Health-related quality of life in patients with hepatocellular carcinoma: the mediation effects of illness perceptions and coping

Dyadic typology of illness perceptions in human immunodeficiency virus (HIV) Serodiscordant couples

OBJECTIVE

Illness perceptions direct coping resources in the illness adaptation process. Previous studies regarding illness perception profiles have been conducted at the individual level, without considering the couple as a unit. This study aimed to investigate the dyadic topologies of illness perceptions in HIV-serodiscordant couples and the association between the identified profiles and individual- and couple-level outcomes.

METHODS

A comprehensive examination was undertaken, encompassing 231 Chinese HIV-serodiscordant couples, who voluntarily participated in this cross-sectional study during the period spanning June to October 2022. To discern various patterns of illness perception, dyadic latent profile analyses were performed, followed by the implementation of one-way analyses of variance to investigate outcome differences at both the individual and couple levels across the identified profiles.

RESULTS

We identified three distinct profiles of illness perception, namely the incongruent-but-low, congruent-but-high, and incongruent-and-high profiles. Except for the partner's sex (p < .01, Cramer' v = 0.214) and the education levels of persons living with HIV and their partners (both p < .01, Cramer' v = 0.236 for persons living with HIV and 0.198 for partners), no significant demographic differences across the various profiles were found. Furthermore, we observed significant differences in all outcomes among the different couple profiles (all p < .001). These differences were of medium-to-large magnitudes (partial η2 values ranging from 0.07 to 0.22).

CONCLUSION

A couple-centered typological approach provides a useful way of identifying the couple's configuration of illness perceptions, which will inform the provision of tailor-made treatment for couples with different profiles.

Patient-reported outcomes in HCC: A scoping review by the Practice Metrics Committee of the American Association for the Study of Liver Diseases

BACKGROUND AND AIMS

HCC is a leading cause of mortality in patients with advanced liver disease and is associated with significant morbidity. Despite multiple available curative and palliative treatments, there is a lack of systematic evaluation of patient-reported outcomes (PROs) in HCC.

APPROACH AND RESULTS

The American Association for the Study of Liver Diseases Practice Metrics Committee conducted a scoping review of PROs in HCC from 1990 to 2021 to (1) synthesize the evidence on PROs in HCC and (2) provide recommendations on incorporating PROs into clinical practice and quality improvement efforts. A total of 63 studies met inclusion criteria investigating factors associated with PROs, the relationship between PROs and survival, and associations between HCC therapy and PROs. Studies recruited heterogeneous populations, and most were cross-sectional. Poor PROs were associated with worse prognosis after adjusting for clinical factors and with more advanced disease stage, although some studies showed better PROs in patients with HCC compared to those with cirrhosis. Locoregional and systemic therapies were generally associated with a high symptom burden; however, some studies showed lower symptom burden for transarterial radiotherapy and radiation therapy. Qualitative studies identified additional symptoms not routinely assessed with structured questionnaires. Gaps in the literature include lack of integration of PROs into clinical care to guide HCC treatment decisions, unknown impact of HCC on caregivers, and the effect of palliative or supportive care quality of life and health outcomes.

CONCLUSION

Evidence supports assessment of PROs in HCC; however, clinical implementation and the impact of PRO measurement on quality of care and longitudinal outcomes need future investigation.

Economic Burden and Quality of Life of Hepatocellular Carcinoma in Greater China: A Systematic Review

Background

Hepatocellular carcinoma (HCC) accounts for more than 85%-90% of primary liver cancer globally, and approximately 45% of deaths from HCC occur in greater China. This disease poses a significant economic burden for patients, payers and society and significantly affects patients' quality of life (QoL). However, such impact of HCC in greater China has not been well characterized. This review was conducted to analyze the current evidence about the economic and humanistic impact of HCC in greater China for informing national disease management and identifying clinical gaps yet to be resolved.

Methods

A systematic search literature using seven databases (Web of Science, PubMed, Medline, Cochrane Central, China National Knowledge Infrastructure, Wanfang, and Weipu) was performed to identify interventional and observational studies that reported the impact of HCC on cost or QoL and published before April 6, 2021. The focus population included adult patients with HCC in greater China. This review excluded any studies that focused on any specific treatment. Study quality was assessed using the Effective Public Health Practice Project tool.

Results

Of 39,930 studies retrieved, 27 were deemed eligible for inclusion. The methodologies, perspectives and data sources used in studies were heterogeneous. In greater China, while few studies reported the health expenditures of HCC patients and investigations about economic burden at national level was lacking, the significant economic impact of HCC on patients and their families had been reported. Health-related costs increased as the disease deteriorated. Additionally, HCC also has a negative impact on the QoL of patients, mostly in terms of physical, cognitive, social functioning and severe symptoms.

Conclusions

HCC has brought significant economic and QoL burden to patients in greater China. Both physical and psychological factors predicted QoL in patients with HCC in greater China. Future studies should explore the disease-related economic effects on Chinese patients and their families, the effects of physical and psychological factors on QoL and the relationships of physical and psychological factors in the region.

Systematic Review Registration:www.crd.york.ac.uk/prospero/display_record.php?RecordID=278421, PROSPERO: CRD42021278421

Return to Work and Work Productivity During the First Year After Cancer Treatment

Objectives

Working-age cancer patients face barriers to resuming work after treatment completion. Those resuming work contend with reduced productivity arising from persisting residual symptoms. Existing studies of return to work (RTW) after cancer diagnosis were done predominantly in Western countries. Given that employment and RTW in cancer survivors likely vary regionally due to healthcare provision and social security differences, we documented rates and correlates of RTW, work productivity, and activity impairment among Chinese cancer survivors in Hong Kong at one-year post-treatment.

Methods

Of 1,106 cancer patients assessed at six-months post-cancer treatment (baseline), 593 previously worked; detailed work status, psychological distress (HADS), physical symptom distress (MSAS-SF), supportive care needs (SCNS-SF34-C), health-related quality of life (SF12), and illness perception (B-IPQ) were assessed. Six months later (follow-up), work productivity and activity impairment were assessed (WPAI; n = 402). Descriptive analyses examined RTW rate. Fully adjusted regressions determined RTW, work productivity, and activity impairment predictors.

Results

At baseline, 39% (232/593) were working, 26% (153/593) on sick leave, and 35% (208/593) were unemployed. Compared to patients returning to work, unemployed participants were older, likely manual/service-oriented workers, and had lower family income, chemotherapy, fewer unmet health system and information needs, poorer physical functioning, and negative illness perceptions. Sick leave participants were likely service-oriented workers, who had head and neck cancer, chemotherapy, and poor physical functioning. At FU, baseline depressive symptoms, physical symptom distress, and negative illness perceptions predicted presenteeism and work productivity loss; gynecological cancer, fewer unmet health system and information needs, and greater unmet sexuality needs predicted absenteeism; physical symptom distress, negative illness perception, and poor physical functioning predicted activity impairment.

Conclusion

Cancer survivors who had more physically demanding jobs and poorer physical functioning delayed RTW. Unmanaged physical symptom and psychological distress hindered work productivity.

The Impact of Illness Perceptions on Depressive Symptoms Among Benign Prostatic Hyperplasia Patients with Lower Urinary Tract Symptom

Objective

This study aimed at exploring whether illness perceptions may mediate the relationship between depressive symptoms and lower urinary tract symptoms (LUTS) among benign prostatic hyperplasia (BPH) patients.

Methods

The Patient Health Questionnaire (PHQ-9) for depression, the International Prostate Symptom Score (IPSS) for the severity of LUTS and the brief Illness Perception Questionnaire (B-IPQ) for illness perceptions (IPs) were used among the 157 BPH patients with LUTS. Pearson’s correlation test and hierarchical regression analyses were used to assess the correlations between LUTS, depressive symptoms and IPs.

Results

Our study found that the severity of LUTS was associated with depressive symptoms and subscales of illness perception; meanwhile, IPs were associated with the level of education. A positive relationship was found between the scores of PHQ9 and the B-IPQ subscales of illness consequences, identity, timeline, concern and emotion; thus, a negative correlation was found between scores of PHQ9 and the B-IPQ subscales of illness coherence, personal control and treatment control. The hierarchical regression analysis showed IPSS and the B-IPQ subscales of illness consequences, concern and emotion were significantly associated with depression, and explained 85.1% of the variance in depressive symptoms (R² = 0.851, p < 0.05).

Conclusion

The relationship between LUTS and depressive symptoms may be mediated by the negative IPs, including consequences, concern and emotions. Clinicians should not only focus on the LUTS but also on the IPs to improve depressive symptoms among BPH patients.

Quality of life and unmet needs in patients with chronic liver disease: A mixed-method systematic review

Background & Aims

In an attempt to uncover unmet patient needs, this review aims to synthesise quantitative and qualitative studies on patients’ quality of life and their experience of having liver disease.

Methods

Three databases (CINAHL, Embase, and PubMed) were searched from January 2000 to October 2020. The methodological quality and data extraction of both quantitative and qualitative studies were screened and appraised using Joanna Briggs Institute instruments for mixed-method systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A convergent, integrated approach to synthesis and integration was used. Studies including patients with autoimmune and cholestatic liver disease, chronic hepatitis B and C, non-alcoholic fatty liver disease and non-alcoholic steatohepatitis, cirrhosis, and hepatocellular carcinoma were considered.

Results

The searches produced 5,601 articles, of which 95 (79 quantitative and 16 qualitative) were included in the review. These represented studies from 26 countries and a sample of 37,283 patients. The studies showed that patients´ quality of life was reduced. Unmet needs for information and support and perceived stigmatisation severely affected patients’ quality of life.

Conclusions

Our study suggests changes to improve quality of life. According to patients, this could be achieved by providing better education and information, being aware of patients’ need for support, and raising awareness of liver disease among the general population to reduce misconceptions and stigmatisation.

Registration number

PROSPERO CRD42020173501.

Lay summary

Regardless of aetiology, patients with liver diseases have impaired quality of life. This is associated with disease progression, the presence of symptoms, treatment response, and mental, physical, and social factors such as anxiety, confusion, comorbidities, and fatigue, as well as limitations in daily living, including loneliness, low income, stigmatisation, and treatment costs. Patients highlighted the need for information to understand and manage liver disease, and awareness and support from healthcare professionals to better cope with the disease. In addition, there is a need to raise awareness of liver diseases in the general population to reduce negative preconceptions and stigmatisation.

•

Patients with liver disease regardless of aetiology and severity have impaired quality of life.

•

Patients call for better education and information to understand and manage their liver disease, and for increased awareness and support from healthcare professionals.

•

Owing to the limited knowledge of liver diseases among the general population, patients experience stigmatisation, resulting in loneliness and social isolation.

•

Addressing unmet needs of patients with liver disease could improve their quality of life.

Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of hepatocellular carcinoma

Patients with advanced hepatocellular carcinoma (HCC) have historically had few options and faced extremely poor prognoses if their disease progressed after standard-of-care tyrosine kinase inhibitors (TKIs). Recently, the standard of care for HCC has been transformed as a combination of the immune checkpoint inhibitor (ICI) atezolizumab plus the anti-vascular endothelial growth factor (VEGF) antibody bevacizumab was shown to offer improved overall survival in the first-line setting. Immunotherapy has demonstrated safety and efficacy in later lines of therapy as well, and ongoing trials are investigating novel combinations of ICIs and TKIs, in addition to interventions earlier in the course of disease or in combination with liver-directed therapies. Because HCC usually develops against a background of cirrhosis, immunotherapy for liver tumors is complex and oncologists need to account for both immunological and hepatological considerations when developing a treatment plan for their patients. To provide guidance to the oncology community on important concerns for the immunotherapeutic care of HCC, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). The expert panel drew on the published literature as well as their clinical experience to develop recommendations for healthcare professionals on these important aspects of immunotherapeutic treatment for HCC, including diagnosis and staging, treatment planning, immune-related adverse events (irAEs), and patient quality of life (QOL) considerations. The evidence- and consensus-based recommendations in this CPG are intended to give guidance to cancer care providers treating patients with HCC.

The impact of hepatocellular carcinoma diagnosis on patients' health-related quality of life

Background

Patients with hepatocellular cancer (HCC) are known to have worse health‐related quality of life (HRQL) than the general population. However, the change in HRQL from before the diagnosis to after diagnosis remains unknown and is difficult to estimate. We aimed to compare HCC cases with matched controls to evaluate the differences in change in HRQL from before to after HCC diagnosis.

Methods

We performed propensity score‐matched analysis using the self‐reported HRQL data from the Surveillance, Epidemiology, and End Results registries (SEER) data linked with Medicare Health Outcomes Survey (MHOS) data (1998–2014). Cases were selected as Medicare beneficiaries (aged ≥65 years) who were diagnosed with HCC between their baseline assessment and follow‐up assessment. Matched controls were selected from the same data resource and the same time period to include subjects without cancer diagnosis by propensity scores. HRQL was assessed using the Medical Outcomes Study Short Form‐36 (SF‐36).

Results

The study included 62 subjects who developed HCC and 365 matched controls. Compared to their baseline HRQL scores, after diagnosis of HCC, subjects were more likely to report declines in scores related to the mental component of HRQL. When stratified by time since diagnosis, mental component remained significantly lower as the disease advanced. In contrast, only general health aspects of physical health worsened after HCC diagnosis.

Conclusions

Diagnosis of HCC has a profound negative impact on patients’ HRQL. Mental health component deteriorated significantly over time. The need of including mental health services within a multidisciplinary HCC care model is clearly evident.

Health-related quality of life in primary hepatic cancer: a systematic review assessing the methodological properties of instruments and a meta-analysis comparing treatment strategies

PURPOSE

Patient-reported outcomes including health-related quality of life (HRQoL) are important oncological outcome measures. The validation of HRQoL instruments for patients with hepatocellular and cholangiocellular carcinoma is lacking. Furthermore, studies comparing different treatment options in respect to HRQoL are sparse. The objective of the systematic review and meta-analysis was, therefore, to identify all available HRQoL tools regarding primary liver cancer, to assess the methodological quality of these HRQoL instruments and to compare surgical, interventional and medical treatments with regard to HRQoL.

METHODS

A systematic literature search was conducted in MEDLINE, the Cochrane library, PsycINFO, CINAHL and EMBASE. The methodological quality of all identified HRQoL instruments was performed according to the COnsensus-based Standards for the selection of health status Measurements INstruments (COSMIN) standard. Consequently, the quality of reporting of HRQoL data was assessed. Finally, wherever possible HRQoL data were extracted and quantitative analyses were performed.

RESULTS

A total of 124 studies using 29 different HRQoL instruments were identified. After the methodological assessment, only 10 instruments fulfilled the psychometric criteria and could be included in subsequent analyses. However, quality of reporting of HRQoL data was insufficient, precluding meta-analyses for 9 instruments.

CONCLUSION

Using a standardized methodological assessment, specific HRQoL instruments are recommended for use in patients with hepatocellular and cholangiocellular carcinoma. HRQoL data of patients undergoing treatment of primary liver cancers are sparse and reporting falls short of published standards. Meaningful comparison of established treatment options with regard to HRQoL was impossible indicating the need for future research.

Psychological Burden and Psycho-Oncological Interventions for Patients With Hepatobiliary Cancers-A Systematic Review

Background

Worldwide, hepatobiliary cancers are frequent diseases and often accompanied by a poor prognosis. These cancers, with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CHC) being the most frequent, are often associated with a considerable amount of psychological burden such as anxiety, depressiveness, and reduced health-related quality of life (HRQOL) which may lead to psychiatric comorbidities. This systematic review gives an overview on psychological burden and on the effectiveness of psycho-oncological interventions for patients with HCC and CHC.

Methods

The databases PubMed, PubPsych, and PsycINFO were used and searched using the following combination of terms: (Neoplasm OR Cancer OR Tumor OR Carcinoma) AND (Psycho-Oncology OR Psychotherapy OR Psychiatr^∗) AND (Liver OR Hepatic OR Hepatocellular OR Gallbladder OR Bile^∗). Studies were eligible for inclusion if investigating patients affected with tumors of the liver (HCC/CHC) and using diagnostic instruments to assess mental health symptoms and research concerning specific psycho-oncological interventions. In total, 1027 studies were screened by one author with regard to title and abstracts. Afterward, the two authors of the paper discussed inclusion of possible articles.

Results

Twelve studies focusing on distress, anxiety, and depression symptoms as well as quality of life among patients with HCC/CHC and three studies on psycho-oncological interventions were included. Patients suffering from hepatobiliary cancers often experience considerable psychological burden. A quarter of patients suffer from depressive symptoms; anxiety is even more common among these patients with almost 40%. The HRQOL of those affected is reduced in almost all areas, suicide rates increased and the level of distress is considerably increased in one third of patients even in comparison to those with other kinds of cancer. By psycho-oncological intervention the prevalence of depressive symptoms and anxiety can be reduced, while the quality of life and also the survival rate of patients with hepatobiliary cancer can be increased.

Discussion and Conclusion

Psychological burden is high in patients with hepatobiliary cancers as reflected in high levels of depressiveness and anxiety as well as reduced quality of life. The use of psycho-oncological interventions can reduce psychological burden and increase quality of life compared to patients receiving standard support only.

Systematic Review Registration

(prospero), identifier (CRD42021243192).

A closer look at quality of life in the hepatocellular carcinoma literature

PURPOSE

Adults with hepatocellular carcinoma (HCC) have a high symptom burden. Their quality of life (QOL) has been shown to be significantly impacted by both the disease and its treatment, adding to the high symptom burden that these patients experience. The primary aims of this paper are as follows: (1) to identify how QOL is being defined in HCC literature and (2) to identify how QOL is being measured in the HCC literature using Ferrell's model of QOL.

METHODS

A systematic review was completed of relevant studies published after 2014, using PubMed, CINHAL, and PsycInfo. Relevant studies were reviewed by 2 reviewers using PRISMA guidelines.

RESULTS

From a total of 1312 papers obtained in the initial database search, 30 met inclusion criteria and are included in this review. From the included articles, 10% included a definition of QOL and 3% addressed the spiritual domain of QOL. Majority of study participants were in the early stage of HCC, though the majority of adults with HCC are diagnosed in the advanced stage. Only 3% of included studies included greater than 22% population of advanced stage of HCC.

CONCLUSION

The results of this systematic review demonstrate the need for future research into QOL in the advanced stage of QOL. It also identified gap in the literature concerning the definition of QOL in HCC and the spiritual domain of QOL in HCC.

Systematic Review of Studies Assessing the Health-Related Quality of Life of Hepatocellular Carcinoma Patients from 2009 to 2018

We reviewed all studies assessing the health-related quality of life (HRQoL) in patients with hepatocellular carcinoma (HCC) between 2009 and 2018 (n = 45). Most studies assessed HRQoL as an outcome, and evaluated or compared the HRQoL of HCC patients depending on the type of treatment or stage of disease. HCC patients had a worse HRQoL than the general population, including in those with early-stage HCC. Patients commonly experienced pain, fatigue, sleep disturbance, distress, and lack of appetite, and these symptoms remained problematic even a few years after treatment. TNM classification of malignant tumors stage, tumor stage, presence of cirrhosis, being Asian, being female, living alone, or being unemployed were associated with a poor HRQoL. While recent studies have included a more diverse patient population, various topics, and different study designs, there were limited studies on supportive interventions. Given the increase in HCC cases and HCC survivors, addressing the HRQoL of HCC patients requires more attention.

The relationship between illness representations, alexithymia, coping strategies and subjective well-being among persons with asthma

BACKGROUND

In order to examine subjective well-being (SWB) among persons with asthma, most of the existing studies have focused on disease-related variables or concentrated on illness representations, alexithymia and coping, making it difficult to determine whether the relationship between illness representations, alexithymia, coping and SWB is just an artifact of the disease's severity.

OBJECTIVE

Based on the Self-Regulation Model, this study aimed to examine the interrelationships between the disease's characteristics (annual mean of asthma attacks, preventive treatment), illness representations, alexithymia, coping strategies and SWB among persons with asthma.

METHODS

A convenience sample of 208 persons with asthma completed measures of the disease's characteristics (annual mean of asthma attacks, preventive treatment), illness representations (identity, causes, timeline, consequences, control, coherence, emotional representations), alexithymia, coping strategies, SWB, and socio-demographic questionnaires. A hierarchical multiple regression was calculated with SWB as the dependent variable.

RESULTS

The regression model was found significant (F(14, 133) = 6.42, p < 0.001), explaining 34% of the variance in SWB. Higher levels of alexithymia, identity, cause and emotional representations and lower levels of control were related to lower levels of SWB. The addition of coping strategies did not add to the explained variance of SWB.

CONCLUSION

This study contributes to a better understanding of the determinants of SWB among persons with asthma. The findings indicate that clinical interventions targeting persons with asthma illness representations and alexithymia may assist persons with asthma to improve their SWB.

Illness perceptions are a potential predictor of psychological distress in patients with non-muscle-invasive bladder cancer: a 12-month prospective, longitudinal, observational study

Depressive and anxiety symptoms are common psychiatric disorders among cancer patients. Among the 137 patients with NMIBC (Non-Muscle-Invasive Bladder cancer), 101 patients who provided answers to the Hospital Anxiety and Depression Scale (HADS) and the Brief Illness Perception Questionnaire (B-IPQ) completed the 12-month longitudinal study. Hierarchical regression analyses were conducted to evaluate the interactions between psychiatric problems and illness perceptions (IPs). Patients with NMIBC displayed less positive IPs and more negative IPs. IPs have explained 42.0% and 39.5% of the variance in anxiety at 3 and 12 months of follow-up. IPs have explained 41.4% and 45.5% of the variance in depressive symptoms at 3 and 12 months of follow-up. The results demonstrated IPs are significantly associated with psychological distress and taken as the potential predictor of psychological distress in patients with NIMBC. Interventions focusing on the modification of poor IPs may be feasible and effective in improving psychiatric disorders and quality of life among patients with NIMBC.

Contribution of the self-regulation model to understanding the health related quality of life of rheumatoid arthritis patients

PURPOSE

This study examined a comprehensive model that integrates the interrelationships among health-related-quality-of-life (HRQoL), disease duration, disease severity, illness representations, and coping resources regarding patients with Rheumatoid arthritis (RA), based on the Self-regulation model.

METHOD

A convenience sample of 164 patients with RA completed measures of disease's characteristics (disease duration, disease status), illness representations (timeline, consequences, self-control, treatment control, symptom burden, concern about RA, understanding RA, emotional representations), coping resources (resilience, social support), HRQoL, and socio-demographic questionnaires. The research model was assessed through path analysis.

RESULTS

Perceptions of higher treatment control, lower consequences of RA and lower symptom burden were directly related to HRQoL. The perceptions of higher self-control, higher treatment control, less concern about RA, and lower emotional representations were associated with higher resilience, which in turn was associated with higher HRQoL. The perceptions of higher treatment control, greater understanding of RA, and lower emotional representations were associated with higher perceived social support; however, social support was not associated with HRQoL.

CONCLUSIONS

This study contributes to a better understanding of the determinants of HRQoL among RA patients. The findings indicate that clinical interventions targeting RA patients' illness representations and resilience may assist patients with RA to improve their HRQoL.

Illness perceptions as predictors of psychological distress among head and neck cancer survivors: a longitudinal study

BACKGROUND

Leventhal's commonsense model implies illness perceptions influence illness outcomes. This study examined illness perceptions among head and neck cancer survivors, and whether these predicted subsequent psychological distress.

METHODS

A total of 124 survivors of head and neck cancer (87% nasopharyngeal carcinoma; NPC) completed measures of psychological distress (Hospital Anxiety and Depression Scale; HADS), illness perceptions (Brief Illness Perception Questionnaire; B-IPQ), dispositional optimism (revised Chinese version of the Life Orientation Test; C-LOT-R), and clinical and demographic data approximately12.9 months after diagnosis (T1). Six months later (T2) psychological distress (HADS) was again measured. Adjusted multivariate analyses tested whether illness perceptions predicted T2 HADS scores.

RESULTS

Illness perception dimensions were significantly intercorrelated (0.01-0.68), explaining 8.0% of anxiety and 4.8% of depression symptom variability at T2. After adjustment for T1 distress, illness identity (β = 0.270, P < .01) and sex identification as a woman (β = 0.275, P < .01) predicted T2 anxiety symptoms while illness identity (β = 0.195, P < .05), unemployment (β = 0.195, P < .05), and pessimism (β = -0.227, P < .01) predicted T2 depression symptoms.

CONCLUSION

Perceived illness identity predicted psychological distress, accounting for modest levels of distress variance. Unresolved symptoms may exacerbate distress.

Differences in illness perception between children with cancer and other chronic diseases and their parents

BACKGROUND

The purpose of this study was to explore the differences in illness perception between children with cancer and other chronic diseases. A secondary aim was to examine the similarities and differences between the illness perception of these children and their parents.

METHODS

The Revised Illness Perception Questionnaire (IPQ-R) was used to measure the children's and parents' illness perceptions. In this study, 184 children (ages 8-18 years) and their caregivers completed the questionnaires.

RESULTS

This study shows that children with cancer feel that they have greater control over their treatment compared to the other two groups. The children's parents have more pessimistic views of the illness than their children.

CONCLUSION

Examinations of illness perceptions among paediatric cancer patients and their families are essential in designing psychosocial interventions for these families. The clinical value of our results can help better understand the cancer-specific features of illness perceptions.

Relationships Between Illness Perception and Post-traumatic Growth Among Newly Diagnosed HIV-Positive Men Who have Sex with Men in China

Newly diagnosed HIV-positive men who have sex with men (NHMSM) are at high risk of mental health problems but may also develop post-traumatic growth (PTG). According to the Common Sense Model, illness perception (including both cognitive representation and emotional representation) affects coping and health-related outcomes. A cross-sectional survey was conducted to examine the associations between illness perception and PTG among 225 NHMSM in Chengdu, China. Linear regression analyses indicated that the constructs of emotional representation subscale (β = -0.49) and five cognitive representation subscales (timeline, consequence, identity, attribution to god's punishment/will, and attribution to chance/luck) (β = -0.13 to -0.37) were negative correlates of PTG, while four other constructs of cognitive representation (coherence, treatment control, personal control, and attribution to carelessness) were positive correlates (β = 0.15 to 0.51). No moderating effects were observed. The associations between five cognitive representation subscales and PTG were fully-mediated via emotional representation. The results indicate that interventions promoting PTG among NHMSM are warranted and should alter illness perception, emotional representation in particular. Future studies should clarify relationships between cognitive representation and emotional representation, and extend similar research to other health-related outcomes and HIV-positive populations.

The function of fatigue and illness perceptions as mediators between self-efficacy and health-related quality of life during the first year after surgery in persons treated for colorectal cancer

AIMS AND OBJECTIVES

To measure changes in health-related quality of life, two dimensions of illness perceptions (i.e., consequences and emotional representations), fatigue and self-efficacy in persons treated for colorectal cancer during the first year after surgical treatment, and to study how fatigue, illness perceptions and self-efficacy measured at 3 months affect health-related quality of life at 12 months postsurgery.

BACKGROUND

There are fluctuations in health-related quality of life during the first year after treatment for colorectal cancer, and fatigue may negatively influence health-related quality of life. Illness perceptions (consequences and emotional representations) and self-efficacy have been shown to be associated with health-related quality of life in other cancer diagnoses. Concerning colorectal cancer, there is a lack of knowledge concerning how illness perceptions and self-efficacy change during recovery, and how these variables and fatigue at 3 months relate to health-related quality of life at 12 months.

DESIGN

A prospective longitudinal design.

METHODS

Thirty-nine persons surgically treated for colorectal cancer, of whom 17 had a colostomy, participated. Health-related quality of life, fatigue, illness perceptions and self-efficacy were assessed using QLQ-C30, the Revised Illness Perception Questionnaire and the Maintain Function Scale. Descriptive and analytical statistics were used.

RESULTS

No changes were reported in levels of health-related quality of life, fatigue or illness perceptions. Self-efficacy was lower at 12 months compared to 3 months. Fatigue and one dimension of illness perceptions mediated the effect of self-efficacy at 3 months on health-related quality of life at 12 months.

CONCLUSION

Persons treated for colorectal cancer who have lower self-efficacy 3 months postsurgery are inclined to have more negative illness perceptions concerning emotions and to experience more fatigue.

RELEVANCE TO CLINICAL PRACTICE

Nurses need to support persons with fatigue and negative illness perceptions concerning emotions and to bolster their self-efficacy, that is carry out follow-up consultations focusing on illness management, symptoms, emotions and information on ways to increase self-efficacy.

Applying the Common Sense Model to predicting quality of life in alopecia areata: The role of illness perceptions and coping strategies

Applying the Common Sense Model, this cross-sectional study examines associations between illness perceptions and quality of life and the mediating role of coping in 243 adults with alopecia areata, a chronic dermatological condition. At least some QoL impairment was reported by 84 percent of participants, with 31 percent reporting very to extremely large impairment. Stronger perceptions of consequences, emotional representations, identity, and lower attribution to chance were related to more impairment, with avoidant coping acting as (partial) mediator. Illness perceptions and avoidant coping seem to play an important role in QoL and are relevant intervention targets in alopecia areata.

Value of quality of life analysis in liver cancer: A clinician’s perspective

Health related quality of life (HRQOL) is increasingly recognized as an important clinical parameter and research endpoint in patients with hepatocellular carcinoma (HCC). HRQOL in HCC patients is multifaceted and affected by medical factor which encompasses HCC and its complications, oncological and palliative treatment for HCC, underlying liver disease, as well as the psychological, social or spiritual reaction to the disease. Many patients presented late with advanced disease and limited survival, plagued with multiple symptoms, rendering QOL a very important aspect in their general well being. Various instruments have been developed and validated to measure and report HRQOL in HCC patients, these included general HRQOL instruments, e.g., Short form (SF)-36, SF-12, EuroQoL-5D, World Health Organization Quality of Life Assessment 100 (WHOQOL-100), World Health Organization Quality of Life Assessment abbreviated version; general cancer HRQOL instruments, e.g., the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, Functional Assessment of Cancer Therapy (FACT)-General, Spitzer Quality of Life Index; and liver-cancer specific HRQOL instruments, e.g., EORTC QLQ-HCC18, FACT-Hepatobiliary (FACT-Hep), FACT-Hep Symptom Index, Trial Outcome Index. Important utilization of HRQOL in HCC patients included description of symptomatology and HRQOL of patients, treatment endpoint in clinical trial, prognostication of survival, benchmarking of palliative care service and health care valuation. In this review, difficulties regarding the use of HRQOL data in research and clinical practice, including choosing a suitable instrument, problems of missing data, data interpretation, analysis and presentation are examined. Potential solutions are also discussed.

Predicting general and cancer-related distress in women with newly diagnosed breast cancer

BACKGROUND

Psychological distress can impact medical outcomes such as recovery from surgery and experience of side effects during treatment. Identifying the factors that explain variability in distress would guide future interventions aimed at decreasing distress. Two factors that have been implicated in distress are illness perceptions and coping, and are part of the Self-Regulatory Model of Illness Behaviour (SRM). The model suggests that coping mediates the relationship between illness perceptions and distress. Despite this; very little research has assessed this relationship with cancer-related distress, and none have examined women with screen-detected breast cancer. This study is the first to examine the relative contribution of illness perceptions and coping on general and cancer-related distress in women with screen-detected breast cancer.

METHODS

Women recently diagnosed with breast cancer (N = 94) who had yet to receive treatment completed measures of illness perceptions (Revised Illness Perception Questionnaire), cancer-specific coping (Mental Adjustment to Cancer Scale), general anxiety and depression (Hospital Anxiety and Depression scale), and cancer-related distress.

RESULTS

Hierarchical regression analyses revealed that medical variables, illness perceptions and coping predicted 50% of the variance in depression, 42% in general anxiety, and 40% in cancer-related distress. Believing in more emotional causes to breast cancer (β = .22, p = .021), more illness identity (β = .25, p = .004), greater anxious preoccupation (β = .23, p = .030), and less fighting spirit (β = -.31, p = .001) predicted greater depression. Greater illness coherence predicted less cancer-related distress (β = -.20, p = .043). Greater anxious preoccupation also led to greater general anxiety (β = .44, p < .001) and cancer-related distress (β = .37, p = .001). Mediation analyses revealed that holding greater beliefs in a chronic timeline, more severe consequences, greater illness identity and less illness coherence increases cancer-specific distress (ps < .001) only if women were also more anxiously preoccupied with their diagnosis.

CONCLUSIONS

Screening women for anxious preoccupation may help identify women with screen-detected breast cancer at risk of experiencing high levels of cancer-related distress; whilst illness perceptions and coping could be targeted for use in future interventions to reduce distress.

Illness representations, coping, and illness outcomes in people with cancer: a systematic review and meta-analysis

OBJECTIVE

Cancer is associated with negative health and emotional outcomes in those affected by it, suggesting the need to better understand the psychosocial determinants of illness outcomes and coping. The common sense model is the leading psychological model of self-regulation in the face of illness and assumes that subjective illness representations explain how people attempt to cope with illness. This systematic review and meta-analysis examines the associations of the common sense model's illness representation dimensions with health and coping outcomes in people with cancer.

METHODS

A systematic literature search located 54 studies fulfilling the inclusion criteria, with 38 providing sufficient data for meta-analysis. A narrative review of the remaining studies was also conducted.

RESULTS

Random-effects models revealed small to moderate effect sizes (Fisher Z) for the relations between illness representations and coping behaviors (in particular between control perceptions, problem-focused coping, and cognitive reappraisal) and moderate to large effect sizes between illness representations and illness outcomes (in particular between identity, consequences, emotional representations, and psychological distress). The narrative review of studies with insufficient data provided similar results.

CONCLUSIONS

The results indicate how illness representations relate to illness outcomes in people with cancer. However, more high-quality studies are needed to examine causal effects of illness representations on coping and outcomes. High heterogeneity indicates potential moderators of the relationships between illness representations and health and coping outcomes, including diagnostic, prognostic, and treatment-related variables. This review can inform the design of interventions to improve coping strategies and mental health outcomes in people with cancer.

Impact of disclosure of diagnosis and patient autonomy on quality of life and illness perceptions in Chinese patients with liver cancer

OBJECTIVE

This prospective cohort study explored the impact of disclosure of diagnosis and patient autonomy on the health-related quality of life (HRQOL) and illness perceptions in Chinese patients with hepatocellular carcinoma (HCC).

METHODS

Patients with HCC who were admitted for potentially curative treatments in a teaching hospital were recruited from August 2013 to July 2014. Patients were interviewed at admission regarding their HRQOL and their attitude towards disclosure of diagnosis. They were interviewed again regarding HRQOL and illness perceptions at discharge.

RESULTS

There were 218 patients recruited; 57.8% of them were aware of their cancer diagnosis (disclosed group). For 63.8% of the participants, their desire for disclosure or nondisclosure was satisfied (autonomy-satisfied group). When comparing the patients in the disclosed group with the patients who were uninformed, the patients in the disclosed group had higher scores for global HRQOL at discharge (p = 0.013) and higher scores on understanding of their illness regarding illness perceptions (p = 0.022). When comparing the patients in the 'autonomy-satisfied' group with the patients whose desire for disclosure was not satisfied, the patients in the autonomy-satisfied group had better emotional functioning and better global HRQOL at discharge (p < 0.001 and p = 0.001, respectively). Additionally, the patients in the autonomy-satisfied group had higher scores for personal control (p = 0.009) and lower scores for emotional reaction (p = 0.007) regarding illness perceptions, even after controlling for other confounding factors.

CONCLUSIONS

Our findings suggest that for patients with HCC who have undergone potentially curative treatment, physicians should satisfy patients' desires for autonomy regarding the disclosure of their diagnosis. Copyright © 2015 John Wiley & Sons, Ltd.

The Common Sense Model in early adolescents with asthma: longitudinal relations between illness perceptions, asthma control and emotional problems mediated by coping

OBJECTIVE

The present study examined the longitudinal relations between illness perceptions and asthma control and emotional problems (i.e., anxiety, depression, stress), respectively, in adolescents with asthma. Furthermore, the mediating effects of asthma-specific coping strategies on these relations were examined, as specified in the Common Sense Model (CSM).

METHODS

In 2011, 2012, and 2013, adolescents (aged 10-15) with asthma were visited at home (N=253) and completed questionnaires about their illness perceptions, asthma-specific coping strategies, asthma control, symptoms of anxiety and depression, and perceived stress. Path analyses were used to examine the direct relations of illness perceptions with asthma control and emotional problems and the mediating effects of coping strategies cross-sectionally and longitudinally.

RESULTS

Perceptions of less perceived control and attributing more complaints to asthma were associated with better asthma control. Perceptions of more concern, less coherence, and increased influence of asthma on emotional well-being were associated with more emotional problems. Longitudinally, perceptions of more treatment control and fewer concerns predicted less emotional problems over time. More worrying mediated the cross-sectional relation between perceiving more concern about asthma and less asthma control and the longitudinal relation between perceiving more concern about asthma and more emotional problems.

CONCLUSION

Illness perceptions were associated with asthma control and emotional problems; however, over time, illness perceptions only predicted changes in emotional problems. Most coping strategies did not mediate the relation between illness perceptions and outcomes. Interventions aimed to change illness perceptions in adolescents with asthma could decrease emotional problems.

Quality of life and hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a common and rapidly fatal cancer ranking third among the leading causes of cancer-related deaths. Potentially curative therapies like surgery, transplant and ablation are not an option for most patients as they are often diagnosed when the disease is advanced. Liver directed therapy and oral targeted therapies are used in these patients to prolong life and palliate symptoms of the cancer and associated liver failure. Overall survival remains poor and hence health-related quality of life (HRQoL) is of paramount importance in these patients. As novel therapies are developed to improve outcomes, a comprehensive knowledge of available tools to assess impact on QoL is needed. Hence we reviewed all the studies in HCC patients published within the last 13 years from 2001-2013 which assessed HRQoL as a primary or secondary endpoint. A total of 45 studies and 4 meta-analysis were identified. Commonly used tools were European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) (15 studies) and the Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire (FACT-Hep) (14 studies). Of the 45 publications which incorporated HRQoL as end-point only 24 were clinical trials, 17/24 (71%) assessed systemic therapies while 7/24 (29%) assessed liver-directed therapies. Majority of the publications (trials + retrospective reviews) that had HRQoL as an endpoint in HCC patients were studies evaluating liver-directed therapies (23/45 or >50%). We discuss the measures included in the tools, their interpretation, and summarize existing QoL data that will help design future HCC trials.

Psychopathological profile and health-related quality of life (HRQOL) in patients with hepatocellular carcinoma (HCC) and cirrhosis

In some tumors, psychosocial interventions may enhance health-related quality of life (HRQOL) of patients. The effects of psychological variables on HRQOL in hepatocellular carcinoma (HCC) patients have been rarely assessed. The aim of this work is to evaluate the psychopathological profile of HCC and cirrhotic patients and its effect on HRQOL. Twenty-four HCC patients (median age 71, Child A 21, Child B 3), 22 cirrhotic patients (median age 68, Child A 20, Child B 2) and 20 control subjects were included in this study. Each subject completes four questionnaires: medical outcomes study short form-36 (SF-36, HRQOL evaluation); Hamilton-D (quantitative evaluation of depression; positive ≥8); symptom check list 90-revised (SCL 90-R, general psychopathological profile; nine domains, each positive >1); Toronto alexithymia scale (TAS 20) (positive ≥60). SCL 90-R: cirrhotic patients differ from HCC subjects for somatization (SOM) (M ± SD 1.09 ± 0.6 vs 0.65 ± 0.6; p = 0.01) and anxiety (M ± SD 0.85 ± 0.46 vs 0.58 ± 0.38; p = 0.01) items. TAS 20: positive in 50% of HCC patients, in 54% of cirrhotic patients (p = n.s.) and in none of controls. Hamilton-D: higher scores in cirrhotic patients than in the HCC group (86 vs 46%; p = 0.005). SF-36: each item, except bodily pain, is lower in both group of patients in comparison with controls. Pearson correlation analysis shows negative correlations on HRQOL of depression, SOM and anxiety both in cirrhotic and HCC subjects, also of obsessive-compulsive and hostility items in HCC. This is the first report on the psychopathological profile of HCC patients: the results open questions on the role of psychological interventions that may improve HRQOL of patients before treatment and in the follow-up.

Avoiding and nonexpressing: coping styles of patients with paragangliomas

CONTEXT

Paraganglioma (PGL) patients and succinate dehydrogenase (SDH) gene mutation carriers at risk for PGLs have a decreased quality of life (QoL). QoL may be affected by the strategy an individual uses when dealing with a stressful situation, ie, specific coping styles. Understanding the various approaches to coping may allow the development of targeted interventions to improve patient QoL.

OBJECTIVE

The objective of the study was to assess coping styles in PGL patients and SDH mutation carriers.

DESIGN

This was a cross-sectional study.

SETTING

The study was conducted at a tertiary referral center.

PATIENTS AND METHODS

Coping styles were assessed using the Utrecht Coping List. The results from the study cohort were compared with a control group and data derived from the literature. Potential differences in coping styles between the various SDH mutation carriers and PGL patients without an SDH mutation were explored.

RESULTS

Of the 174 patients who responded, 122 were SDHD, 25 SDHB, and 2 SDHC mutation carriers. An additional 25 patients lacked an SDH mutation. They recruited 100 peers as controls. Compared with the general population, the study cohort was more avoidant of problems (P < .001) and reported less expression of emotion (P < .01). Compared with patients with other conditions, they sought more social support (P < .001). There were no significant differences in coping styles between the various categories of mutation carriers or PGL patients lacking a mutation.

CONCLUSIONS

Coping styles of PGL patients and SDH mutation carriers differ from those of control and reference groups and include an avoidant coping style and a lack of emotional expression.