Exploring the relationship among dispositional optimism, health-related quality of life, and CIPN severity among colorectal cancer patients with chronic peripheral neuropathy

Patient-reported outcomes in cancer survivorship: insights from two decades of population-based PROFILES registry research

PURPOSE

When the field of cancer survivorship research was in its infancy, the PROFILES registry was set up in 2004 to monitor patient-reported outcomes (PROs) in survivors and a normative population. This scoping review aims to summarize lessons learned from developing a population-based PRO registry, focusing on study methodologies, data collection shifts, data utilization, multidisciplinary collaboration, societal impact, and data sharing.

METHODS

A systematic computerized literature search through PubMed was performed to collect all publications using data from the PROFILES registry between January 1, 2004, and December 31, 2023.

RESULTS

The PROFILES registry's research today encompassed 249 papers from 35 studies. Key insights include the importance of multi-hospital collaboration, which enhances participant inclusion and result generalizability. Optimizing response rates and patient inclusion is achieved through proactive data collection methods such as inclusion by health care professionals, and using both web-based and paper questionnaires. Longitudinal studies, despite their intensive data collection efforts, provide critical insights into the consequences of cancer and its treatment on patient-reported outcomes (PROs) from diagnosis through survivorship. Combining PRO data with comprehensive clinical registry data ensures reliable datasets, crucial for drawing meaningful conclusions. The shift towards multidisciplinary collaboration, open-access publishing, and data sharing all contribute to accessible and impactful research.

CONCLUSIONS

This review highlights key insights from the PROFILES registry, emphasizing multi-hospital collaboration, proactive data collection, and the integration of PROs with clinical data.

IMPLICATIONS FOR CANCER SURVIVORS

These lessons can guide future research on cancer survivorship, improving methodologies to enhance survivorship care and quality of life through multidisciplinary collaboration and data sharing.

Fluctuations in core depressive symptoms in colorectal cancer patients. A prospective, population-based PROFILES-registry study

PURPOSE

Research investigating depressive symptoms among cancer patients rarely distinguish between core symptoms of depression (motivational and consummatory anhedonia, and negative affect). This distinction is important as these symptoms may show different trajectories during the course of the illness and require different treatment approaches. The aim of the present study is to investigate fluctuations in core depressive symptoms in patients with colorectal cancer (CRC). It is hypothesized that these core depressive symptoms fluctuate differently during the course of the illness and depend on the phase of the illness (diagnostic, treatment, recovery and palliative phase).

METHOD

This study is based on data from the PROCORE study. PROCORE is a prospective, population-based study aimed to examine the longitudinal impact of CRC and its treatment on patient-reported outcomes. Eligible patients completed self-report questionnaires (i.e. Multifactorial Fatigue Index, Hospital Anxiety and Depression scale, EORTC-C30) after diagnosis, after surgery and at one and two years after diagnosis.

RESULTS

In total, 539 patients participated of whom 68 have died until March 1ste 2021. Core depressive symptoms fluctuated differently during the course of the illness with higher levels of motivational anhedonia during treatment and palliative phase (P<.001), consummatory anhedonia at the palliative phase (p < .001) and negative affect at the diagnostic and palliative phase (P<.001).

CONCLUSION

It is important to distinguish between different core depressive symptoms as they fluctuate differently during the course of an illness like CRC. The various depressive symptoms may require a different treatment approach at specific moments during the illness process.

Vitamin B6 status and chronic chemotherapy-induced peripheral neuropathy: a prospective cohort study among patients with non-metastatic colorectal cancer receiving oxaliplatin-based chemotherapy

Objective

Chronic chemotherapy-induced peripheral neuropathy (CIPN) is a long-lasting side-effect of oxaliplatin. Vitamin B6 might play a role in the pathogenesis of CIPN. Therefore, we investigated associations between plasma vitamin B6 markers and the occurrence and severity of chronic CIPN in patients with non-metastatic colorectal cancer (CRC).

Methods and analysis

242 patients with CRC receiving oxaliplatin-based chemotherapy were included. Blood samples were collected at diagnosis (ie, before chemotherapy), and 6 and 12 months after diagnosis (ie, during and after chemotherapy, respectively). Pyridoxal 5'-phosphate (PLP), pyridoxal (PL) and xanthurenic acid:3-hydroxykynurenine (XA:HK) ratio were measured as vitamin B6 markers using liquid chromatography tandem mass spectrometry. Chronic CIPN was assessed 12 months after diagnosis using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-CIPN twenty-item scale questionnaire. Prevalence ratios (PRs) and restricted cubic splines (RCSs) were used to assess associations with chronic CIPN occurrence, and linear regressions were used to assess associations with chronic CIPN severity. Analyses were adjusted for age, sex, smoking, alcohol consumption, diabetes and timing of chemotherapy (neoadjuvant/adjuvant/both).

Results

Chronic CIPN was found in 80% (n=194) of patients. Higher PLP levels and XA:HK ratios during chemotherapy were associated with lower occurrence of chronic CIPN (PRperdoubling 0.75, 95% CI 0.62 to 0.91 and PRCS<0.05, respectively) and lower chronic CIPN severity (βperdoubling -4.54, 95% CI -7.12 to -1.96 and βperdoubling -6.30, 95% CI -9.53 to -3.07, respectively). No associations between PL levels and chronic CIPN were observed.

Conclusion

Within this population, merely having PLP levels within the normal range, higher vitamin B6 status during chemotherapy was associated with lower occurrence and severity of chronic CIPN. Future research is warranted to investigate causality and the optimal vitamin B6 status during chemotherapy.

The effect of cognitive behavioral therapy on chemotherapy-induced side effects and immune function in colorectal cancer patients undergoing chemotherapy: study protocol for a randomized controlled trial

Background

Colorectal cancer (CRC) was one of the most widely diagnosed cancers in the United States in 2021. CRC patients may experience significant psychological stress and are susceptible to depression and anxiety. Previous studies have shown that cognitive behavioral therapy (CBT) can reduce fatigue and improve quality of life among breast cancer patients. However, as a non-pharmaceutical treatment, it remains unclear whether CBT improves chemotherapy-induced side effects and immune function in CRC patients. In this study, we will conduct a randomized controlled trial (RCT) among CRC patients undergoing chemotherapy to determine whether CBT can reduce the side effects of chemotherapy and improve the immune function of CRC patients.

Methods

The study will be a single-center RCT. CRC patients undergoing chemotherapy will receive either eight sessions of group-based CBT (every 2-3 weeks) or usual care (usual oncology care). Each participant will undergo assessments at baseline (T0), immediately post-intervention (T1), 3 months post-intervention (T2), and 6 months post-intervention (T3). The primary outcome will include chemotherapy-induced side effects in CRC patients. The secondary outcome will be immune function (measured by levels of inflammatory cytokines). Other outcomes will include the levels of tumor markers, assessments of psychological status (perception of stress, depression and anxiety, self-efficacy, sleep quality, quality of life, social support condition, and cognitive function), and necessary laboratory examinations (biochemical index and blood cell counts) among CRC patients undergoing chemotherapy.

Discussion

Our study will provide clinical evidence regarding whether CBT should be generalized in clinical treatment and the extent to which CBT reduces chemotherapy-induced side effects for CRC patients.

Trial Registration

ClinicalTrials.gov registration number NCT04741308.

Chemotherapy-induced polyneuropathy in cancer care-the patient perspective

PURPOSE

Chemotherapy-related polyneuropathy (CIPN) is a very common, often dose-limiting side effect that affects the patients' quality of life. Treatment usually consists of a combination of medicinal, medical, and individualized treatment approaches, although the effectiveness of these therapies is insufficient for many patients. The aim of this article is to review and evaluate the impact of CIPN on patients' daily lives and possible effective treatment approaches.

METHODS

A standardized questionnaire was developed based on ten anonymous telephone interviews with CIPN patients. The content of the questionnaire was divided into 5 categories: demographics, clinical presentation, everyday symptoms, treatment of CIPN symptoms, and medical care. Mostly closed questions were used but multiple choice and individual additions by free text answers were possible.

RESULTS

CIPN limits patients' quality of life over a long period of time. In addition to diurnal and situational fluctuations, the emotional burden negatively affects patients' daily lives in many ways. From the patients' point of view, the individually implemented therapy measures were most effective in treating their complaints. But even the combination of different therapy methods insufficiently alleviates the symptoms of the patients.

CONCLUSION

It is important and necessary to comprehensively inform patients about CIPN as a possible side effect, to point out prevention strategies, and to critically examine and evaluate different therapy approaches. In this way, misunderstandings of the doctor-patient relationship can be avoided. In addition, patient satisfaction and quality of life can be increased in the long term.

The effect of Augmented-Reality media-based health education on healthy lifestyle knowledge, attitude, and healthy lifestyle behaviors among pregnant women during COVID-19 pandemic in Jakarta, Indonesia

Pregnancy is a critical period. Pregnant women need to perform healthy lifestyle behavior in order to ensure good fetal development. During COVID-19 pandemic, Augmented-Reality (AR) media may be used in pregnant women health education. However, there is a lack of research that investigated the effect of AR media use in pregnant women health education. Therefore, this research aimed to investigate the impact of AR media use on healthy lifestyle knowledge, attitude, and behaviors among pregnant women during COVID-19 pandemic. This cohort-longitudinal study involved 86 pregnant women aged 18-45 years. The subjects who participated in this research received health education interventions using AR media for 5 months. The data collection was performed at the pre-post-intervention through a survey with questionnaire. Changes in subjects' healthy lifestyle knowledge, attitude, and behaviors were analyzed by using t-test. The research results show that the AR media use in health education significantly improved the subjects' scores for healthy lifestyle knowledge (5.0 ± 10.9; p < .05) and behaviors (9.7 ± 17.5; p < .05). However, the subject score for attitude was not significantly improved (0.3 ± 7.1; p ≥ .05). This research results provide evidence of the importance of using AR media in health education for pregnant women during COVID-19 pandemic.

Post-traumatic Stress Symptoms, Distress, and Optimism in Mexican Colorectal Cancer Patients

Background

The diagnosis and treatment of colorectal cancer are considered highly stressful and potentially traumatic events that can generate post-traumatic stress symptoms and distress among patients.

Objective

This study assessed levels of post-traumatic stress symptoms, distress, and optimism, as well as differences between these conditions relative to sociodemographic and medical variables, in Mexican patients with colorectal cancer.

Design

A cross-sectional descriptive study design was employed, in which 192 colorectal cancer patients over the age of 18 years participated. They filled out the following questionnaires in person: a sociodemographic and medical data questionnaire; the Event Impact Scale-Revised (EIE-R); the Hospital Anxiety and Depression Scale (HADS); and the Life Orientation Test (LOT-R).

Results

The results showed that 32.3% of the patients reported post-traumatic stress symptomatology, and 21.4% reported distress. Post-traumatic stress symptoms and distress varied according to age and monthly income. Significant differences between the sexes were also observed in the levels of post-traumatic stress symptoms and distress. Post-traumatic stress was positively and significantly related to distress, and negatively and significantly to optimism.

Conclusion

Based on these data, we concluded that a significant percentage of colorectal cancer patients present high levels of post-traumatic stress symptoms as well as distress, and that these levels may vary according to sociodemographic and medical characteristics.

Psychosocial adaptation and influencing factors among patients with chemotherapy-induced peripheral neuropathy

BACKGROUND

Chemotherapy-induced peripheral neuropathy (CIPN) is a severe and long-lasting side effect caused by various anticancer agents that damage sensory, motor and autonomic nerves. It can cause maladaptive behaviors, including disease severity, anxiety, depression, sleep disorders, falls, and social impairment. These disorders have physical, psychological and social effects on patients and can seriously influence their quality of life.

AIM

To investigate the current situation of psychosocial adaptation to the disease and its influencing factor in patients with CIPN.

METHODS

A convenience sampling method was used to select 233 patients with CIPN in our hospital from February to August 2021. In addition, a cross-sectional survey was conducted using a sociodemographic questionnaire, the Self-Report Psychosocial Adjustment to Illness Scale, and the European Organisation for the Research and Treatment of Cancer Quality of Life CIPN20 (QLQ-CIPN20). Factors influencing psychosocial adaptation in patients with CIPN were analyzed by t-test or one-way analysis of variance, correlation analysis, multiple stepwise regression analysis, and structural equation models.

RESULTS

The psychosocial adaptation score of patients with CIPN was 52.51 ± 13.18. Multivariate analysis showed that autonomic nerves, tumor stage, motor nerves, education level, availability of caregivers, semi-retirement status, CIPN grade were independent risk factors for patients with CIPN (P < 0.05). Structural equation models showed that QLQ-CIPN20 mediated the relationship between CIPN grade, tumor stage, and psychosocial adaptation.

CONCLUSION

Patients with CIPN have poor psychosocial adaptation and are affected by a variety of physiological, psychological, and social factors. Patients’ adaptive responses should be assessed, and targeted interventions implemented.

Study on the Conduction Analysis and Blocking Intervention Scheme of Emotional Disorders between Cancer Patients and Their Families

Objective

To analyze the transmission and blocking intervention scheme of emotional disorders between cancer patients and their families.

Methods

About 150 patients with cancer and 150 family members with mood disorders treated in a tertiary hospital in North China from March 2021 to Octobor2021 were enrolled. The patients were randomly assigned into control group and study group. The control group received routine intervention, and the study group received the diagnosis, intervention, and treatment strategies of doctor-patient-affective disorder. The factors related to the transmission of emotional disorders between cancer patients and their families were analyzed, and the alterations of anxiety, depression, social support, and satisfaction of the two groups were compared under different blocking intervention schemes.

Results

(1) Univariate analysis indicated that there were significant differences in family age, family income, sex, location of tumor, course of disease, TNM stage, somatic symptoms, and the incidence of anxiety and depression. There exhibited no significant difference between the gender of the family, the years of education of the family, the occupational status of the family, the relationship between the family and the patient, the mode of payment of the patient's medical expenses, the age of the patient, the mode of treatment of the patient, the degree of knowledge of the disease, and the incidence of anxiety and depression (P > 0.05). The anxiety and depression status of relatives were taken as dependent variables, and the age of family members, family income status, sex of patients, location of tumor, course of disease, TNM stage, and physical symptoms of patients were taken as independent variables, and the data were analyzed by Logistic regression analysis. Logistic regression analysis indicated that family income, tumor location, disease course, TNM stage, and somatic symptoms were the risk factors of anxiety and depression in relatives. (2) Comparison of social support status and intergroup, the objective support, subjective support, support utilization, and total score of social support in the study group were higher compared to the control group. In terms of the depression score before intervention, there exhibited no significant difference (P > 0.05), but after intervention, the depression score of the two groups decreased, and the depression score of the study group was lower compared to the control group before intervention, 1 week, 2 weeks, 3 weeks, and 4 weeks after intervention (P < 0.05). In terms of the anxiety score before intervention, there exhibited no significant difference (P > 0.05), but after intervention, the anxiety score of the two groups decreased, and the anxiety score of the study group was lower compared to the control group before intervention, 1 week, 2 weeks, 3 weeks, and 4 weeks after intervention (P < 0.05). Comparison of the satisfaction between the two groups and the study group was very satisfied in 56 cases, satisfactory in 14 cases, and general in 5 cases, and the satisfaction rate was 100.00%. The control group was very satisfied in 35 cases, satisfactory in 23 cases, general in 12 cases, and dissatisfied in 5 cases, and the satisfaction rate was 93.33%. The satisfaction of the study group was higher compared to the control group (P < 0.05).

Conclusion

Family income, tumor location, course of disease, TNM stage, and somatic symptoms are the risk factors of anxiety and depression in relatives. After establishing the diagnosis, intervention and treatment strategies of doctor-patient-affective disorder, the emotional disorder of family members of cancer patients, is significantly promoted, and the intervention satisfaction is high, so the scheme is worth promoting.

A Qualitative Study on Coping Strategies of Chinese Women With Metastatic Breast Cancer Undergoing Chemotherapy

Objectives

Women who underwent chemotherapy (CT) for metastatic breast cancer (MBC) used both adaptive and maladaptive coping strategies but had low implementation levels. The present study explores the qualitative experience of coping strategies for women with MBC undergoing CT in Beijing.

Methods

A hermeneutic phenomenological approach was employed on twenty Chinese MBC women undergoing CT. These interviews were transcribed verbatim, coded using thematic analysis, and analyzed using NVivo 11.

Results

Three themes are highlighted: Maintaining hope; Spiritual growth, and Self-perceived support resources.

Conclusion

The present study results have led to a greater understanding of the tremendous impact of CT on MBC women’s lives. This research provides insight into the scope of maintaining hope. Spiritual growth and self-perceived support resources were crucial factors to coping strategies among MBC women to improve their quality of life.

Clinical Relevance

By attaining the adaptive coping strategies and further understanding about Chinese MBC women, health care professionals are encouraged to appraise MBC women’s specific problems and adopt effective interventions to improve MBC women’s psychosocial wellbeing.

Symptoms of pre-treatment anxiety are associated with the development of chronic peripheral neuropathy among colorectal cancer patients

PURPOSE

Identifying potentially modifiable predictors of chronic (chemotherapy-induced) peripheral neuropathy (PN) is important, especially in light of the limited treatment options. We aimed to examine pre-treatment anxiety and depressive symptoms as predictors of chronic PN symptom severity in colorectal cancer (CRC) patients up to 2 years after diagnosis.

METHODS

Newly diagnosed CRC patients from four Dutch hospitals were eligible for participation. Patients (N = 336) completed a questionnaire on anxiety and depressive symptoms (HADS) and sensory (SPN) and motor peripheral neuropathy (MPN) (EORTC QLQ-CIPN20) before initial treatment (baseline) and 1 and 2 years after diagnosis. Patients were included in the analyses if they either developed some level of SPN or MPN symptoms, or experienced a worsening of pre-treatment SPN or MPN symptoms.

RESULTS

At 1-year follow-up, 115 patients (34%) reported SPN symptoms and 134 patients (40%) reported MPN symptoms. Of these patients, SPN and MPN symptoms had not returned to baseline level at 2-year follow-up in, respectively, 51% and 54% of patients. In multivariable regression analyses, neither pre-treatment anxiety symptoms nor pre-treatment depressive symptoms were associated with SPN or MPN symptom severity at 1-year follow-up. At 2-year follow-up, pre-treatment anxiety symptoms (β = 0.44, p = 0.01), but not depressive symptoms, were associated with SPN symptom severity.

CONCLUSIONS

Pre-treatment anxiety symptoms, but not depressive symptoms, were associated with SPN symptom severity 2 years after diagnosis. Future studies are needed that assess whether interventions targeted to reduce anxiety before and during treatment can reduce chronic PN severity or even prevent the persistence of PN.

Mindfulness is associated with severity of peripheral neuropathy and related patient-reported outcomes among colorectal cancer patients

PURPOSE

Despite the detrimental impact of chronic (chemotherapy-induced) peripheral neuropathy PN on patients' lives, treatment options remain limited. We examined the association between mindfulness and chronic PN symptom severity and impairments in related patient-reported outcomes (PROs) among colorectal cancer (CRC) patients up to 2 years after diagnosis.

METHODS

Newly diagnosed stage I-IV CRC patients from four Dutch hospitals were eligible for participation. Patients (N = 336) completed a questionnaire on mindfulness (MAAS) at 1 year after diagnosis, and questionnaires on sensory (SPN) and motor peripheral neuropathy (MPN) (EORTC QLQ-CIPN20), anxiety and depressive symptoms (HADS), sleep quality (PSQI), and fatigue (EORTC QLQ-C30) before initial treatment (baseline) and 1 and 2 years after diagnosis.

RESULTS

At 1-year follow-up, 115 patients (34%) and 134 patients (40%), respectively, reported SPN or MPN symptoms. In multivariable regression analyses, higher mindfulness at 1-year follow-up was associated with less severe MPN and fewer anxiety and depressive symptoms, better sleep quality, and less fatigue. Of the patients with SPN or MPN at 1-year follow-up, symptoms had not returned to baseline level at 2-year follow-up in 59 (51%) and 72 (54%) patients, respectively. In this subgroup, higher mindfulness was associated with less severe SPN and fewer anxiety symptoms, depressive symptoms, and fatigue at 2-year follow-up.

CONCLUSION

Mindfulness was associated with less severe PN and better related PROs among CRC patients with chronic PN. More research is needed to examine the role of mindfulness in the transition from acute to chronic PN.

Association between peripheral neuropathy and sleep quality among colorectal cancer patients from diagnosis until 2-year follow-up: results from the PROFILES registry

PURPOSE

Studies on the association between peripheral neuropathy (PN) and patient-reported outcomes have mostly overlooked sleep quality. Therefore, we aimed to assess the association between PN and sleep quality in a population-based sample of colorectal cancer (CRC) patients up 2 years after diagnosis.

METHODS

All newly diagnosed CRC patients from four Dutch hospitals were eligible for participation. Patients (N = 340) completed questionnaires about PN (EORTC QLQ-CIPN20) and sleep (PSQI) before initial treatment (baseline) and 1 and 2 years after diagnosis.

RESULTS

Patients who developed sensory PN (n = 76) or motor PN (n = 79) after treatment more often reported poor sleeping scores (PSQI > 5) compared with those who did not develop SPN or MPN at 1-year (SPN: 38% vs. 261%, MPN: 37% vs. 14%) and 2-year follow-up (SPN: 38 vs. 23%, MPN: 37% vs. 18%) (all p < 0.05). Overall, results showed that among patients who did not develop SPN or MPN, sleep quality improved after baseline, while among patients with SPN or MPN, sleep quality did not improve at one and two years after diagnosis.

CONCLUSIONS

Both SPN and MPN were significantly associated with the course of sleep quality among CRC patients up to 2 years after diagnosis. Clinicians should be encouraged to discuss sleep quality with their patients who either report PN or are at risk of developing PN.

IMPLICATIONS FOR CANCER SURVIVORS

Improving sleep quality among survivors with PN is important, either by reducing PN symptoms or directly targeting sleep.