Psychological aspects of cancer and chemotherapy

Information Needs and Its Association With Depressive Symptoms in People With Type 2 Diabetes

PURPOSE

The purpose of this study was to describe the information needs and examine its association with depressive symptoms in people with type 2 diabetes (T2D).

METHODS

A descriptive, correlational design was used. People with T2D (N = 358) were recruited from 12 communities in Shanghai, China. Self-reported information needs and depressive symptoms were measured using the Information Needs in Diabetes Questionnaire and Patient Health Questionnaire-9 (PHQ-9), respectively. Multivariate linear regression analysis was performed.

RESULTS

The participants were 64.8 years on average, and 46.6% were men. One hundred fifty-one (42.2%) had depressive symptoms (PHQ-9 ≥ 5). Participants had the least knowledge about "diabetes research," "acute complications," and "lifestyle adjustment." The sample had the highest levels of information needs about topics including "mental strain," "treatment/therapy," and "diabetes in everyday life." Compared to those without depressive symptoms, those experiencing depressive symptoms were less informed and had higher levels of need for further information. Controlling for covariates, higher levels of need for further information were significantly associated with greater depressive symptoms (B = 0.368, 95% CI, 0.155-0.582, P = .001).

CONCLUSIONS

This study demonstrated areas that should be prioritized when meeting patients' information needs. It also showed the potential negative effect of unmet information needs on depression. These findings may help develop a more tailored intervention for people with T2D.

Anxiety, depression and quality of life after cancer diagnosis: what psychosocial variables best predict how patients adjust?

OBJECTIVE

Significant numbers of cancer patients suffer distress, reduced quality of life and various other psychological problems. Evidence regarding psychological predictors of these outcomes is inconsistent. This study explored a range of predictors using an established psychological framework to identify the most important predictors of cancer adjustment, and when these are best assessed for optimal outcome prediction.

METHODS

One hundred sixty newly diagnosed breast, colorectal, lung and prostate cancer patients completed questionnaires after diagnosis and at 3- and 6-month follow-up. Measures included personality, illness cognitions, emotion, coping and outcome (anxiety, depression and quality of life).

RESULTS

Between 47-74% of variance in psychosocial outcome was explained although large proportions were accounted for by clinical factors, demographics and earlier levels of anxiety, depression and quality of life. Of the psychological variables, cognitive appraisals featured more consistently then either emotions or coping.

CONCLUSIONS

There are clear and consistent predictors of negative psychosocial outcome that could be used in clinical practice to risk-assess and monitor patients for adjustment difficulties. The finding that appraisals were more predictive of outcome than emotions and coping may inform the development of psychological interventions for cancer patients.

A longitudinal investigation of coping and posttraumatic growth in breast cancer survivors

This study supported several predictions for coping and distress during chemotherapy (Time 1), and coping, perceived stress, and posttraumatic growth two years later (Time 2) in women with breast cancer. At T1, the emotion-focused coping strategies of disengagement, denial, self-blame, and venting were positively related to physical and psychological distress. In addition, the cognitive strategies of religion, positive reframing, and acceptance together accounted for a significant amount of the variance in fatigue and distressed mood. Positive reframing and acceptance negatively related to chemotherapy distress, while using religion positively related. However, using religion at chemotherapy (T1) related to more posttraumatic growth at two-year follow-up (T2). Furthermore, at two-year follow-up, (1) using religion, positive reframing, and acceptance accounted for forty-six percent (46%) of the variance in posttraumatic growth; (2) positive reframing related to more posttraumatic growth; (3) instrumental and emotional support related to more posttraumatic growth; (4) acceptance related to less perceived stress; (5) self-blame related to more perceived stress; and (6) posttraumatic growth marginally related to lower perceived stress. These findings support the current theoretical model that posttraumatic growth is adaptive, that it results from cognitively processing trauma, and that coping may moderate this growth.

Depressive und Angststörungen bei somatischen Krankheiten

Depressiv-ängstliche Störungen sind bei den unterschiedlichen somatischen Erkrankungen häufig. Sie sind nicht nur als Reaktion auf die Situation der Erkrankung zu verstehen, sondern in ein komplexes Bedingungsgefüge eingebettet. Sie sind besonders häufig bei Erkrankungen, die das Zentralnervensystem oder endokrine Regulationssysteme direkt betreffen. Es besteht ein enger Zusammenhang zur Chronizität, Schwere und Prognose der Erkrankung. Eigenständige Effekte von diversen pharmakologischen Substanzgruppen sind wahrscheinlich.

Anticipating an altered appearance: Women undergoing chemotherapy treatment for breast cancer

Chemotherapy treatment for cancer can have a profound impact on appearance, and is often experienced as distressing. Few qualitative studies explore experiences of chemotherapy, and seldom focus on the process of anticipation and preparation for an altered appearance. We report findings from an interview study of 19 women which explored their expectations of chemotherapy-induced hair loss, their anticipated reactions to hair loss and how women intend to prepare for an altered appearance. The results demonstrate that women are active in anticipating hair loss and adopt a range of different strategies to manage their alopecia--even before it has occurred. Four key themes were identified: (a) anticipating hair loss, (b) coming to terms with the inevitability of hair loss, (c) becoming ready, and (d) taking control. We argue that this can be seen as a form of anticipatory coping, which involves affective and behavioural rehearsal so that women can feel more in control of their experience of the side effects of chemotherapy treatment for cancer. We suggest seeing these activities as a form of anticipatory coping, and understanding the psychological reasons why women engage in these activities, may help nursing professionals to better support women through this often traumatic time.

Distress and coping in cancer patients: feasibility of the Icelandic version of BSI 18 and the WOC-CA questionnaires

The aim of this study was to test the feasibility of two instruments within an Icelandic context, the Brief Symptom Inventory 18 (BSI 18) and the Ways of Coping Inventory--Cancer Version (WOC-CA) with specific focus on gender and type of treatment and coping techniques among cancer patients during time of treatment. The sample consisted of 40 cancer patients in three oncology outpatient clinics in Iceland, 53% were women and 47% men. The majority of the participants belonged to the age group 51-70. Cronbach alpha, means, confidence intervals and standard deviations were used for analysis as well as Mann-Whitney U-test for testing differences between genders in relation to psychological distress and coping. Anxiety was the factor causing the greatest distress, mainly reported by patients receiving chemotherapy. More women experienced depression than men, women (18.4%), men (8.3%). Distancing was the most frequently reported coping strategy, and men seemed to focus on the positive side more often than women did (P < 0.01). Although the results should be approached with caution, as the sample size was small, they do provide support for the strength of the measurements. Also the findings indicate that gender differences should be taken into account.

Short-term monitoring of cognitive functions before and during the first course of treatment

PURPOSE

Side effects of chemotherapy on cognitive functions in older patients have rarely been investigated. Addressing this lack of research, the present study evaluated cognitive functions in older cancer patients.

METHODS

A total of 130 younger (n=59; age<60) and older (n=71; age>or=60) cancer patients with hematological disease or cancer of the intestinal tract took part in the study. To explore short-term effects of chemotherapy, a group of patients assessed before the start of chemotherapy was compared with patients who already received their first course of chemotherapy.

RESULTS

Cognitive impairments of verbal learning, word fluency, and memory were observed following the first few days after treatment onset. Older patients showed stronger memory impairments after start of chemotherapy than younger cancer patients. Additionally, depression was neither associated with short-term effect of chemotherapy nor with age.

CONCLUSIONS

The results suggest that chemotherapy has negative short-term effects on some cognitive functions. But age-dependent effects were only found for memory.

Medium-term effects of chemotherapy in older cancer patients

PURPOSE

To address the lack of research in older cancer patients, the present study prospectively evaluated their cognitive functions across the first six months following diagnosis and chemotherapy.

PATIENTS AND METHODS

A total of 77 younger (n=43, age < 60) and older (n=34, age > or = 60) cancer patients with hematological disease or cancer of the intestinal tract took part in the study. Medium-term effects of chemotherapy were examined in these cancer patients by means of a battery of cognitive tests during baseline and six months after start of treatment.

RESULTS

In contrast to baseline verbal learning, word fluency and memory capacity improved in all patients six months after start of treatment. A negative effect of age on cognitive functions could not be demonstrated. Additionally, depression was neither associated with medium-term effects of chemotherapy nor was it related to age.

CONCLUSION

The results suggest that chemotherapy has no negative effects on cognitive functions after the first six months following the onset of treatment. It was demonstrated that complete recovery of cognitive functions is independent of the patient's age.

Cancer caregiving and subjective stress: a multi-site, multi-dimensional analysis

Although research has emerged documenting the psychosocial impact of family care for cancer patients, few efforts capture the multi-dimensional nature of cancer caregiving stress, particularly among socioeconomically diverse samples. Utilizing data collected from cancer caregivers at a non-urban, Southern US site and an inner-city, Northeastern US site (N=233), the present study identified predictors of multiple dimensions of caregivers' subjective stress (i.e. emotional appraisals of care demands). Various indicators representing the sociodemographic context of care, cancer care demands, and psychosocial resources were found to exacerbate or buffer caregivers from feelings of exhaustion, role entrapment, and loss of intimacy with the cancer patient. The multivariate regression model also emphasized the diffuse yet potent role care recipient mood problems and caregiver mastery/optimism have on multiple dimensions of subjective stress. The findings offer a number of recommendations for future research and practice focused on informal cancer care.

Measuring information needs among cancer patients

A scale for assessing information needs of cancer patients was constructed and validated. Two studies were conducted. Study 1 was designed to test the factor structure of the measurement instrument. A total of 498 patients with breast cancer and Hodgkin disease were interviewed. In study 2, 133 patients with head and neck cancer were measured just before treatment as well as 6, 13 and 52 weeks after treatment. Study 2 aimed to confirm the factor structure established in study 1, and to test for construct validity in a new population, the psychometric properties of the information needs scales, and the scales' sensitivity to change. In study 1 a two-factor structure (an action and a disease-oriented scale) including 17 items was revealed. The second study confirmed the factor structure from study 1. As hypothesized, greater information needs related to higher levels of state-anxiety, more depression, and more psychological complaints. Although, correlations over time per information need scale indicate some stability of scores, findings suggested that the need for information about disease and treatment is less stable over time than need for information about access to help and solutions. Further validation of the instrument is required.

Consumer participation in the development of psychosocial clinical practice guidelines: opinions of women with breast cancer

Clinical practice guidelines are playing an increasingly important role in defining quality care and consumers have a considerable interest in participating in the development of guidelines. The objective of this study was to explore consumer's perceptions of guideline items relating to psychosocial care of women with breast cancer, developed by Australia's National Health and Medical Research Council National Breast Cancer Centre. Women diagnosed with breast cancer in the previous 2 years (n = 313) received a letter about the study via their radiation oncologist. Consenting women were contacted by the researchers to complete a telephone survey. The survey asked women to rate the importance of draft guidelines items, including discussing prognosis, providing information and choice, doctor-patient communication, preparation for surgery, providing emotional support, providing social support, dealing with practical and cultural issues and continuity of care. One hundred and forty women (45%) completed the survey. The results indicated that at least 50% of respondents rated 28 of the 52 items as 'essential' components, with respondents identifying providing information and choice, and doctor-patient communication as the most important aspects of psychosocial care. The findings suggest the guidelines adequately reflect consumer opinions and identify priority areas for clinicians to address in providing psychosocial support to women with breast cancer.

The psychosocial burden of caring for some Nigerian women with breast cancer and cervical cancer

In Nigeria, the rising incidence of cancer and the paucity of institutional facilities and specialist man-power implies that the burden of care rests largely on relatives. We assessed the severity of indices of psycho-social and economic burden among relatives of women with breast and cervical cancer; and its relationship with patients' psychosocial distress. Using a burden questionnaire, relatives of 73 women with cancer (41 cervical and 32 breast, mean age of caregivers 35.6 years) were interviewed, in out-patient clinics. While the caregivers admitted high frequency of all indices of 'objective' burden, emotional ties at home and social relationships in the neighbourhood seemed intact, indicating tolerance and lack of social stigma. The financial burden was more problematic than the effect of caring on family routines; and these two factors significantly predicted global rating of burden. The severity of patient's worries and psychopathological symptoms were not significantly correlated with care-giver global rating of burden. The tolerance shown by this group of relatives implies that they have strong potentials for playing useful roles in community care of patients.

Exercise in the rehabilitation of breast cancer survivors

With the increase in the number of women who have survived breast cancer, there is a growing need to attend to the physical and emotional effects of cancer and its treatment as experienced by these survivors. Psychological distress, fatigue, weight gain, premature menopause and changes in body image are some of the long-term sequelae of breast cancer. Exercise as an adjunctive treatment may help to attenuate these effects and thereby contribute to rehabilitation of women with breast cancer. We present data from the exercise literature and from studies on breast cancer patients that support this role of exercise. Following a critique of the research efforts, we present a brief outline of questions that should be addressed in evaluating the role of exercise in cancer rehabilitation.

Psychological sequelae of cancer diagnosis: a meta-analytical review of 58 studies after 1980

OBJECTIVE

In a review of the literature from 1980 to 1994 on psychological and psychiatric problems in patients with cancer, the prevalence, severity, and the course of these problems (i.e., depression, anxiety, and general psychological distress) were studied with the help of meta-analyses and qualitative analyses. Apart from this, qualitative analyses were also applied with respect to other relevant variables.

METHOD

A literature search in MEDLINE was conducted and cross-references of articles identified via MEDLINE. Meta-analysis was applied when possible.

RESULTS

There seemed to be a wide variation across studies in psychological and psychiatric problems. Meta-analysis showed no significant differences between cancer patients and the normal population with respect to anxiety and psychological distress. However, cancer patients seemed to be significantly more depressed than normals. Compared with psychiatric patients, cancer patients were significantly less depressed, anxious, or distressed. Compared with a sample of other medical patients, cancer patients showed significantly less anxiety. With respect to course, a significant decrease was found in the meta-analysis for anxiety, but not for depression. Further meta-analyses showed significant differences among groups of cancer patients with regard to tumor site, sex, age, design of the study, and year of publication. From the qualitative analyses, it seemed that medical, sociodemographic, and psychological variables were related inconsistently to psychological and psychiatric problems.

CONCLUSION

With the exception of depression, the amount of psychological and psychiatric problems in patients with cancer does not differ from the normal population. The amount of psychological and psychiatric problems is significantly less in cancer patients than in psychiatric patients. The amount of anxiety is significantly less in cancer patients than in other groups of medical patients with mixed diagnoses, whereas depression is not. Future studies should aim at exploring possible causes for the sometimes impressive differences in psychological or psychiatric problems among patients with cancer.

Alternative therapies and control for health in cancer and AIDS

People who are coping with AIDS and many forms of cancer have a sense of being out of control in dealing with their diseases. This stems, to a great degree, from the uncertainty that they feel relative to the accepted medical treatment for their disease. Informants in this naturalistic research study were adamant in their belief that alternative therapies helped them to regain a sense of control over their care and, thus, enhanced their health. It is important that clinical nurse specialists, who often serve as consultants to other nurses, understand and support their patients' choices of therapy. In addition, with evidence to support the benefit of stress reduction on length of survival, advanced practice nurses can play a key role in helping patients reduce stress and, hopefully, effect longevity and quality of life.

Evaluation by multidimensional instruments of health-related quality of life of elderly cancer patients undergoing three different "psychosocial" treatment approaches. A randomized clinical trial

Our study belongs to the clinical trials in which the health-related quality of life (HQL) evaluation constitutes the primary endpoint. It was carried out with the aim of comparing the impact of three different types of psychological intervention, namely a psychopharmacological treatment alone, the same treatment plus social support carried out by volunteers (SSV) and a third treatment modality including "structured psychotherapy" (autogenous training), on improving the HQL of elderly cancer patients undergoing antineoplastic therapy with symptoms of anxiety and/or depression related to their disease. The eight questionnaires used for HQL evaluation were generally self-rated and multidimensional but unidimensional models were also employed. Seventy-four patients aged over 65 years with either solid tumors in different sites or hematological malignancies, generally in advanced stages (III-IV), were enrolled in the study. Of these patients, 72 (42 men and 30 women, mean age 70.68 years, range 66-85) were evaluable. Our study highlighted the usefulness of the pharmacological therapy (alprazolam + sulpiride) and of other specific ancillary treatments in reducing the incidence of the main HQL-related side-effects of antineoplastic therapy and the superiority of an "integrated" strategy, based both on psychopharmacology and psychosocial interventions, such as SSV with or without structured psychotherapy. The one-way analysis of variance carried out by us did not allow us to draw definitive conclusions about which of the two integrated treatments was to be considered the treatment of choice, as they proved to be almost equally effective.

Women's perceptions of their experiences with breast cancer: are their needs being addressed?

Breast cancer is the major cause of female deaths in Western Europe. In the United Kingdom, one woman in 14 is liable to develop this disease. An increasing emphasis on recognizing survival from cancer and remission periods of up to 20 years for breast cancer has important implications for health-care professionals. Care and support should effectively meet patients' needs to enable them to cope with the impact of a breast cancer diagnosis. This paper provides an overview of selected literature on women's experiences of breast cancer. It places particular emphasis on their perceptions of the information they received about the disease and its treatment, and their perceptions of the support available to them. The overview illustrates the problem of inadequacies in the information and support currently available to women with breast cancer. The necessity for a more comprehensive and sensitive assessment of these women's needs is emphasized and suggestions are made for the direction of future research in this area.

Person variables and health: personality predispositions and acute psychological states as shared determinants for disease

This article reviews prospective evidence linking certain classes of person variables to multiple disease end points. Included in the review is a consideration of the effects of hostility and anger, emotional suppression, depression, fatalism, and pessimism on coronary heart disease, cancer, and acquired immunodeficiency syndrome. A model is presented that integrates several of these variables into an overall conceptual scheme. In addition, several variables are identified that appear to moderate the strength of the relationships that are found between person variables and health. The article concludes with some suggested directions for future research.

A problem solving intervention for caregivers of cancer patients

Effects of a psychosocial intervention program on spouses of cancer patients, and on the cancer patients themselves, will be described. A six session intervention program, which included support, problem-solving and coping skills, was designed to help spouses to cope with the stress of caring for their partner. Forty male and forty female spouses of cancer patients of a regional oncology center were randomly assigned to intervention or usual treatment conditions. Spouses and patients were interviewed prior to intervention, and within two weeks after intervention on a battery of assessment instruments including: (1) demographic variables; (2) psychological variables; (3) health status; (4) social supports; (5) assessment of pressing problems; (6) coping skills; (7) burden levels; and (8) marital satisfaction. Participants were found to be more psychologically distressed than the general population but were not as distressed as psychiatric outpatients. Differences were also found in marital satisfaction and coping activities, when compared to the general population. No significant differences between the conditions were found on any of the measures. Caregivers' level of caregiving activities proved to be low. It is suggested that this may account for why the intervention only appeared effective for a distressed subsample of the caregivers in the study. The implications of these findings is discussed. Recommendations are also made for future research on cancer caregivers.

Depression following laryngectomy. A pilot study

When a group of 10 patients who had received surgery for carcinoma of the larynx were compared with 10 control patients who had received radiotherapy for carcinoma of the larynx, four of the former but none of the latter were found to be suffering from depression, a statistically significant difference. Depression was associated with poor communication skills and geographical isolation. Psychiatric intervention is recommended for patients undergoing mutilating forms of surgery.