Depressive symptoms and mental adjustment in women with breast cancer

How do mindfulness-based interventions promote coping and self-efficacy in patients with cancer: A systematic review of qualitative and quantitative data

OBJECTIVE

The purpose of this study was to review the existing quantitative and qualitative evidence regarding how mindfulness-based interventions (MBIs) help cope with cancer-related challenges and increase affected patients' perceived self-efficacy.

METHODS

A systematic literature search was conducted on PubMed, PsycInfo, PubPsych, and CINAHL. Quantitative, qualitative, and mixed methods studies were included if they (1) evaluated MBIs (2) for patients with cancer or cancer survivors (3) regarding their impact on coping with cancer and perceived self-efficacy. The reports were screened by two independent reviewers and conflicts were resolved by a third reviewer. The review was pre-registered on PROSPERO (CRD42022368765).

RESULTS

Findings from 28 reports of 19 quantitative studies, six qualitative studies, and three mixed-methods studies (total N = 1722) were extracted and integrated. The synthesis of quantitative data showed considerable heterogeneity in outcomes and measurement instruments. Most often reported were significant positive impacts of mindfulness on general coping skills, self-regulation, and perceived efficacy in coping with cancer. Qualitative interviews with patients supported those results. The three meta-themes identified were that MBI (1) provided patients with tools to use in stressful situations, (2) promoted a general change of mindset and (3) created a feeling of social connectedness.

CONCLUSIONS

The reviewed studies suggest that MBI can promote coping and enhance the perceived self-efficacy of patients with cancer. In the future, more research investigating the different aspects of coping and the potentially moderating role of self-efficacy could provide further insights with respect to how coping and self-efficacy related to MBI.

Effect of a novel pilot support group on distress and quality of life in breast cancer patients in Nigeria

OBJECTIVE

To assess the effect of a new breast cancer support group (BCSG) on breast cancer patients' self-reported distress and quality of life.

METHODS

A single arm pre-post trial providing an eight session healthcare provider led BCSG. Primary outcome variables were distress and quality of life assessed using the National Comprehensive Cancer Network Distress Thermometer (DT) and The Functional Assessment of Cancer Therapy - Breast plus Arm Morbidity (FACT-B+4), respectively. Topics in each session addressed a wide range of issues some of which were pre-selected by the patients themselves.

DATA ANALYSIS

Paired sample t-test was used for data analysis on International Business Machine Statistical Package for the Social Sciences 21.

RESULTS

The participants (N = 18) had a mean age of 51. Most had secondary school level education (54%), were traders (59%) and had stage 3 or 4 disease (67%). A larger proportion (78% or n = 14) of the patients lived in rural areas, while 4 (22%) of the patients lived in Ibadan. Out of the 8 sessions, 12 (67%) of the participants attended 1-3 sessions while 6 (33%) attended 4-8 sessions. There were, significant improvements in emotional wellbeing (t = -4.253; p < 0.05) and functional wellbeing (t = -2.191; p < 0.05) on the FACT-B+4. There was a significant reduction in the DT score (t = 2.345; p < 0.05) but the number of items on the problem list were not significantly reduced (t = 1.191; p > 0.05). Majority (75%) of the patients rated the support group activities as satisfactory.

CONCLUSION

These data show that the support group can benefit breast cancer patients in terms of reduced distress levels along with satisfaction and improvement in the functional and emotional wellbeing indices of quality of life.

Coping with cancer: the role of different sources of psychosocial support and the personality of patients with cancer in (mal)adaptive coping strategies

OBJECTIVES

Cancer is a serious event in a person's life. However, certain coping strategies in relation to selected social, emotional, and personality factors appear to manage the disease.

METHODS

Sources of social support were tested in cancer survivors (N = 696) using hierarchical linear regression. Selected personality variables in terms of sociodemographic, clinical, and emotional factors were used as predictors of adaptive and maladaptive coping strategies.

RESULTS

It was found that adaptive coping strategies were more frequent in younger patients, in patients who attended cancer support groups and those with a greater level of optimism. Maladaptive coping was related to the higher level of experience of pain and sadness, neuroticism, and pessimism. The absence of a relapse and the time since the disease had been diagnosed were also important factors in coping with cancer.

CONCLUSIONS

The results point to the importance of considering various individual factors in the process of intervention to facilitate adaptive coping and to reduce maladaptive coping.

The effect of the preoperational psychoeducation program for Taiwanese breast cancer patients: A three-month follow-up study

Objective

Studies suggest that psychosocial interventions might be more effective during highly stressful periods, such as before surgery. This study aimed to explore the effectiveness of the Preoperational Health Psychology Education program among Taiwanese breast cancer patients.

Methods

A total of 137 adult women (1) diagnosed with breast cancer; and (2) admitted to the ward for surgery were recruited to join the program one day before surgery. Emotional distress, worries, and cancer self-efficacy were evaluated at admission, post-program, and 3-month post-surgery. Patients were grouped into high/low distress groups, and mixed-design ANOVA was used to examine the program's effectiveness.

Results

The results showed significant interactions of Group × Time in emotional distress (F = 16.15, p = .000) and worry (F = 5.81, p = .005), but not in self-efficacy (F = 2.97, p = .068). The post-hoc tests revealed significant decreases in emotional distress and worry in the high distress group.

Conclusion

The program was found helpful in reducing emotional distress and worries. The effect lasting for three-month for those with higher preoperational emotional distresses.

Innovation

This psycho-education program with a relatively rare one-session design, targeted at a less-studied pre-surgery period, is helpful to a less-studied population, Asian cancer patients.

Time to First Dressing Change after Peripherally Inserted Central Venous Catheter (PICC) Insertion in Breast Cancer Patients

Background. Peripherally inserted central catheter (PICC) is the most commonly used infusion route for chemotherapy in Chinese breast cancer patients because of its convenience, ease of operation, and many maintenance sites. Objective. The objective of this study is to investigate the effect of the first dressing change time on the healing of puncture site and the economic and psychological impact in patients with breast cancer after PICC insertion. Methods. From April 2020 to October 2020, 120 patients with PICC intubation after breast cancer surgery were selected as the research objects and divided into test group and the control group with 60 cases in each group according to the random number table method. The time of the first dressing change in the control group was routinely performed within 24 hours after PICC catheter placement, while the first dressing change in test group was performed at 48 hours after catheter placement. The effect of the first dressing change time after PICC catheterization on patients after breast cancer surgery was compared between the two groups. Results. There were significant differences between the two groups in the degree of pain after the first dressing change, the degree of oozing at the puncture site within 1 week, the duration of oozing, and the frequency of maintenance within 3 weeks, cost, depression, and anxiety ( $P<0.05$ ). Conclusion. The first dressing change 48 hours after PICC cauterization in patients after breast cancer surgery reduces significantly puncture site bleeding, reduces the frequency of dressing change, and benefits the physical and mental health of patients.

The Relationship Between Spirituality and Hopelessness Among Cancer Patients in Turkey

The aim of this study was to determine the relationship between spirituality and hopelessness in cancer patients. The study used a cross-sectional and correlational design and included 650 cancer patients. The data were collected using a patient information form, the Spiritual Orientation Scale, and the Beck Hopelessness Scale. The data were analyzed by MANOVA and linear regression analysis. Cancer patients had high levels of spirituality (89.74 ± 32.79) and low levels of hopelessness (6.50 ± 5.61). A statistically significant relationship was found between the mean Spiritual Orientation Scale scores of the patients and their sociodemographic characteristics (sex, age, marital status, educational status, employment status, income) (p < 0.05). A statistically significant relationship was found between the mean Beck Hopelessness Scale scores of the patients and their sociodemographic characteristics (age, marital status, income status) (p < 0.05). According to the linear regression analysis, a significant negative correlation was found between the spirituality and hopelessness levels of the patients (p < 0.01, R² = 0.503, b =  - 0.641). As the patients' spirituality increased, their levels of hopelessness decreased.

The relationship between spiritual well-being, hope and depression in gynecologic oncology patients

The authors' aim in this study was to determine the relationship between spiritual well-being, hope and depression in gynecologic oncology patients. This is a descriptive and correlational study. The patients received a total of 41.59 ± 12.11 points from the Spiritual Well-Being Scale, 5.57 ± 4.19 points from the Beck Hopelessness Scale, and 14.92 ± 11.61 points from the Beck Depression Scale. Gynecologic oncology patients had high spiritual well-being levels and low hopelessness and depression levels, and their hopelessness and depression levels decreased and hope levels increased as their spiritual well-being levels increased.

Factors associated with and risk factors for depression in cancer patients - A systematic literature review

Objective

The prevalence of depression in oncological patients is 3, 4-fold compared to the general population. However, the specific risk factors for these prevalence rates are not fully understood.

Methods

A systematic literature review was conducted in nine electronic databases between 2005 and 2020. The quality of the eligible studies was appraised by two persons using the adapted 11-items Downs and Black checklist.

Results

Among 2010 potentially relevant articles, 40 studies were eligible, with 27 studies of high quality and 13 studies of moderate quality. A total of 156 factors associated with depression were identified which were clustered into somatic, psychological, social and sociodemographic factors. Pre-existing depression and personality factors were the most consistent associated factors with depression in cancer patients, while for most somatic and treatment-related factors only modest associations were found.

Conclusions

Grouped as bio-psycho-social associated factors, somatic factors showed a modest influence, whereas social relationship (support) and previous depression are unequivocally significantly associated with depression.

Normalization of the Mini-MAC (Mental Adjustment to Cancer) Questionnaire among Cancer Patients

Cancer is associated with discomfort and many changes in patients’ lives to which they must adapt. The main objective of the study was to assess the use of the mini-MAC questionnaire scale among persons diagnosed with malignant cancer and to develop standards allowing differentiation of patients with diagnosed cancer in terms of their style of adjustment to the disease. The mini-MAC questionnaire is a widely used tool in assessing coping strategies among cancer patients. Sten standards have been developed to determine the level of results on the questionnaire scales in the low–average–high categories. The study included 1187 patients diagnosed with malignant cancer who are covered by outpatient care at the Maria Sklodowska-Curie Institute—Oncology Center in Warsaw. The questionnaire concerning mental adjustment to cancer was used (mini-MAC). Patients with cancer most often adopt strategies of fighting spirit and positive reevaluation. The variables that differentiate the results most significantly include gender, presence of metastasis, and the state of undergoing chemotherapy. The mini-MAC questionnaire should be a tool for psycho-oncological diagnosis of patients’ attitudes towards cancer. The obtained results indicate that cancer patients are characterized by their constructive style of adjustment to the disease.

Self-Esteem as a Predictor of Mental Adjustment in Patients with Breast Cancer

This study aimed to explore the relationship between self-esteem and mental adjustment and examine the directional effects in patients with breast cancer using path modeling. This was a cross-sectional, descriptive, and correlational study. A total of 128 patients with breast cancer were selected through convenience sampling at a medical center in northern Taiwan. They completed a basic characteristics questionnaire, the Memorial Symptom Assessment Scale short form, the Rosenberg Self-Esteem Scale, and the mini-Mental Adjustment to Cancer Scale. Descriptive statistics, regression analysis, and path analysis were used to analyze the data. The results showed that higher self-esteem was associated with better mental adjustment (β = 0.9, 95% confidence interval 0.6~1.3, p < 0.001). Age, religious beliefs, employment, cancer stage, and symptom distress were correlated with mental adjustment. Path modeling demonstrated that self-esteem, cancer stage, performance status, and symptom distress directly affected mental adjustment in patients with breast cancer. These findings suggest that health professionals should evaluate self-esteem, performance status, and symptom distress in patients with breast cancer immediately upon admission. This can facilitate early implementation of relevant nursing interventions and, consequently, improve self-esteem and symptom distress and increase mental adjustment in these patients.

Relation entre ajustement marital et santé mentale dans des couples faisant face au cancer du sein

Le lien entre l’ajustement marital perçu et la santé mentale de 48 couples dont l’épouse est atteinte d’un cancer du sein fait l’objet de cette étude. Les conjoints qui évaluent plus positivement la qualité de l’ajustement marital au moment du diagnostic montrent un risque moins élevé d’anxiété et de dépression un mois après la fin du traitement. Cela confirme l’importance de l’approche dyadique et de la prise en compte des conjoints dans la prise en charge du cancer.

Health-Related Quality of Life: Longitudinal Analysis From the Time of Breast Biopsy Into the Post-treatment Period

Background: The physical, psychological, social, and spiritual quality of life (QoL) may be affected by breast cancer diagnosis and treatment, with mixed findings for psychological quality of life and cognitive ability performance. The present study aimed to evaluate QoL in women over 1 year from biopsy for a breast abnormality. Methods: Self-reported measures of physical, psychological, social, and spiritual QoL were obtained after biopsy results but prior to treatment initiation (baseline), 4 and 12 months later. CogState computerized neuropsychological screening battery also provided an evaluation of psychological QoL. Three groups of women including those with benign biopsy results, those with malignancy treated with chemotherapy, and those with malignancy not treated with chemotherapy were compared at 4 and 12 months after adjusting for baseline to isolate the effects of treatment. Additional covariates included are age, level of education, and income. Results: Benign biopsy results group included 72 women, whereas malignancy was found in 87 women of whom 33 were treated with chemotherapy and 54 without chemotherapy. At the time of diagnosis, women with cancer had worse psychological and social QoL but better spiritual QoL than those with benign biopsy results. Only CogState monitoring accuracy was worse for women with cancer compared with the controls at the time of biopsy results. After adjusting for QoL at baseline, women treated for cancer had worse physical and social QoL at 4 and 12 months later. Psychological well-being was worse for women with cancer at 4th month but improved at 1 year. No differences in cognition were found at 4 and 12 months when adjusted for baseline cognition and covariates. Discussion: Breast cancer is a traumatic life event for women, affecting psychological and social QoL domains, yet increasing spiritual QoL. Later, cancer treatment worsens physical, psychological, and social QoL compared with those without cancer. Conclusions: These findings suggest that interventions to improve psychological QoL may be especially important at the time of cancer diagnosis, while interventions to improve physical well-being are the most needed during and following cancer treatment. Support to improve social QoL is needed from the time of diagnosis into post-treatment survivorship.

Optimism and social support as contributing factors to spirituality in Cancer patients

BACKGROUND/OBJECTIVE

The impact a cancer diagnosis and its treatment are affected by psychosocial factors and how these factors interrelate among themselves. The objective of this study was to analyze the relationship between optimism and social support in spiritual wellbeing in cancer patients initiating chemotherapy.

METHODS

A cross-sectional, multi-center (15 sites), prospective study was conducted with 912 cancer patients who had undergone curative surgery for a stage I-III cancer and were to receive adjuvant chemotherapy. They completed the Functional Assessment of Chronic Illness-Spiritual Well-being Scale (FACIT-Sp), Life Orientation Test-Revised (LOT-R), and the Multidimensional Scale of Perceived Social Support (MSPSS).

RESULTS

Significant differences on spirituality scales (meaning/peace and faith) were detected depending on age (≤ 65 vs > 65), sex, marital status, employment, and cancer treatment. Married or partnered participants had significantly higher meaning/peace scores compared to their non-partnered counterparts (p = 0.001). Women, > 65 years, unemployed, and patients treated with chemotherapy and radiotherapy had significantly higher faith scores versus men, ≤ 65 years, employed, and subjects only receiving adjuvant chemotherapy (all p < 0.030). Multivariate analyses indicated that meaning/peace and faith correlated positively with optimism and social support.

CONCLUSION

During oncological treatment, the positive effects of optimism and social support exhibit a positive correlation with spiritual coping. A brief assessment evaluation of these factors can aid in identifying at risk for a worse adaptation to the disease.

Coping Processes of Patients with Ostomies in South Korea: A Focus Group Study

Despite the adverse effects of negative coping after receiving a stoma, there is a lack of information on how patients cope with ostomies and on their families' experiences throughout the coping process. We aimed to explore the coping experiences of individuals with ostomies throughout their illness, applying the Corbin and Strauss Chronic Illness Trajectory Framework, using exploratory qualitative methods involving focus group interviews. Purposive sampling was utilized to recruit 19 participants (split across three groups) through an ostomy association in South Korea. Two focus group interviews were separately conducted from March through to May 2017 until data saturation was achieved. Using qualitative content analysis, we analyzed the transcribed interviews and identified words and themes to interpret the results. The coping experiences of patients with ostomies were expressed through three interrelated themes: struggling and suffering, learning how to live with ostomy, and living with ostomy. We found gender differences in spousal support and a struggle among older patients regarding social coping. The themes identified suggest that gender should be considered when designing interventions to help patients cope with ostomies.

Integrative Literature Review on Psychological Distress and Coping Strategies Among Survivors of Adolescent Cancer

PROBLEM IDENTIFICATION

Cancer survivors, particularly those diagnosed in adolescence, are faced with physical, mental, and emotional stressors associated with the disease and its treatment. These stressors add to the demand placed on survivors' already taxed coping skills. This article reviews the literature on psychological distress experienced by survivors diagnosed with cancer during adolescence and the coping strategies they employed.

LITERATURE SEARCH

Three electronic databases (CINAHL®, PsycINFO®, PubMed®) were searched, and 19 studies were selected. Garrard's matrix method guided this integrative review.

DATA EVALUATION

Gough's weight of evidence framework was used to evaluate each study.

SYNTHESIS

Analysis revealed important findings about the types of coping strategies used by adolescents during and after cancer treatment and the impact of each on levels of psychological distress.

IMPLICATIONS FOR PRACTICE

Healthcare providers, who regularly assess for negative thoughts and unmet needs among survivors, may identify symptoms of psychological distress, intervene early, and facilitate better outcomes for their patients. Patient-centered interventions aimed at coping with psychological distress are most helpful.

Impact of illness perception, mental adjustment, and sociodemographic characteristics on return to work in patients with head and neck cancer

PURPOSE

To examine the effects of emotional distress, illness perception, and mental adjustment on return to work (RTW) among patients with head and neck cancer (HNC) and identify factors associated with RTW.

METHODS

A cross-sectional study with convenience sampling was conducted in Taiwan. Structured questionnaires were used to collect data on RTW status and to explore possible factors related to RTW. RTW status was assessed by a single question. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, illness perception was assessed by the Brief Illness Perception Questionnaire, and mental adjustment was assessed using the Mini-mental Adjustment to Cancer Scale. Sociodemographic and disease background data were also collected and analyzed. Factors related to RTW were identified by multivariate logistic regression.

RESULTS

A total of 150 patients with HNC were recruited into the study. Of them, 58 (38.7%) returned to work after treatment. Compared to those who did not RTW, patients who did RTW had lower levels of emotional distress (anxiety and depression), better illness perception (cognitive illness representations and illness comprehensibility), and better mental adjustment (hopelessness and helplessness, anxious preoccupation, avoidance, and fatalism). Multivariable analysis indicated that anxiety (OR = 0.863, p < 0.05), avoidance (OR = 1.280, p < 0.001), cognitive illness representations (OR = 0.891, p < 0.01), illness comprehensibility (OR = 1.271, p < 0.05), higher education level (OR = 3.048-3.609, p < 0.05), married status (OR = 5.220, p < 0.05), tumor site in oral cavity (OR = 5.057, p < 0.05), and no reconstruction (OR = 3.415, p < 0.05) were significantly associated with RTW.

CONCLUSION

The issue of RTW among patients with HNC is related to multidimensional factors, including sociodemographic, psychological, and disease-related situations. We suggest that programs for emotional rehabilitation and occupational counseling need to be developed to assist patients with HNC to RTW at an early stage.

Health literacy, mental disorders and fear of progression and their association with a need for psycho-oncological care over the course of a breast cancer treatment

This studyinvestigates the need for psycho-oncological care over the course of a breast cancer treatment and possible associated factors to develop such a need. The PIAT-Study was a longitudinal postal survey study conducted in Germany (2013 to 2014) with breast cancer patients (BCPs). Patients received a questionnaire at three-time points (T1: few days after surgery, T2: after 10 weeks; T3: after 40 weeks). This study considers information about patients' needs for psycho-oncological care, their breast cancer disease, social support, anxiety, health literacy (HL) and sociodemographic information. Data were analysed with descriptive statistics and logistic regression modelling to estimate the association between a need for psycho-oncological treatment and patient characteristics. N = 927 breast cancer patients reported their psycho-oncological need. 35.2% of patients report at least at one measuring point to be in need for psycho-oncological care. In a multiple logistic regression, noticeable determinants for developing such a need are an inadequateHL(OR = 1.97), fear of progression (FoP) (OR = 2.08) and psychological comorbidities (OR = 8.15) as well as certain age groups. BCPs with a low HL, suffering from a dysfunctional level of FoP or mental disorders are more likely to develop a need for psycho-oncological care.

Association of depression and anxiety disorder with the risk of mortality in breast cancer: A National Health Insurance Service study in Korea

PURPOSE

To examine whether depression, anxiety disorder, and their co-occurrence would increase the risk of mortality in patients with breast cancer, and whether antidepressant treatment would reduce the same.

METHODS

Data were retrieved from the database of the Korean National Health Insurance Service. Of 145,251 patients diagnosed with breast cancer between 2007 and 2014, 20,870 patients diagnosed with depression or anxiety disorder one year before breast cancer diagnosis were excluded. Thus, data of 124,381 patients were included in this study.

RESULTS

Depression and anxiety disorder were associated with an increased risk of mortality [Hazard Ratio (HR) 1.26, 95% CI 1.18-1.36; HR 1.14, 95% CI 1.08-1.22, respectively] and their co-occurrence further increased the risk (HR = 1.38, 95% CI 1.24-1.54). Antidepressant treatment was related to a reduced risk of mortality. Compared to patients without any psychiatric comorbidity with no antidepressant treatment, the mortality risk increased in patients with either psychiatric comorbidity or both, but the risk seemed to attenuate with antidepressant treatments.

CONCLUSION

The current findings suggest that psychiatric comorbidities are markers of increased mortality risk in patients with breast cancer, and antidepressant treatment may attenuate the risk. This underscores the need for screening and treating depression and anxiety disorders to improve survival in patients with breast cancer.

Correlation of Clinicopathological Characteristics of Breast Carcinoma and Depression

The prevalence of depression among women with breast cancer (BC) is extremely variable in research studies. The aim of this study was to determine the prevalence of depressive disorder in women suffering from BC as well as to examine its relationship with clinical–pathological and immunophenotypic characteristics of BC. The study included 194 patients with BC who were diagnosed with the disease between 2009 and 2015 in the Clinical Center Kragujevac, Serbia. Pathohistological and immunohistochemical analyses was used on the material obtained after the surgical removal of breast tumors, determining all significant clinical and morphological parameters. The level of depression among the examinees confirmed that the differences in the level of depression between the histological grades were statistically significant. According to the univariate binary logistic regression, the depression of a patient correlates with the category of molecular tumor subtype/Luminal A (p < 0.0005), PR expression (p = 0.050) and lymphatic invasion (p = 0.025). Multivariate binary logistic regression showed that the onset of depression associated with the present molecular subtype of the tumor of a worse prognostic character (p = 0.019). Depression is a common disorder in women with breast cancer. The level of depression is correlates with some of the clinicоmorphological and immunophenotypic characteristics of BC.

Depression and health-related quality of life among Cambodian patients with cancer

BACKGROUND

Symptom assessment and quality of life (QoL) are considered two of the most important factors in the overall care of cancer patients. Although cancer is one of the leading causes of death after communicable disease in Cambodia, the QoL of Cambodian cancer patients has not been examined previously. This study aimed to describe the QoL of cancer patients in Cambodia.

METHODS

A cross-sectional study was conducted with cancer patients who visited Khmer-Soviet Friendship Hospital in Phnom Penh. Two hundred patients participated in this study. The inventory comprised two previously validated scales: the Center for Epidemiological Studies Depression Scale-10 (CESD-10) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30. Descriptive analyses, independent samples t-tests, and Pearson's correlation analysis were performed to examine the differences and relationship between study variables.

RESULTS

The mean global health score was 51.62, and 58.5% of the participants had depressive symptom. The global health score was statistically significantly lower in depressive patients. The QoL was negatively correlated with depression, but positively and significant correlated with physical function, role function, emotional function, cognitive function, and social function.

CONCLUSION

This study is the first to describe the QoL of Cambodian cancer patients. Our findings suggest that more attention should be paid to psychological concerns and symptom management in Cambodian cancer patients. Appropriate management could be effective in improving the QoL of cancer patients.

CaringGuidance™ after breast cancer diagnosis eHealth psychoeducational intervention to reduce early post-diagnosis distress

Purpose

Significant cancer-related distress affects 30–60% of women diagnosed with breast cancer. Fewer than 30% of distressed patients receive psychosocial care. Unaddressed distress is associated with poor treatment adherence, reduced quality of life, and increased healthcare costs. This study aimed to evaluate the preliminary efficacy of a new web-based, psychoeducational distress self-management program, CaringGuidance™ After Breast Cancer Diagnosis, on newly diagnosed women’s reported distress.

Methods

One-hundred women, in five states, diagnosed with breast cancer within the prior 3 months, were randomized to 12 weeks of independent use of CaringGuidance™ plus usual care or usual care alone. The primary multidimensional outcome, distress, was measured with the Distress Thermometer (DT), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Impact of Events Scale (IES) at baseline and months 1, 2, and 3. Intervention usage was continually monitored by the data analytic system imbedded within CaringGuidance™.

Results

Although multilevel models showed no significant overall effects, post hoc analysis showed significant group differences in slopes occurring between study months 2 and 3 on distress (F(1,70) = 4.91, p = .03, η² = .065) measured by the DT, and depressive symptoms (F(1, 76) = 4.25, p = .043, η² = .053) favoring the intervention.

Conclusions

Results provide preliminary support for the potential efficacy of CaringGuidance™ plus usual care over usual care alone on distress in women newly diagnosed with breast cancer. This analysis supports and informs future study of this self-management program aimed at filling gaps in clinical distress management.

Understanding the roles of patient symptoms and subjective appraisals in well-being among breast cancer patients

PURPOSE

To examine the roles of both patient symptoms, and subjective appraisals of stress (self-efficacy, symptom barriers, symptom distress), in understanding well-being (anxiety, depression, cancer-specific quality of life, mental health quality of life, and physical health quality of life) in breast cancer patients.

METHODS

We examined data from 104 female breast cancer patients. Using a stress process model, we hypothesized that while high levels of patient symptoms would be associated with poorer patient well-being, these effects would be mediated by subjective appraisals, including patient self-efficacy, perceived symptom barriers, and symptom distress.

RESULTS

As expected, higher levels of patient symptoms were associated with poorer well-being on all five indicators. Subjective appraisals of stress added significantly to predictors of well-being, and were mediators of this relationship across all five outcomes.

CONCLUSIONS

While patient symptoms are important predictors of patient well-being, subjective appraisals of the stressfulness of symptoms, and of patients' self-efficacy in managing symptoms, are also key factors. The findings suggest the utility of a stress process model in understanding well-being in breast cancer patients, and point to the potential value of targeting patient appraisals as well as symptoms to improve psychological well-being and quality of life.

Efficacy of a hypnosis-based intervention to improve well-being during cancer: a comparison between prostate and breast cancer patients

BACKGROUND

Prostate and breast cancer can have a lot of negative consequences such as fatigue, sleep difficulties and emotional distress, which decrease quality of life. Group interventions showed benefits to emotional distress and fatigue, but most of these studies focus on breast cancer patients. However, it is important to test if an effective intervention for breast cancer patients could also have benefits for prostate cancer patients.

METHODS

Our controlled study aimed to compare the efficacy of a self-hypnosis/self-care group intervention to improve emotional distress, sleep difficulties, fatigue and quality of life of breast and prostate cancer patients. 25 men with prostate cancer and 68 women with breast cancer participated and were evaluated before (T0) and after (T1) the intervention.

RESULTS

After the intervention, the breast cancer group showed positive effects for anxiety, depression, fatigue, sleep difficulties, and global health status, whereas there was no effect in the prostate cancer group. We showed that women suffered from higher difficulties prior to the intervention and that their oncological treatments were different in comparison to men.

CONCLUSION

The differences in the efficacy of the intervention could be explained by the baseline differences. As men in our sample reported few distress, fatigue or sleep problems, it is likely that they did not improve on these dimensions.

TRIAL REGISTRATION

ClinicalTrials.gov ( NCT02569294 and NCT03423927 ). Retrospectively registered in October 2015 and February 2018 respectively.

Age Differences in the Coping Strategies of Patients With Colorectal Cancer

BACKGROUND

Colon and/or rectum cancer (CRC) patients use various strategies to cope with their condition, and these can vary between age groups.

OBJECTIVES

The aims of this study were to investigate differences between psychosocial/spiritual variables and coping strategies in CRC patients of different age groups (younger vs older) and to identify the predictors of coping for both age groups.

METHODS

A cross-sectional descriptive study was conducted at 3 outpatient clinics in Korea. The Hospital Anxiety and Depression Scale, Social Support Scale, and Self-Transcendence Scale were used to measure psychosocial and spiritual variables; the Mini-Mental Adjustment to Cancer Scale was used to assess cancer-specific coping strategies.

RESULTS

Both younger and older patients who were psychologically distressed used more maladaptive coping. Individuals who received less social support from healthcare providers used more maladaptive coping strategies. For younger patients, self-transcendence was the only significant predictor of both adaptive and maladaptive coping strategies; for older patients, Hospital Anxiety and Depression Scale score was the only significant predictor of maladaptive coping.

CONCLUSION

Differences in psychological distress, social support, and self-transcendence due to age are important protective or risk factors for the use of coping strategies among CRC patients.

IMPLICATIONS FOR PRACTICE

Considering our findings, we encourage healthcare professionals to be aware of patients' coping strategies and take them into account when planning age-specific interventions related to coping, before hospital discharge.

Prevalence, correlates, and impact of depressive and anxiety disorder in cancer: Findings from a multicenter study

Objective:

Our aim was to examine the prevalence, correlates, and association of depressive and anxiety disorders with quality of life (QoL) and such other outcomes as the need for psychosocial services in cancer patients.

Method:

A total of 400 patients participated in a multicenter survey involving five cancer centers located throughout Korea. The Short-Form Health Survey, the MD Anderson Symptom Inventory, the Mini-Mental Adjustment to Cancer (MINI-MAC), and Mini-International Neuropsychiatric Interview were administered.

Results:

The prevalence rates for depressive and anxiety disorders were 16 and 17.1%, respectively. Younger age and poor Eastern Cooperative Oncology Group performance status, and all physical symptoms, as well as helplessness/hopelessness, anxious preoccupation (AP), and cognitive avoidance (CA) on the MINI-MAC were found to be significantly related to depressive disorder (DD) in a univariate logistic regression analysis. Metastases, the symptoms of disturbed sleep, dry mouth, and numbness or tingling, as well as AP and CA were significantly correlated with anxiety disorder (AD) in the univariate analysis. In the multivariate analyses, only AP was significant for AD (odds ratio = 2.94,p< 0.001), while none reached statistical significance for DD. Psychiatric comorbidity status had a detrimental effect on various dimensions of QoL. Patients with DD or AD reported a significantly higher need for professional psychosocial services.

Significance of results:

Given the substantial prevalence and pervasive impact of DD and AD on various aspects of QoL, its assessment and care should be integrated as a regular part of oncological care throughout the cancer continuum.

Group interventions to reduce emotional distress and fatigue in breast cancer patients: a 9-month follow-up pragmatic trial

Background:

Long-term effects of psychosocial interventions to reduce emotional distress, sleep difficulties, and fatigue of breast cancer patients are rarely examined. We aim to assess the effectiveness of three group interventions, based on cognitive behavioural therapy (CBT), yoga, and self-hypnosis, in comparison to a control group at a 9-month follow-up.

Methods:

A total of 123 patients chose to participate in one of the interventions. A control group was set up for those who agreed not to participate. Emotional distress, fatigue, and sleep quality were assessed before (T0) and after interventions (T1), and at 3-month (T2) and 9-month follow-ups (T3).

Results:

Nine months after interventions, there was a decrease of anxiety (P=0.000), depression (P=0.000), and fatigue (P=0.002) in the hypnosis group, and a decrease of anxiety (P=0.024) in the yoga group. There were no significant improvements for all the investigated variables in the CBT and control groups.

Conclusions:

Our results showed that mind–body interventions seem to be an interesting psychological approach to improve the well-being of breast cancer patients. Further research is needed to improve the understanding of the mechanisms of action of such interventions and their long-term effects on quality of life.

Tailoring exercise interventions to comorbidities and treatment-induced adverse effects in patients with early stage breast cancer undergoing chemotherapy: a framework to support clinical decisions

PURPOSE

Delivery of exercise interventions to patients with early-stage breast cancer undergoing chemotherapy requires complex clinical decisions. The purpose of this study was to develop a framework to support clinical decisions for tailoring exercise interventions to common comorbidities and cancer treatment-induced adverse effects.

METHOD

Tailored exercise prescriptions were developed in four steps, following the i3-S strategy. All steps were based on current best available evidence, complemented with expert opinions. First, common comorbidities and treatment-induced adverse effects were identified. In the subsequent steps, contra-indications and restrictions for exercise were described, along with possible exercise adaptations. In the final step, the obtained information was synthesized into a framework.

RESULTS

Prevalent comorbidities were hypertension, heart disease, diabetes mellitus, (osteo)arthritis, chronic obstructive pulmonary disease, and obesity. Adverse effects included conditions induced by pretreatment (e.g., lymphedema as a result of surgery) or by chemotherapy (e.g., reduced blood cell counts). Adaptations to the recommended exercise program were related to exercise tolerance, safety, and hygiene. A framework was proposed to guide clinical decisions during the exercise intervention.

CONCLUSION

Comorbidities and adverse effects of breast cancer treatment require exercise adaptations. The proposed framework provides guidance on tailored exercise prescriptions in patients with breast cancer undergoing chemotherapy. Implications for Rehabilitation Exercise is recommended for patients with breast cancer undergoing chemotherapy, but requires complex clinical decisions of the health professional. We identified the most important comorbidities and adverse effects of breast cancer treatment, and the resultant contra-indications and restrictions to exercise. We incorporated these findings into a clinical decision framework that provides suggestions for exercise adaptations in patients with breast cancer undergoing chemotherapy.

Effect of the childhood trauma on the adjustment to cancer in the patients with breast cancer

BACKGROUND

Early identification of patients coping poorly is important for compliance with treatment and control of distress. This study aims to investigate the effect of the childhood trauma experience on the type of reaction and adjustment that the person exhibits to the cancer among the patients with breast cancer.

METHODS

This cross-sectional study enrolled 310 patients with breast cancer. The effect of the childhood trauma and the psychological condition on the adjustment to cancer was investigated by assessing the adjustment to cancer, the experiences of childhood trauma and psychological status of the subjects using mental adjustment to cancer scale (MAC), childhood trauma questionnaire (CTQ28), Beck Depression Inventory (BDI) and Beck anxiety inventory (BAI).

RESULTS

Majority of the subjects (77.4%) showed positive adjustment to cancer. Fighting spirit (63.9%) was the most commonly seen mechanism of adjustment to cancer. Of the subjects, 54.5% suffered at least one of the childhood trauma types. Among the patients, 47.1% had depression and 58.4% had anxiety. In the multivariate logistic regression analysis, emotional neglect and depression, respectively, have an effect on both positive and negative adjustment to cancer.

CONCLUSIONS

Our study demonstrated that childhood trauma, especially emotional neglect, affects coping and adjustment among the patients with breast cancer. It is necessary to determine the childhood experiences to ensure the development of psychosocial interventions that will increase the adjustment and quality of life after the diagnosis of the cancer.

To carry on as before: A meta-synthesis of qualitative studies in lung cancer

As a complement to quantitative studies, qualitative studies give us a better understanding of how persons affected by lung cancer live their everyday lives and how they deal with the obvious strain of having lung cancer. Because qualitative studies are based on only a few participants in specific contexts, the purpose of the present study is to synthesize knowledge from these qualitative studies to get a more general picture of the everyday lives of patients with lung cancer. A search on PubMed, CINAHL, Medline and PsychInfo yielded 383 hits. After exclusion we found 16 studies that focused on how these patients lived, reflected, and dealt with their new life situation. These studies comprised 393 interviews with 283 patients with primary lung cancer, and the findings from these studies were synthesized into a core process with subcategories. The overarching process was that the patients were eager "to carry on as before". They wanted to resume their former everyday life, and their views on their relationships with their bodies and side effects of treatments, their families, the health care staff, and with dying and death were very much related to how these could assist the core process. The synthesis presented here suggests that health care in consultations with patients with lung cancer should defer to the importance of the patient's core idea that life carries on despite the fact that it will probably soon come to an end.

The Mediating Role of Mental Adjustment in the Relationship between Perceived Stress and Depressive Symptoms in Hematological Cancer Patients: A Cross-Sectional Study

Background

Depression is a particularly common psychological disorder that affects cancer patients. Diagnosed with hematological malignancies constitute a serious unpredictable and uncontrollable medical stress situation and patients are susceptible to suffer from depressive symptoms. The aims of the study were to explore the correlation between perceived stress and depressive symptoms in patients with hematological malignancies, and assess the mediating role of mental adjustment between these variables.

Methods

A single center, cross-sectional study was performed by convenience sampling between July 2013 and April 2014 in a hospital of China. The Center for Epidemiologic Studies Depression Scale, Perceived Stress Scale, and Mini-Mental Adjustment Scale, as well as questions about demographic and clinical factors was distributed to 300 hematological cancer patients. Completed questionnaires were received from 227 inpatients.

Results

The results showed that perceived stress was positively correlated with depressive symptoms. The mental adjustment significantly mediated the relationship between perceived stress and depressive symptoms.

Conclusions

Among hematological cancer patients perceived stress may be a risk factor for depressive symptoms, whereas positive coping style might be protective against depressive symptoms. Results showed that medical managers could support the development of mental adjustment in the patients to alleviate psychological disorders.