1
|
Nissen ER, Neumann H, Knutzen SM, Henriksen EN, Amidi A, Johansen C, von Heymann A, Christiansen P, Zachariae R. Interventions for insomnia in cancer patients and survivors-a comprehensive systematic review and meta-analysis. JNCI Cancer Spectr 2024; 8:pkae041. [PMID: 38781520 PMCID: PMC11188797 DOI: 10.1093/jncics/pkae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/19/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Considering the persistent nature and higher prevalence of insomnia in cancer patients and survivors compared with the general population, there is a need for effective management strategies. This systematic review and meta-analysis aimed to comprehensively evaluate the available evidence for the efficacy of pharmacological and nonpharmacological interventions for insomnia in adult cancer patients and survivors. METHODS Following the PRISMA guidelines, we analyzed data from 61 randomized controlled trials involving 6528 participants. Interventions included pharmacological, physical, and psychological treatments, with a focus on insomnia severity and secondary sleep and non-sleep outcomes. Frequentist and Bayesian analytical strategies were employed for data synthesis and interpretation. RESULTS Cognitive-Behavioral Therapy for Insomnia (CBT-I) emerged as the most efficacious intervention for reducing insomnia severity in cancer survivors and further demonstrated significant improvements in fatigue, depressive symptoms, and anxiety. CBT-I showed a large postintervention effect (g = 0.86; 95% confidence interval [CI] = 0.57 to 1.15) and a medium effect at follow-up (g = 0.55; 95% CI = 0.18 to 0.92). Other interventions such as bright white light therapy, sleep medication, melatonin, exercise, mind-body therapies, and mindfulness-based therapies showed benefits, but the evidence for their efficacy was less convincing compared with CBT-I. Brief Behavioral Therapy for Insomnia showed promise as a less burdensome alternative for patients in active cancer treatment. CONCLUSIONS CBT-I is supported as a first-line treatment for insomnia in cancer survivors, with significant benefits observed across sleep and non-sleep outcomes. The findings also highlight the potential of less intensive alternatives. The research contributes valuable insights for clinical practice and underscores the need for further exploration into the complexities of sleep disturbances in cancer patients and survivors.
Collapse
Affiliation(s)
- Eva Rames Nissen
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Henrike Neumann
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Sofie Møgelberg Knutzen
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Emilie Nørholm Henriksen
- Centre for Involvement of Relatives, Mental Health Services, Region of Southern Denmark, Odense, Denmark
| | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects (CASTLE) – a Danish Cancer Society National Research Center, Department of Oncology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Annika von Heymann
- Cancer Survivorship and Treatment Late Effects (CASTLE) – a Danish Cancer Society National Research Center, Department of Oncology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Peer Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
- Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
- Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
2
|
Jiang X, Sun J, Song R, Wang Y, Li J, Shi R. Acceptance and commitment therapy reduces psychological distress in patients with cancer: a systematic review and meta-analysis of randomized controlled trials. Front Psychol 2024; 14:1253266. [PMID: 38250124 PMCID: PMC10796538 DOI: 10.3389/fpsyg.2023.1253266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/16/2023] [Indexed: 01/23/2024] Open
Abstract
Objective This study aimed to systematically review and meta-analyze the clinical efficacy of acceptance and commitment therapy (ACT) in patients with cancer and psychological distress. Methods Randomized controlled trials (RCTs) from seven English electronic databases were systematically investigated from inception to 3 October 2023. A total of 16 RCTs from 6 countries with 711 participants were included in this study. Estimated pooled effect sizes (ESs) were calculated via inverse-variance random-effects or fixed-effects (I2 ≤ 50%) model and presented by standardized mean difference (SMD). Subgroup analyses were performed to reduce confounding factors and heterogeneity, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to evaluate the quality of the pooled ESs. Results The pooled ESs revealed that statistically significant improvements in anxiety [postintervention SMD = -0.41 (95% confidence interval (CI), -0.71, -0.11); p = 0.008; I2 = 65%; follow-up SMD = -0.37 (95% CI, -0.66, -0.08); p = 0.01; I2 = 29%], depression [postintervention SMD = -0.45 (95% CI, -0.63, -0.27); p < 0.001; I2 = 49%; follow-up SMD = -0.52 (95% CI, -0.77, -0.28); p < 0.001; I2 = 0%], and psychological flexibility [postintervention SMD = -0.81 (95% CI, -1.50, -0.11); p = 0.02; I2 = 84%; follow-up SMD = -0.71 (95% CI, -1.12, -0.31); p = 0.0006; I2 = 38%] in ACT-treated participants were observed compared to patients treated with control conditions. However, other outcomes, such as physical symptom alleviation, were not significantly associated. Conclusion The findings of this systematic review and meta-analysis suggest that ACT is associated with improvements in anxiety, depression, and psychological flexibility in patients with cancer. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022320515.
Collapse
Affiliation(s)
- Xing Jiang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jian Sun
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ruiwen Song
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yue Wang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jinglian Li
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Rongwei Shi
- Department of Internal Medicine, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| |
Collapse
|
3
|
Krueger E, Secinti E, Stewart JC, Rand KL, Mosher CE. Cognitive-behavioral and mindfulness-based interventions for distress in patients with advanced cancer: A meta-analysis. Psychooncology 2024; 33:e6259. [PMID: 38054530 DOI: 10.1002/pon.6259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/17/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE Various psychosocial interventions have been developed to reduce distress and improve quality of life (QoL) in patients with advanced cancer, many of which are traditional cognitive-behavioral interventions (CBIs) or mindfulness-based interventions (MBIs). The aims of this meta-analysis were to determine and compare the overall effects of traditional CBIs and MBIs on distress and QoL in this population and to explore potential moderators of intervention efficacy. METHODS A systematic search was conducted in CINAHL, Embase, PsycINFO, PubMed, and Web of Science. Randomized controlled trials (RCTs) comparing CBIs or MBIs to controls on distress and QoL outcomes were eligible for inclusion. Random effects meta-analyses using standardized baseline to post-intervention mean differences were calculated using Hedges's g. Meta-regressions were used to compare intervention effects and examine potential moderators. RESULTS Across 37 RCTs (21 CBIs, 14 MBIs, 2 combination therapies), there was a small decrease in distress (Hedges's g = 0.21) and a minimal improvement in QoL (Hedges's g = 0.15). Traditional CBIs and MBIs did not differ in effect sizes. Heterogeneity was significant across distress effect sizes but not across QoL effects. Interventions delivered to individuals (vs. dyads/group) had larger effects on QoL. No moderators of intervention effects on distress were found. CONCLUSIONS Findings suggest traditional CBIs and MBIs produce small reductions in distress compared to controls in patients with advanced cancer, although effects on QoL appear minimal. Given limitations in the number of studies and their quality, rigorous trials are needed to directly compare the impact of traditional CBIs and MBIs in this population.
Collapse
Affiliation(s)
- Ellen Krueger
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| |
Collapse
|
4
|
Zhang Y, Ding Y, Chen X, Li Y, Li J, Hu X. Effectiveness of acceptance and commitment therapy on psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer: A meta-analysis of randomized controlled trials. Worldviews Evid Based Nurs 2023; 20:582-592. [PMID: 37194163 DOI: 10.1111/wvn.12652] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Current studies have revealed that acceptance and commitment therapy (ACT) can alleviate the adverse effects of cancer; however, its effectiveness on the psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer remains unclear. AIMS The aims of this study were to identify the effectiveness of ACT on psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer, and to explore moderators. METHODS PubMed, Embase, Web of Science, CENTRAL, PsycINFO, CINAHL, CNKI, VIP, and Wanfang electronic databases were searched from inception to September 29, 2022. The Cochrane Collaboration's risk-of-bias assessment tool II and the Grading of Recommendations Assessment, Development, and Evaluation approach were used to evaluate evidence certainty. The data were analyzed using R Studio. The study protocol was registered with PROSPERO (CRD42022361185). RESULTS The study included 19 relevant studies (1643 patients) published between 2012 and 2022. The pooled results showed that ACT significantly improved psychological flexibility (mean difference [MD] = -4.22, 95% CI [-7.86, -0.58], p = .02) and quality of life (Hedges' g = 0.94, 95% CI [0.59, 1.29], Z = 5.31, p < .01) but did not significantly improve fatigue (Hedges' g = -0.03, 95% CI [-0.24, 0.18], p = .75) or sleep disturbance (Hedges' g = -0.26, 95% CI [-0.82, 0.30], p = .37) in patients with cancer. Additional analyses revealed a 3-month sustainable effect on psychological flexibility (MD = -4.36, 95% CI [-8.67, -0.05], p < .05), and moderation analysis showed that intervention duration (β = -1.39, p < .01) and age (β = 0.15, p = .04) moderated the effects of ACT on psychological flexibility and sleep disturbance, respectively. LINKING EVIDENCE TO ACTION Acceptance and commitment therapy demonstrates effectiveness for psychological flexibility and quality of life of patients with cancer, but there is a lack of evidence regarding its effects on fatigue and sleep disturbance. In clinical practice, ACT should be designed in more detail and rounded to achieve better results.
Collapse
Affiliation(s)
- Yalin Zhang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yuxin Ding
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaoli Chen
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yunhuan Li
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Juejin Li
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaolin Hu
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| |
Collapse
|
5
|
Gibson Watt T, Gillanders D, Spiller JA, Finucane AM. Acceptance and Commitment Therapy (ACT) for people with advanced progressive illness, their caregivers and staff involved in their care: A scoping review. Palliat Med 2023; 37:1100-1128. [PMID: 37489074 PMCID: PMC10503261 DOI: 10.1177/02692163231183101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
BACKGROUND People with an advanced progressive illness and their caregivers frequently experience anxiety, uncertainty and anticipatory grief. Traditional approaches to address psychological concerns aim to modify dysfunctional thinking; however, this is limited in palliative care, as often concerns area valid and thought modification is unrealistic. Acceptance and Commitment Therapy is a mindfulness-based behavioural therapy aimed at promoting acceptance and valued living even in difficult circumstances. Evidence on its value in palliative care is emerging. AIMS To scope the evidence regarding Acceptance and Commitment Therapy for people with advanced progressive illness, their caregivers and staff involved in their care. DESIGN Systematic scoping review using four databases (Medline, PsychInfo, CINAHL and AMED), with relevant MeSH terms and keywords from January 1999 to May 2023. RESULTS 1,373 papers were identified and 26 were eligible for inclusion. These involved people with advanced progressive illness (n = 14), informal caregivers (n = 4), palliative care staff (n = 3), bereaved carers (n = 3), and mixed groups (n = 2). Intervention studies (n = 15) showed that Acceptance and Commitment Therapy is acceptable and may have positive effects on anxiety, depression, distress, and sleep in palliative care populations. Observational studies (n = 11) revealed positive relationships between acceptance and adjustment to loss and physical function. CONCLUSION Acceptance and Commitment Therapy is acceptable and feasible in palliative care, and may improve anxiety, depression, and distress. Full scale mixed-method evaluation studies are now needed to demonstrate effectiveness and cost-effectiveness amongst patients; while further intervention development and feasibility studies are warranted to explore its value for bereaved carers and staff.
Collapse
Affiliation(s)
- Tilly Gibson Watt
- University of Edinburgh Medical School, University of Edinburgh, Scotland, UK
| | - David Gillanders
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Scotland, UK
| | - Juliet A Spiller
- University of Edinburgh Medical School, University of Edinburgh, Scotland, UK
- Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK
| | - Anne M Finucane
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Scotland, UK
- Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK
| |
Collapse
|
6
|
Gibson B, Rosser BA, Schneider J, Forshaw MJ. The role of uncertainty intolerance in adjusting to long-term physical health conditions: A systematic review. PLoS One 2023; 18:e0286198. [PMID: 37267292 DOI: 10.1371/journal.pone.0286198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 05/10/2023] [Indexed: 06/04/2023] Open
Abstract
Long-term physical health conditions (LTPHCs) are associated with poorer psychological well-being, quality of life, and longevity. Additionally, individuals with LTPHCs report uncertainty in terms of condition aetiology, course, treatment, and ability to engage in life. An individual's dispositional ability to tolerate uncertainty-or difficulty to endure the unknown-is termed intolerance of uncertainty (IU), and may play a pivotal role in their adjustment to a LTPHC. Consequently, the current review sought to investigate the relationship between IU and health-related outcomes, including physical symptoms, psychological ramifications, self-management, and treatment adherence in individuals with LTPHCs. A systematic search was conducted for papers published from inception until 27 May 2022 using the databases PsycINFO, PubMed (MEDLINE), CINAHL Plus, PsycARTICLES, and Web of Science. Thirty-one studies (N = 6,201) met the inclusion criteria. Results indicated that higher levels of IU were associated with worse psychological well-being outcomes and poorer quality of life, though impacts on self-management were less clear. With the exception of one study (which looked at IU in children), no differences in IU were observed between patients and healthy controls. Although findings highlight the importance of investigating IU related to LTPHCs, the heterogeneity and limitations of the existing literature preclude definite conclusions. Future longitudinal and experimental research is required to investigate how IU interacts with additional psychological constructs and disease variables to predict individuals' adjustment to living with a LTPHC.
Collapse
Affiliation(s)
- Benjamin Gibson
- School of Applied Social Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Benjamin A Rosser
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Jekaterina Schneider
- Centre for Appearance Research, School of Social Sciences, College of Health, Science and, University of the West of England, Bristol, United Kingdom
| | - Mark J Forshaw
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| |
Collapse
|
7
|
El Rafihi-Ferreira R, Morin CM, Hasan R, Brasil IS, Zago Ribeiro JH, Cecília Toscanini A. A Pilot Randomized Controlled Trial (RCT) of Acceptance and Commitment Therapy Versus Cognitive Behavioral Therapy for Chronic Insomnia. Behav Sleep Med 2023; 21:193-207. [PMID: 35535772 DOI: 10.1080/15402002.2022.2071272] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To compare the effectiveness of protocols for acceptance and commitment therapy for insomnia (ACT-I) and cognitive behavioral therapy for insomnia (CBT-I) in adults. METHOD Participants were 37 adults (74.3% women; M = 43.7 years, SD = 10.7) with chronic insomnia who were randomized to 6 weekly group sessions consisting of ACT-I (n = 19) or CBT-I (n = 18). The primary outcome measures were based on the Insomnia Severity Index (ISI) total score, a measure of insomnia complaints, and included the proportions of treatment responders (defined as a change in score of 8 points or more) and remitters (defined as a final score below 8). RESULTS Both treatment modalities significantly reduced insomnia severity. Post-treatment, the proportion of treatment responders was higher in the CBT-I than the ACT-I (64.7% vs. 50.0%, respectively) group and six months later, ACT-I made further improvements whereas CBT-I had a reduced treatment response (58.8% vs. 55.6%, respectively). CBT-I was associated with a higher proportion of insomnia remission at post treatment. CONCLUSIONS Both CBT-I and ACT-I are effective, with a higher proportion of insomnia remitters in CBT-I post-treatment. The different change trajectories for the two therapy groups provide insights into behavioral change via a cognitive versus contextual approach.
Collapse
Affiliation(s)
- Renatha El Rafihi-Ferreira
- Department of Psychiatry, Ambulatório de Sono do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina de São Paulo, Brazil
| | - Charles M Morin
- Department of Psychology, École de Psychologie, Université Laval, Sainte-Foy, Québec, Canada
| | - Rosa Hasan
- Department of Psychiatry, Ambulatório de Sono do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina de São Paulo, Brazil
| | - Israel S Brasil
- Department of Psychiatry, Ambulatório de Sono do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina de São Paulo, Brazil
| | - José Humberto Zago Ribeiro
- Department of Psychiatry, Ambulatório de Sono do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina de São Paulo, Brazil
| | - Andrea Cecília Toscanini
- Department of Psychiatry, Ambulatório de Sono do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina de São Paulo, Brazil
| |
Collapse
|
8
|
Guthrie D. How I Learned to Stop Worrying and Love the Eco-Apocalypse: An Existential Approach to Accepting Eco-Anxiety. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:210-223. [PMID: 35969891 DOI: 10.1177/17456916221093613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Climate crisis presents a near-term existential threat to the human species, one that society has neither the physical nor psychological infrastructure to manage. Eco-anxiety increases as awareness about climate crisis spreads. Despite an urgent need for resources on how to help people cope with the psychological ramifications of climate crisis, there is little literature that both addresses people's apocalyptic fears and takes the scientific bases of those fears seriously. In this article, I synthesize research on existential psychology, Acceptance and Commitment Therapy, grief, and end-of-life care to present an original perspective on how people, individually and collectively, can become psychologically resilient to climate crisis. First, I establish that death anxiety underlies eco-anxiety. Second, I demonstrate that preparing psychologically for eco-apocalypse requires people to cultivate death acceptance. Finally, I illustrate how commitment to palliative values can enable people to live rich and meaningful lives despite their most likely imminent end.
Collapse
Affiliation(s)
- Devin Guthrie
- Department of Psychological & Brain Sciences, Texas A&M University
| |
Collapse
|
9
|
Burns MF, Secinti E, Johns SA, Wu W, Helft PR, Turk AA, Loehrer PJ, Sehdev A, Al-Hader AA, Mosher CE. Impact of acceptance and commitment therapy on physical and psychological symptoms in advanced gastrointestinal cancer patients and caregivers: Secondary results of a pilot randomized trial. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023; 27:107-115. [PMID: 37064761 PMCID: PMC10100868 DOI: 10.1016/j.jcbs.2023.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with advanced gastrointestinal cancer often experience high symptom burden, which is associated with heightened distress in both patients and their family caregivers. Few interventions have been tested to jointly address patient and caregiver symptoms in advanced gastrointestinal cancer. In a randomized pilot trial, telephone-based, dyadic acceptance and commitment therapy (ACT) was found to be feasible in this population. The present secondary analyses examined the impact of this intervention on patient and caregiver physical and psychological symptoms. Patients and caregivers (N = 40 dyads) were recruited from clinics in Indianapolis, Indiana and randomized to either six weeks of telephone-based ACT or education/support, an attention control condition. Outcomes were assessed at baseline and at 2 weeks and 3 months post-intervention. Study group differences in outcomes were not statistically significant. However, when examining within-group change, only ACT patients experienced moderate reductions in pain severity and interference at 2 weeks post-intervention (effect size [ES]=-0.47; -0.51) as well as moderate reductions in depressive symptoms at 2 weeks (ES=-0.42) and 3 months (ES=-0.41) post-intervention. ACT caregivers experienced moderate reductions in sleep disturbance (ES=-0.56; -0.49) and cognitive concerns (ES=-0.61; -0.85) across follow-ups. Additionally, caregivers in both conditions experienced moderate reductions in fatigue (ES=-0.38 to -0.70) and anxiety (ES=-0.40 to -0.49) across follow-ups. Findings suggest that ACT may improve certain symptoms in dyads coping with advanced gastrointestinal cancer and warrant replication in a larger trial.
Collapse
Affiliation(s)
- Marcia F. Burns
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Shelley A. Johns
- Indiana University School of Medicine, Center for Health Services Research, Regenstrief Institute, 1101 W. 10th Street, Indianapolis, IN, 46202, USA
| | - Wei Wu
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Paul R. Helft
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN, 46202, USA
| | - Anita A. Turk
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN, 46202, USA
| | - Patrick J. Loehrer
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN, 46202, USA
| | - Amikar Sehdev
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN, 46202, USA
| | - Ahmad A. Al-Hader
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN, 46202, USA
| | - Catherine E. Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| |
Collapse
|
10
|
Pakenham K, Martin CL. Psychosocial palliative care: Patients' preferred intervention medium, target domains, and well-being priorities. Palliat Support Care 2022:1-9. [PMID: 36377378 DOI: 10.1017/s1478951522001535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Although psychological distress in palliative patients has at least an equal or greater impact on the quality of life compared to physical or spiritual distress, there is limited research on contextual factors associated with psychosocial intervention accessibility and relevance. This is the first published study to explore patients' views on psychosocial intervention delivery medium preferences, key biopsychosocial target domains, and well-being priorities during the palliative and end-of-life (EOL) phases. METHODS Eighty-one palliative patients from a Specialist Palliative Care Service completed a questionnaire, which collected quantitative and qualitative data on preferred mediums for receiving psychosocial interventions, priority biopsychosocial target domains, and well-being priorities during the palliative and EOL phases. RESULTS Results showed that an individual in-person was the most preferred medium for receiving psychosocial interventions. Improving quality of life, distressing emotions, and adjusting to the palliative care context were the 3 most frequently endorsed biopsychosocial target domains. Valued living and comfortable living were the key priority well-being themes for the palliative phase, whereas being surrounded by loved ones and comfortable and dignified dying were the priority well-being themes for the EOL phase. SIGNIFICANCE OF RESULTS Findings highlight psychosocial interventions as an essential part of a holistic approach to patient-centered care throughout both the palliative and the EOL phases. Results can inform the refinement of existing and the development of new psychosocial interventions, particularly those that target emotional distress, adjustment, and quality of life. Furthermore, in-person treatment delivery remains essential in an evolving digital world.
Collapse
Affiliation(s)
- Kenneth Pakenham
- School of Psychology, The University of Queensland Faculty of Health and Behavioural Sciences, St Lucia, QLD, Australia
| | - Christopher Lloyd Martin
- School of Psychology, The University of Queensland Faculty of Health and Behavioural Sciences, St Lucia, QLD, Australia
- Specialist Palliative Care Service, Sunshine Coast Hospital and Health Service, 2B West Terrace, Caloundra, QLD, Australia
| |
Collapse
|
11
|
Li H, Jin X, Ng MSN, Mann KF, Wang N, Wong CL. Effects of Acceptance and Commitment Therapy on fatigue interference and health-related quality of life among patients with advanced lung cancer: A pilot randomized controlled trial. Asia Pac J Oncol Nurs 2022; 9:100102. [PMID: 36092683 PMCID: PMC9449559 DOI: 10.1016/j.apjon.2022.100102] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/30/2022] [Indexed: 12/02/2022] Open
Abstract
Objective The present study aimed to examine the feasibility and preliminary effects of Acceptance and Commitment Therapy (ACT) on fatigue interference and health-related quality of life in patients with advanced lung cancer. Methods In a single-blinded, parallel-group randomized controlled trial, 40 patients with advanced lung cancer were randomized to either the intervention group, which received the four-session individual ACT in 4 weeks, or the control group, which received usual care. The outcomes were evaluated at baseline and one week postintervention. Results Intervention feasibility and acceptability were established with a high attendance rate of 88.75% and a high retention rate of 75%. Approximately 95% of the participants reported satisfaction with the intervention. Despite the insignificant effects on fatigue interference, statistically significant interactions effects of ACT for health-related quality of life (P = 0.001), cancer-related fatigue (P < 0.001), depressive symptoms (P < 0.001), anxiety (P < 0.001), and distress (P = 0.003) were noted. Conclusions This pilot trial supports the feasibility and acceptability of conducting ACT for patients with advanced lung cancer. The findings show the potential positive effects of ACT on health-related quality of life. Future studies with full-scale samples are recommended to evaluate the long-term effects of ACT on fatigue interference.
Collapse
Affiliation(s)
- Huiyuan Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaohuan Jin
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Marques Shek Nam Ng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Fai Mann
- School of Continuing and Professional Education, City University of Hong Kong, Hong Kong SAR, China
| | - Nina Wang
- Respiratory Department, Xiangya Hospital Central South University, Changsha, China
| | - Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
12
|
Yuan Y, Lin L, Xie C, Lu Y, Liang J, Qi Y, Dong B, Chen Q, Fang Q, Tian L. Effectiveness comparisons of various psychosocial therapies for cancer-related fatigue: A Bayesian network meta-analysis. J Affect Disord 2022; 309:471-481. [PMID: 35504400 DOI: 10.1016/j.jad.2022.04.152] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/09/2022] [Accepted: 04/26/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The purpose of this network meta-analysis (NMA) is to compare the effect of several psychosocial therapies on CRF critically. METHODS We applied systematic strategies based on eight databases, namely the Cochrane Central Register of Controlled Trials, PubMed, Embase, PsycINFO, China Biology Medicine (CBM), Wan Fang database, VIP, and China National Knowledge Infrastructure (CNKI) database to preliminary literature retrieval to identify relevant randomized controlled trials (RCTs). Studies, including adult patients (≥18 years) diagnosed with cancer, were eligible regardless of cancer stage and current treatment. We carried out an expression analysis for comparing the efficacy of various psychosocial therapies using Bayesian NMA. A battery of analyses and assessments, such as conventional meta-analysis and risk of bias, were performed concurrently. RESULTS We identified 41 RCTs including six different psychosocial interventions (4422 participants), namely cognitive-behavioral therapy (CBT), mindfulness-based stress reduction therapy (MBSR), psychoeducational therapy (PE), stress management therapy (SMT), meditation therapy (MT) and comprehensive therapy (CT). Our NMA results showed that three psychosocial intervention therapies were effective for CRF in cancer patients. The most effective psychosocial intervention was MBSR (SMD = -1.23, CrI: -1.88, -0.59, SUCRA = 83.33%), followed by PE (SMD = -0.86, CrI: -1.53, -0.18, SUCRA = 58.51%) and CBT (SMD = -0.84, CrI: -1.31, -0.37, SUCRA = 57.67%). CONCLUSIONS Our study showed that MBSR was most likely to be the best psychosocial intervention to relieve CRF in cancer patients. Medical staff should pay attention to applying MBSR to cancer patients in future clinical care.
Collapse
Affiliation(s)
- Yang Yuan
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China; The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China
| | - Lu Lin
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China; The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China
| | - Congyan Xie
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Yang Lu
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Jinghong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Yishu Qi
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Bei Dong
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Qiuyun Chen
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Qian Fang
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Li Tian
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China; The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China.
| |
Collapse
|
13
|
Psychological interventions targeting patients with metastatic cancer and prolonged survival expectancies: advances and challenges. Curr Opin Oncol 2022; 34:256-264. [PMID: 35703243 DOI: 10.1097/cco.0000000000000838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this article is to review the formats and techniques of psychological interventions designed for patients with metastatic cancer and prolonged survival expectancies. RECENT FINDINGS Fifteen interventional studies were selected for this article. One group of psychological interventions focused primarily on patients' adaptation by increasing their knowledge, developing patients' stress management skills, promoting their open communication with healthcare providers, and helping them deal with existential concerns. Another group of interventions focused on patients with moderate and high levels of distress. These interventions provided specific techniques to manage anxiety, depression, fear of cancer progression, and existential distress. Interestingly, interventions targeting distressed patients are not necessarily longer or more intensive than interventions targeting adaptation. The interventions were examined in few randomized controlled trials, and incorporated a broad range of techniques, making comparison of their efficacy difficult. No intervention specifically targeted patients newly diagnosed with metastatic cancer. SUMMARY On the basis of this review, we proposed suggestions according to patients' levels of distress, which differ in intensity, format, techniques, and tools offered. These suggestions may be relevant for the future development and assessment of interventions targeting patients with newly diagnosed metastatic cancer and prolonged survival expectancies.
Collapse
|
14
|
Chapman EJ, Martino ED, Edwards Z, Black K, Maddocks M, Bennett MI. Practice review: Evidence-based and effective management of fatigue in patients with advanced cancer. Palliat Med 2022; 36:7-14. [PMID: 34903113 PMCID: PMC8793304 DOI: 10.1177/02692163211046754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Fatigue affects most patients living with advanced cancer and is a symptom that healthcare professionals can find difficult to manage. AIM To provide healthcare professionals with a pragmatic overview of approaches to management of fatigue in patients with advanced cancer that are commonly recommended by guidelines and to evaluate evidence underpinning them. DESIGN Scoping review methodology was used to determine the strength of evidence supporting use of interventions recommended in management of fatigue in patients with advanced cancer. DATA SOURCES National or international guidelines were examined if they described the management of fatigue in adult cancer patients and were written within the last 6 years (2015-2021) in English. The Cochrane Database of Systematic Reviews (January 2011-December 2021) was searched for 'cancer' AND 'fatigue' in title, abstract or keywords. A PubMed search was also made. RESULTS Evidence indicates physical exercise interventions are effective and patients may benefit from energy conservation tactics. Evidence does not support use of psychostimulants such as methylphenidate. Limited data were found on efficacy of corticosteroids, psychological interventions, nutritional intervention, sleep optimization or complementary therapies for management of fatigue in advanced cancer. CONCLUSION We recommend regular assessment, review and acknowledgement of the impact of fatigue. Exercise and energy conservation should be considered. Pharmacological interventions are not endorsed as a routine approach. Many interventions currently recommended by guidelines are not supported by a robust evidence base and further research on their efficacy is required.
Collapse
Affiliation(s)
- Emma J Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, Leeds, UK
| | - Erica Di Martino
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, Leeds, UK
| | - Zoe Edwards
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, Leeds, UK
| | | | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, Leeds, UK
| |
Collapse
|
15
|
Paulos-Guarnieri L, Linares IMP, El Rafihi-Ferreira R. Evidence and characteristics of Acceptance and Commitment Therapy (ACT)-based interventions for insomnia: A systematic review of randomized and non-randomized trials. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
16
|
Nursing, psychotherapy and advanced cancer: A scoping review. Eur J Oncol Nurs 2021; 56:102090. [PMID: 35026499 DOI: 10.1016/j.ejon.2021.102090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Many individuals with advanced cancer have unmet psychological needs and often lack access to supportive care. Psychotherapy for adults with advanced cancer is a promising way to address some of the challenges in meeting these care needs. Nurses are the largest cohort of healthcare workers who can practice as psychotherapists and are positioned ideally to integrate these interventions as part of routine care. The purpose of this scoping review is to map the literature on psychotherapeutic interventions among adults with advanced cancer and to explore the nursing role in this body of evidence. METHODS We conducted a scoping review for relevant quantitative, qualitative, and mixed methods studies. The content of included studies was analyzed and grouped based on two broad categories that describe how nursing's role was mentioned, described, and utilized: 1. Nurses are not the interventionist/psychotherapist and, 2. Nurses are mentioned as the interventionist/psychotherapist. RESULTS Eighty-six studies were included. Overall, majority of studies did not mention a role for nursing in any capacity. Some studies mentioned a non-interventionist role for nursing in the research study. Fourteen studies mentioned nurses as interventionists/psychotherapists. These studies focused on feasibility, acceptability and patient related outcomes of brief psychotherapies. Dignity therapy was the most common psychotherapy in studies where nurses were utilized as interventionists, followed by life review and supportive expressive therapies. Very few studies discussed nursing's role in this area and nursing's capacity to deliver this form of care. CONCLUSION There is paucity in nursing research focused on psychotherapy for adults with advanced cancer. It is feasible and acceptable for nurses to deliver brief psychotherapies to adults with advanced cancer, and the integration of these techniques in everyday practice has great potential that must be explored. The development of this knowledge base is needed to support future education, research, and practice policy agendas.
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW Depression is a prevalent comorbidity in cancer that significantly increases the risk for numerous negative health outcomes. This review updates the current evidence base for management of depression in cancer, highlighting new research directions based on the inflammatory hypothesis of depression. RECENT FINDINGS Research on pharmacotherapy and psychotherapy for depression in cancer has shown mixed efficacy partly because of methodological issues arising from the phenomenology of depression in cancer. After decades of stagnancy, more recent high-quality clinical trials are beginning to provide an evidence base to guide treatment. Inflammatory cytokine-associated depression is a subtype of depression that may have particular relevance in cancer, opening new avenues to explore therapeutic targets and biobehavioral impacts of interventions, which may improve cancer outcomes. SUMMARY The continuum of severity in cancer-related depression is important to consider in management approaches. Choice of treatment should be personalized to the patient and their symptom profile as there is currently insufficient evidence to recommend any particular medication or psychotherapy over another. Psychological interventions should be considered first line for mild-to-moderate depression, and pharmacological treatment added for more severe depression, which can be optimally delivered within a collaborative care model. VIDEO ABSTRACT http://links.lww.com/YCO/A62.
Collapse
Affiliation(s)
- Aliza A Panjwani
- Division of Psychosocial Oncology, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network
| | - Madeline Li
- Division of Psychosocial Oncology, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
18
|
Deshields TL, Wells-Di Gregorio S, Flowers SR, Irwin KE, Nipp R, Padgett L, Zebrack B. Addressing distress management challenges: Recommendations from the consensus panel of the American Psychosocial Oncology Society and the Association of Oncology Social Work. CA Cancer J Clin 2021; 71:407-436. [PMID: 34028809 DOI: 10.3322/caac.21672] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
Distress management (DM) (screening and response) is an essential component of cancer care across the treatment trajectory. Effective DM has many benefits, including improving patients' quality of life; reducing distress, anxiety, and depression; contributing to medical cost offsets; and reducing emergency department visits and hospitalizations. Unfortunately, many distressed patients do not receive needed services. There are several multilevel barriers that represent key challenges to DM and affect its implementation. The Consolidated Framework for Implementation Research was used as an organizational structure to outline the barriers and facilitators to implementation of DM, including: 1) individual characteristics (individual patient characteristics with a focus on groups who may face unique barriers to distress screening and linkage to services), 2) intervention (unique aspects of DM intervention, including specific challenges in screening and psychosocial intervention, with recommendations for resolving these challenges), 3) processes for implementation of DM (modality and timing of screening, the challenge of triage for urgent needs, and incorporation of patient-reported outcomes and quality measures), 4) organization-inner setting (the context of the clinic, hospital, or health care system); and 5) organization-outer setting (including reimbursement strategies and health-care policy). Specific recommendations for evidence-based strategies and interventions for each of the domains of the Consolidated Framework for Implementation Research are also included to address barriers and challenges.
Collapse
Affiliation(s)
- Teresa L Deshields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Sharla Wells-Di Gregorio
- Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University Wexner Medical Center, James Cancer Hospital, Columbus, Ohio
| | - Stacy R Flowers
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Kelly E Irwin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan Nipp
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lynne Padgett
- Department of Psychology, Veterans Affairs Medical Center, Washington, District of Columbia
| | - Brad Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
19
|
Dinkel A, Marten-Mittag B, Kremsreiter K. Association Between Daily Worry, Pathological Worry, and Fear of Progression in Patients With Cancer. Front Psychol 2021; 12:648623. [PMID: 34456783 PMCID: PMC8384960 DOI: 10.3389/fpsyg.2021.648623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Fear of progression (FoP), or fear of cancer recurrence (FCR), is characterized by worries or concerns about negative illness-related future events. Actually, to worry is a common cognitive process that, in its non-pathological form, belongs to daily life. However, worry can also become pathological appearing as a symptom of mental disorders. This study aimed at investigating the associations among daily worry, pathological worry, and FoP in patients with cancer. Methods: This is a cross-sectional study that includes 328 hospitalized patients with cancer. Patients filled out the FoP Questionnaire (FoP-Q), the Worry Domains Questionnaire (WDQ) for the assessment of daily worry, and the Penn State Worry Questionnaire (PSWQ) for the assessment of pathological worry. Depressive, anxiety, and somatic symptoms were measured with modules of the Patient Health Questionnaire [Patient Health Questionnaire-Depressive Symptoms (PHQ-2), Generalized Anxiety Disorder-2 (GAD-2), and Patient Health Questionnaire-Somatic Symptoms (PHQ-15)]. Furthermore, a structured clinical interview was conducted for the assessment of anxiety disorders. The hierarchical multiple linear regression analysis was used to identify factors independently associated with FoP. Results: Mean age of the participants was M = 58.5 years (SD = 12.8), and 64.6% were men. FoP and worry were significantly intercorrelated (r = 0.58–0.78). The level of FoP was most strongly associated with daily worry (β = 0.514, p < 0.001), followed by pathological worry (β = 0.221, p < 0.001). Further significant determinants were younger age and depressive and anxiety symptoms. Clinical variables were not independently associated with FoP. The final model explained 74% of the variance. Discussion: Fear of progression is strongly associated with daily worry and pathological worry. These results bring up the question of whether FoP is an expression of a general tendency to worry. Whether a general tendency to worry, in fact, represents an independent vulnerability factor for experiencing FCR/FoP needs to be investigated in a longitudinal research design.
Collapse
Affiliation(s)
- Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Birgitt Marten-Mittag
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Katrin Kremsreiter
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, University Medical Center Mannheim, Mannheim, Germany
| |
Collapse
|
20
|
Murphy M, Newby J, Butow P, Joubert A, Kirsten L, Shaw J, Shepherd H, Andrews G. A mixed methods pilot and feasibility open trial of internet-delivered cognitive behaviour therapy ( iCanADAPT Advanced) for people with advanced cancer with depression and/or anxiety. Internet Interv 2021; 26:100449. [PMID: 34504779 PMCID: PMC8416957 DOI: 10.1016/j.invent.2021.100449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Evaluate the feasibility, acceptability and potential efficacy of a form of online therapy for clinical depression and/or anxiety in people living with advanced cancer. METHODS A single-arm open trial of a six-lesson clinician-supervised, internet-delivered cognitive behavioural therapy (iCBT) transdiagnostic intervention (iCanADAPT Advanced) was undertaken. Qualitative (semi-structured telephone interview conducted at 3-months) and quantitative data (questionnaires collected at pre-, post-, and 3-month follow-up) were analysed. RESULTS 27 participants partook (26 women, 56% breast cancer, mean age 56yo; average number of mental health diagnoses 1.8, with majority (81%) meeting criteria for generalised anxiety disorder). Feasibility - Unanticipated numbers (48%) of participants had physical health deterioration (cancer progression or death). iCBT had high adherence overall (completion rates: 37% did 6 lessons; 70% did 4 lessons) but adherence was higher for those whose cancer remained stable (completion rates: 43% did 6 lessons; 85% did 4 lessons). Acceptability - the intervention was acceptable to the majority of participants, with high treatment satisfaction. Advisory data was achieved regarding future versions. Potential efficacy - regardless of physical health status, participants who completed the iCBT showed a significant decrease over time in anxiety and depression symptoms. CONCLUSIONS Online therapies may be useful in assisting those living with advanced cancer dealing with clinical depression and anxiety disorders. The specific modality of clinician supervised iCBT has significant potential to be a suitable modality of online therapy.
Collapse
Affiliation(s)
- M.J. Murphy
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW, Sydney, NSW 2010, Australia
- Corresponding author.
| | - J.M. Newby
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW, Sydney, NSW 2010, Australia
- School of Psychology, UNSW, NSW 2052, Australia
| | - P. Butow
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW 2006, Australia
| | - A. Joubert
- School of Psychology, UNSW, NSW 2052, Australia
| | - L. Kirsten
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW 2006, Australia
- Nepean Cancer Care Centre, NSW 2747, Australia
| | - J. Shaw
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW 2006, Australia
| | - H.L. Shepherd
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW 2006, Australia
| | - G. Andrews
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW, Sydney, NSW 2010, Australia
| |
Collapse
|
21
|
Guan T, Qan'ir Y, Song L. Systematic review of illness uncertainty management interventions for cancer patients and their family caregivers. Support Care Cancer 2021; 29:4623-4640. [PMID: 33495851 PMCID: PMC8236440 DOI: 10.1007/s00520-020-05931-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/02/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Illness uncertainty pervades individuals' experiences of cancer across the illness trajectory and is associated with poor psychological adjustment. This review systematically examined the characteristics and outcomes of interventions promoting illness uncertainty management among cancer patients and/or their family caregivers. METHODS PubMed, Scopus, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Cochrane Database of Systematic Reviews were systematically searched for relevant literature. We included randomized controlled trials (RCTs) and quasi-experimental studies focusing on interventions for uncertainty management in cancer patients and/or their family caregivers. RESULTS Our database searches yielded 26 studies. Twenty interventions were only offered to cancer patients, who were mostly elder, female, and White. All interventions included informational support. Other intervention components included emotional support, appraisal support, and instrumental support. Most interventions were delivered in person and via telephone (n = 8) or exclusively in person (n = 7). Overall, 18 studies identified positive intervention effects on illness uncertainty outcomes. CONCLUSION This systematic review foregrounds the promising potential of several interventions-and especially multi-component interventions-to promote uncertainty management among cancer patients and their family caregivers. To further improve these interventions' effectiveness and expand their potential impact, future uncertainty management interventions should be tested among more diverse populations using rigorous methodologies.
Collapse
Affiliation(s)
- Ting Guan
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yousef Qan'ir
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lixin Song
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| |
Collapse
|
22
|
Hulbert-Williams NJ, Norwood SF, Gillanders D, Finucane AM, Spiller J, Strachan J, Millington S, Kreft J, Swash B. Brief Engagement and Acceptance Coaching for Hospice Settings (the BEACHeS study): results from a Phase I study of acceptability and initial effectiveness in people with non-curative cancer. BMC Palliat Care 2021; 20:96. [PMID: 34172029 PMCID: PMC8235846 DOI: 10.1186/s12904-021-00801-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/11/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives Transitioning into palliative care is psychologically demanding for people with advanced cancer, and there is a need for acceptable and effective interventions to support this. We aimed to develop and pilot test a brief Acceptance and Commitment Therapy (ACT) based intervention to improve quality of life and distress. Methods Our mixed-method design included: (i) quantitative effectiveness testing using Single Case Experimental Design (SCED), (ii) qualitative interviews with participants, and (iii) focus groups with hospice staff. The five-session, in-person intervention was delivered to 10 participants; five completed at least 80%. Results At baseline, participants reported poor quality of life but low distress. Most experienced substantial physical health deterioration during the study. SCED analysis methods did not show conclusively significant effects, but there was some indication that outcome improvement followed changes in expected intervention processes variables. Quantitative and qualitative data together demonstrates acceptability, perceived effectiveness and safety of the intervention. Qualitative interviews and focus groups were also used to gain feedback on intervention content and to make design recommendations to maximise success of later feasibility trials. Conclusions This study adds to the growing evidence base for ACT in people with advanced cancer. A number of potential intervention mechanisms, for example a distress-buffering hypothesis, are raised by our data and these should be addressed in future research using randomised controlled trial designs. Our methodological recommendations—including recruiting non-cancer diagnoses, and earlier in the treatment trajectory—likely apply more broadly to the delivery of psychological intervention in the palliative care setting. This study was pre-registered on the Open Science Framework (Ref: 46,033) and retrospectively registered on the ISRCTN registry (Ref: ISRCTN12084782).
Collapse
Affiliation(s)
| | - Sabrina F Norwood
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
| | - David Gillanders
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Anne M Finucane
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK.,Marie Curie Hospice, Edinburgh, UK
| | | | | | | | - Joseph Kreft
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
| | - Brooke Swash
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
| |
Collapse
|
23
|
Salari N, Rezaie L, Khazaie H, Bokaee S, Ghasemi H, Mohammadi M, Khaledi-Paveh B. The effect of acceptance and commitment therapy on anxiety and depression in patients with cancer: A systematic review. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01934-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
24
|
Li H, Wong CL, Jin X, Chen J, Chong YY, Bai Y. Effects of Acceptance and Commitment Therapy on health-related outcomes for patients with advanced cancer: A systematic review. Int J Nurs Stud 2021; 115:103876. [PMID: 33517079 DOI: 10.1016/j.ijnurstu.2021.103876] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Advanced cancer is an incurable and life-threatening disease that poses a major challenge to patients' psychological and physical well-being. Acceptance and Commitment Therapy is a mindfulness-based behavioural therapy for managing health outcomes and inducing health-related behaviour changes. However, the components and modality of Acceptance and Commitment Therapy and its effectiveness on health outcomes for patients with advanced cancer remain unclear. OBJECTIVES This review aimed to identify the main content, delivery mode, dosage and duration of Acceptance and Commitment Therapy, and to systematically summarise evidence regarding its application in patients with advanced cancer for improving physical and psychological outcomes and health-related quality of life. DESIGN Systematic review. DATA SOURCES PubMed, British Nursing Index, Medline, PsycINFO, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure and WANFANG Data were searched to identify eligible clinical trials. REVIEW METHODS Two reviewers independently assessed the eligibility of each study and extracted data. The Joanna Briggs Institute critical appraisal checklist was used to evaluate the risk of bias in the included studies. Narrative synthesis was used to present the findings of this review. RESULTS Six studies involving 261 participants were included in this review, including five randomised control trials and one with a pretest-posttest design. Two out of the five studies reported Acceptance and Commitment Therapy significantly reduced depressive symptoms and psychological distress post-intervention with a large effect size compared with usual care. One study indicated significant improvements in anxiety, sleep characteristics and health-related quality of life with a large effect size post-intervention. Non-significant changes in fatigue and pain were found. Intervention programmes with no more than four sessions had high adherence rates. CONCLUSION Acceptance and Commitment Therapy may be a beneficial way to improve depressive symptoms, anxiety, psychological distress, sleep characteristics and health-related quality of life in patients with advanced cancer. However, limited studies, small sample size and methodological heterogeneity weaken the evidence. More rigorous research using brief Acceptance and Commitment Therapy programmes should be conducted within larger samples to further confirm the effectiveness and evaluate its long-term effect on this population.
Collapse
Affiliation(s)
- Huiyuan Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
| | - Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
| | - Xiaohuan Jin
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
| | - Jieling Chen
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
| | - Yuen Yu Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
| | - Yang Bai
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
| |
Collapse
|
25
|
Kraemer KM, Luberto CM, Hall DL, Ngo LH, Yeh GY. A systematic review and meta-analysis of mindfulness- and acceptance-based interventions for affect intolerance/sensitivity. Behav Res Ther 2020; 135:103746. [PMID: 33011486 PMCID: PMC7943058 DOI: 10.1016/j.brat.2020.103746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/18/2022]
Abstract
Affect intolerance/sensitivity, defined as one's sensitivity to, or inability to tolerate, affective states, is a transdiagnostic process implicated in the development and maintenance of numerous forms of psychopathology. Mindfulness and acceptance interventions are posited to improve affect intolerance/sensitivity; however, there has been no quantitative synthesis of this research to date. Seven electronic databases were searched up until November 2018. Hedges' g values, 95% confidence intervals, p-values, and Q-values were calculated for a series of random-effects models. Twenty-five studies (pooled N = 1778) met eligibility criteria and were included in the qualitative synthesis (n = 22 included in the meta-analysis). There was a small, significant effect of mindfulness and acceptance interventions on improving affect intolerance/sensitivity from pre-to post-intervention (Hedges' g = -0.37, 95% CI = -0.52 to -0.23, p < .001), with effects maintained up to 6-months (Hedges' g = -0.35, 95% CI = -0.61 to -0.09, p < .01). There was a significantly larger effect for studies with inactive compared to active controls. No significant effect size differences were found for intervention length (<8 vs. ≥ 8 sessions), intervention type (mindfulness vs. acceptance) or sample type (clinical vs. non-clinical). Mindfulness and acceptance interventions modestly improve affect intolerance/sensitivity.
Collapse
Affiliation(s)
- Kristen M Kraemer
- Division of General Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, 330 Brookline Avenue, CO-1309, 2nd Floor, Boston, MA, 02215, USA.
| | - Christina M Luberto
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02108, USA.
| | - Daniel L Hall
- Division of General Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, 330 Brookline Avenue, CO-1309, 2nd Floor, Boston, MA, 02215, USA; Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02108, USA.
| | - Long H Ngo
- Division of General Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, 330 Brookline Avenue, CO-1309, 2nd Floor, Boston, MA, 02215, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Gloria Y Yeh
- Division of General Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, 330 Brookline Avenue, CO-1309, 2nd Floor, Boston, MA, 02215, USA.
| |
Collapse
|
26
|
Ballesio A, Bacaro V, Vacca M, Chirico A, Lucidi F, Riemann D, Baglioni C, Lombardo C. Does cognitive behaviour therapy for insomnia reduce repetitive negative thinking and sleep-related worry beliefs? A systematic review and meta-analysis. Sleep Med Rev 2020; 55:101378. [PMID: 32992228 DOI: 10.1016/j.smrv.2020.101378] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/19/2022]
Abstract
Repetitive negative thinking (RNT), i.e., worry, rumination, and transdiagnostic repetitive thinking, is thought to exacerbate and perpetuate insomnia in cognitive models. Moreover, RNT is a longitudinal precursor of depression and anxiety, which are often co-present alongside insomnia. Whilst accumulating evidence supports the efficacy of cognitive behavioural therapy for insomnia (CBT-I) in reducing depression and anxiety symptoms, the literature on the effects of CBT-I on RNT has never been systematically appraised. Importantly, preliminary evidence suggests that reduction of RNT following CBT-I may be associated with reduction of depression and anxiety. Therefore, we aimed to conduct a systematic review and meta-analysis on the effects of CBT-I on RNT. Seven databases were searched, and 15 randomised controlled trials were included. Results showed moderate-to-large effects of CBT-I on worry (Hedge's g range: -0.41 to g = -0.71) but small and non-reliable effects on rumination (g = -0.13). No clear evidence was found for an association between post-treatment reduction in RNT and post-treatment reduction in depression and anxiety. Although the literature is small and still developing, CBT-I seems to have a stronger impact on sleep-related versus general measures of RNT. We discuss a research agenda aimed at advancing the study of RNT in CBT-I trials.
Collapse
Affiliation(s)
- Andrea Ballesio
- Department of Psychology, Sapienza University of Rome, Italy; Department of Developmental and Social Psychology, Sapienza University of Rome, Italy.
| | - Valeria Bacaro
- Department of Human Sciences, University of Rome "G. Marconi"- Telematic, Italy
| | | | - Andrea Chirico
- Department of Developmental and Social Psychology, Sapienza University of Rome, Italy
| | - Fabio Lucidi
- Department of Developmental and Social Psychology, Sapienza University of Rome, Italy
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Chiara Baglioni
- Department of Human Sciences, University of Rome "G. Marconi"- Telematic, Italy; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | | |
Collapse
|
27
|
Salari N, Khazaie H, Hosseinian-Far A, Khaledi-Paveh B, Ghasemi H, Mohammadi M, Shohaimi S. The effect of acceptance and commitment therapy on insomnia and sleep quality: A systematic review. BMC Neurol 2020; 20:300. [PMID: 32791960 PMCID: PMC7425538 DOI: 10.1186/s12883-020-01883-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/10/2020] [Indexed: 01/11/2023] Open
Abstract
Background Acceptance and Commitment Therapy (ACT), as a type of behavioral therapy, attempts to respond to changes in people’s performance and their relationship to events. ACT can affect sleep quality by providing techniques to enhance the flexibility of patients’ thoughts, yet maintaining mindfullness. Therefore, for the first time, a systematic review on the effects of ACT on sleep quality has been conducted. Methods This systematic review was performed to determine the effect of ACT on insomnia and sleep quality. To collect articles, the PubMed, Web of Science (WOS), Cochrane library, Embase, Scopus, Science Direct, ProQuest, Mag Iran, Irandoc, and Google Scholar databases were searched, without a lower time-limit, and until April 2020. Results Related articles were derived from 9 research repositories, with no lower time-limit and until April 2020. After assessing 1409 collected studies, 278 repetitive studies were excluded. Moreover, following the primary and secondary evaluations of the remaining articles, 1112 other studies were removed, and finally a total of 19 intervention studies were included in the systematic review process. Within the remaining articles, a sample of 1577 people had been assessed for insomnia and sleep quality. Conclusion The results of this study indicate that ACT has a significant effect on primary and comorbid insomnia and sleep quality, and therefore, it can be used as an appropriate treatment method to control and improve insomnia.
Collapse
Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amin Hosseinian-Far
- Department of Business Systems & Operations, University of Northampton, Northampton, UK
| | - Behnam Khaledi-Paveh
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hooman Ghasemi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| |
Collapse
|
28
|
Buffart LM, Schreurs MAC, Abrahams HJG, Kalter J, Aaronson NK, Jacobsen PB, Newton RU, Courneya KS, Armes J, Arving C, Braamse AM, Brandberg Y, Dekker J, Ferguson RJ, Gielissen MF, Glimelius B, Goedendorp MM, Graves KD, Heiney SP, Horne R, Hunter MS, Johansson B, Northouse LL, Oldenburg HS, Prins JB, Savard J, van Beurden M, van den Berg SW, Brug J, Knoop H, Verdonck-de Leeuw IM. Effects and moderators of coping skills training on symptoms of depression and anxiety in patients with cancer: Aggregate data and individual patient data meta-analyses. Clin Psychol Rev 2020; 80:101882. [PMID: 32640368 DOI: 10.1016/j.cpr.2020.101882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/21/2020] [Accepted: 06/11/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE This study evaluated the effects of coping skills training (CST) on symptoms of depression and anxiety in cancer patients, and investigated moderators of the effects. METHODS Overall effects and intervention-related moderators were studied in meta-analyses of pooled aggregate data from 38 randomized controlled trials (RCTs). Patient-related moderators were examined using linear mixed-effect models with interaction tests on pooled individual patient data (n = 1953) from 15 of the RCTs. RESULTS CST had a statistically significant but small effect on depression (g = -0.31,95% confidence interval (CI) = -0.40;-0.22) and anxiety (g = -0.32,95%CI = -0.41;-0.24) symptoms. Effects on depression symptoms were significantly larger for interventions delivered face-to-face (p = .003), led by a psychologist (p = .02) and targeted to patients with psychological distress (p = .002). Significantly larger reductions in anxiety symptoms were found in younger patients (pinteraction < 0.025), with the largest reductions in patients <50 years (β = -0.31,95%CI = -0.44;-0.18) and no significant effects in patients ≥70 years. Effects of CST on depression (β = -0.16,95%CI = -0.25;-0.07) and anxiety (β = -0.24,95%CI = -0.33;-0.14) symptoms were significant in patients who received chemotherapy but not in patients who did not (pinteraction < 0.05). CONCLUSIONS CST significantly reduced symptoms of depression and anxiety in cancer patients, and particularly when delivered face-to-face, provided by a psychologist, targeted to patients with psychological distress, and given to patients who were younger and received chemotherapy.
Collapse
Affiliation(s)
- L M Buffart
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
| | - M A C Schreurs
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - H J G Abrahams
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - J Kalter
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands.
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - P B Jacobsen
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD, Florida, USA.
| | - R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
| | - K S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.
| | - J Armes
- School of Health Science, University of Surrey, Surrey, UK.
| | - C Arving
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - A M Braamse
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Y Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - J Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - R J Ferguson
- Division of Hematology-Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
| | | | - B Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - M M Goedendorp
- Department of Health Science, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - K D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
| | - S P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, USA.
| | - R Horne
- UCL School of Pharmacy, University College London, London, UK.
| | - M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - B Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - L L Northouse
- University of Michigan School of Nursing, Ann Arbor, MI, USA.
| | - H S Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - J B Prins
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands.
| | - J Savard
- School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, QC, Canada.
| | - M van Beurden
- Department of Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - S W van den Berg
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands.
| | - J Brug
- National Institute of Public Health and the Environment, Bilthoven, the Netherlands.
| | - H Knoop
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - I M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery and Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, the Netherlands.
| |
Collapse
|
29
|
Lin C, Kang SY, Donermeyer S, Teknos TN, Wells-Di Gregorio SM. Supportive Care Needs of Patients with Head and Neck Cancer Referred to Palliative Medicine. Otolaryngol Head Neck Surg 2020; 163:356-363. [PMID: 32178571 DOI: 10.1177/0194599820912029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Patients with head and neck cancer (HNC) face a unique set of unmet needs. A subset of these patients experience symptom control challenges related to their disease burden and treatments. A multidisciplinary approach involving palliative medicine is underutilized but crucial to identify and address these concerns. There is limited information on palliative integration with head and neck oncology. STUDY DESIGN Case series with planned data collection. SETTING Academic quaternary care center. SUBJECTS AND METHODS We provide descriptive analyses of patients with HNC, including psychodiagnostic assessment and validated quality-of-life screening, from patients' first encounter at outpatient palliative medicine. RESULTS HNC (N = 80) contributed the greatest number of palliative referrals (25%) between 2010 and 2012. This cohort was 74% male and 79% Caucasian with a mean age of 53 years (95% CI, 51.1-54.9) and with stage IV disease of the oral cavity (28%) or oropharynx (31%). Sixty-three percent of patients had no evidence of disease. Seventy-five percent had a psychological history based on DSM-IV criteria (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), and 70% had a history of substance use disorder. The most distressing quality-of-life concerns were pain, housing and financial problems, and xerostomia. CONCLUSIONS Patients with HNC who were referred to palliative medicine are burdened by multiple physical, psychological, substance use, and social challenges. We recommend comprehensive cancer-specific screening, such as the James Supportive Care Screening, to triage patients to appropriate supportive care services. Palliative care is one of many services that these patients may need, and it should be utilized at any point of the disease trajectory rather than reserved for end-of-life care.
Collapse
Affiliation(s)
- Chen Lin
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Samantha Donermeyer
- Department of Psychiatry and James Psychosocial Oncology, The Ohio State University, Columbus, Ohio
| | - Theodoros N Teknos
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | | |
Collapse
|
30
|
Long-term sleep disturbance and prescription sleep aid use among cancer survivors in the United States. Support Care Cancer 2019; 28:551-560. [DOI: 10.1007/s00520-019-04849-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 04/16/2019] [Indexed: 11/25/2022]
|