopathic PAH (iPAH) and pulmonary veno-occlusive disease (PVOD) patients in our clinic. Here, we report the lessons learned from (re-)contacting iPAH/PVOD patients concerning the uptake and analysis of identified PAH-associated genes and patient perspectives of the approach. Methods: Between January 2018 and April 2020, all iPAH/PVOD patients who were not previously genetically tested (contact group) and those who tested negative on prior analysis of BMPR2 and SMAD9 variants (re-contact group) were (re-)contacted for (additional) genetic testing. Results: With our approach, 58% of patients (84 out of 165) opted for genetic counselling, and a pathogenic variant was found in 12% of cases (n = 10) (re-contact group, 11%, and contact group, 13%). Eighty-six percent of participants of the survey study appreciated being (re-)contacted for genetic testing. Mild psychosocial impacts were observed. Conclusions: Our report shows the importance of (re-)contact and interest of patients (as indicated by the uptake, mild psychosocial impact and appreciation) in PAH.
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Affiliation(s)
- Samara M. A. Jansen
- Department of Pulmonary Medicine, Amsterdam University Medical Center (UMC) (Vrije Universiteit), 1081 HV Amsterdam, The Netherlands; (S.M.A.J.); (F.S.d.M.); (A.V.N.)
| | - Lieke M. van de Heuvel
- Department of Human Genetics, Amsterdam University Medical Center (UMC) (Vrije Universiteit), 1081 HV Amsterdam, The Netherlands; (L.M.v.d.H.); (A.C.H.); (J.P.v.T.)
- University Medical Centre Utrecht, Department of Genetics, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Arjan C. Houweling
- Department of Human Genetics, Amsterdam University Medical Center (UMC) (Vrije Universiteit), 1081 HV Amsterdam, The Netherlands; (L.M.v.d.H.); (A.C.H.); (J.P.v.T.)
| | - J. Peter van Tintelen
- Department of Human Genetics, Amsterdam University Medical Center (UMC) (Vrije Universiteit), 1081 HV Amsterdam, The Netherlands; (L.M.v.d.H.); (A.C.H.); (J.P.v.T.)
- University Medical Centre Utrecht, Department of Genetics, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Frances S. de Man
- Department of Pulmonary Medicine, Amsterdam University Medical Center (UMC) (Vrije Universiteit), 1081 HV Amsterdam, The Netherlands; (S.M.A.J.); (F.S.d.M.); (A.V.N.)
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam University Medical Center (UMC) (Vrije Universiteit), 1081 HV Amsterdam, The Netherlands; (S.M.A.J.); (F.S.d.M.); (A.V.N.)
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam University Medical Center (UMC) (Vrije Universiteit), 1081 HV Amsterdam, The Netherlands; (S.M.A.J.); (F.S.d.M.); (A.V.N.)
- Correspondence:
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20
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Steenbeek MP, van Bommel MHD, Harmsen MG, Hoogerbrugge N, van Doorn HC, Keurentjes JHM, van Beurden M, Zweemer RP, Gaarenstroom KN, Penders CGJ, Brood-van Zanten MMA, Vos MC, Piek JM, van Lonkhuijzen LRCW, Apperloo MJA, Coppus SFPJ, IntHout J, de Hullu JA, Hermens RPMG. Evaluation of a patient decision aid for BRCA1/2 pathogenic variant carriers choosing an ovarian cancer prevention strategy. Gynecol Oncol 2021; 163:371-377. [PMID: 34456057 DOI: 10.1016/j.ygyno.2021.08.019] [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] [Received: 05/10/2021] [Revised: 08/16/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Risk-reducing surgery is advised to BRCA1/2 pathogenic variant (PV) carriers around the age of 40 years to reduce ovarian cancer risk. In the TUBA-study, a multicenter preference study (NCT02321228), BRCA1/2-PV carriers are offered a choice: the standard strategy of risk-reducing salpingo-oophorectomy or the novel strategy of risk-reducing salpingectomy with delayed oophorectomy. We evaluated feasibility and effectiveness of a patient decision aid for this choice. METHODS Premenopausal BRCA1/2-PV carriers were counselled for risk-reducing surgical options in the TUBA-study; the first cohort was counselled without and the second cohort with decision aid. Evaluation was performed using digital questionnaires for participating women and their healthcare professionals. Outcome measures included actual choice, feasibility (usage and experiences) and effectiveness (knowledge, cancer worry, decisional conflict, decisional regret and self-estimated influence on decision). RESULTS 283 women were counselled without and 282 women with decision aid. The novel strategy was chosen less frequently in women without compared with women with decision aid (67% vs 78%, p = 0.004). The decision aid was graded with an 8 out of 10 by both women and professionals, and 78% of the women would recommend this decision aid to others. Users of the decision aid reported increased knowledge about the options and increased insight in personal values. Knowledge on cancer risk, decisional conflict, decisional regret and cancer worry were similar in both cohorts. CONCLUSIONS The use of the patient decision aid for risk-reducing surgery is feasible, effective and highly appreciated among BRCA1/2-PV carriers facing the decision between salpingo-oophorectomy or salpingectomy with delayed oophorectomy.
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Affiliation(s)
- Miranda P Steenbeek
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
| | - Majke H D van Bommel
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands.
| | - Marline G Harmsen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
| | - Nicoline Hoogerbrugge
- Radboud University Medical Center, Department of Human Genetics, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Helena C van Doorn
- Department of Gynecology, Erasmus MC Cancer Clinic, 's, Gravendijkwal 230, 3015, CE, Rotterdam, the Netherlands
| | - José H M Keurentjes
- Department of Gynecologic Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - Marc van Beurden
- Centre for Gynecological Oncology Amsterdam (CGOA), Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - Ronald P Zweemer
- Department of Gynecological Oncology, UMC Utrecht Cancer Centre, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Katja N Gaarenstroom
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands
| | - Charlotte G J Penders
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, GROW-School for Oncology and Developmental Biology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Monique M A Brood-van Zanten
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - M Caroline Vos
- Gynecologic Oncologic Centre South location Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5000, LC, Tilburg, the Netherlands
| | - Jurgen M Piek
- Gynecologic Oncologic Centre South location Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
| | - Luc R C W van Lonkhuijzen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Mirjam J A Apperloo
- Department of Obstetrics and Gynecology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934, AD, Leeuwarden, the Netherlands
| | - Sjors F P J Coppus
- Department of Obstetrics and Gynecology, Maxima Medical Centre, De Run 4600, 5504, DB, Veldhoven, the Netherlands
| | - Joanna IntHout
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department for Health Evidence, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Joanne A de Hullu
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
| | - Rosella P M G Hermens
- Radboud University Medical Center, Scientific Institute for Quality of Healthcare, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
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Reijers SJM, Husson O, Soomers VLMN, Been LB, Bonenkamp JJ, van de Sande MAJ, Verhoef C, van der Graaf WTA, van Houdt WJ. Health-related quality of life after isolated limb perfusion compared to extended resection, or amputation for locally advanced extremity sarcoma: Is a limb salvage strategy worth the effort? Eur J Surg Oncol 2021; 48:500-507. [PMID: 34389213 DOI: 10.1016/j.ejso.2021.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/12/2021] [Accepted: 08/06/2021] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION The aim of this study was to compare long-term patient reported outcomes (PROs) in patients with locally advanced extremity soft tissue sarcoma (eSTS) after isolated limb perfusion followed by resection (IR), compared to extended resection (ER), primary amputation (A) or secondary amputation after IR (IR-A). METHODS Patients were selected from the respondents of a multi-institutional cross-sectional cohort survivorship study (SURVSARC) conducted among sarcoma survivors registered in the Netherlands Cancer Registry (NCR), 2-10 years after diagnosis. Used PROs were the EORTC QLQ-C30, the Cancer worry scale (CWS), the Hospital Anxiety and Depression Scale (HADS), and the Toronto Extremity Salvage Score (TESS). RESULTS We identified 97 eSTS survivors: IR = 20, ER = 49, A = 20, IR-A = 8. While there were no differences in PROs between IR and ER, results showed better functioning and functionality in both groups versus the amputation groups. The amputation groups scored significantly lower on physical functioning (A = 62.7, IR-A = 65.7 versus IR = 78.0, ER = 82.7, p = 0.001) and role functioning (A = 67.5, IR-A = 52.8 versus IR = 79.2, ER = 80.6, p = 0.039), both EORTC QLQ-C30 scales. Also for the TESS, the scores were significantly lower for the amputation groups compared to the limb sparing groups (upper extremity p = 0.007 with A = 68.9, IR-A = 71.6 versus IR = 93.3, ER = 91.1; lower extremity p < 0.001 with A = 72.2, IR-A50.9 versus IR = 84.5 and ER = 85.5). There were no significant differences between the groups on cancer worry, anxiety and depression. CONCLUSION HRQoL in eSTS survivors treated with IR or ER is equal; for maintenance of physical functioning and functionality IR and ER outperform an amputation.
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Affiliation(s)
- Sophie J M Reijers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| | - Vicky L M N Soomers
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lukas B Been
- Department of Surgical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Johannes J Bonenkamp
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
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Crook A, Kwa R, Ephraums S, Wilding M, Thiyagarajan L, Fleming J, Moore K, Berman Y. The psychological impact and experience of breast cancer screening in young women with an increased risk of breast cancer due to neurofibromatosis type 1. Fam Cancer 2021; 21:241-253. [PMID: 33963463 PMCID: PMC8105152 DOI: 10.1007/s10689-021-00259-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/20/2021] [Indexed: 01/22/2023]
Abstract
Women with neurofibromatosis type 1 (NF1) have an increased risk of developing early breast cancer with a poorer prognosis compared to the general population. Therefore, international management guidelines recommend regular screening in women with NF1 starting from 30 to 35 years. As the psychological impacts of breast cancer screening in other high-risk populations cannot be extended to women with NF1, due to increased incidence of cognitive and mental health issues, the psychological harms of breast screening in women with NF1 are unknown. Consequently, the aim of this study was to assess the psychological impact of breast cancer screening in women with NF1 attending an established risk management clinic. Twenty-eight women with NF1 (30–50 years) completed psychological well-being and patient experience questionnaires, administered across five time points, before and after their initial and second round annual breast screening visits. Preliminary findings demonstrated the screening regimen was well-tolerated, with most participants reporting high satisfaction with the screening process. Overall, no significant increase in psychological distress related to the breast screening process was identified, with mean cancer worry and anxiety scores decreasing over time. However, some women did experience negative aspects of screening and barriers to re-attendance at annual breast screening appointments. As some women with NF1 exhibited clinical levels of psychological distress prior to screening, efforts to identify those at risk and additional support to address concerns and expectations throughout the breast screening process may be beneficial.
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Affiliation(s)
- Ashley Crook
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia.
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Rebekah Kwa
- Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Sarah Ephraums
- Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Mathilda Wilding
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Lavvina Thiyagarajan
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jane Fleming
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Katrina Moore
- Department of Breast Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Yemima Berman
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
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Abstract
Screening for pancreatic cancer (PC) in high-risk groups aimed to detect early cancers is currently done only in the research setting, and data on psychological outcomes of screening in these populations is scarce. To determine the psychological impact of a national Australian pancreatic screening program, a prospective study was conducted using validated psychological measures: impact of events scale (IES), psychological consequences questionnaire (PCQ) and the cancer worry scale. Measures were administered at baseline, 1-month and at 1-year post-enrolment and correlations with abnormal endoscopic ultrasound (EUS) results were calculated. Over a 6-year period, 102 participants were recruited to the screening program. Thirty-nine patients (38.2%) had an abnormal endoscopic ultrasound, and two patients (2.0%) were diagnosed with PC and two with other malignancies. Those with a personal history of cancer or a positive BRCA2 mutation demonstrated significantly increased worry about developing other types of cancer at baseline (p < 0.01). Irrespective of EUS result, there was a significant decrease of total IES score at 1 year (Z = - 2.0, p = 0.041). In patients with abnormal EUS results, there was a decrease in the total IES score at 1 year (Z = - 2.5, p = 0.011). In participants deemed to be most distressed at baseline based on their negative PCQ score, there was a significant decrease of the total PCQ (Z = - 3.2, p = 0.001), emotional (Z = - 3.0, p = 0.001), social (Z = 3.0, p = 0.001) and physical (Z = - 2.8, p = 0.002) subscale at 1-year post-intervention. This study provides evidence of the long-term psychological benefits of PC screening in high-risk patients. There was no negative impact of screening in the short-term and the positive benefits appeared at 1-year post-intervention irrespective of screening result.
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Terra L, Hooning MJ, Heemskerk-Gerritsen BAM, van Beurden M, Roeters van Lennep JE, van Doorn HC, de Hullu JA, Mom C, van Dorst EBL, Mourits MJE, Slangen BFM, Gaarenstroom KN, Zillikens MC, Leiner T, van der Kolk L, Collee M, Wevers M, Ausems MGEM, van Engelen K, Berger LP, van Asperen CJ, Gomez-Garcia EB, van de Beek I, Rookus MA, Hauptmann M, Bleiker EM, Schagen SB, Aaronson NK, Maas AHEM, van Leeuwen FE. Long-Term Morbidity and Health After Early Menopause Due to Oophorectomy in Women at Increased Risk of Ovarian Cancer: Protocol for a Nationwide Cross-Sectional Study With Prospective Follow-Up (HARMOny Study). JMIR Res Protoc 2021; 10:e24414. [PMID: 33480862 PMCID: PMC7864779 DOI: 10.2196/24414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 01/24/2023] Open
Abstract
Background BRCA1/2 mutation carriers are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO) at 35 to 45 years of age. RRSO substantially decreases ovarian cancer risk, but at the cost of immediate menopause. Knowledge about the potential adverse effects of premenopausal RRSO, such as increased risk of cardiovascular disease, osteoporosis, cognitive dysfunction, and reduced health-related quality of life (HRQoL), is limited. Objective The aim of this study is to assess the long-term health effects of premenopausal RRSO on cardiovascular disease, bone health, cognitive functioning, urological complaints, sexual functioning, and HRQoL in women with high familial risk of breast or ovarian cancer. Methods We will conduct a multicenter cross-sectional study with prospective follow-up, nested in a nationwide cohort of women at high familial risk of breast or ovarian cancer. A total of 500 women who have undergone RRSO before 45 years of age, with a follow-up period of at least 10 years, will be compared with 250 women (frequency matched on current age) who have not undergone RRSO or who have undergone RRSO at over 55 years of age. Participants will complete an online questionnaire on lifestyle, medical history, cardiovascular risk factors, osteoporosis, cognitive function, urological complaints, and HRQoL. A full cardiovascular assessment and assessment of bone mineral density will be performed. Blood samples will be obtained for marker analysis. Cognitive functioning will be assessed objectively with an online neuropsychological test battery. Results This study was approved by the institutional review board in July 2018. In February 2019, we included our first participant. As of November 2020, we had enrolled 364 participants in our study. Conclusions Knowledge from this study will contribute to counseling women with a high familial risk of breast/ovarian cancer about the long-term health effects of premenopausal RRSO. The results can also be used to offer health recommendations after RRSO. Trial Registration ClinicalTrials.gov NCT03835793; https://clinicaltrials.gov/ct2/show/NCT03835793. International Registered Report Identifier (IRRID) DERR1-10.2196/24414
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Affiliation(s)
- Lara Terra
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Maartje J Hooning
- Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Marc van Beurden
- Department of Gynaecology, Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | | | - Helena C van Doorn
- Department for Gynaecologic Oncology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Joanne A de Hullu
- Department for Gynaecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Constantijne Mom
- Department of Gynaecology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Eleonora B L van Dorst
- Department for Gynaecologic Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marian J E Mourits
- Department for Gynaecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Brigitte F M Slangen
- Department for Gynaecology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Katja N Gaarenstroom
- Department of Gynaecology, Leiden University Medical Center, Leiden, Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Tim Leiner
- Department Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lizet van der Kolk
- Family Cancer Clinic, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Margriet Collee
- Department for Clinical Genetics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marijke Wevers
- Department for Clinical Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Margreet G E M Ausems
- Division of Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Klaartje van Engelen
- Department for Clinical Genetics, Amsterdam University Medical Centers, Vrije University Amsterdam, Amsterdam, Netherlands
| | - Lieke Pv Berger
- Department of Genetics, University Medical Center Groningen, Groningen, Netherlands
| | - Christi J van Asperen
- Department for Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Irma van de Beek
- Department for Clinical Genetics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Matti A Rookus
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Michael Hauptmann
- Brandenburg Medical School Theodor Fontane, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - Eveline M Bleiker
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Neil K Aaronson
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Flora E van Leeuwen
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
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25
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Velthuizen ME, van der Luijt RB, de Vries BJ, Koudijs MJ, Bleiker EMA, Ausems MGEM. Recontacting non-BRCA1/2 breast cancer patients for germline CHEK2 c.1100del pathogenic variant testing: uptake and patient experiences. Hered Cancer Clin Pract 2021; 19:9. [PMID: 33468213 PMCID: PMC7814590 DOI: 10.1186/s13053-021-00166-1] [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] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background CHEK2 has been recognized as a breast cancer risk gene with moderate effect. Women who have previously tested negative for a BRCA1/2 gene germline pathogenic variant may benefit from additional genetic testing for the CHEK2 c.1100del pathogenic variant. The aims of this study were: 1) to assess the uptake of an active approach by recontacting BRCA1/2-negative women for additional CHEK2 c.1100del testing on stored DNA-samples and 2) to explore patients’ experiences with this approach. Methods Between 2015 and 2017, women who had been tested earlier negative for BRCA1/2 germline pathogenic variants, were recontacted for additional CHEK2 c.1100del testing on stored DNA-samples, free-of-charge. They received an information letter about the CHEK2 pathogenic variant and could return an informed consent form when they opted for additional genetic testing. Those in whom the CHEK2 pathogenic variant was absent, received a letter describing this result. Those who tested positive, were invited for a personal counseling at the department of genetics. On average 21 months (range 4–27) after the genetic test result, a questionnaire was sent to all identified carriers and a control group of women who tested negative for the pathogenic variant to explore patients’ experiences with our approach. Results In total, 70% (N = 1666) of the N = 2377 women contacted opted for additional testing, and 66 (4%) of them proved to be carriers of the CHEK2 c.1100del pathogenic variant. Regardless of the outcome of the genetic test, women were generally satisfied with our approach and reported that the written information was sufficient to make an informed decision about the additional CHEK2 testing. Conclusions The uptake (70%) of our approach was considered satisfactory. Patients considered the benefits more important than the psychosocial burden. Given the rapid developments in DNA-diagnostics, our findings may support future initiatives to recontact patients about additional genetic testing when they previously tested negative for a pathogenic variant in a breast cancer gene.
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Affiliation(s)
- Mary E Velthuizen
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Rob B van der Luijt
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.,Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Beja J de Vries
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Marco J Koudijs
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Eveline M A Bleiker
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Margreet G E M Ausems
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
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26
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Custers JA, Kwakkenbos L, van der Graaf WT, Prins JB, Gielissen MF, Thewes B. Not as Stable as We Think: A Descriptive Study of 12 Monthly Assessments of Fear of Cancer Recurrence Among Curatively-Treated Breast Cancer Survivors 0-5 Years After Surgery. Front Psychol 2020; 11:580979. [PMID: 33224072 PMCID: PMC7667242 DOI: 10.3389/fpsyg.2020.580979] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/24/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose: Previous studies suggest one-third of breast cancer survivors (BCS) experience elevated fear of cancer recurrence (FCR) and that it remains stable. Most studies include long assessment intervals and aggregated group data. This study aimed to describe the individual trajectories of FCR when assessed monthly using both a statistical and descriptive approach. Methods: Participants were curatively-treated BCS 0-5 years post-surgery. Questionnaire data were collected monthly for 12 months. Primary outcome was FCR [Cancer Worry Scale (CWS)]. For the descriptive approach, 218 participants were classified as low (CWS ≤ 13 at each assessment), high (CWS ≥ 14 at each assessment), or fluctuating FCR (CWS scores above and below cut-off). Latent class growth analysis (LCGA; n = 377) was conducted to identify trajectories over time. Results: Around 58% of the women reported fluctuating CWS scores, 22% reported a consistently high and 21% consistently low course. Results of the LCGA confirmed the three-class approach including a stable high FCR group (13%), a low FCR group (40%), and a moderate FCR group (47%). Both the moderate and low scoring groups reported declining scores over time. Younger patients, higher educated patients, and those less satisfied with the medical treatment were more likely to belong to the moderate or high trajectory. Conclusion: Assessed monthly, the majority of BCS report fluctuating levels of FCR. Stepped-care models should assess FCR on multiple occasions before offering tailored interventions.
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Affiliation(s)
- José Ae Custers
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, Netherlands
| | - Winette Ta van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands.,Radboud Institute for Health Sciences, Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Judith B Prins
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marieke Fm Gielissen
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands.,Siza (disability service) Arnhem, Arnhem, Netherlands
| | - Belinda Thewes
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, NSW, Australia
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27
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Britton J, Taxiarchi P, Martin G, Willert R, Horne M, Hamdy S, McLaughlin J, Ang Y. Comparative quantitative survey of patient experience in Barrett's oesophagus and other gastrointestinal disorders. BMJ Open Gastroenterol 2020; 7:e000357. [PMID: 32337055 PMCID: PMC7170407 DOI: 10.1136/bmjgast-2019-000357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/13/2020] [Accepted: 01/30/2020] [Indexed: 12/22/2022] Open
Abstract
Objective To assess health-related quality of life in patients with non-dysplastic Barrett's oesophagus (NDBO) and endoscopically treated dysplastic Barrett's oesophagus (DBO). Design This quantitative, self-administered questionnaire study was conducted across three National Health Service hospitals. Data were collected from three other cohorts; gastro-oesophageal reflux disease (GORD), colonic polyp surveillance and healthy individuals. Fisher's exact and Spearman's rank correlation tests were used for analysis. Propensity score matching adjusted for age, sex and comorbidities. Results 687 participants were eligible for analysis (NDBO n=306, DBO n=49, GORD n=132, colonic polyps n=152 and healthy n=48). 53% of NDBO participants reported similarly high cancer worry, comparable to DBO (50%, p=0.933) and colonic polyp participants (51%, p=0.355). Less cancer worry was reported in GORD participants (43.4%, p=0.01 vs NDBO). NDBO participants reported anxiety in 15.8% and depression in 8.6% of cases, which was similar to the other disease cohorts. Moderate or severe heartburn or acid regurgitation was found in 11% and 10%, respectively, in the NDBO cohort, comparable to DBO participants (heartburn 2% p=0.172, acid regurgitation 4% p=0.31) but lower (better) than GORD participants (heartburn 31% p=<0.001, acid regurgitation 25% p=0.001). NDBO participants with moderate or severe GORD symptoms were associated with higher rates of anxiety (p=<0.001), depression (p=<0.001) and cancer worry (p=<0.001). NDBO patients appropriately perceiving their cancer risk as low had lower rates of cancer worry (p=<0.001). Conclusion This study provides insight into the problems Barrett's oesophagus patients may face. Future care pathways must be more patient focussed to address misconceptions of cancer risk, oesophageal cancer related worry and GORD symptom control.
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Affiliation(s)
- James Britton
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK.,Gastroenterology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Paraskevi Taxiarchi
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Glen Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Robert Willert
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Maria Horne
- Faculty of Medicine and Health, School of Healthcare, University of Leeds, Leeds, UK
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK.,Salford Royal NHS Foundation Trust, Salford, UK
| | - John McLaughlin
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK.,Salford Royal NHS Foundation Trust, Salford, UK
| | - Yeng Ang
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK.,Salford Royal NHS Foundation Trust, Salford, UK
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28
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Vermeer NCA, van der Valk MJM, Snijders HS, Vasen HFA, Gerritsen van der Hoop A, Guicherit OR, Liefers GJ, van de Velde CJH, Stiggelbout AM, Peeters KCMJ. Psychological distress and quality of life following positive fecal occult blood testing in colorectal cancer screening. Psychooncology 2020; 29:1084-1091. [PMID: 32237002 PMCID: PMC7317528 DOI: 10.1002/pon.5381] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/11/2020] [Accepted: 03/21/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to assess psychological functioning, quality of life, and regret about screening after a positive fecal immunochemical test (FIT) and subsequent colonoscopy, and to evaluate changes over time. METHODS This is a prospective cohort study. Individuals aged 55 to 75 with a positive FIT that were referred for colonoscopy between July 2017 and November 2018, were invited to complete questionnaires related to psychological distress and health-related quality of life at three predefined time points: before colonoscopy, after histopathology result notification, and after 6 months. Four questionnaires were used: the Psychological Consequences Questionnaire (PCQ), the six-item Cancer Worry Scale (CWS), the Decision Regret Scale (DRS), and the 36-item Short-Form (SF-36). RESULTS A total of 1066 participants out of 2151 eligible individuals were included. Patients with cancer showed a significant increase in psychological dysfunction (P = .01) and cancer worry (P = .008) after colonoscopy result notification, and a decline to pre-colonoscopy measurements after 6 months. In the no-cancer groups, psychological dysfunction and cancer worry significantly decreased over time (P < .05) but there was no ongoing decline. After 6 months, 17% of participants with no cancer experienced high level of cancer worry (CWS ≥ 10). Yet, only 5% reported high level of regret about screening participation (DRS > 25). A good global quality of life was reported in participants with no cancer. CONCLUSION Some psychological distress remains up to 6 months after colonoscopy in participants who tested false-positive in the Dutch bowel cancer screening program.
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Affiliation(s)
- Nina C A Vermeer
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Heleen S Snijders
- Department of Surgery, Groene Hart ziekenhuis, Gouda, The Netherlands
| | - Hans F A Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Onno R Guicherit
- Department of Surgery, Haaglanden Medical Centre, Leidschendam, The Netherlands
| | - Gerrit-Jan Liefers
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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29
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Bancroft EK, Saya S, Brown E, Thomas S, Taylor N, Rothwell J, Pope J, Chamberlain A, Page E, Benafif S, Hanson H, Dias A, Mikropoulos C, Izatt L, Side L, Walker L, Donaldson A, Cook JA, Barwell J, Wiles V, Limb L, Eccles DM, Leach MO, Shanley S, Gilbert FJ, Gallagher D, Rajashanker B, Whitehouse RW, Koh DM, Sohaib SA, Evans DG, Eeles RA, Walker LG. Psychosocial effects of whole-body MRI screening in adult high-risk pathogenic TP53 mutation carriers: a case-controlled study (SIGNIFY). J Med Genet 2020; 57:226-236. [PMID: 31719169 PMCID: PMC7146942 DOI: 10.1136/jmedgenet-2019-106407] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/18/2019] [Accepted: 09/21/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Germline TP53 gene pathogenic variants (pv) cause a very high lifetime risk of developing cancer, almost 100% for women and 75% for men. In the UK, annual MRI breast screening is recommended for female TP53 pv carriers. The SIGNIFY study (Magnetic Resonance Imaging screening in Li Fraumeni syndrome: An exploratory whole body MRI) study reported outcomes of whole-body MRI (WB-MRI) in a cohort of 44 TP53 pv carriers and 44 matched population controls. The results supported the use of a baseline WB-MRI screen in all adult TP53 pv carriers. Here we report the acceptability of WB-MRI screening and effects on psychosocial functioning and health-related quality of life in the short and medium terms. METHODS Psychosocial and other assessments were carried out at study enrolment, immediately before MRI, before and after MRI results, and at 12, 26 and 52 weeks' follow-up. RESULTS WB-MRI was found to be acceptable with high levels of satisfaction and low levels of psychological morbidity throughout. Although their mean levels of cancer worry were not high, carriers had significantly more cancer worry at most time-points than controls. They also reported significantly more clinically significant intrusive and avoidant thoughts about cancer than controls at all time-points. There were no clinically significant adverse psychosocial outcomes in either carriers with a history of cancer or in those requiring further investigations. CONCLUSION WB-MRI screening can be implemented in TP53 pv carriers without adverse psychosocial outcomes in the short and medium terms. A previous cancer diagnosis may predict a better psychosocial outcome. Some carriers seriously underestimate their risk of cancer. Carriers of pv should have access to a clinician to help them develop adaptive strategies to cope with cancer-related concerns and respond to clinically significant depression and/or anxiety.
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Affiliation(s)
- Elizabeth K Bancroft
- Oncogenetics Team, The Royal Marsden NHS Foundation Trust, London, UK
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - Sibel Saya
- Oncogenetics Team, The Institute of Cancer Research, London, UK
- Centre for Cancer Research & Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Emma Brown
- Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Thomas
- Oncogenetics Team, The Royal Marsden NHS Foundation Trust, London, UK
| | - Natalie Taylor
- Oncogenetics Team, The Royal Marsden NHS Foundation Trust, London, UK
| | - Jeanette Rothwell
- Clinical Genetics, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jennifer Pope
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | | | - Elizabeth Page
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - Sarah Benafif
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - Helen Hanson
- South West Thames Regional Genetics Service, St Georges NHS Foundation Trust, London, UK
| | - Alexander Dias
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | | | - Louise Izatt
- Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lucy Side
- Clinical Genetics, Wessex Clinical Genetics Service, Southampton, UK
| | - Lisa Walker
- Clinical Genetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alan Donaldson
- Clinical Genetics, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jackie A Cook
- Department of Clinical Genetics, Sheffield Children's Hospital, Sheffield, UK
| | - Julian Barwell
- Clinical Genetics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Vicki Wiles
- Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lauren Limb
- North West Thames Regional Genetics Service (Kennedy-Galton Centre), London North West University Healthcare NHS Trust, Harrow, UK
| | - Diana M Eccles
- Cancer Sciences, University of Southampton Faculty of Medicine, Southampton, UK
| | - Martin O Leach
- Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, London, UK
- Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Susan Shanley
- Formerly at the Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - David Gallagher
- Cancer Genetics Service, Mater Hospital School, Dublin, Ireland
| | | | | | - Dow-Mu Koh
- Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, London, UK
- Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - S Aslam Sohaib
- Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - D Gareth Evans
- Clinical Genetics, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rosalind A Eeles
- Oncogenetics Team, The Royal Marsden NHS Foundation Trust, London, UK
- Oncogenetics Team, The Institute of Cancer Research, London, UK
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30
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Luberto CM, Hall DL, Chad-Friedman E, Park ER. Theoretical Rationale and Case Illustration of Mindfulness-Based Cognitive Therapy for Fear of Cancer Recurrence. J Clin Psychol Med Settings 2019; 26:449-460. [PMID: 30756278 PMCID: PMC6689451 DOI: 10.1007/s10880-019-09610-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Fear of cancer recurrence (FCR) is a common problem among cancer survivors and evidence-based interventions grounded in theoretical models are needed. Mindfulness-Based Cognitive Therapy (MBCT) is an evidence-based intervention for reducing health anxiety that could be useful to apply to FCR. However, there has only been one study of MBCT for FCR to date, and the theoretical rationale and practical application of MBCT for FCR has not been described. The purpose of this paper is to offer an evidence-based rationale for MBCT to treat FCR based on a health anxiety model; describe the process of adapting MBCT to target FCR; and present a case study of the adapted protocol for treating FCR in a young adult breast cancer survivor to illustrate its delivery, feasibility, acceptability, and associated changes in outcomes. Clinical implications and directions for future research are discussed.
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Affiliation(s)
- Christina M Luberto
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Benson-Henry Institute for Mind Body Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge St, 15th floor, Boston, MA, 02114, USA.
| | - Daniel L Hall
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Benson-Henry Institute for Mind Body Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Outcomes Research, Massachusetts General Hospital, Boston, MA, USA
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge St, 15th floor, Boston, MA, 02114, USA
| | - Emma Chad-Friedman
- Benson-Henry Institute for Mind Body Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elyse R Park
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Benson-Henry Institute for Mind Body Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Outcomes Research, Massachusetts General Hospital, Boston, MA, USA
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge St, 15th floor, Boston, MA, 02114, USA
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31
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Solomon I, Rybak C, Van Tongeren L, Kuzmich L, Blazer K, Nehoray B, Niell-Swiller M, Bray S, Bray TH, Hurley K, Weitzel JN, Slavin TP. Experience Gained from the Development and Execution of a Multidisciplinary Multi-syndrome Hereditary Colon Cancer Family Conference. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:1204-1212. [PMID: 30259397 PMCID: PMC6437007 DOI: 10.1007/s13187-018-1430-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Genetic healthcare professionals provide genetic cancer risk assessment and follow-up care for patients facing hereditary cancers. To meet the needs of those affected by hereditary colorectal cancer, City of Hope and the Hereditary Colon Cancer Foundation collaborated to develop a "Family Day" conference. We describe the development of our conference based upon the Hereditary Colon Cancer Foundation's "Family Day" program model, with refinements completed using the Participatory Action Research theoretical framework, which incorporated input from conference participants and researchers. Thirty-one participants attended the conference, representing patients with, or families, friends, and caregivers of those with, multiple colorectal cancer predisposition syndromes, including Lynch, familial adenomatous polyposis, and juvenile polyposis. Participants who completed the feedback surveys (n = 22) were highly satisfied with the presentation content, ranking the keynote lecture on family communication the highest of the conference events. Participants also provided feedback regarding how to improve future conferences. In conclusion, we share our experience and provide guidance for developing a successful hereditary colon cancer predisposition patient and family conference.
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Affiliation(s)
- Ilana Solomon
- City of Hope, Division of Clinical Cancer Genomics, Duarte, CA, USA
| | - Christina Rybak
- City of Hope, Division of Clinical Cancer Genomics, Duarte, CA, USA
| | | | - Lili Kuzmich
- City of Hope, Division of Clinical Cancer Genomics, Duarte, CA, USA
| | - Kathleen Blazer
- City of Hope, Division of Clinical Cancer Genomics, Duarte, CA, USA
| | - Bita Nehoray
- City of Hope, Division of Clinical Cancer Genomics, Duarte, CA, USA
| | | | - Shawnie Bray
- Hereditary Colon Cancer Foundation, Portland, OR, USA
| | - Travis H Bray
- Hereditary Colon Cancer Foundation, Portland, OR, USA
| | | | - Jeffrey N Weitzel
- City of Hope, Division of Clinical Cancer Genomics, Duarte, CA, USA.
| | - Thomas P Slavin
- City of Hope, Division of Clinical Cancer Genomics, Duarte, CA, USA.
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Abstract
BACKGROUND Almost all patients with familial adenomatous polyposis undergo abdominal surgery with a risk of disease and surgery-related complications. This, the familial nature of the syndrome, and its wide-ranging manifestations make patients prone to mental health symptoms. If this is true, patients need appropriate evaluation and treatment. OBJECTIVE The purpose of this study was to record the experience of mental health symptoms in a group of unselected patients with FAP. DESIGN We conducted an observational study using an anonymized mental health symptom survey for patients affected with familial adenomatous polyposis. SETTINGS The study was conducted using the Hereditary Colorectal Cancer Registry in a tertiary referral center. PATIENTS Patients affected with familial adenomatous polyposis were included. MAIN OUTCOME MEASURES Results of the mental health survey were measured. RESULTS Seventy nine of 100 patients completed the survey; 57 endorsed ≥1 psychosocial symptom (72.2%). with a mean of 4 per patient. Nine patients (11.4%) met all 4 of the American Psychiatric Association diagnostic criteria for posttraumatic stress disorder, and 8 (10.1%) endorsed partial posttraumatic stress disorder criteria (3/4 symptoms). Patients who met all of the criteria for posttraumatic stress disorder had an average of 9.3 psychosocial symptoms each compared with 8.3 for those who met 3 of 4 and 2.2 for those who met <3. Six patients endorsed suicidal thoughts, all of whom met 3 or 4 of the criteria for posttraumatic stress disorder. LIMITATIONS The study was limited by its referral bias toward severe cases and relatively small number of patients. Because of the limitations of an anonymous self-administered screening, no mental health diagnoses have been given. CONCLUSIONS Patients with familial adenomatous polyposis are at risk for mental health symptoms, which can be multiple and severe. Some patients need professional counseling. A correlation between familial adenomatous polyposis patients with posttraumatic stress disorder and suicidal ideation is important. See Video Abstract at http://links.lww.com/DCR/A995. SÍNTOMAS PSICOPATOLÓGICOS EN PACIENTES CON PÓLIPOSIS ADENOMATOSO FAMILIAR: UN ESTUDIO OBSERVACIONAL: Un mayoría de pacientes con póliposis adenomatoso familiar (PAF) se someten a cirugía abdominal con los riesgos de enfermedad propria y complicaciones relacionadas a cirugía. Estos factores, la relación familiar del síndrome y sus manifestaciones altamente variables hacen que los pacientes sean propensos a psicopatologías. Si estas consideraciones son validas, los pacientes requieren evaluación y tratamiento adecuado. OBJETIVO Documentar la experiencia de los síntomas psicopatológicos en un grupo de pacientes no seleccionados con PAF. DISEÑO:: Estudio observacional utilizando una encuesta anónima de síntomas psicopatológicos en pacientes afectados con póliposis adenomatoso familiar. AMBIENTE CLINICO Registro de cáncer colorrectal hereditario en un centro de referencia de tercer nivel. PACIENTES Individuos afectados con póliposis adenomatoso familiar. OBJETIVOS PRINCIPALES A VALORACIÓN:: Resultados de la encuesta de salud mental. RESULTADOS Setenta y nueve de 100 pacientes completaron la encuesta; 57 afirmaron uno o más síntomas psicosociales (72,2%) con un promedio de 4 por paciente. 9 (11,4%) pacientes cumplieron con los 4 criterios de diagnóstico de la Asociación Estadounidense de Psiquiatría para el trastorno por estrés postraumático, y 8 (10,1%) llenaron los criterios del trastorno de estrés postraumático parcial (3/4 síntomas). Los pacientes que cumplieron con todos los criterios para el trastorno por estrés postraumático tuvieron un promedio de 9.3 síntomas psicosociales cada uno, en comparación con 8.3 para los que cumplieron con 3/4 y 2.2 para los que cumplieron con <3. 6 pacientes afirmaron pensamientos de suicidio, todos los cuales cumplieron con 3 o 4 de los criterios para el trastorno por estrés postraumático. LIMITACIONES Sesgo de referencia hacia casos graves, y un número relativamente pequeño de pacientes. Debido a las limitaciones de un examen anónimo auto administrado, no se confirmaron diagnósticos de psicopatología. CONCLUSIONES Los pacientes con póliposis adenomatoso familiar tienen riesgo de síntomas de salud mental alterada que pueden ser múltiples y graves. Algunos pacientes necesitan asesoramiento profesional. La correlación entre los pacientes con póliposis adenomatoso familiar con trastorno por estrés postraumático y ideación suicida es importante. Vea el Resumen del Video en http://links.lww.com/DCR/A995.
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Van de Beek I, Smets EMA, Legdeur MA, de Hullu JA, Lok CAR, Buist MR, Mourits MJE, Kets CM, van der Kolk LE, Oosterwijk JC, Aalfs CM. Genetic counseling of patients with ovarian carcinoma: acceptance, timing, and psychological wellbeing. J Community Genet 2019; 11:183-191. [PMID: 31168696 PMCID: PMC7062983 DOI: 10.1007/s12687-019-00427-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 05/27/2019] [Indexed: 12/15/2022] Open
Abstract
The new Dutch guidelines on hereditary and familial ovarian carcinoma recommend genetic testing of all patients with epithelial ovarian cancer (EOC). With this study, we aimed to obtain insight into (1) the acceptance and timing of the offer of genetic counseling in women with EOC, (2) reasons for accepting or declining genetic counseling, and (3) psychological differences between women who did and did not have genetic counseling. A multicenter questionnaire survey was performed in patients with EOC in four Dutch oncology centers. The questionnaire addressed whether, how, and when genetic counseling was offered, women’s arguments to accept or decline genetic counseling, and included the Cancer Worry Scale (CWS) and the Hospital Anxiety and Depression Scale (HADS). A total of 67 women completed the questionnaire, of which 43 had genetic counseling. Despite a wide variability in the timing of the offer of genetic counseling, 89% of the women were satisfied with the timing. No significant differences were found between the CWS and HADS scores for the timing of the offer of genetic counseling and whether or not women had genetic counseling. Taking the small sample size into account, the results tentatively suggest that genetic counseling may have limited impact on the psychosocial wellbeing of women with EOC. Therefore, we assume that implementation of the new guidelines offering genetic counseling to all patients with EOC will not cause considerable additional burden to these patients.
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Affiliation(s)
- I Van de Beek
- Department of Clinical Genetics, Amsterdam UMC, location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Department of Clinical Genetics, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - E M A Smets
- Department of Clinical Genetics, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.,Department of Medical Psychology, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M A Legdeur
- Department of Clinical Genetics, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J A de Hullu
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - C A R Lok
- Department of Obstetrics and Gynaecology, Center of Gynaecologic Oncology Amsterdam, PO Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - M R Buist
- Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M J E Mourits
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - C M Kets
- Department of Human Genetics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - L E van der Kolk
- Family Cancer Clinic, Netherlands Cancer Institute, PO Box 90203, 1006 BE, Amsterdam, the Netherlands
| | - J C Oosterwijk
- Department of Genetics, University Medical Center, University of Groningen, PO Box 30001, 9700 RB, Groningen, the Netherlands
| | - C M Aalfs
- Department of Clinical Genetics, Amsterdam UMC, location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Department of Clinical Genetics, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
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Cazacu IM, Luzuriaga Chavez AA, Saftoiu A, Bhutani MS. Psychological impact of pancreatic cancer screening by EUS or magnetic resonance imaging in high-risk individuals: A systematic review. Endosc Ultrasound 2019; 8:17-24. [PMID: 30246710 PMCID: PMC6400091 DOI: 10.4103/eus.eus_25_18] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives: There is an increasing global interest in screening programs aiming to detect pancreatic cancer (PC) in an early and potentially curable stage. Concerns still remain as to whether screening would confer any survival benefit. Another approach to evaluate the benefits of the pancreatic screening programs would be to consider its impact on the quality of life of the individuals who at risk of developing cancer. The aim of this systematic review was to investigate the current knowledge regarding the psychological impact of participation in routine screening for PC. Methods: A systematic literature search was carried out in January 2018 in three major databases which are as follows: PubMed, Scopus, and Web of Science. Cross-sectional and prospective studies evaluating the psychological aspects of screening in high-risk individuals were included in the study. For each study, the following data were recorded: name of first author, year of publication, study design, study population, aims, screening protocol, outcomes and instruments, main results, and summary of findings. Results: Six cohort studies and one cross-sectional study that addressed the psychological aspects of PC screening were included in the analysis. Overall, studies have shown that high-risk individuals have positive psychological outcomes from participating in PC screening programs. Conclusions: Although screening might not always be reassuring, it may improve individuals’ quality of life, and this should be an important aspect when considering PC screening.
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Affiliation(s)
- Irina Mihaela Cazacu
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | | | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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van de Wal M, Servaes P, Berry R, Thewes B, Prins J. Cognitive Behavior Therapy for Fear of Cancer Recurrence: A Case Study. J Clin Psychol Med Settings 2018; 25:390-407. [PMID: 29468568 PMCID: PMC6209054 DOI: 10.1007/s10880-018-9545-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This case study describes the course and content of cognitive behavior therapy (CBT) for clinical fear of cancer recurrence (FCR) in a breast cancer survivor. The CBT for clinical FCR consisted of seven face-to-face therapy sessions and one telephone session. The primary treatment goal was to reduce FCR severity by modifying cognitive processes and dysfunctional behavior. Assessments of FCR and quality of life were completed by the breast cancer survivor pre-therapy, post-therapy, and at 6 and 12 months of post-therapy. In each treatment session, perceived control over FCR was assessed. A clinical nurse specialist participated in evaluation interviews. The patient's perceived control over FCR increased during the therapy, and FCR severity declined to a non-clinical level. This improvement was still evident at the 6- and 12-month follow-up assessments and was supported by results for secondary and exploratory outcomes measures. FCR offers a great challenge for health care professionals due to the lack of effective treatment options. This case study shows how clinical FCR can be addressed with CBT and can contribute to the improvement of care for cancer survivors.
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Affiliation(s)
- Marieke van de Wal
- Department of Medical Psychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
- Department of Medical Psychology, Maxima Medical Center, Eindhoven/Veldhoven, The Netherlands.
| | - Petra Servaes
- Department of Medical Psychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Rebecca Berry
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Belinda Thewes
- Department of Medical Psychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Judith Prins
- Department of Medical Psychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Custers JAE, Kwakkenbos L, van de Wal M, Prins JB, Thewes B. Re-validation and screening capacity of the 6-item version of the Cancer Worry Scale. Psychooncology 2018; 27:2609-2615. [PMID: 29843189 DOI: 10.1002/pon.4782] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/27/2018] [Accepted: 05/22/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is one of the major existential unmet needs of cancer survivors. Due to growing availability of evidenced-based interventions for high FCR, valid and reliable brief measures of FCR are needed. This study aimed to validate the 6-item Cancer Worry Scale (CWS) and to establish a cut-off score for high FCR. METHODS Participants in this study were 1033 cancer survivors and patients recruited as part of 5 existing studies on FCR involving patients and survivors with gastro-intestinal stromal tumors, colorectal, breast, and prostate cancer. De-identified data of the CWS, Fear of Cancer Recurrence Inventory (FCRI), Impact of Event Scale, Hospital Anxiety and Depression Scale, and EORTC-QLQ-C30 were amalgamated for the analyses. Confirmatory factor analysis of the CWS was performed. Sensitivity and specificity were tested with the FCRI as gold standard. RESULTS Results confirmed that the 6-item version of the CWS maintained good construct validity, convergent and divergent validity, and high internal consistency (α 0.90). The optimal cut-off for the 6-item CWS was 9 versus 10 using the 12 vs 13 FCRI-SF score (sensitivity 82%, specificity 83%) and the 15 vs 16 FCRI-SF score (sensitivity 88%, specificity 73%). Using the highest FCRI-SF cut-off (21 vs 22), the optimal CWS cut-off was 11 vs 12 (sensitivity 88%, specificity 81%). CONCLUSIONS The present results provide researchers and clinicians with a brief valid and reliable measure of FCR which is suitable for measuring FCR in cancer patients and survivors.
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Affiliation(s)
- José A E Custers
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, The Netherlands.,Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Marieke van de Wal
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith B Prins
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Belinda Thewes
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
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van Leeuwaarde RS, Pieterman CRC, Bleiker EMA, Dekkers OM, van der Horst-Schrivers AN, Hermus AR, de Herder WW, Drent ML, Bisschop PH, Havekes B, Vriens MR, Valk GD. High Fear of Disease Occurrence Is Associated With Low Quality of Life in Patients With Multiple Endocrine Neoplasia Type 1: Results From the Dutch MEN1 Study Group. J Clin Endocrinol Metab 2018; 103:2354-2361. [PMID: 29618015 DOI: 10.1210/jc.2018-00259] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/26/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Multiple endocrine neoplasia type 1 (MEN1) is a hereditary disease characterized by a high risk of developing primary hyperparathyroidism, duodenopancreatic neuroendocrine tumors, and pituitary tumors (PITs). It is unclear if having MEN1 leads to psychological distress because of fear of disease occurrence (FDO), thereby potentially affecting quality of life. DESIGN A cross-sectional study was performed using the Dutch MEN1 cohort. All patients received the Cancer Worry Scale (a score ≥14 reflects high FDO), the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), and questions on sociodemographic and medical history. RESULTS A total of 227 of 285 (80%) eligible patients with MEN1 completed the questionnaire. The mean (± standard deviation) age was 47 ± 15 years. Overall, patients experienced an FDO of 15.1 ± 4.7, with 58% of patients having a score ≥14. This is higher than reported in previous studies assessing fear of cancer recurrence in different cancer populations (31% to 52%). Adjusted for age and sex, the FDO score was negatively associated with almost all SF-36 subscales. In multivariable analysis, the diagnosis of a PIT, a pancreatic neuroendocrine tumor, and not being employed were associated with FDO (P < 0.05). Patients had higher FDO scores for their family members than for themselves. CONCLUSION The majority of patients with MEN1 have FDO for themselves and even more for their relatives. This psychological distress is associated with a lower health-related quality of life. Therefore, in the medical care for MEN1, emphasis should also be placed on FDO and quality of life.
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Affiliation(s)
| | - Carolina R C Pieterman
- Dutch MEN Advocacy Group, Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Eveline M A Bleiker
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Olaf M Dekkers
- Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Ad R Hermus
- Department of Endocrinology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wouter W de Herder
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Madeleine L Drent
- Department of Internal Medicine, Section of Endocrinology, VU University Medical Center, Amsterdam, Netherlands
| | - Peter H Bisschop
- Department of Endocrinology and Metabolism, Academic Medical Center, Amsterdam, Netherlands
| | - Bas Havekes
- Department of Internal Medicine, Division of Endocrinology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Menno R Vriens
- Department of Endocrine Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gerlof D Valk
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, Netherlands
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Arts-de Jong M, DeJong CAJ, Hermens RP, Kissane DW, Massuger LM, Hoogerbrugge N, Prins JB, deHullu JA. High demoralization in a minority of oophorectomized BRCA1/2 mutation carriers influences quality of life. J Psychosom Obstet Gynaecol 2018; 39:96-104. [PMID: 28279121 DOI: 10.1080/0167482x.2017.1296429] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Demoralization is a relatively neglected issue in which low morale and poor coping result from a stressor such as familial cancer risk. Female BRCA1/2 mutation carriers are highly susceptible for developing breast and ovarian cancer. The aim of this study was to evaluate demoralization in oophorectomized BRCA1/2 mutation carriers and its relation to quality of life. METHODS This cross-sectional study examined 288 oophorectomized BRCA1/2 mutation carriers using the following standardized self-report measures: Demoralization Scale, EORTC Quality of Life Questionnaire-C30, State-Trait Anxiety Inventory and the Cancer Worry Scale. RESULTS The mean score on the Demoralization Scale was 17.8 (SD 14.0). A clinically significant level of demoralization, defined as a score ≥30, was found in 45 BRCA1/2 mutation carriers (16%). Being highly demoralized was associated with a significantly lower quality of life, and higher levels of physical problems, anxiety and cancer worries. No demographic or clinical factors could predict higher levels of demoralization. CONCLUSIONS Our findings established that a clear proportion of oophorectomized BRCA1/2 mutation carriers experience demoralization impacting on their well-being. Further research is needed to explore the natural trajectory of demoralization and the resultant need for support in these women.
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Affiliation(s)
- Marieke Arts-de Jong
- a Department of Obstetrics and Gynaecology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Cor A J DeJong
- b Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University Nijmegen , Nijmegen , The Netherlands
| | - Rosella P Hermens
- c Scientific Institute for Quality of Health Care, Radboud University Medical Center , Nijmegen , The Netherlands
| | - David W Kissane
- d Department of Psychiatry, School of Clinical Sciences at Monash Health , Monash University , Clayton , Victoria , Australia
| | - Leon M Massuger
- a Department of Obstetrics and Gynaecology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Nicoline Hoogerbrugge
- e Department of Human Genetics , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Judith B Prins
- f Department of Medical Psychology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Joanne A deHullu
- a Department of Obstetrics and Gynaecology , Radboud University Medical Center , Nijmegen , The Netherlands
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McBride KA, Ballinger ML, Schlub TE, Young MA, Tattersall MHN, Kirk J, Eeles R, Killick E, Walker LG, Shanley S, Thomas DM, Mitchell G. Psychosocial morbidity in TP53 mutation carriers: is whole-body cancer screening beneficial? Fam Cancer 2018; 16:423-432. [PMID: 28124295 DOI: 10.1007/s10689-016-9964-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Germline TP53 mutation carriers are at high risk of developing a range of cancers. Effective cancer risk management is an important issue for these individuals. We assessed the psychosocial impact in TP53 mutation carriers of WB-MRI screening as part of the Surveillance in Multi-Organ Cancer (SMOC+) protocol, measuring their unmet needs, anxiety and depression levels as well as cancer worry using psychological questionnaires and in-depth interviews about their experiences of screening. We present preliminary psychosocial findings from 17 participants during their first 12 months on the trial. We found a significant reduction in participants' mean anxiety from baseline to two weeks post WB-MRI (1.2, 95% CI 0.17 to 2.23 p = 0.025), indicative of some benefit. Emerging qualitative themes show most participants are emotionally supported and contained by the screening program and are motivated by their immediate concern about staying alive, despite being informed about the current lack of evidence around efficacy of screening for people with TP53 mutations in terms of cancer morbidity or mortality. For those that do gain emotional reassurance from participating in the screening study, feelings of abandonment by the research team are a risk when the study ends. For others, screening was seen as a burden, consistent with the relentless nature of cancer risk associated with Li-Fraumeni syndrome, though these patients still declared they wished to participate due to their concern with staying alive. Families with TP53 mutations need ongoing support due to the impact on the whole family system. These findings suggest a comprehensive multi-organ screening program for people with TP53 mutations provides psychological benefit independent of an impact on cancer morbidity and mortality associated with the syndrome. The benefits of a multi-organ screening program will be greater still if the screening tests additionally reduce the cancer morbidity and mortality associated with the syndrome. These findings may also inform the care of individuals and families with other multi-organ cancer predisposition syndromes.
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Affiliation(s)
- Kate A McBride
- School of Science and Health and Centre for Health Research, Western Sydney University, Building 3, Centre for Health Research, Campbelltown, NSW, 2560, Australia. .,Sydney School of Public Health, Camperdown, NSW, 2006, Australia.
| | - Mandy L Ballinger
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia
| | - Timothy E Schlub
- Sydney School of Public Health, Camperdown, NSW, 2006, Australia
| | - Mary-Anne Young
- Familial Cancer Clinic, Peter MacCallum Cancer Centre, E. Melbourne, VIC, 3002, Australia
| | - Martin H N Tattersall
- Department of Cancer Medicine, The Chris O'Brien Lifehouse, Sydney Medical School, Camperdown, NSW, 2006, Australia
| | - Judy Kirk
- The Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead, NSW, 2145, Australia
| | - Ros Eeles
- Oncogenetics, The Institute of Cancer Research, London, UK
| | - Emma Killick
- Medical Oncology Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Sue Shanley
- Familial Cancer Clinic, Peter MacCallum Cancer Centre, E. Melbourne, VIC, 3002, Australia
| | - David M Thomas
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia
| | - Gillian Mitchell
- Familial Cancer Clinic, Peter MacCallum Cancer Centre, E. Melbourne, VIC, 3002, Australia.,Sir Peter MacCallum Dept. of Oncology, University of Melbourne, Parkville, VIC, Australia
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D'Andrea E, Lagerberg T, De Vito C, Pitini E, Marzuillo C, Massimi A, Vacchio MR, Grammatico P, Villari P. Patient experience and utility of genetic information: a cross-sectional study among patients tested for cancer susceptibility and thrombophilia. Eur J Hum Genet 2018; 26:518-526. [PMID: 29374276 DOI: 10.1038/s41431-017-0083-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/13/2017] [Accepted: 12/05/2017] [Indexed: 01/08/2023] Open
Abstract
We evaluated whether genetic tests with evidence of clinical and personal utility (i.e. APC and BRCA1/2 tests) are associated with higher satisfaction and a more positive perception of care experience than those with undefined utility (i.e. tests for thrombophilia). A cross-sectional survey was performed through telephone interviews to patients tested for deleterious variants in APC or BRCA1/2 genes, or for inherited thrombophilia (FV Leiden and/or FIIG20210A) during a 5-year period (2008-2012). Three aspects of patient experience were assessed: effective communication through pre- and post-test genetic counselling; collaboration between caregivers on the management of patient care; and impact of genetic testing on quality of life. Overall 237 patients had telephone interviews. Multivariate logistic regression analyses showed that patients tested for APC or BRCA1/2 variants were more likely to be satisfied with both pre- and post-test counselling than those tested for inherited thrombophilia (APC vs. thrombophilia, p = 0.039 and 0.005; BRCA1/2 vs. thrombophilia, p = 0.030 and <0.001). Patients tested for APC were more likely to report an improvement in quality of life than those for thrombophilia (OR = 2.97, 95%CI 1.14, 7.72; p = 0.025). A positive association was observed between patients who underwent BRCA1/2 testing, and self-perceived improvement in quality of life (OR = 1.41, 95%CI 0.74, 2.69; p = 0.294). Tests of undefined clinical and personal utility are associated with a lower degree of patient satisfaction with genetic counselling and no clear opinions on changes in quality of life compared with those with well-defined utility.
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Affiliation(s)
- Elvira D'Andrea
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy. .,Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
| | | | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Erica Pitini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Azzurra Massimi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Rosaria Vacchio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paola Grammatico
- Laboratory of Medical Genetics, Department of Molecular Medicine, San Camillo-Forlanini Hospital, Sapienza University, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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41
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Thewes B, Kaal SEJ, Custers JAE, Manten-Horst E, Jansen R, Servaes P, van der Graaf WTA, Prins JB, Husson O. Prevalence and correlates of high fear of cancer recurrence in late adolescents and young adults consulting a specialist adolescent and young adult (AYA) cancer service. Support Care Cancer 2017; 26:1479-1487. [PMID: 29168035 PMCID: PMC5876258 DOI: 10.1007/s00520-017-3975-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE High fear of cancer recurrence (FCR) is a frequently reported problem among cancer patients. Previous research has shown that younger age is associated with higher levels of FCR. However, little attention has been given to date about how FCR manifests itself among adolescent and young adult (AYA) cancer patients. This study explores the prevalence, correlates of high FCR, and its association with HRQoL in cancer patients in their late adolescence or young adulthood. METHODS Seventy-three AYA cancer patients, aged 18-35 years at diagnosis, consulted the AYA team of the Radboud University Medical Center completed questionnaires including the Cancer Worry Scale (CWS), Quality of Life-Cancer Survivors (QOL-CS), and Hospital Anxiety and Depression Scale (HADS). Sociodemographic and medical data was collected by self-reported questionnaire. RESULTS Forty-five participants experienced high FCR (62%), which was higher than the 31-52% reported in previous studies among mixed adult cancer patient samples. Sociodemographic and medical variables were not associated with levels of FCR. High FCR was significantly associated with lower levels of social and psychological functioning and overall HRQoL and higher levels of anxiety and psychological distress. CONCLUSION Results illustrate that FCR is a significant problem among AYA cancer patients consulting an AYA team, with participants reporting higher levels of FCR than cancer patients of mixed ages. Health care providers should pay specific attention to this problem by screening and the provision of appropriate psychosocial care when needed.
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Affiliation(s)
- Belinda Thewes
- Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Suzanne E J Kaal
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jose A E Custers
- Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Eveliene Manten-Horst
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rosemarie Jansen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Petra Servaes
- Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
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42
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Konings ICAW, Harinck F, Kuenen MA, Sidharta GN, Kieffer JM, Aalfs CM, Poley JW, Smets EMA, Wagner A, van Rens A, Vleggaar FP, Ausems MGEM, Fockens P, van Hooft JE, Bruno MJ, Bleiker EMA. Factors associated with cancer worries in individuals participating in annual pancreatic cancer surveillance. Fam Cancer 2017; 16:143-151. [PMID: 27629874 PMCID: PMC5243886 DOI: 10.1007/s10689-016-9930-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
It is important to adequately and timely identify individuals with cancer worries amongst participants in a pancreatic ductal adenocarcinoma (PDAC) surveillance program, because they could benefit from psychosocial support to decrease distress. Therefore, the aim of this study was to assess both psychosocial and clinical factors associated with cancer worries. High-risk individuals participating in PDAC-surveillance were invited to annually complete a cancer worry scale (CWS) questionnaire which was sent after counseling by the clinical geneticist (T0), after intake for participation in PDAC-surveillance (T1), and then annually after every MRI and endoscopic ultrasonography (EUS) (T2 and further). Analyses were performed to identify factors associated with cancer worries in the second year of surveillance (T3). We found a significant intra-individual decrease in cancer worries (β = −0.84, P < 0.001), nevertheless, 33 % of individuals had a CWS-score ≥14 at T3. We found one factor significantly associated with cancer worries at T3: having a family member affected by PDAC <50 years of age (β = 0.22, P = 0.03). The detection of a cystic lesion, a shortened surveillance interval, or undergoing pancreatic surgery did not lead to more cancer worries (P = 0.163, P = 0.33, and P = 0.53, respectively). In conclusion, this study identified ‘a family history of PDAC <50 years of age’ as the only predictor of cancer worries experienced after 2 years of surveillance in individuals at high risk of developing PDAC. This knowledge could help clinicians to timely identify individuals ‘at risk’ for high levels of cancer worries who would likely benefit from psychosocial support.
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Affiliation(s)
- Ingrid C A W Konings
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Femme Harinck
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marianne A Kuenen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, Amsterdam, The Netherlands
| | - Grace N Sidharta
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, Amsterdam, The Netherlands
| | - Jacobien M Kieffer
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, Amsterdam, The Netherlands
| | - Cora M Aalfs
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - Anja Wagner
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anja van Rens
- Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Margreet G E M Ausems
- Department of Clinical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eveline M A Bleiker
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, Amsterdam, The Netherlands. .,Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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van de Wal M, Thewes B, Gielissen M, Speckens A, Prins J. Efficacy of Blended Cognitive Behavior Therapy for High Fear of Recurrence in Breast, Prostate, and Colorectal Cancer Survivors: The SWORD Study, a Randomized Controlled Trial. J Clin Oncol 2017; 35:2173-2183. [PMID: 28471726 DOI: 10.1200/jco.2016.70.5301] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose Fear of cancer recurrence (FCR) is a common problem experienced by cancer survivors. Approximately one third of survivors report high FCR. This study aimed to evaluate whether blended cognitive behavior therapy (bCBT) can reduce the severity of FCR in cancer survivors curatively treated for breast, prostate, or colorectal cancer. Patients and Methods This randomized controlled trial included 88 cancer survivors with high FCR (Cancer Worry Scale score ≥ 14) from 6 months to 5 years after cancer treatment. Participants were randomly allocated (ratio 1:1, stratified by cancer type) to receive bCBT, including five face-to face and three online sessions (n = 45) or care as usual (CAU; n = 43). Participants completed questionnaires at baseline (T0) and 3 months later (T1). The intervention group completed bCBT between T0 and T1. The primary outcome was FCR severity assessed with the Cancer Worry Scale. Secondary outcomes included other distress-related measures. Statistical (one-way between-group analyses of covariance) and clinical effects (clinically significant improvement) were analyzed by intention to treat. Results Participants who received bCBT reported significantly less FCR than those who received CAU (mean difference, -3.48; 95% CI, -4.69 to -2.28; P < .001) with a moderate-to-large effect size ( d = 0.76). Clinically significant improvement in FCR was significantly higher in the bCBT group than in the CAU group (13 [29%] of 45 compared with 0 [0%] of 43; P < .001); self-rated improvement was also higher in the bCBT group (30 [71%] of 42 compared with 12 [32%] of 38 in the CAU group; P < .001). Conclusion bCBT has a statistically and clinically significant effect on the severity of FCR in cancer survivors and is a promising new treatment approach.
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Affiliation(s)
- Marieke van de Wal
- Marieke van de Wal, Belinda Thewes, Anne Speckens, and Judith Prins, Radboud University Medical Center, Nijmegen; and Marieke Gielissen, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Belinda Thewes
- Marieke van de Wal, Belinda Thewes, Anne Speckens, and Judith Prins, Radboud University Medical Center, Nijmegen; and Marieke Gielissen, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marieke Gielissen
- Marieke van de Wal, Belinda Thewes, Anne Speckens, and Judith Prins, Radboud University Medical Center, Nijmegen; and Marieke Gielissen, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Anne Speckens
- Marieke van de Wal, Belinda Thewes, Anne Speckens, and Judith Prins, Radboud University Medical Center, Nijmegen; and Marieke Gielissen, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Judith Prins
- Marieke van de Wal, Belinda Thewes, Anne Speckens, and Judith Prins, Radboud University Medical Center, Nijmegen; and Marieke Gielissen, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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44
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van de Wal M, Langenberg S, Gielissen M, Thewes B, van Oort I, Prins J. Fear of cancer recurrence: a significant concern among partners of prostate cancer survivors. Psychooncology 2017; 26:2079-2085. [DOI: 10.1002/pon.4423] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 02/25/2017] [Accepted: 03/15/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Marieke van de Wal
- Department of Medical Psychology; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Medical Psychology; Maxima Medical Center; Eindhoven/Veldhoven The Netherlands
| | - Simône Langenberg
- Department of Medical Oncology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Marieke Gielissen
- Department of Psychology; Academic Medical Center; Amsterdam The Netherlands
| | - Belinda Thewes
- Department of Medical Psychology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Inge van Oort
- Department of Urology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Judith Prins
- Department of Medical Psychology; Radboud University Medical Center; Nijmegen The Netherlands
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45
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van Helmondt SJ, van der Lee ML, de Vries J. Study protocol of the CAREST-trial: a randomised controlled trial on the (cost-) effectiveness of a CBT-based online self-help training for fear of cancer recurrence in women with curatively treated breast cancer. BMC Cancer 2016; 16:527. [PMID: 27455846 PMCID: PMC4960756 DOI: 10.1186/s12885-016-2562-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/14/2016] [Indexed: 12/12/2022] Open
Abstract
Background One of the most prevalent long-term consequences of surviving breast cancer is fear of cancer recurrence (FCR), which is associated with higher (mental) healthcare costs and lower surveillance rates. The majority of breast cancer survivors report a need for professional help in dealing with FCR. An easy-accessible and cost-effective evidence‐based psychological intervention for reducing FCR is lacking. In the current study an online self-help training to reduce FCR will be evaluated. In addition, the secondary aim of this study is to identify factors that predict whether women can benefit from the online self-help training or not. Methods/Design A multi-centre, parallel-groups, randomised controlled trial will be conducted to evaluate the (cost-) effectiveness of the CAREST-trial. A sample of 454 women with curatively treated breast cancer will be recruited from 8 hospitals in the Netherlands. Participants will be randomised to the intervention or usual care group (1:1). Self-report measures will be completed at baseline, 3 (post-intervention), 9, and 24 months. Primary outcome is FCR severity; secondary outcomes are healthcare costs, health status, and psychological distress. The online tailored self-help training “Less fear after cancer” is based on cognitive behavioural therapy and consists of 2 basic modules (psycho-education; basic principles of cognitive behavioural therapy) and 4 optional modules (rumination; action; relaxation; reassurance) to choose from. Each module consists of an informative part (texts, videos, audio files) and a practical part (exercises). For every patient, the intervention will be available for three months. Personal online support by an e-mail coach is available. Discussion Online self-help training may be an easy-accessible and cost-effective treatment to reduce the impact of FCR at an early stage in a large group of breast cancer survivors. A strength is the 24 months follow-up period in the health economic evaluation. The results of the study will provide information on the possible strengths and benefits of online self-help training for FCR in breast cancer survivors. Trial registration This study is registered at the Netherlands Trial Register (NTR4119, date registered: August 15, 2013).
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Affiliation(s)
| | | | - Jolanda de Vries
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Medical Psychology, St Elisabeth Hospital, Tilburg, The Netherlands
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46
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Towards an evidence-based model of fear of cancer recurrence for breast cancer survivors. J Cancer Surviv 2016; 11:41-47. [PMID: 27412726 PMCID: PMC5266772 DOI: 10.1007/s11764-016-0558-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 06/16/2016] [Indexed: 11/27/2022]
Abstract
Purpose In order to understand the multidimensional mechanism of fear of cancer recurrence (FCR) and to identify potential targets for interventions, it is important to empirically test the theoretical model of FCR. This study aims at assessing the validity of Lee-Jones et al.’s FCR model. Methods A total of 1205 breast cancer survivors were invited to participate in this study. Participants received a questionnaire booklet including questionnaires on demographics and psychosocial variables including FCR. Data analysis consisted of the estimation of direct and indirect effects in mediator models. Results A total of 460 women (38 %) participated in the study. Median age was 55.8 years (range 32–87). Indirect effects of external and internal cues via FCR were found for all mediation models with limited planning for the future (R2 = .28) and body checking (R2 = .11–.15) as behavioral response variables, with the largest effects for limited planning for the future. A direct relation was found between feeling sick and seeking professional advice, not mediated by FCR. Conclusions In the first tested models of FCR, all internal and external cues were associated with higher FCR. In the models with limited planning for the future and body checking as behavioral response, an indirect effect of cues via FCR was found supporting the theoretical model of Lee-Jones et al. Implications for Cancer Survivors An evidence-based model of FCR may facilitate the development of appropriate interventions to manage FCR in breast cancer survivors.
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47
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Konings ICAW, Sidharta GN, Harinck F, Aalfs CM, Poley JW, Kieffer JM, Kuenen MA, Smets EMA, Wagner A, van Hooft JE, van Rens A, Fockens P, Bruno MJ, Bleiker EMA. Repeated participation in pancreatic cancer surveillance by high-risk individuals imposes low psychological burden. Psychooncology 2015; 25:971-8. [PMID: 26632416 DOI: 10.1002/pon.4047] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 11/09/2015] [Accepted: 11/13/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND When assessing the feasibility of surveillance for pancreatic cancer (PC), it is important to address its psychological burden. The aim of this ongoing study is to evaluate the psychological burden of annual pancreatic surveillance for individuals at high risk to develop PC. METHODS This is a multicenter prospective study. High-risk individuals who undergo annual pancreatic surveillance with magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) were invited to complete questionnaires to assess motivations for participating in surveillance, experiences with participation, perceived PC risk, topics of concern, and psychological distress. Questionnaires were sent after intake for participation (T1), after the first MRI and EUS (T2), and after the MRI and EUS 1 (T3), 2 (T4), and 3 years (T5) after first surveillance. RESULTS In total, 140 out of 152 individuals returned one or more of the questionnaires (response 92%); 477 questionnaires were analyzed. The most frequently reported motivation for participating in surveillance was the possible early detection of (a precursor stage of) cancer (95-100%). Only a minority of respondents experienced MRI and EUS as uncomfortable (10% and 11%, respectively), and respondents dreaded their next EUS investigation less as surveillance progressed. Respondents' cancer worries decreased significantly over time, and both their anxiety and depression scores remained stable and low over the 3-year period of follow-up. CONCLUSIONS The psychological burden of pancreatic surveillance is low at all assessments. Therefore, from a psychological point of view, participation of high-risk individuals in an annual pancreatic surveillance program is feasible.Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ingrid C A W Konings
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Grace N Sidharta
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Femme Harinck
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Cora M Aalfs
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jacobien M Kieffer
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marianne A Kuenen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - Anja Wagner
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Anja van Rens
- Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eveline M A Bleiker
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Hébert JR, Braun KL, Kaholokula JK, Armstead CA, Burch JB, Thompson B. Considering the Role of Stress in Populations of High-Risk, Underserved Community Networks Program Centers. Prog Community Health Partnersh 2015. [PMID: 26213406 DOI: 10.1353/cpr.2015.0028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cancer disparities are associated with a broad range of sociocultural determinants of health that operate in community contexts. High-risk populations may be more vulnerable to social and environmental factors that lead to chronic stress. Theoretical and empirical research indicates that exposure to contextual and sociocultural stress alters biological systems, thereby influencing cancer risk, progression, and, ultimately, mortality. OBJECTIVE We sought to describe contextual pathways through which stress likely increases cancer risk in high-risk, underserved populations. METHODS This review presents a description of the link between contextual stressors and disease risk disparities within underserved communities, with a focus on 1) stress as a proximal link between biological processes, such as cytokine responses, inflammation, and cancer and 2) stress as a distal link to cancer through biobehavioral risk factors such as poor diet, physical inactivity, circadian rhythm or sleep disruption, and substance abuse. These concepts are illustrated through application to populations served by three National Cancer Institute-funded Community Networks Program Centers (CNPCs): African Americans in the Deep South (the South Carolina Cancer Disparities Community Network [SCCDCN]), Native Hawaiians ('Imi Hale-Native Hawaiian Cancer Network), and Latinos in the Lower Yakima Valley of Washington State (The Center for Hispanic Health Promotion: Reducing Cancer Disparities). CONCLUSIONS Stress experienced by the underserved communities represented in the CNPCs is marked by social, biological, and behavioral pathways that increase cancer risk. A case is presented to increase research on sociocultural determinants of health, stress, and cancer risk among racial/ethnic minorities in underserved communities.
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49
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Eriksson LE, Fritzell K, Rixon L, Björk J, Wettergren L. The role of illness perceptions in adherence to surveillance in patients with familial adenomatous polyposis (FAP). Psychooncology 2015; 25:699-706. [PMID: 26425823 DOI: 10.1002/pon.3997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 09/03/2015] [Accepted: 09/07/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of the study was to examine patients' beliefs about having familial adenomatous polyposis (FAP), a hereditary colorectal cancer syndrome, and how these beliefs are associated with adherence to endoscopic surveillance. METHODS Adult patients diagnosed with FAP on the national Swedish polyposis register who had undergone prophylactic colorectal surgery (n 209, response rate 76%) completed the Illness Perception Questionnaire (IPQ). Logistic regression analysis was used to investigate the relationships between illness perceptions and adherence, when controlling for demographic and clinical factors. RESULTS FAP was less distressing in men and those with fewer symptoms, reporting less serious consequences and more coherent understanding of FAP. Non-adherence (14%) to surveillance was associated with being older, having undergone surgery less recently and no history of malignancy. Patients' beliefs about their FAP were able to explain unique variance in non-adherence, in particular those who believed FAP was less distressing. CONCLUSIONS Patients who were non-adherent to endoscopic surveillance had more positive perceptions about their FAP and, in particular, were less emotionally affected compared to those who adhered. As non-adherence implies a greater risk of future malignancies, special efforts are required to effectively prevent cancer in all patients with FAP. Those who have lived with the condition for a long time, and are not troubled by gastrointestinal symptoms or worried about their FAP, may be in need of specific information and support. Further prospective research is required to examine emotional predictors and consequences of non-adherence. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lars E Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,School of Health Sciences, City University London, London, United Kingdom
| | - Kaisa Fritzell
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,The Swedish Polyposis Registry, Department of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden
| | - Lorna Rixon
- School of Health Sciences, City University London, London, United Kingdom
| | - Jan Björk
- The Swedish Polyposis Registry, Department of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lena Wettergren
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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50
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Custers JAE, Gielissen MFM, Janssen SHV, de Wilt JHW, Prins JB. Fear of cancer recurrence in colorectal cancer survivors. Support Care Cancer 2015; 24:555-562. [PMID: 26108170 PMCID: PMC4689743 DOI: 10.1007/s00520-015-2808-4] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/08/2015] [Indexed: 01/22/2023]
Abstract
Purpose Although long-term colorectal cancer (CRC) survivors generally report a good quality of life, fear of cancer recurrence (FCR) remains an important issue. This study investigated whether the Cancer Worry Scale (CWS) can detect high FCR, the prevalence, and characteristics of FCR in CRC survivors. Methods Two hundred and eleven patients who had undergone successful CRC surgery in the period 2003–2010 in the Radboud University Medical Center in the Netherlands were asked to participate. All patients were sent an information letter plus questionnaires for collecting information on demographic and medical variables, FCR, distress, and quality of life. Results Seventy-six patients (36 %; median age of 67.7 years range 41–88 years) completed the questionnaires a median of 5.1 years after surgery. A cut-off score of 14 or higher on the CWS was optimal to detect high FCR. Twenty-nine patients (38 %) experienced high levels of FCR, characterized by higher levels of distress, post-traumatic stress symptoms, and lower quality of life. These individuals particularly reacted to disease-related triggers, felt helpless, were worried, and experienced limitations in daily functioning. High FCR was not associated with demographic or medical variables. Conclusion Long after successful CRC surgery, FCR is a serious problem that impairs the quality of life for a substantial proportion of patients. With the CWS, it is possible to detect high FCR and thereby assist survivors in receiving appropriate care.
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Affiliation(s)
- José A E Custers
- Department of Medical Psychology 840, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Marieke F M Gielissen
- Department of Medical Psychology 840, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Stephanie H V Janssen
- Department of Surgery 618, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery 618, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology 840, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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