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Dils AT, O'Keefe K, Dakka N, Azar M, Chen M, Zhang A. The efficacy of cognitive behavioral therapy for mental health and quality of life among individuals diagnosed with cancer: A systematic review and meta-analysis. Cancer Med 2024; 13:e70063. [PMID: 39165223 PMCID: PMC11336377 DOI: 10.1002/cam4.70063] [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: 11/09/2023] [Revised: 07/12/2024] [Accepted: 07/20/2024] [Indexed: 08/22/2024] Open
Abstract
OBJECTIVE It has long been documented that cognitive behavioral therapy (CBT) has positive impacts on improving mental health (MH) and quality of life (QoL) in the general population, but investigations on its effect on cancer survivors remain limited, especially for QoL outcomes. The purpose of this meta-analysis is to investigate the effects of CBT as compared to control on cancer patients' MH and QoL outcomes. Control is defined in this study as standard therapy, waitlist control, and active/alternative therapy. METHODS In total, 154 clinical trials creating a sample size of 1627 individuals were collected. Analysis focusing on MH and QoL excluded 29 clinical trials resulting in a final analysis of 132 clinical trials (and 1030 effect sizes). R Statistical Software (version 4.2.2) and the robumeta package were utilized to complete analysis, which entailed robust variance estimation (RVE) in intercept-only meta-regression, and univariate meta-regression (for moderator analysis). RESULTS Across 132 clinical trials and 1030 effect size estimates, we identified that CBT moderately improves MH and QoL in cancer patients d = 0.388, 95% CI 0.294-0.483, p < 0.001. Additionally, age and delivery format can influence the efficacy of CBT in this patient population. CONCLUSIONS CBT statistically improves the MH and QoL psychosocial parameters in cancer patients with greater efficacy in younger patients. Important clinical and intervention-related factors, that is, age and delivery, should be considered when oncologists consider CBT as a psychotherapeutic intervention for individuals with cancer.
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Affiliation(s)
| | - Kathryn O'Keefe
- Central Michigan University College of MedicineSaginawMichiganUSA
| | - Nada Dakka
- Central Michigan University College of MedicineSaginawMichiganUSA
| | - Michelle Azar
- Central Michigan University College of MedicineSaginawMichiganUSA
| | - Meiyan Chen
- The University of Texas at Austin Steve Hicks School of Social WorkAustinTexasUSA
| | - Anao Zhang
- The University of Texas at Austin Steve Hicks School of Social WorkAustinTexasUSA
- University of Michigan Health, Adolescent and Young Adult Oncology ProgramAnn ArborMichiganUSA
- University of Michigan School of Social WorkAnn ArborMichiganUSA
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Cui C, Wang L, Wang X. Effects of physical and psychological symptoms on cancer-related fatigue among esophageal cancer patients. BMC Cancer 2024; 24:398. [PMID: 38553681 PMCID: PMC10981330 DOI: 10.1186/s12885-024-12138-4] [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: 08/19/2023] [Accepted: 03/18/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF) is considered one of the most prevalent and distressing symptoms among cancer patients and may vary among patients with different cancer types. However, few studies have explored the influence of physical and psychological symptoms on CRF among esophageal cancer (EC) patients without esophagectomy. Therefore, this study aimed to examine the effects of physical and psychological symptoms on CRF among EC patients without esophagectomy. METHODS In the present study, a cross-sectional study was conducted from February 2021 to March 2022 in Liaoning Province, China. Among the 112 included participants, 97 completed our investigation. The questionnaires used consisted of the Brief Fatigue Inventory (BFI), the MD Anderson Symptom Inventory Gastrointestinal Cancer Module (MDASI-GI), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and demographic and clinical information. Multivariate linear regression was conducted to test the relationships between physical and psychological symptoms and CRF. RESULTS Of the 97 EC patients, 60.8% reported CRF (BFI ≥ 4). The mean age of the participants was 64.92 years (SD = 8.67). According to the regression model, all the variables explained 74.5% of the variance in CRF. Regression analysis indicated that physical symptoms, including constipation, diarrhoea, and difficulty swallowing, contributed to CRF. On the other hand, depressive symptoms increased the level of CRF among EC patients without esophagectomy. CONCLUSIONS Given the high prevalence of CRF among EC patients without esophagectomy, it is urgent to emphasize the importance of fatigue management interventions based on physical and psychological symptoms to alleviate CRF in EC patients.
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Affiliation(s)
- ChunYing Cui
- School of Humanities and Management, Wannan Medical College, 241002, Wuhu, Anhui, PR China
| | - Lie Wang
- School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, PR China
| | - XiaoXi Wang
- Medical Basic Experimental Teaching Center, China Medical University, No.77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, PR China.
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Sırlıer Emir B, Yıldız S, Kurt O, Emre E, Aydın S. Relationships between Anxiety, Depression, and Illness Perceptions in Lung and Breast Cancer Patients throughout the Cancer Continuum. Healthcare (Basel) 2023; 11:2794. [PMID: 37893868 PMCID: PMC10606067 DOI: 10.3390/healthcare11202794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Cancer is a devastating disease that has significant psychological and biological impacts. Generally, lung cancer primarily affects men while breast cancer primarily affects women. Thus, this study aimed to investigate the levels of anxiety and depression in patients with these prevalent cancer types, as well as their perceptions of the illness and any potential connections between them. The study included a total of 252 participants, consisting of 110 breast cancer patients, 112 lung cancer patients, and 30 healthy individuals as controls. The Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were administered to assess mood, while the Illness Perception Questionnaire (IPQ) was used to evaluate cancer perceptions. Results revealed that both breast cancer and lung cancer patients had significantly higher BDI and BAI scores compared to the control group. Furthermore, the BDI and BAI scores were lower in breast cancer patients compared to lung cancer patients. The IPQ causal representation-immunity score was significantly higher in lung cancer patients than in breast cancer patients (p = 0.01). Positive correlations were found between BDI scores and BAI scores, as well as between BDI scores and certain subscale scores of the IPQ related to illness representation and causal representation. Additionally, a positive correlation was observed between BAI scores and the IPQ illness representation-timeline acute/chronic subscale, while a negative correlation was found between BAI scores and the IPQ causal representation-accident or chance scores. Overall, the study findings demonstrated that breast and lung cancer patients possess negative perceptions of their disease and experience high levels of anxiety and depression. To enhance the quality of life and promote resilience in these patients, it is recommended to incorporate psychological interventions that consider anxiety, depression, and disease perception.
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Affiliation(s)
- Burcu Sırlıer Emir
- Department of Psychiatry, Elazığ Fethi Sekin City Hospital, 23100 Elazığ, Turkey;
| | - Sevler Yıldız
- Department of Psychiatry, Elazığ Fethi Sekin City Hospital, 23100 Elazığ, Turkey;
| | - Osman Kurt
- Department of Public Health, Adıyaman Provincial Health Directorate, 02100 Adıyaman, Turkey;
| | - Elif Emre
- Department of Anatomy, Faculty of Medicine, University of Fırat, 23119 Elazığ, Turkey;
| | - Süleyman Aydın
- Department of Biochemistry, Faculty of Medicine, University of Fırat, 23119 Elazığ, Turkey;
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Kirsch JL, Ehlers SL. Factor Analysis of the Beck Depression Inventory-II and Long-Term Hematopoietic Stem Cell Transplantation Survival Using the Research Domain Criteria Framework. Transplant Cell Ther 2023; 29:205.e1-205.e7. [PMID: 36563787 DOI: 10.1016/j.jtct.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
The presence of depressive symptoms prior to hematopoietic stem cell transplantation (HSCT) is a common experience, with long-term impacts on survival. Using the National Institute of Mental Health Research Domain Criteria (RDoC) framework, this study sought to characterize depressive symptoms in patients prior to HSCT through exploratory factor analysis and to determine whether depressive factors were significant predictors of long-term survival. Individuals were included in the study if they were preparing to undergo HSCT and endorsed depressive symptoms measured by the Beck Depression Inventory-II (BDI-II). Patients were scheduled to undergo transplantation between 2005 and 2010. Survival analyses were conducted in 2022 to assess long-term outcomes. The primary outcomes were exploring the factor structure of the BDI-II and conducing univariate and multivariate Cox regression analyses of depression symptoms and known demographic and disease characteristics that impact survival. Of the 695 participants included in the study, most were male, middle aged (mean age, 55.08 ± 11.75 years), white, and married. Exploratory factor analysis revealed a 4-factor structure consisting of "negative valence systems: internalizing" (eg, worthlessness, guilt), "arousal and threat" (eg, agitation, irritability), "arousal and regulatory systems" (eg, loss of energy, fatigue), and "negative valence systems: externalizing" (eg, loss of pleasure, loss of interest). Univariate survival analyses identified age, sex, disease type, acute graft-versus-host disease (GVHD), and negative valence systems: externalizing as significant predictors of survival. Transplant type, chronic GVHD, performance status, and the other 3 depression factor structures were not significant in univariate models. In the multivariate model, older age (hazard ratio [HR], 1.031; 95% confidence interval [CI], 1.021 to 1.041; P < .001) and presence of negative valence systems: externalizing symptoms (HR, 1.132; 95% CI, 1.030 to 1.244; P = .010) were significant predictors of shorter survival. Additionally, individuals diagnosed with acute leukemia were significantly more likely to have shorter survival compared to those with other disease types, including amyloidosis (HR, .362; 95% CI, .229 to .575; P < .001) and non-Hodgkin lymphoma (HR, .526; 95% CI, .349 to .793; P = .002). Exploratory factor analysis of depressive symptoms mapped well onto the RDoC constructs. Loss of pleasure and loss of interest, two key components of depression, were predictive of shorter survival. Exploration of key components of depression rather than the total depression score may provide important prognostic information for long-term survivorship and may help inform future and more individualized care.
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Affiliation(s)
- Janae L Kirsch
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Shawna L Ehlers
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
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Jassim GA, Doherty S, Whitford DL, Khashan AS. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev 2023; 1:CD008729. [PMID: 36628983 PMCID: PMC9832339 DOI: 10.1002/14651858.cd008729.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015. OBJECTIVES To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer. SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles. SELECTION CRITERIA Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer. DATA COLLECTION AND ANALYSIS Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes. MAIN RESULTS We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months. Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.
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Affiliation(s)
- Ghufran A Jassim
- Department of Family & Community Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | - Sally Doherty
- Psychiatry, Royal College of Surgeons in Ireland- Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | | | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
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Peng F, Li H, Zhang J, Li X, Zhang H, Li Y. Effects of different psychological interventions on quality of life and remission rate in patients with acute leukemia receiving chemotherapy: A randomized controlled trial. Front Psychol 2023; 14:1045031. [PMID: 36874817 PMCID: PMC9978370 DOI: 10.3389/fpsyg.2023.1045031] [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: 09/15/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Aims This study aimed to examine and compare different psychological intervention effects on the quality of life (QoL) and remission rates of patients with acute leukemia receiving chemotherapy. Methods A total of 180 participants were randomly divided into a cognitive intervention group, a progressive muscle relaxation (PMR) group, a cognitive intervention plus PMR group, and a usual care control group. QoL via the Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 and remission rate were assessed at baseline and immediate post-intervention. A Generalized Linear Mixed Model was used for statistical analysis. Cost-effectiveness analysis with the value of the Incremental Cost-effectiveness Ratio was conducted to realize the economic evaluation of psychological interventions. Results The total score of QoL and its most dimensions were significantly improved for participants in the intervention groups compared with the control group. The cognitive intervention plus PMR intervention was the most effective concerning QoL with cost-effectiveness. No significant improvements were indicated in participants' remission rates among the groups. Conclusion The cognitive intervention plus PMR intervention is the most effective in improving QoL with cost-effectiveness among patients with acute leukemia receiving chemotherapy. More rigorous randomized controlled trials with multiple follow-up points are suggested to clarify the psychological interventions on remission rates in this population.
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Affiliation(s)
- Fang Peng
- Changsha Social Work College, Changsha, China
| | - Huiyuan Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jingping Zhang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiaoyun Li
- Second Xiangya Hospital of Central South University, Changsha, China
| | - Haimiao Zhang
- The School of Nursing and Rehabilitation, Xi'an Medical University, Xi'an, China
| | - Yifei Li
- Xiangya School of Nursing, Central South University, Changsha, China
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Umashankar S, Mamounas ME, Matthys M, Hadeler EK, Wong EC, Hicks G, Hwang J, Chien AJ, Rugo HS, Hamolsky D, Esserman L, Melisko M. Evaluation of the Pathways for Survivors Program to Address Breast Cancer Survivorship-Associated Distress: Survey Study. JMIR Cancer 2022; 8:e31756. [PMID: 35212641 PMCID: PMC8917438 DOI: 10.2196/31756] [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: 07/02/2021] [Revised: 11/04/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background Patients with breast cancer frequently experience escalation of anxiety after completing curative treatment. Objective This study evaluated the acceptability and psychological impact of a 1-day workshop to emphasize behavioral strategies involving intention and self-efficacy. Methods Breast cancer survivors who attended a 1-day Pathways for Survivors workshop provided feedback and completed electronic quality of life (QOL) questionnaires at baseline, 1 and 6 weeks, and 6 months after the workshop. Attendees’ baseline QOL scores were compared to follow-up (FUP) scores. Scores from patients receiving routine FUP care were also compiled as a reference population. Results In total, 77 patients attended 1 of 9 workshops. The mean satisfaction score was 9.7 out of 10 for the workshop and 9.96 out of 10 for the moderator. Participants’ baseline mean Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depression scores were 57.8 (SD 6.9) and 55.3 (SD 7.5), respectively, which were significantly higher than those of patients receiving routine FUP care (49.1, SD 8.3 and 47.3 SD 8.0, respectively). PROMIS anxiety and depression scores decreased, and the Happiness Index Profile (HIP-10) score—measuring intention and resiliency—increased significantly at 1- and 6-week FUPs. Conclusions The Pathways for Survivors program was favorably received. Anxiety and depression decreased significantly at 1- and 6-weeks after the workshop and remained below baseline at 6 months. Increased HIP-10 scores suggest that patients acquired and implemented skills from the workshop. A 1-day workshop led by a lay moderator significantly improved several psychological measures, suggesting that it may be a useful and time-efficient strategy to improve QOL in breast cancer survivors. We are investigating whether an abbreviated “booster” of the intervention at a later date could further improve and maintain QOL gains.
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Affiliation(s)
- Saumya Umashankar
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Matina Elise Mamounas
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Madeline Matthys
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Edward Kenji Hadeler
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Emily Claire Wong
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Greg Hicks
- Foster, Hicks & Associates, San Francisco, CA, United States
| | - Jimmy Hwang
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Amy Jo Chien
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Hope S Rugo
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Deborah Hamolsky
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Laura Esserman
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Michelle Melisko
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
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Bickel EA, Fleer J, Ranchor A, Schroevers MJ. Are cancer patients with high depressive symptom levels able to manage these symptoms without professional care? The role of coping and social support. Psychooncology 2022; 31:1102-1109. [PMID: 35133052 PMCID: PMC9542510 DOI: 10.1002/pon.5896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/16/2022]
Abstract
Objective Around 25% of cancer patients experiences depressive symptoms. However, the majority does not receive formal psychological care because patients often prefer managing symptoms alone or with informal social support. Previous research has shown that adaptive coping and social support can indeed be effective in managing relatively mild depressive symptoms. However, higher depressive symptom levels rarely improve without psychological treatment. This longitudinal study examined how and to what extent coping and social support are related to reductions in depressive symptoms in cancer patients with moderate to severe depressive symptoms. Methods Respondents were diagnosed with cancer in the past five years, experienced high depressive symptom levels (PHQ‐9 ≥ 10) and were not receiving psychological care at baseline. We collected data with self‐report questionnaires (including PHQ‐9, brief COPE and Social Support List) at two assessments, taken three months apart. Results Although depressive symptoms decreased significantly between baseline and follow‐up, the average level at follow‐up was still moderate to severe. Patients using less avoidant coping, specifically less substance use, were more likely to report a reduction of depressive symptoms. We found no significant beneficial effects of approach coping and social support (coping) on the course of depressive symptoms. Conclusions A significant group of cancer patients with high levels of depressive symptoms do not seem able to effectively manage depressive symptoms by themselves, especially those more likely to avoid dealing with their symptoms. Cancer patients can be educated about avoidant coping and its possible detrimental effects, as well as being informed about possibilities of psychosocial services.
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Affiliation(s)
- E. A. Bickel
- University of Groningen University Medical Center Groningen Department of Health Psychology the Netherlands
| | - J. Fleer
- University of Groningen University Medical Center Groningen Department of Health Psychology the Netherlands
| | - A.V. Ranchor
- University of Groningen University Medical Center Groningen Department of Health Psychology the Netherlands
| | - M. J. Schroevers
- University of Groningen University Medical Center Groningen Department of Health Psychology the Netherlands
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Jabbarian LJ, Rietjens JAC, Mols F, Oude Groeniger J, van der Heide A, Korfage IJ. Untangling the relationship between negative illness perceptions and worse quality of life in patients with advanced cancer-a study from the population-based PROFILES registry. Support Care Cancer 2021; 29:6411-6419. [PMID: 33891204 PMCID: PMC8464557 DOI: 10.1007/s00520-021-06179-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/24/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Quality of life (QoL) is an important yet complex outcome of care in patients with advanced cancer. QoL is associated with physical and psychosocial symptoms and with patients' illness perceptions (IPs). IPs are modifiable cognitive constructs developed to make sense of one's illness. It is unclear how IPs influence patients' QoL. A better understanding of this relationship can inform and direct high quality care aimed at improving patients' QoL. We therefore investigated the mediating role of anxiety and depression in the association of IPs with QoL. METHODS Data from 377 patients with advanced cancer were used from the PROFILES registry. Patients completed measures on IPs (BIPQ), QoL (EORTC QLQ-C30), and symptoms of anxiety and depression (HADS). Mediation analyses were conducted to decompose the total effect of IPs on QoL into a direct effect and indirect effect. RESULTS All IPs but one ("Comprehensibility") were negatively associated with QoL (p<0.001); patients with more negative IPs tended to have worse QoL. The effect was strongest for patients who felt that their illness affected their life more severely ("Consequences"), patients who were more concerned about their illness ("Concern"), and patients who thought that their illness strongly affected them emotionally ("Emotions"). Anxiety mediated 41-87% and depression mediated 39-69% of the total effect of patients' IPs on QoL. CONCLUSION Negative IPs are associated with worse QoL. Anxiety and depression mediate this association. Targeting symptoms of anxiety and depression, through the modification of IPs, has the potential to improve QoL of patients with advanced cancer.
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Affiliation(s)
- Lea J. Jabbarian
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Judith A. C. Rietjens
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Floortje Mols
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- Netherlands Comprehensive Cancer Organisation (IKNL), Netherlands Cancer Registry, Eindhoven, the Netherlands
| | - Joost Oude Groeniger
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
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Gholampour Y, Khani Jeihooni A, Momenabadi V, Amirkhani M, Afzali Harsini P, Akbari S, Rakhshani T. The Effect of Educational Intervention Based on PRECEDE Model on Health Promotion Behaviors, Hope Enhancement, and Mental Health in Cancer Patients. Clin Nurs Res 2021; 31:1050-1062. [PMID: 34628952 DOI: 10.1177/10547738211051011] [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: 11/17/2022]
Abstract
In this experimental study, 200 cancer patients (100 subject in experimental group and 100 subjects in control group) referred to Amir Oncology Hospital in Shiraz were investigated. Educational intervention for experimental group consisted of 12 educational sessions for 50 to 55 minutes. A questionnaire including demographic information, PRECEDE constructs (knowledge, attitude, self-efficacy, enabling factors, and social support), was used to measure health promotion behaviors, patients' hope, and mental health before and 6 months after intervention. Six months after intervention, experimental group showed significant increase in knowledge, attitude, self-efficacy, enabling factors, social supports, health promotion behaviors, patients' hope, and mental health compared to the control group. This study showed the effectiveness of intervention based on PRECEDE constructs in mentioned factors 6 months after intervention. Hence, this model can act as a framework for designing and implementing educational intervention for health promotion behaviors of cancer patients.
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Ellawindi MI, Shoman TH, Taher E, Gohar S, Shehata S. Effectiveness of Psychosocial Supportive Care Trial on Quality of Life among Breast Cancer Patients: An Interventional Study at the National Cancer Institute, Egypt. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Breast cancer (BC) patients suffer from many psychosocial problems due to their health condition and treatment side effects so they are in great need for psychosocial supportive care.
AIM: The aim of the study was to provide a comprehensive psych-social supportive health-care model for BC patients a step toward improving their quality of life (QOL).
PATIENTS AND METHODS: Random assignment was done for 185 patients with primary operated BC to a control or an intervention group. The researcher offered five daily successive psychosocial supportive care sessions for the patients in the intervention group. All patients were followed up for coping ability, mood and QOL 8 weeks after the intervention.
RESULTS: The intervention had statistically significant effects on psychological distress, depression, problem focused, and active emotional coping domain, while had not any statistically significant effects on avoidant emotional coping domain.
CONCLUSION: Psychosocial supportive developed health-care model decreased psychological distress, depression, and improved QOL among patients with primary BC.
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Akkol-Solakoglu S, Hevey D, Richards D. A randomised controlled trial comparing internet-delivered cognitive behavioural therapy (iCBT) with and without main carer access versus treatment-as-usual for depression and anxiety among breast cancer survivors: Study protocol. Internet Interv 2021; 24:100367. [PMID: 33552931 PMCID: PMC7851185 DOI: 10.1016/j.invent.2021.100367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Depression and anxiety are common problems among breast cancer survivors. Carer support is one of the most important determinants of women's psychological wellbeing. Survivors' distress can be alleviated by giving carers access to survivors' evidence-based treatment, which will help carers understand what survivors have been going through and help survivors feel more supported. Given the limited access to evidence-based treatments, an adapted internet-delivered cognitive behavioural therapy (iCBT) intervention for breast cancer survivors, but also open for carers' access, has the potential to decrease survivors' depression and anxiety symptoms and improve cancer-related communication and relationship quality between survivors and carers. OBJECTIVES This study evaluates (1) the effectiveness of a guided iCBT intervention for depression and/or anxiety symptoms among breast cancer survivors with and without main carer access, and (2) the acceptability and satisfaction with the iCBT programme. METHOD In this pilot study comparing the effectiveness of an adapted 7-week iCBT without main carer access against the iCBT with main carer access and treatment-as-usual control, 108 breast cancer survivors will be recruited and then randomised to either (1) treatment (n = 72) or (2) treatment-as-usual control group (n = 36) with a 2:1 ratio. The participants in the treatment group will be assigned to either iCBT alone or iCBT with the main carer also having access to the same content based on their preference. The primary outcome measure is the Hospital Anxiety and Depression Scale, and alongside secondary measures such as Cancer-Related Quality of Life, Breast Cancer Worry Scale, Brief COPE, and Medical Outcomes Study Social Support Survey will be completed by the survivors at baseline, post-treatment, and 2-month follow-up. Survivors who have carers will also complete Survivor-Carer Cancer Communication and Relationship Quality measures to provide insights into the effects of carer access. To assess the acceptability and satisfaction with the programme, survivors and their main carers will fill out the Helpful Aspects of Therapy Form (HAT) and Satisfaction with Online Treatment (SAT). Programme effectiveness and the effects of carer access on primary and secondary outcome measures will be evaluated on intention-to-treat and per-protocol basis using Linear-Mixed-Models. DISCUSSION This is the first trial comparing the effectiveness and acceptability of iCBT with and without carer access for depression and anxiety among breast cancer survivors. The findings of this study will provide novel data on the acceptability of iCBT programmes for breast cancer survivors and the impact of carer access on them and their carers.
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Affiliation(s)
- Selin Akkol-Solakoglu
- Aras an Phiarsaigh, School of Psychology, Trinity College Dublin, Dublin, Ireland
- Corresponding author.
| | - David Hevey
- Aras an Phiarsaigh, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Derek Richards
- Aras an Phiarsaigh, School of Psychology, Trinity College Dublin, Dublin, Ireland
- Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland
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Hopko DR, Lejuez CW, Ryba MM, Shorter RL, Bell JL. Support for the efficacy of behavioural activation in treating anxiety in breast cancer patients. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Derek R. Hopko
- Department of Psychology, The University of Tennessee, Knoxville, Tennessee, USA,
| | - Carl W. Lejuez
- Department of Psychology, The University of Maryland, College Park, Maryland, USA,
| | - Marlena M. Ryba
- Department of Psychology, The University of Tennessee, Knoxville, Tennessee, USA,
| | - Rebecca L. Shorter
- Department of Psychology, The University of Tennessee, Knoxville, Tennessee, USA,
| | - John L. Bell
- Cancer Institute, The University of Tennessee Medical Center, Knoxville, Tennessee, USA,
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14
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Yu YL, Yeo H, Kang S. The impact of depressive symptoms on health value in patients with gynecologic cancer: A comparison with physical symptoms and performance status. Gynecol Oncol 2020; 157:733-739. [PMID: 32307127 DOI: 10.1016/j.ygyno.2020.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/03/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The importance of managing depressive symptoms is frequently underestimated in the clinic. In this study, the effects of depressive symptoms on health utility value (HUV) in gynecologic cancer patients are evaluated. In addition, the effects were compared with those of performance status and physical symptoms. METHODS Patient-reported outcome data from 274 gynecologic cancer patients were prospectively collected. HUV was measured using the 3-level version of the EuroQoL 5-dimension descriptive system (EQ-5D-3L) and the EuroQoL visual analog scale (EQ-VAS). The Patient Health Questionnaire-9 (PHQ-9) was used to measure the severity of depressive symptoms. The impact of depressive symptoms on HUV was analyzed using the generalized linear model. RESULTS Moderate-severe depressive symptoms were significantly associated with a decrease in HUV in gynecologic cancer patients (p < 0.0001 for the EQ-5D-3L and EQ-VAS). Severe fatigue and severe pain were also associated with a decrease in HUV (p = 0.018 and p < 0.0001 for the EQ-5D-3L and EQ-VAS; p < 0.0001 for the EQ-5D-3L, respectively), and the effect sizes were comparable to that of moderate-severe depressive symptoms. In addition to the patients with moderate-severe depressive symptoms, the patients with mild depressive symptoms also experienced a significant decrease in HUV (p < 0.0001 for the EQ-5D-3L and EQ-VAS). The effect size for mild depressive symptoms was comparable to those for mild fatigue or mild pain. CONCLUSIONS Even mild depressive symptoms may significantly compromise HUV in gynecologic cancer patients, and the effect is comparable to that of performance status or physical symptoms. Gynecologic oncologists should put more effort into properly preventing, detecting, and managing depressive symptoms.
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Affiliation(s)
- Ye Lee Yu
- Division of Precision Medicine, National Cancer Center Korea, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea.
| | - Hyemin Yeo
- Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Sokbom Kang
- Division of Precision Medicine, National Cancer Center Korea, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea.
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15
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Therapist Guided Activity Practice for Depressive Symptoms in University Students: A Randomized Controlled Trial. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10095-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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16
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Hata K, Ono H, Ogawa Y, Suzuki SI. The mediating effect of activity restriction on the relationship between perceived physical symptoms and depression in cancer survivors. Psychooncology 2020; 29:663-670. [PMID: 31984588 PMCID: PMC7216991 DOI: 10.1002/pon.5303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/07/2019] [Accepted: 11/15/2019] [Indexed: 12/20/2022]
Abstract
Purpose Several studies have explored factors causing depression in cancer survivors, including perceived physical symptoms. Another critical factor in the depression symptomatology of cancer survivors is activity restriction (AR). We investigated how AR mediate the effects of perceived pain and fatigue on depression in cancer survivors. Methods Cancer survivors (n = 61; mean age 56.16 years) that were recruited through cancer support groups in Japan participated in this study. Participants completed a battery of questionnaires comprising demographic and clinical information, the Pain Catastrophizing Scale, the Cancer Fatigue Scale, the Activity Restriction Scale for Cancer Patients, and the Hospital Anxiety and Depression Scale. Results Mediation analysis indicated that AR partially mediates the effect of pain on depression. Direct paths from pain to AR, AR to depression, and pain to depression were significant (P < .005). Moreover, indirect paths from pain to AR, AR to depression, and pain to depression were also significant at the 95% level [0.04‐0.13]. However, AR did not mediate the effect of fatigue on depression, and fatigue had a significant direct path to both AR and depression (P < .005). Conclusion This study aimed to explore the mediating effect of AR in the relationships of perceived pain and fatigue and depression in cancer survivors. We found that AR mediates perceived pain to depression, however not for perceived fatigue. In addition, because AR was experienced in the face of any survivorship period, AR may need to be treated as a long‐term effect of the cancer diagnosis
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Affiliation(s)
- Kotone Hata
- Graduate School of Human Sciences, Waseda University, Saitama, Japan.,Japan Society for the Promotion of Science, Research Fellow
| | - Haruka Ono
- Graduate School of Human Sciences, Waseda University, Saitama, Japan
| | - Yuko Ogawa
- Department of Psycho-Oncology, National Cancer Center, Tokyo, Japan
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17
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Desautels C, Savard J, Ivers H. Moderators of Cognitive Therapy and Bright Light Therapy Effects on Depressive Symptoms in Patients with Breast Cancer. Int J Behav Med 2019; 26:380-390. [PMID: 31264101 DOI: 10.1007/s12529-019-09802-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive therapy (CT) and bright light therapy (BLT) have been found to be effective to treat depressive symptoms in breast cancer patients. No study has investigated the baseline patients' characteristics that are associated with better outcomes with CT vs. BLT in this population. This study aimed to assess, in breast cancer patients, the moderating role of eight clinical variables on the effects of CT and BLT on depressive symptoms. METHODS This is a secondary analysis of a randomized controlled trial conducted in 59 women who received an 8-week CT or BLT and completed questionnaires evaluating depression and possible moderating variables. RESULTS Patients benefited more from BLT when they had no prior history of major depressive disorder, higher depression scores on the Hospital Anxiety and Depression Scale (HADS-D) at baseline, a greater initial preference for BLT, and when they received BLT during spring or summer. Patients benefited more from CT when they had a lower initial preference for receiving CT, higher depression scores on the HADS-D, and seasonal depressive symptoms. CONCLUSIONS Although replication is needed, findings of this study suggest the existence of different profiles of patients more likely to benefit from CT and BLT. TRIAL REGISTRATION NCT01637103 https://clinicaltrials.gov/ct2/show/NCT01637103.
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Affiliation(s)
- Caroline Desautels
- School of Psychology, Université Laval, Québec, QC, Canada
- CHU de Québec - Université Laval Research Center, Québec, QC, Canada
- Université Laval Cancer Research Center, Québec, QC, Canada
| | - Josée Savard
- School of Psychology, Université Laval, Québec, QC, Canada.
- CHU de Québec - Université Laval Research Center, Québec, QC, Canada.
- Université Laval Cancer Research Center, Québec, QC, Canada.
- Centre de recherche du CHU de Québec - L'Hôtel-Dieu de Québec, 11 Côte du Palais, Québec, Québec, G1R 2J6, Canada.
| | - Hans Ivers
- School of Psychology, Université Laval, Québec, QC, Canada
- CHU de Québec - Université Laval Research Center, Québec, QC, Canada
- Université Laval Cancer Research Center, Québec, QC, Canada
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18
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Feasibility and impact of a guided symptom exposure augmented cognitive behavior therapy protocol to prevent symptoms of pharmacologically induced depression: A pilot study. COGNITIVE THERAPY AND RESEARCH 2019; 43:679-692. [PMID: 31777409 DOI: 10.1007/s10608-018-09990-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Depression is the leading cause of disability and a major cause of morbidity worldwide, with societal costs now upwards of 1 trillion dollars across the globe. Hence, extending current efforts to augment prevention outcomes is consistent with global public health interests. Although many prevention programs have been developed and have demonstrated efficacy, studies have yet to demonstrate that CBT is effective in preventing symptoms in populations at risk for developing depression induced by pharmacological substances. Using a randomized, controlled design, this pilot study reports on the feasibility and preliminary effects of a novel, guided symptom exposure augmented cognitive behavioral prevention intervention (GSE-CBT) in a sample diagnosed with Hepatitis C at risk for developing medication induced depression. Results demonstrated that the guided symptom exposure augmented CBT (GSE-CBT) was feasible in this population and was delivered with high integrity. Although not statistically different, we observed a pattern of lower depression levels in the GSE-CBT group versus those in the control group throughout. This pilot study demonstrates that a psychosocial prevention intervention is feasible for use in patients at risk for developing pharmacologically induced depression and that a guided symptom exposure augmented CBT protocol has the potential to prevent symptoms of depression that develop as a side effect to taking these medications. Results are preliminary and future studies should use larger samples and test the intervention in other populations.
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19
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Ratcliff C, Naik AD, Martin LA, Moye J. Examining cancer survivorship trajectories: Exploring the intersection between qualitative illness narratives and quantitative screening instruments. Palliat Support Care 2018; 16:712-718. [PMID: 29282156 PMCID: PMC6023785 DOI: 10.1017/s1478951517000967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This article examines the associations of quantitatively refined trajectories of adjustment to cancer survivorship determined by previously published qualitative narrative analysis. METHOD Patients completed measures of cancer-related worry (Cancer Related Worries Scale), depression (Patient Health Questionnaire-9), posttraumatic growth (Benefit Finding Scale), and open-ended survey questions 6, 12, and 18 months postdiagnosis of head and neck, esophageal, gastric, or colorectal cancer. Previously published narrative analysis revealed five distinct survivorship "paths," which were combined into four paths in the present article: Moving On, Seeing the World Differently, Taking One Day at a Time, and Never the Same. To determine the association of qualitatively determined paths with quantitatively assessed adjustment (i.e., Cancer Related Worries Scale, Patient Health Questionnaire-9, Benefit Finding Scale), we used linear multilevel modeling to regress the adjustment variables on time, path, the time-by-path interaction, and relevant covariates (age, stage, cancer site, ethnicity, and Deyo score). RESULTS There was a significant main effect of path on cancer worry, depression, and posttraumatic growth (p < 0.02 for all). Patients in the Moving On group reported consistently low worry, depression, and growth compared to the other groups. Patients in the Seeing the World Differently and Taking One Day at a Time paths both reported moderate worry and depression; but those in the Seeing the World Differently path reported the highest posttraumatic growth, whereas patients in the Taking One Day at a Time path reported little growth. Finally, patients in the Never the Same path reported the highest worry and depression but lowest posttraumatic growth.Significance of resultsThis longitudinal study reinforces the notion that cancer survivorship is not a one-size-fits-all experience nor a dichotomized experience of "distress" or "no distress." Additionally, this hypothesis-generating study suggests future directions for potential self-report measures to help clinicians identify cancer survivors' trajectory to develop a more patient-centered survivorship care plan.
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Affiliation(s)
- Chelsea Ratcliff
- South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
- Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - Aanand D. Naik
- Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - Lindsey Ann Martin
- South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
- Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - Jennifer Moye
- VA Boston Healthcare System, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- New England Geriatric Research, Education and Clinical Center, Boston and Bedford, Massachusetts
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20
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Ahmadian S, Rasouli A. Stress Management Training on Reducing Anxiety and Promoting Happiness and Sexual Integrity in Women with Breast Cancer. IRANIAN JOURNAL OF NURSING RESEARCH 2018; 13:18-25. [DOI: 10.21859/ijnr-13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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21
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Sanson-Fisher RW, Noble NE, Searles AM, Deeming S, Smits RE, Oldmeadow CJ, Bryant J. A simple filter model to guide the allocation of healthcare resources for improving the treatment of depression among cancer patients. BMC Cancer 2018; 18:125. [PMID: 29402237 PMCID: PMC5800015 DOI: 10.1186/s12885-018-4009-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/18/2018] [Indexed: 11/29/2022] Open
Abstract
Background Depression is highly prevalent yet often poorly detected and treated among cancer patients. In light of the move towards evidence-based healthcare policy, we have developed a simple tool that can assist policy makers, organisations and researchers to logically think through the steps involved in improving patient outcomes, and to help guide decisions about where to allocate resources. Methods The model assumes that a series of filters operate to determine outcomes and cost-effectiveness associated with depression care for cancer patients, including: detection of depression, provider response to detection, patient acceptance of treatment, and effectiveness of treatment provided. To illustrate the utility of the model, hypothetical data for baseline and four scenarios in which filter outcomes were improved by 15% were entered into the model. Results The model provides outcomes including: number of people successfully treated, total costs per scenario, and the incremental cost-effectiveness ratio per scenario compared to baseline. The hypothetical data entered into the model illustrate the relative effectiveness (in terms of the number of additional incremental successes) and relative cost-effectiveness (in terms of cost per successful outcome and total cost) of making changes at each step or filter. Conclusions The model provides a readily accessible tool to assist decision makers to think through the steps involved in improving depression outcomes for cancer patents. It provides transparent guidance about how to best allocate resources, and highlights areas where more reliable data are needed. The filter model presents an opportunity to improve on current practice by ensuring that a logical approach, which takes into account the available evidence, is applied to decision making.
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Affiliation(s)
- Robert W Sanson-Fisher
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Natasha E Noble
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia. .,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Andrew M Searles
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Simon Deeming
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rochelle E Smits
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Christopher J Oldmeadow
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, NSW, Australia
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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22
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Fernández-Rodríguez C, Villoria-Fernández E, Fernández-García P, González-Fernández S, Pérez-Álvarez M. Effects of Behavioral Activation on the Quality of Life and Emotional State of Lung Cancer and Breast Cancer Patients During Chemotherapy Treatment. Behav Modif 2017; 43:151-180. [PMID: 29276837 DOI: 10.1177/0145445517746915] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Research suggests that the progressive abandonment of activities in cancer patients are related to depression and worse quality of life. Behavioral activation (BA) encourages subjects to activate their sources of reinforcement and modify the avoidance responses. This study assesses the effectiveness of BA in improving quality of life and preventing emotional disorders during chemotherapy treatment. One sample of lung cancer patients and another of breast cancer patients were randomized into a BA experimental group (E.G.lung/4sess.n = 50; E.G.breast/6sess.n = 33) and a control group (C.G.lung/4sess.n = 40; C.G.breast/6sess.n = 35), respectively. In each session and in follow-ups (3/6/9 months), all participants completed different assessment scales. The results converge to show the effectiveness of BA, encouraging cancer patients to maintain rewarding activities which can activate their sources of day-to-day reinforcement and modify their experience avoidance patterns. BA appears to be a practical intervention which may improve social and role functioning and the emotional state of cancer patients during chemotherapy treatment.
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23
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Barani M, Bakhtiari M, Firoozabadi VS, Mehdizadeh M, Sadeghi A. An Evaluation of Adjuvant Psychological Therapy (APT) Effectiveness on the Quality of Life of Patients with Hematologic Malignancies. CURRENT PSYCHOLOGY 2017. [DOI: 10.1007/s12144-017-9716-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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24
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Fisher HM, Jacobs J, Taub CJ, Lechner S, Lewis JE, Carver CS, Blomberg BB, Antoni MH. How changes in physical activity relate to fatigue interference, mood, and quality of life during treatment for non-metastatic breast cancer. Gen Hosp Psychiatry 2017; 49:37-43. [PMID: 28583700 PMCID: PMC5681387 DOI: 10.1016/j.genhosppsych.2017.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/15/2017] [Accepted: 05/27/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Physical activity (PA) following surgery for breast cancer may improve depressive symptoms and quality of life (QoL) via reduction in fatigue-related daily interference (FRDI). Less is known about how change in PA may relate to these psychosocial factors throughout the course of treatment. In a secondary analysis of a previous psychosocial intervention trial, we examined relationships between change in PA, depressive symptoms, and functional QoL, as mediated by change in FRDI, and whether naturally occurring change in PA provided benefit independent of the intervention. METHOD Women (N=240) with non-metastatic stage 0-III breast cancer were randomized to cognitive-behavioral stress management (CBSM) or a control 2-10weeks post-surgery. PA, FRDI, clinician-rated depressive symptoms, self-reported depressed mood, and functional QoL were assessed at baseline and three months post-intervention. RESULTS Increased PA was associated with reductions in clinician-rated depressive symptoms, depressed mood, and improved QoL, mediated by a reduction in FRDI. This was above and beyond the effect of CBSM. CONCLUSIONS Increased PA may mitigate FRDI and improve depressive symptoms and functional QoL for women undergoing breast cancer treatment, beyond effects of a psychosocial intervention. Benefits of an integrated PA and psychosocial approach should be investigated further.
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Affiliation(s)
- Hannah M. Fisher
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, United States
| | - Jamie Jacobs
- Massachusetts General Hospital, Center for Psychiatric Oncology and Behavioral Sciences, Boston, MA, 02114, United States,Harvard Medical School, Boston, MA, 02115, United States
| | - Chloe J. Taub
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, United States
| | - Suzanne Lechner
- Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, United States,Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, United States
| | - John E. Lewis
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, United States
| | - Charles S. Carver
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, United States,Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, United States
| | - Bonnie B. Blomberg
- Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, United States,Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL, 33136, United States
| | - Michael H. Antoni
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, United States,Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, United States,Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, United States
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25
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Fisher PL, Byrne A, Salmon P. Metacognitive Therapy for Emotional Distress in Adult Cancer Survivors: A Case Series. COGNITIVE THERAPY AND RESEARCH 2017; 41:891-901. [PMID: 29104332 PMCID: PMC5656708 DOI: 10.1007/s10608-017-9862-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Many adult cancer survivors experience persistent emotional distress after completing cancer treatment. The aim of this study was to test the potential of a brief transdiagnostic psychological intervention—metacognitive therapy (MCT)—in reducing emotional distress in adult cancer survivors. A non-concurrent multiple baseline design with 3- and 6-months follow-up was used to evaluate the effects of MCT in four patients consecutively referred to a psycho-oncology service. Each patient received six 1-h sessions of MCT. Anxiety, depression, worry/rumination, fear of cancer recurrence and metacognitive beliefs were assessed using self-report questionnaires. MCT was associated with clinically significant reductions in anxiety, depression, fear of cancer recurrence, worry/rumination and metacognitive beliefs at the end of treatment, and gains were maintained in all patients to 3-months follow-up and in three out of four patients to 6-months follow-up. MCT is a promising brief transdiagnostic approach to psychological morbidity in adult survivors of cancer. Larger scale controlled trials are now required.
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Affiliation(s)
- Peter L Fisher
- Psychological Sciences, University of Liverpool, Whelan Buliding, Liverpool, L69 3GB UK.,Liverpool Psychology Cancer Service, Royal Liverpool and Broadgreen NHS Trust, Liverpool, UK.,Nidaros, Østmarka University Hospital, Trondheim, Norway
| | - Angela Byrne
- Psychological Sciences, University of Liverpool, Whelan Buliding, Liverpool, L69 3GB UK.,Liverpool Psychology Cancer Service, Royal Liverpool and Broadgreen NHS Trust, Liverpool, UK
| | - Peter Salmon
- Psychological Sciences, University of Liverpool, Whelan Buliding, Liverpool, L69 3GB UK.,Liverpool Psychology Cancer Service, Royal Liverpool and Broadgreen NHS Trust, Liverpool, UK
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26
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Hofmann SG, Curtiss J, Carpenter JK, Kind S. Effect of treatments for depression on quality of life: a meta-analysis. Cogn Behav Ther 2017; 46:265-286. [PMID: 28440699 DOI: 10.1080/16506073.2017.1304445] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are the two first-line treatments for depression, but little is known about their effects on quality of life (QOL). A meta-analysis was conducted to examine changes in QOL in adults with major depressive disorder who received CBT (24 studies examining 1969 patients) or SSRI treatment (13 studies examining 4286 patients) for their depression. Moderate improvements in QOL from pre to post-treatment were observed in both CBT (Hedges' g = .63) and SSRI (Hedges' g = .79) treatments. The effect size remained stable over the course of the follow-up period for CBT. No data were available to examine follow-ups in the SSRI group. QOL effect sizes decreased linearly with publication year, and greater improvements in depression were significantly associated with greater improvements in QOL for CBT, but not for SSRIs. CBT and SSRIs for depression were both associated with moderate improvements in QOL, but are possibly caused by different mechanisms.
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Affiliation(s)
- Stefan G Hofmann
- a Department of Psychological and Brain Sciences , Boston University , 648 Beacon Street, 6th Floor, Boston , MA 02215 , USA
| | - Joshua Curtiss
- a Department of Psychological and Brain Sciences , Boston University , 648 Beacon Street, 6th Floor, Boston , MA 02215 , USA
| | - Joseph K Carpenter
- a Department of Psychological and Brain Sciences , Boston University , 648 Beacon Street, 6th Floor, Boston , MA 02215 , USA
| | - Shelley Kind
- a Department of Psychological and Brain Sciences , Boston University , 648 Beacon Street, 6th Floor, Boston , MA 02215 , USA.,b Psychology Department , Suffolk University , 73 Tremont Street, 8th Floor, Boston , MA 02108 , USA
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Baeza-Velasco C, Baguet F, Allart P, Aguerre C, Sultan S, Ninot G, Soubeyran P, Cousson-Gelie F. Major depressive disorder and associated factors in elderly patients with non-Hodgkin’s lymphoma. Health Psychol Behav Med 2016. [DOI: 10.1080/21642850.2016.1264879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Carolina Baeza-Velasco
- Institut de Psychologie, Université Paris Descartes, Sorbonne Paris Cité, Laboratoire de Psychopathologie et Processus de Santé EA, Paris, France
| | - Fanny Baguet
- Institut Régional du Cancer de Montpellier, Epidaure Pôle Prévention, Montpellier, France
- Université Montpellier 1 & 3, Laboratory Epsylon EA, Dynamics of Human Abilities and Health Behaviors, Montpellier, France
| | - Priscilla Allart
- Université de Bordeaux, Laboratoire Psychologie Santé et Qualité de Vie EA, Bordeaux, France
| | - Colette Aguerre
- Université François Rabelais, Laboratoire Psychologie des Ages de la Vie EA, Tours, France
| | - Serge Sultan
- Université de Montréal, CHU Sainte-Justine, QC, Canada
| | - Gregory Ninot
- Université Montpellier 1 & 3, Laboratory Epsylon EA, Dynamics of Human Abilities and Health Behaviors, Montpellier, France
| | - Pierre Soubeyran
- Departement d'Oncologie Médicale, Institut Bergonié, Bordeaux, France
| | - Florence Cousson-Gelie
- Institut Régional du Cancer de Montpellier, Epidaure Pôle Prévention, Montpellier, France
- Université Montpellier 1 & 3, Laboratory Epsylon EA, Dynamics of Human Abilities and Health Behaviors, Montpellier, France
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Psychosocial Health of Older Adults with Cancer: Clinical Interventions Promoting Meaning and Value-Driven Behavior. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0180-y] [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]
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Walsh K. Addressing psychosocial issues in cancer survivorship: past, present and future. Future Oncol 2016; 12:2823-2834. [PMID: 27467398 DOI: 10.2217/fon-2016-0138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
With a burgeoning population of cancer survivors, organizations in the USA and around the world are considering how to address the many long-term and late psychosocial effects of cancer and cancer treatment. This article reviews the changing landscape of survivorship care over the past 50 years, from the time when there were relatively few survivors to the future, when the number of cancer survivors in the USA alone is expected to reach close to 20 million. Institute of Medicine Reports, intra-organizational summits and accrediting standards that have influenced the development of survivorship care plans and programs and the roles of the Internet and smartphone applications along with oncology specialist and primary care providers are discussed.
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Steel JL, Geller DA, Kim KH, Butterfield LH, Spring M, Grady J, Sun W, Marsh W, Antoni M, Dew MA, Helgeson V, Schulz R, Tsung A. Web-based collaborative care intervention to manage cancer-related symptoms in the palliative care setting. Cancer 2016; 122:1270-82. [PMID: 26970434 PMCID: PMC4828258 DOI: 10.1002/cncr.29906] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/23/2015] [Accepted: 12/28/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND The aim of this study was to examine the efficacy of a collaborative care intervention in reducing depression, pain, and fatigue and improve quality of life. METHODS A total of 261 patients with advanced cancer and 179 family caregivers were randomized to a web-based collaborative care intervention or enhanced usual care. The intervention included the following: 1) a web site with written and audiovisual self-management strategies, a bulletin board, and other resources; 2) visits with a care coordinator during a physician's appointment every 2 months; and 3) telephone follow-up every 2 weeks. Primary patient outcomes included measures of depression, pain, fatigue, and health-related quality of life. Secondary outcomes included Interleukin (IL)-1α, IL-1β, IL-6, and IL-8 levels, Natural Killer (NK) cell numbers, and caregiver stress and depression. RESULTS At the baseline, 51% of the patients reported 1 or more symptoms in the clinical range. For patients who presented with clinical levels of symptoms and were randomized to the intervention, reductions in depression (Cohen's d = 0.71), pain (Cohen's d = 0.62), and fatigue (Cohen's d = 0.26) and improvements in quality of life (Cohen's d = 0.99) were observed when compared to those in the enhanced usual car arm at 6 months. Reductions in IL-6 (φ = 0.18), IL-1β (φ = 0.35), IL-1α (φ = 0.19), and IL-8 (φ = 0.15) and increases in NK cell numbers (φ = 0.23) were observed in comparison with enhanced usual care arm at 6 months. Reductions in caregiver stress (Cohen's d = 0.75) and depression (Cohen's d = 0.37) were observed at 6 months for caregivers whose loved ones were randomized to the intervention arm. CONCLUSIONS The integration of screening and symptom management into cancer care is recommended.
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Affiliation(s)
- Jennifer L Steel
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David A Geller
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kevin H Kim
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lisa H Butterfield
- Departments of Medicine, Surgery and Immunology, Hillman Cancer Center, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Michael Spring
- School of Information Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan Grady
- School of Information Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Weiing Sun
- Cancer Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Wallis Marsh
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Antoni
- Department of Psychology, University of Miami, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vicki Helgeson
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Richard Schulz
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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31
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Mindfulness-based therapy and behavioral activation: A randomized controlled trial with depressed college students. Behav Res Ther 2016; 77:118-28. [DOI: 10.1016/j.brat.2015.12.012] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 11/13/2015] [Accepted: 12/20/2015] [Indexed: 01/18/2023]
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Jassim GA, Whitford DL, Hickey A, Carter B. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev 2015:CD008729. [PMID: 26017383 DOI: 10.1002/14651858.cd008729.pub2] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. OBJECTIVES To assess the effects of psychological interventions on psychological morbidities, quality of life and survival among women with non-metastatic breast cancer. SEARCH METHODS We searched the following databases up to 16 May 2013: the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL and PsycINFO; and reference lists of articles. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) search portal and ClinicalTrials.gov for ongoing trials in addition to handsearching. SELECTION CRITERIA Randomised controlled trials that assessed the effectiveness of psychological interventions for non-metastatic breast cancer in women. DATA COLLECTION AND ANALYSIS Two review authors independently appraised and extracted data from eligible trials. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcome. MAIN RESULTS Twenty-eight randomised controlled trials comprising 3940 participants were included. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. A wide range of interventions were evaluated, with 24 trials investigating a cognitive behavioural therapy and four trials investigating psychotherapy compared to control. Pooled standardised mean differences (SMD) from baseline indicated less depression (SMD -1.01, 95% confidence interval (CI) -1.83 to -0.18; P = 0.02; 7 studies, 637 participants, I(2) = 95%, low quality evidence), anxiety (SMD -0.48, 95% CI -0.76 to -0.21; P = 0.0006; 8 studies, 776 participants, I(2) = 64%, low quality evidence) and mood disturbance (SMD -0.28, 95% CI -0.43 to -0.13; P = 0.0003; 8 studies, 1536 participants, I(2) = 47%, moderate quality evidence) for the cognitive behavioural therapy group than the control group. For quality of life, only an individually-delivered cognitive behavioural intervention showed significantly better quality of life than the control with an SMD of 0.65 (95% CI 0.07 to 1.23; P = 0.03; 3 studies, 141 participants, I(2) = 41%, very low quality evidence). Pooled data from two group-delivered studies showed a non-significant overall survival benefit favouring cognitive behavioural therapy compared to control (pooled hazard ratio (HR) 0.76, 95% CI 0.25 to 2.32; P = 0.63; 530 participants, I(2) = 84%, low quality evidence). Four studies compared psychotherapy to control with one to two studies reporting on each outcome. The four studies were assessed as high risk of bias and provided limited evidence of the efficacy of psychotherapy. Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS A psychological intervention, namely cognitive behavioural therapy, produced favourable effects on some psychological outcomes, in particular anxiety, depression and mood disturbance. However, the evidence for survival improvement is still lacking. These findings are open to criticism because of the notable heterogeneity across the included studies and the shortcomings of the included studies.
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Affiliation(s)
- Ghufran A Jassim
- Department of Family & Community Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Adliya, Bahrain
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Alemi M, Ghanbarzadeh A, Meghdari A, Moghadam LJ. Clinical Application of a Humanoid Robot in Pediatric Cancer Interventions. Int J Soc Robot 2015. [DOI: 10.1007/s12369-015-0294-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Casten RJ, Brawer R, Haller JA, Hark LA, Henderer J, Leiby B, Murchison AP, Plumb J, Rovner BW, Weiss DM. Trial of a behavioral intervention to increase dilated fundus examinations in African–Americans aged over 65 years with diabetes. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.11.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hopko DR, Funderburk JS, Shorey RC, McIndoo CC, Ryba MM, File AA, Benson K, Vitulano M. Behavioral Activation and Problem-Solving Therapy for Depressed Breast Cancer Patients. Behav Modif 2013; 37:747-67. [DOI: 10.1177/0145445513501512] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Major depressive disorder (MDD) is the most common psychiatric disorder in breast cancer patients. The prevalence of suicidal ideation in breast cancer patients is considerable, and relative to the general population, the prevalence of completed suicide is elevated, particularly in cancer patients with MDD. A major component of suicide prevention is effective treatment of MDD. Although some research has explored the utility of psychotherapy with breast cancer patients, only three trials have explored the benefits of behavior therapy in patients with well-diagnosed MDD and there has been no systematic investigation of the potential benefits of psychotherapy toward reducing suicidal ideation in breast cancer patients. As a follow-up to a recently completed randomized trial, this study examined the efficacy of 8 weeks of behavioral activation treatment for depression (BATD) and problem-solving therapy (PST) in reducing depression and suicidal ideation, as well as increasing hopefulness in breast cancer patients with MDD ( n = 80). Across both treatments, GEE analyses revealed decreased depression and suicidal ideation and increased hopefulness at posttreatment, results that were maintained at 12-month follow-up. Moreover, follow-up patient contact at approximately 2 years posttreatment yielded no indication of completed suicide. Although these data are preliminary, BATD and PST may represent practical approaches to decrease suicidal ideation in depressed breast cancer patients.
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Affiliation(s)
- D. R. Hopko
- The University of Tennessee-Knoxville, TN, USA
| | - J. S. Funderburk
- Syracuse VA Medical Center, NY, USA
- Syracuse University, NY, USA
- University of Rochester, NY, USA
| | | | | | - M. M. Ryba
- The University of Tennessee-Knoxville, TN, USA
| | - A. A. File
- The University of Tennessee-Knoxville, TN, USA
| | - K. Benson
- The University of Tennessee-Knoxville, TN, USA
| | - M. Vitulano
- The University of Tennessee-Knoxville, TN, USA
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Loh J, Gulati A. The use of transcutaneous electrical nerve stimulation (TENS) in a major cancer center for the treatment of severe cancer-related pain and associated disability. PAIN MEDICINE 2013; 16:1204-10. [PMID: 23438255 DOI: 10.1111/pme.12038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cancer pain is difficult to treat, often requiring a multimodal approach. While medication management remains the mainstay for the treatment of cancer pain, medications are often associated with undesired side effects. Transcutaneous electrical nerve stimulation (TENS) provides a potential adjunctive method for treating cancer pain with minimal side effects. OBJECTIVE Few studies have been performed evaluating the efficacy of TENS on cancer pain. We sought to examine the usefulness of TENS on all cancer patients and to specifically look at the use of TENS as a goal-directed therapy to improve functionality. DESIGN Retrospective cohort study. METHODS Since 2008, patients with chronic cancer pain and on multimodal pain regimens were trialed with TENS. Those patients who showed an improvement in pain symptoms or severity were educated about and provided with a TENS unit for use at home. Pain symptoms and scores were monitored with the visual analog scale (VAS), the numerical rating pain (NRP) scale, and Short-Form McGill Questionnaire at the start of TENS treatment and at 2 months follow-up. RESULTS TENS proved beneficial in 69.7% of patients over the course of 2 months. In TENS responsive patients, VAS scores decreased by 9.8 on a 0-100 mm scale (P < 0.001), and NRP scores decreased by 0.8 on a 1-10 scale (P < 0.001). LIMITATIONS Lack of placebo and lack of blinding of physician and patient. CONCLUSIONS TENS provides a beneficial adjunct for the treatment of cancer pain, especially when utilized as a goal-directed therapy.
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Affiliation(s)
- Jeffrey Loh
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, California, USA
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Board Certified in Anesthesiology and Pain management, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Abstract
In medically ill patients, given the many entities the phenotype of depression may represent, clinicians must be prepared to cast their diagnostic nets widely, not settling for the obvious but frequently incorrect choice of major depressive episode and throwing antidepressants at it willy nilly. Having chosen the correct diagnosis from among a broad differential of depression “look-alikes,” clinicians can draw upon a broad swath of treatment modalities including medications, psychotherapy, social supports, and spiritual interventions. Working as a psychiatrist in the medical arena requires the curiosity and analytic skills of a detective and the breadth of knowledge of a polymath adapting therapeutic tools from across the biopsychosociospiritual spectrum to the specific needs of the patient.
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Affiliation(s)
- Sandra Rackley
- Department of Psychiatry, The George Washington University School of Medicine, 2300 I Street NW, Washington, DC 20037, USA
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Reynolds EK, Macpherson L, Tull MT, Baruch DE, Lejuez CW. Integration of the brief behavioral activation treatment for depression (BATD) into a college orientation program: depression and alcohol outcomes. J Couns Psychol 2011; 58:555-64. [PMID: 21787070 PMCID: PMC4104126 DOI: 10.1037/a0024634] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
College freshmen face a variety of academic and social challenges as they adjust to college life that can place them at risk for a number of negative outcomes, including depression and alcohol-related problems. Orientation classes that focus on teaching incoming students how to better cope with college-oriented stress may provide an opportunity to prevent the development of these adjustment problems. This article outlines a program based on behavioral activation that can be integrated into college orientation programs to provide a more comprehensive orientation experience. Data are presented from an initial pilot study in which 71 first-semester freshman at the University of Maryland participated in a 15-week, 2 hr per week orientation class (n = 37 in the behavioral activation-enhanced orientation classes and n = 34 in the control orientation as usual classes). Students' depression and alcohol use were evaluated at the beginning, middle, and end of the course. Results indicated a Time × Group interaction such that problem drinking (but not consumption) was significantly reduced across assessments in the behavioral activation classes and largely unchanged in the standard classes. No difference was observed in depression scores; however, fairly low depression scores across the 3 time points may have limited the opportunity to observe any meaningful impact of the orientation classes on depression. The authors conclude with a discussion of the implications of their findings for preventing adjustment problems among incoming college students and future directions.
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Affiliation(s)
- Elizabeth K Reynolds
- Center for Addictions, Personality, and Emotion Research, University of Maryland, MD, USA.
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Hopko DR, Magidson JF, Lejuez CW. Treatment failure in behavior therapy: focus on behavioral activation for depression. J Clin Psychol 2011; 67:1106-16. [PMID: 21953441 DOI: 10.1002/jclp.20840] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Behavioral activation (BA) has come to be recognized as an empirically supported treatment for depression. Despite the general success of the approach, many patients experience treatment failure. Based on behavioral models of depression, we present several reasons for treatment failure in BA, including patient inability to understand and adopt the treatment rationale, lack of awareness or ability to articulate and behave according to life values, behavioral noncompliance, and ineffectiveness of contingency management to increase exposure to environmental rewards and reduce contact with both aversive environmental events and reinforcement of depressed behavior. A case study of treatment failure with a depressed breast cancer patient is presented, along with recommendations to reduce failure rates in BA.
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Affiliation(s)
- Derek R Hopko
- University of Tennessee–Knoxville, Department of Psychology, Room 301D, Austin Peay Building, Knoxville, Tennessee 37996-0900, USA.
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40
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Brothers BM, Yang HC, Strunk DR, Andersen BL. Cancer patients with major depressive disorder: testing a biobehavioral/cognitive behavior intervention. J Consult Clin Psychol 2011; 79:253-60. [PMID: 21341891 DOI: 10.1037/a0022566] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In this Phase II trial, we evaluated a novel psychological treatment for depressed patients coping with the stresses of cancer. Effectiveness of a combined biobehavioral intervention (BBI) and cognitive behavior therapy (CBT) was studied. METHOD Participants were 36 cancer survivors (mean age = 49 years; 88% Caucasian; 92% female) diagnosed with major depressive disorder. A single group pre-post design was used. Treatment consisted of up to 20 individual 75-min combined BBI/CBT sessions. Outcomes were change in interviewer (Hamilton Rating Scale for Depression; Williams, 1988) and self-rated depressive symptoms (Beck Depression Inventory-Second Edition; Beck, Steer, & Brown, 1996) as well as change in cancer relevant symptoms (Fatigue Symptom Inventory [Hann et al., 1998] and Brief Pain Questionnaire [Daut, Cleeland, & Flanery, 1983]) and quality of life (Medical Outcomes Study Short Form-36; Ware et al., 1995). Mixed-effects modeling, a reliability change index, and generalized linear models were used. All analyses were intent-to-treat. RESULTS Depressive symptoms significantly improved. In addition, 19 of 21 study completers met criteria for remission. Significant improvements were also noted in fatigue and mental health quality of life. Both concurrent anxiety disorders and high levels of cancer stress (Impact of Events Scale; Horowitz, Wilner, & Alvarez, 1979) were each associated with beginning and concluding treatment with greater depressive symptoms. CONCLUSIONS CBT components were successfully incorporated into a previously efficacious intervention for reducing cancer stress. The BBI/CBT intervention warrants further research in evaluating its efficacy compared with well-established treatments for depression.
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Affiliation(s)
- Brittany M Brothers
- Comprehensive Cancer Center, The Ohio State University, 159 Psychology Building, 1835 Neil Avenue, Columbus, OH 43210, USA.
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Baruch DE, Kanter JW, Bowe WM, Pfennig SL. Improving Homework Compliance in Career Counseling With a Behavioral Activation Functional Assessment Procedure: A Pilot Study. COGNITIVE AND BEHAVIORAL PRACTICE 2011. [DOI: 10.1016/j.cbpra.2010.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kangas M, McDonald S. Is it time to act? The potential of acceptance and commitment therapy for psychological problems following acquired brain injury. Neuropsychol Rehabil 2011; 21:250-76. [PMID: 21246445 PMCID: PMC3877858 DOI: 10.1080/09602011.2010.540920] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Behaviour therapies have a well-established, useful tradition in psychological treatments and have undergone several major revisions. Acceptance and Commitment Therapy (ACT) and mindfulness-based approaches are considered a third wave of behavioural therapies. Emerging evidence for ACT has demonstrated that this paradigm has promising effectiveness in improving functionality and well-being in a variety of populations that have psychological disturbances and/or medical problems. In this review we first evaluate traditional cognitive behavioural therapy (CBT) interventions used to manage psychological problems in distressed individuals who have sustained an acquired brain injury (ABI). We provide an overview of the ACT paradigm and the existent evidence base for this intervention. A rationale is outlined for why ACT-based interventions may have potential utility in assisting distressed individuals who have sustained a mild to moderate ABI to move forward with their lives. We also review emerging evidence that lends preliminary support to the implementation of acceptance and mindfulness-based interventions in the rehabilitation of ABI patient groups. On the basis of existent literature, we recommend that it is an opportune time for forthcoming research to rigorously test the efficacy of ACT-based interventions in facilitating ABI patient groups to re-engage in living a valued and meaningful life, in spite of their neurocognitive and physical limitations. The promising utility of testing the efficacy of the ACT paradigm in the context of multimodal rehabilitation programmes for ABI populations is also addressed.
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Affiliation(s)
- Maria Kangas
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia.
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Hung R, Krebs P, Coups EJ, Feinstein MB, Park BJ, Burkhalter J, Ostroff JS. Fatigue and functional impairment in early-stage non-small cell lung cancer survivors. J Pain Symptom Manage 2011; 41:426-35. [PMID: 21216563 PMCID: PMC3063865 DOI: 10.1016/j.jpainsymman.2010.05.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 05/05/2010] [Accepted: 05/06/2010] [Indexed: 12/22/2022]
Abstract
CONTEXT Fatigue is the most common sequela among non-small cell lung cancer (NSCLC) survivors one to six years post-treatment and is associated with functional limitations. OBJECTIVES This study examined the prevalence, severity, and correlates of fatigue among early stage NSCLC survivors. METHODS Three-hundred fifty individuals diagnosed and surgically treated for Stage IA or IB NSCLC completed a survey that included the Brief Fatigue Inventory (BFI) to assess the prevalence and severity of fatigue. The Karnofsky Self-Reported Performance Rating scale (SR-KPS) was used as a measure of functional status and was compared with the severity of fatigue through Chi-squared analyses. Demographic, psychological, and medical correlates of fatigue were examined using logistic regression. RESULTS The prevalence of fatigue was 57%. Forty-one percent (n=142) of participants had mild fatigue and 16.8% (n=59) had moderate or severe fatigue (BFI≥4). Among the individuals reporting moderate or severe fatigue, 23.7% (n=14) had significant functional impairment (SR-KPS≤70%) compared with 2.8% (n=8) with mild or no fatigue (χ(2)=58.1, P<0.001). In the multivariate analysis, NSCLC survivors with pulmonary disease (odds ratio [OR]=2.28), depressive symptoms (OR=6.99), and anxiety symptoms (OR=2.31) were more likely to report experiencing clinically significant fatigue, whereas those who met physical activity guidelines (OR=0.29) reported less fatigue. CONCLUSION Fatigue is highly prevalent among NSCLC survivors and associated with more functional impairment. A comprehensive approach to the treatment of fatigue includes the screening and management of anxious and depressive symptoms, and pulmonary disorders such as chronic obstructive pulmonary disease.
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Affiliation(s)
- Robert Hung
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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Mehta S, Orenczuk S, Hansen KT, Aubut JAL, Hitzig SL, Legassic M, Teasell RW. An evidence-based review of the effectiveness of cognitive behavioral therapy for psychosocial issues post-spinal cord injury. Rehabil Psychol 2011; 56:15-25. [PMID: 21401282 PMCID: PMC3206089 DOI: 10.1037/a0022743] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To examine the evidence supporting the effectiveness of cognitive behavioral therapy (CBT) for improving psychosocial outcomes in individuals with spinal cord injury (SCI). METHOD Electronic databases (MEDLINE, CINAHL, EMBASE, and PsycINFO) were searched for studies published between 1990 and October 2010. Randomized control trials (RCTs) and nonrandomized control trials (non-RCTs) utilizing a CBT intervention to improve psychosocial outcomes (depressive symptomatology, anxiety, coping, and adjustment to disability) in outpatient persons with SCI were included for review. Levels of evidence were assigned to each study using a modified Sackett scale. Effect size calculations for the interventions were provided where possible. RESULTS Nine studies met the inclusion criteria. The studies reviewed included two RCTs, six prospective controlled trials (PCTs) and one cohort study. All studies examined at least two groups. There is Level 1 and Level 2 evidence supporting the use of specialized CBT protocols in persons with SCI for improving outcomes related to depression, anxiety, adjustment, and coping. CONCLUSIONS CBT holds promise as an effective approach for persons with SCI experiencing depression, anxiety, adjustment, and coping problems. As CBT may involve many different components, it is important in the future to determine which of these elements alone or in combination is most effective in treating the emotional consequences of SCI.
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Affiliation(s)
- Swati Mehta
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON
- St. Joseph’s Parkwood Hospital, London ON
| | | | | | - Jo-Anne L. Aubut
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON
- St. Joseph’s Parkwood Hospital, London ON
| | | | - Matthew Legassic
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON
- St. Joseph’s Parkwood Hospital, London ON
| | - Robert W. Teasell
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON
- St. Joseph’s Parkwood Hospital, London ON
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London ON
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Jassim GA, Whitford DL, Grey IM. Psychological interventions for women with non-metastatic breast cancer. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Daughters SB, Magidson JF, Schuster RM, Safren SA. ACT HEALTHY: A Combined Cognitive-Behavioral Depression and Medication Adherence Treatment for HIV-Infected Substance Users. COGNITIVE AND BEHAVIORAL PRACTICE 2010; 17:309-321. [PMID: 21709737 DOI: 10.1016/j.cbpra.2009.12.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The two most common comorbid conditions with HIV are substance use disorders and depression, and individuals with comorbid HIV, depression, and substance dependence face a more chronic and treatment-resistant course. As an example of how to adapt evidence-based approaches to a complex comorbid population, the current case study examined the integration of a combined depression and HIV medication adherence treatment. The resulting intervention, ACT HEALTHY, combines a brief behavioral activation approach specifically developed to treat depression in individuals receiving residential substance abuse treatment (LETS ACT; Daughters et al., 2008) with a brief cognitive-behavioral approach to improving HIV medication adherence (Life-Steps; Safren et al., 1999; Safren et al., 2009). The current case series demonstrates the use of ACT HEALTHY among 3 depressed HIV-positive, low-income African Americans entering residential substance abuse treatment.
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47
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Kanter JW, Santiago-Rivera AL, Rusch LC, Busch AM, West P. Initial Outcomes of a Culturally Adapted Behavioral Activation for Latinas Diagnosed With Depression at a Community Clinic. Behav Modif 2010; 34:120-44. [DOI: 10.1177/0145445509359682] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Latinos demonstrate high rates of depression, often do not seek treatment, and terminate prematurely for a variety of reasons, including lack of sensitivity to contextual and cultural factors in treatment approaches. For decades researchers have suggested a behavioral approach to Latinos diagnosed with depression because such an approach targets the complex environmental stressors experienced by these populations with a simple, pragmatic approach. Recently, behavioral activation has been culturally and linguistically adapted for Latinos/Latinas diagnosed with depression (BA-Latino or BAL). The current study consists of a pilot evaluation of BAL at a bilingual (Spanish—English) community mental health clinic ( N = 10 Latinas). Results provide preliminary support for the feasibility and effectiveness of BAL for Latinas in a community setting in terms of treatment adherence, retention, and outcomes. Implications and future directions are discussed.
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Affiliation(s)
| | | | | | | | - Paul West
- Sixteenth Street Community Health Center, Milwaukee, Wisconsin
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48
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Hopko DR, Robertson SMC, Carvalho JP. Sudden gains in depressed cancer patients treated with behavioral activation therapy. Behav Ther 2009; 40:346-56. [PMID: 19892080 DOI: 10.1016/j.beth.2008.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 08/19/2008] [Accepted: 09/20/2008] [Indexed: 10/21/2022]
Abstract
Many patients who receive cognitive-behavioral therapy experience sudden gains that are associated with improved treatment response and decreased risk of relapse. Extending prior research, this study examined sudden gains among depressed cancer patients receiving brief (9-session) behavioral activation therapy. Fifty percent of patients experienced sudden gains of large magnitude (M=11.8 BDI-II points), with sudden gains associated with improved treatment response and maintenance of gains at 3-month follow-up. Relative to those without sudden gains, at pretreatment assessment, cancer patients with sudden gains were more likely to present with less severe depression, less somatic anxiety, fewer coexistent anxiety disorders, as well as less bodily pain, better overall physical functioning, and fewer problems with daily activities as a result of emotional problems. These findings provide increasing support for behavioral activation with a difficult-to-treat population but raise important questions regarding mechanism of change. Clinical implications for treating depressed cancer patients are discussed.
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Affiliation(s)
- Derek R Hopko
- Department of Psychology, University of Tennessee, Knoxville, TN 37996, USA.
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Abstract
Problem-solving therapy (PST) has emerged as a promising treatment for major depressive disorder (MDD). The treatment, which is brief and easily accessible to a variety of health practitioners, has often been implemented within primary care settings. Building on this research, this case study highlights utilization of problem-solving therapy with a breast cancer patient diagnosed with recurrent major depression, applied within the context of a medical center oncology clinic. Following an 8-session PST protocol, the patient demonstrated notable decreases in self-reported depression and anxiety symptoms and an overall increase in quality of life and medical functioning. Consistent with an accumulating literature, these data support PST as an effective and parsimonious intervention for individuals with depression and concurrent medical problems such as breast cancer.
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50
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Current World Literature. Curr Opin Support Palliat Care 2009; 3:79-82. [DOI: 10.1097/spc.0b013e3283277013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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