Association between dietary supplement use and mortality in cancer survivors with different body mass index and frailty status: a cohort study

Background

The association between Body Mass Index (BMI), frailty index (FI), and dietary supplement in cancer survivors has been a subject of growing interest. This study investigates the relationship of BMI and FI with mortality in American cancer survivors and explores the impact of dietary supplement usage on different BMI and FI groups.

Methods

Three thousand nine hundred and thirty-two cancer patients from the National Health and Nutrition Examination Survey (NHANES) database were included in the analyses. BMI, FI, and supplement usage were obtained through the NHANES structured survey and the 49-item FI tool. Weighted logistic and Cox proportional hazards models, Kaplan-Meier survival analyses, and propensity score matching (PSM) were used to elucidate the relationships between BMI, FI, dietary supplement, and mortality outcomes.

Results

The study found significant associations between higher BMI and increased frailty (Odds ratio [OR] = 1.04, 95% confidence interval [95% CI], 1.02-1.06). BMI < 25 kg/m2 and FI > 0.2 are associated with an increased mortality rate. Dietary supplement use can reduce all-cause and cancer mortality in cancer patients with BMI < 25 kg/m2 (Hazard ratio [HR] = 0.63, 95% CI, 0.47-0.84; HR = 0.48, 95% CI, 0.29-0.80) or FI ≤ 0.2 (HR = 0.77, 95% CI, 0.60-0.99; HR = 0.59, 95% CI, 0.39-0.89). In cancer patients with BMI < 25 kg/m2 and FI ≤ 0.2, dietary supplement users had lower all-cause and cancer mortality (HR = 0.49, 95% CI, 0.30-0.79; HR = 0.25, 95% CI, 0.10-0.60).

Conclusion

The study revealed a negative correlation between BMI and the FI among the cancer patient cohort as well as their complex impact on mortality and highlighted the role of dietary supplement in cancer prognosis, indicating benefits for non-frail patients with BMI < 25 kg/m2.

A correlation-based feature analysis of physical examination indicators can help predict the overall underlying health status using machine learning

As a systematic investigation of the correlations between physical examination indicators (PEIs) is lacking, most PEIs are currently independently used for disease warning. This results in the general physical examination having limited diagnostic values. Here, we systematically analyzed the correlations in 221 PEIs between healthy and 34 unhealthy statuses in 803,614 individuals in China. Specifically, the study population included 711,928 healthy participants, 51,341 patients with hypertension, 12,878 patients with diabetes, and 34,997 patients with other unhealthy statuses. We found rich relevance between PEIs in the healthy physical status (7662 significant correlations, 31.5%). However, in the disease conditions, the PEI correlations changed. We focused on the difference in PEIs between healthy and 35 unhealthy physical statuses and found 1239 significant PEI differences, suggesting that they could be candidate disease markers. Finally, we established machine learning algorithms to predict health status using 15-16% of the PEIs through feature extraction, reaching a 66-99% accurate prediction, depending on the physical status. This new reference of the PEI correlation provides rich information for chronic disease diagnosis. The developed machine learning algorithms can fundamentally affect the practice of general physical examinations.

The dyadic effects of personality traits on depression in advanced lung cancer patients and caregivers: The mediating role of acceptance of illness

OBJECTIVE

This study aimed to explore the intrapersonal and interpersonal effects of three personality traits-neuroticism, extraversion and conscientiousness-on depression and examine whether acceptance of illness mediates the actor and partner effects in advanced lung cancer patients and caregivers using the Actor-Partner Interdependence Mediation Model (APIMeM).

METHODS

A total of 304 dyads of advanced lung cancer patients and caregivers were studied. Personality traits, acceptance of illness and depression were measured using 44-item Big Five Inventory, the Acceptance of Illness (AIS) scale and the Patient Health Questionnaire (PHQ-9).

RESULTS

The APIMeMs suggested that there were significant actor-actor effects of the three personality traits on depression through their own acceptance of illness. Additionally, significant actor-partner effects of neuroticism and extraversion on depression were also found. Specifically, patients' neuroticism was negatively related to their own acceptance of illness, which increased caregivers' depression, and caregivers' higher extraversion was related to their own higher acceptance of illness, which reduced patients' depression. Furthermore, a significant partner-actor effect was only found in the neuroticism model. Patients' neuroticism was negatively related to caregivers' acceptance of illness, which increased caregivers' depression.

CONCLUSION

The three personality traits had both interpersonal and intrapersonal effects on depression in advanced lung cancer patient-caregiver dyads, and acceptance of illness played an important mediating role in these relationships.

A Smartphone-Based App to Improve Adjuvant Treatment Adherence to Multidisciplinary Decisions in Patients With Early-Stage Breast Cancer: Observational Study

BACKGROUND

Multidisciplinary treatment (MDT) and adjuvant therapy are associated with improved survival rates in breast cancer. However, nonadherence to MDT decisions is common in patients. We developed a smartphone-based app that can facilitate the full-course management of patients after surgery.

OBJECTIVE

This study aims to investigate the influence factors of treatment nonadherence and to determine whether this smartphone-based app can improve the compliance rate with MDTs.

METHODS

Patients who had received a diagnosis of invasive breast cancer and had undergone MDT between March 2013 and May 2019 were included. Patients were classified into 3 groups: Pre-App cohort (November 2017, before the launch of the app); App nonused, cohort (after November 2017 but not using the app); and App used cohort (after November 2017 and using the app). Univariate and multivariate analyses were performed to identify the factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy, was also evaluated.

RESULTS

A total of 4475 patients were included, with Pre-App, App nonused, and App used cohorts comprising 2966 (66.28%), 861 (19.24%), and 648 (14.48%) patients, respectively. Overall, 15.53% (695/4475) patients did not receive MDT recommendations; the noncompliance rate ranged from 27.4% (75/273) in 2013 to 8.8% (44/500) in 2019. Multivariate analysis demonstrated that app use was independently associated with adherence to adjuvant treatment. Compared with the patients in the Pre-App cohort, patients in the App used cohort were less likely to deviate from MDT recommendations (odds ratio [OR] 0.61, 95% CI 0.43-0.87; P=.007); no significant difference was found in the App nonused cohort (P=.77). Moreover, app use decreased the noncompliance rate for adjuvant chemotherapy (OR 0.41, 95% CI 0.27-0.65; P<.001) and radiotherapy (OR 0.49, 95% CI 0.25-0.96; P=.04), but not for anti-HER2 therapy (P=.76) or endocrine therapy (P=.39).

CONCLUSIONS

This smartphone-based app can increase MDT adherence in patients undergoing adjuvant therapy; this was more obvious for adjuvant chemotherapy and radiotherapy.

Attitudes towards social distancing in response to COVID-19

OBJECTIVES

COVID-19 has highlighted differences in our engagement in health prevention behaviors. The Health Belief Model (HBM), personality traits (conscientiousness, extraversion, and neuroticism), and sociodemographic variables were used to evaluate social distancing during the first month of a state-mandated Stay At Home (SAH) order.

DESIGN

A web-based convenience sample of 645 Ohioans was surveyed. Hierarchical linear regression and mediation analysis were used to examine predictors of social distancing attitudes and behaviors and whether health beliefs mediated the relationship between personality and social distancing.

RESULTS

Most respondents agreed with and adhered to social distancing guidelines. HBM constructs were strong predictors of SAH attitudes, while personality accounted for little additional variance. Anxiety was indirectly related to overall social distancing attitudes and behavior through its relationship with health beliefs. However, violations of social distancing were best explained by situational factors (e.g., being an essential worker).

CONCLUSION

The results demonstrate the power of components of the HBM to explain attitudes and behaviors regarding the SAH order beyond any contribution from personality. By examining the role of personality and health beliefs on social distancing attitudes and behaviors, this research will benefit public health nurses and others tasked with communicating and promoting preventative health behavior.

Locus of control, personality and depression symptoms in cancer: Testing a moderated mediation model

OBJECTIVE

To investigate the mediator role of locus of control on the relationship between the Big Five personality traits and the manifestation of depression symptoms in cancer outpatients.

METHOD

Participants consisted of 220 cancer outpatients (138 women and 82 men), evaluated individually at the hospital waiting room. The measures applied were as follows: The NEO-Five Factor Inventory (NEO-FFI), Multidimensional Health Locus of Control (MHLC) Scale and Hospital Anxiety and Depression Scale (HADS).

RESULTS

The factor structure of NEO-FFI was reexamined. A moderated mediation model was found for the powerful others external locus of control (LOC), depression symptoms and extraversion and conscientiousness traits across sex.

CONCLUSIONS

Extraverted individuals can seek for others' support and use their attachments to find someone to guide them; conscientious patients can rely on their physician and follow every rule and orientation demanded, temporarily delegating to others the responsibility for their lives. All these strategies can help to decrease symptoms of depression. The perception of control can be taught, and it may be specifically relevant for mental health and in the performance of health behaviours.

Effect of personality traits on the oral health-related quality of life in patients with oral lichen planus undergoing treatment

OBJECTIVES

The aim of this study was to evaluate the relationship between personality traits and perceived treatment success in oral lichen planus.

MATERIAL AND METHODS

A total of 53 patients with diagnosed oral lichen planus were evaluated at the time of diagnosis and along the course of their treatment. The visual analogue scale (VAS) was used for evaluating pain and burning sensation, along with an evaluation of the oral health-related quality of life (OHIP) and the clinical severity. In order to determine the personality trait, the NEO-FFI questionnaire was applied. Data were assessed with the statistical software Stata by a multiple linear regression.

RESULTS

A significant relationship between the two personality traits: "conscientiousness" and "extraversion" and a perceived improvement in oral lichen planus could be observed. The higher the "conscientiousness," the better the perceived oral health-related quality of life. Furthermore, "extraversion" had a significant influence on the improvement in clinical severity index (P < 0.05).

CONCLUSIONS

Personality traits, especially conscientiousness and extraversion, have a significant impact on the perception of therapeutic intervention in oral lichen planus.

CLINICAL RELEVANCE

As personalized patient management is gaining importance and psychosocial factors play a significant role in mucosal diseases, the patient's psychological profile should be considered in the oral lichen planus management.

Adherence to oral chemotherapy: Evidence from a randomised clinical trial

OBJECTIVE

To evaluate the efficacy of a reinforcement message (RM) administered by a hospital pharmacist on adherence, through a randomised study involving patients undergoing oral chemotherapy from which an objective outcome measure and patients' subjective opinions were collected. A secondary aim was to detect which psychological or clinical factors influence adherence.

METHODS

Forty patients were enrolled and randomised to an experimental group (EG) or a control group (CG). The EG received a 10-minute RM provided by a hospital pharmacist with a doctor and a nurse. The CG received the standard of care. To measure adherence, plasma drug concentration and subjective evaluation were taken during the visits, in addition to a psychological assessment (coping strategies, psychological distress and personality traits).

RESULTS

The EG reported higher drug levels and a statistically significant higher mean score on the subjective evaluation. A linear regression model highlighted statistically significant differences in the plasma drug concentration, after considering toxicity and dose reduction and controlling for the Reward Dependence Scale of the Temperament and Character Inventory between the EG and the CG.

CONCLUSION

Adequate information and education on the therapy, using an RM strategy provided by a hospital pharmacist, seems to positively influence adherence to the treatment.

Metacognitive Beliefs, Positive States of Mind, and Emotional Approach Coping as the Predictors of Medical Compliance in Patients with Cancer

Background: Medical compliance plays an essential role in the control of cancer and psychological factors such as metacognitive beliefs, positive psychology, and coping styles which are among the predictors of medical compliance. Objectives: The aim of this study was to determine how much metacognitive beliefs, positive states of mind, and emotional approach coping can predict medical compliance in patients with breast cancer. Methods: This was a descriptive correlational study. By available sampling method, 154 women with breast cancer who were medically treated and had inclusion criteria, responded to the Morisky Medication Adherence scale (MMAS), Metacognitive Beliefs questionnaire (MCBQ), Positive states of mind (PSOM) scale, and emotional approach coping (EAC) scale. Stepwise multiple regression analysis by SPSS statistics version 24 was applied for data analysis. Results: There was a significant correlation between positive states of mind and metacognitive beliefs and between emotional approach coping with medical compliance (P < 0.05). Positive states of mind and metacognitive beliefs were the best predictors of medical compliance (P < 0.001), while the emotional approach coping could not predict medical compliance. Results also showed that positive states of mind (β = 0. 51) have the greatest predictive power to medical compliance, and the variable of emotional approach coping is not effective in predicting. Conclusions: Research findings suggest that positive states of mind and orientation toward metacognitive beliefs can control anxiety among patients and predict medical compliance in patients with breast cancer but research about emotional approach coping needs to more investigation.

The association of depressive symptoms, personality traits, and sociodemographic factors with health-related quality of life and quality of life in patients with advanced-stage lung cancer: an observational multi-center cohort study

Background

Identification of patient-related factors associated with Health-Related Quality of Life (HRQoL) and Quality of Life (QoL) at the start of treatment may identify patients who are prone to a decrease in HRQoL and/or QoL resulting from chemotherapy. Identification of these factors may offer opportunities to enhance patient care during treatment by adapting communication strategies and directing medical and psychological interventions. The aim was to examine the association of sociodemographic factors, personality traits, and depressive symptoms with HRQoL and QoL in patients with advanced-stage lung cancer at the start of chemotherapy.

Methods

Patients (n = 151) completed the State-Trait Anxiety Inventory (trait anxiety subscale), the Neuroticism-Extraversion-Openness-Five Factor Inventory (NEO-FFI), the Center for Epidemiologic Studies Depression (CES-D), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Simple linear regression analyses were performed to select HRQoL and QoL associated factors (a P ≤ 0.10 was used to prevent non-identification of important factors) followed by multiple linear regression analyses (P ≤ 0.05).

Results

In the multiple regression analyses, CES-D score (β = − 0.63 to − 0.53; P-values < 0.001) was most often associated with the WHOQOL-BREF domains and general facet, whereas CES-D score (β = − 0.67 to − 0.40; P-values < 0.001) and Eastern Cooperative Oncology Group (ECOG) performance status (β = − 0.30 to − 0.30; P-values < 0.001) were most often associated with the scales of the EORTC QLQ-C30. Personality traits were not related with HRQoL or QoL except for trait anxiety (Role functioning: β = 0.30; P = 0.02, Environment: β = − 0.39; P = 0.007) and conscientiousness (Physical health: β = 0.20; P-value < 0.04).

Conclusions

Higher scores on depressive symptoms and ECOG performance status were related to lower HRQoL and QoL in patients with advanced-stage non-small cell lung cancer. Supportive care interventions aimed at improvement of depressive symptoms and performance score may facilitate an increase of HRQoL and/or QoL during treatment.

Progress in psycho-oncology with special reference to developing countries

PURPOSE OF REVIEW

Psycho-oncology has completed 25 years. There is growing recognition of the psychosocial needs of persons living with cancer and the role of sociocultural factors in addressing the needs. This review addresses the research in developing countries relating to distress associated with living with cancer and psychosocial care.

RECENT FINDINGS

There is growing recognition of the emotional needs, understanding of the sociocultural aspects of the emotional responses of persons, caregivers, role of resilience and posttraumatic growth and spirituality in cancer care. Psychosocial aspects of cancer are largely influenced by social, economic, cultural, religious and health systems. A number of innovative approaches to care like use of yoga, financial and material support and involvement of caregivers have been implemented. A positive development is the increasing professional attention to document and develop innovative care programmes.

SUMMARY

A significant proportion of the general population are living with cancer. There are significant psychosocial needs largely influenced by social, economic, cultural, religious aspects of the communities. There are a wide range of interventions from self-care to professional care to address the needs. In developing countries, there is need for longitudinal studies of psycho-social experiences, develop interventions that are culturally appropriate, along with enhanced use of information technology along with evaluation of interventions.