Consulting and prescribing behaviour for anxiety and depression in long-term survivors of cancer in the UK

Bipolar spectrum in prostate cancer patients and its role in stress related symptoms

BACKGROUND

Studies show significant co-occurrence of bipolar disorder and prostate cancer, as well as the presence of shared genes associated with both diseases. Our aim was to evaluate whether prostate cancer patients present bipolar spectrum symptoms and to establish their possible associations with stress related symptoms during diagnosis and the course of the cancer therapy.

METHODS

200 participants were enrolled to this study: 100 prostate cancer patients and 100 healthy males. Bipolar spectrum symptoms were measured with the use of Mood Disorder Questionnaire and Hypomania Checklist-32 (HCL-32). Stress related symptoms were rated with The Impact of Events Scale-Revised (IES-R), Perceived Stress Scale-10 (PSS-10) and Generalised Self-Efficacy Scale (GSES).

RESULTS

In comparison to healthy controls group, prostate cancer patients have shown higher HCL-32 scores. Mood Disorder Questionnaire measures were associated with more severe stress related to prostate cancer diagnosis and treatment reflected by higher scores of IES-R and its subscales (Avoidance, Intrusions and Hyperarousal). Mood Disorder Questionnaire, HCL-32, PSS-10, IES-R and GSES measures were not associated with clinical characteristics of prostate cancer severity.

LIMITATIONS

Cross-sectional study model precluded identification of causal relationship among variables. Bipolar spectrum symptoms and stress related measures were based on auto-questionnaires.

CONCLUSIONS

To our best knowledge, this is the first study evaluating bipolar spectrum symptoms in prostate cancer patients. We have shown that this clinical group presents increased bipolarity traits compared to healthy individuals. Moreover, bipolar spectrum symptoms were associated with more severe stress related to the prostate cancer diagnosis and its treatment, reflected in avoidance, hyperarousal, and intrusions.

Risk of Pharmacological or Hospital Treatment for Depression in Patients with Colorectal Cancer-Associations with Pre-Cancer Lifestyle, Comorbidity and Clinical Factors

Simple Summary

Depression is a common disorder in cancer patients. In this population-based prospective cohort study, we investigated if patients with colorectal cancer experience a higher risk of pharmacological or hospital treatment for depression than age- and gender-matched cancer-free comparison persons when differences in lifestyle, anthropometry, socioeconomic position or comorbidity where taken into account. To identify potential risk factors, we further investigated the associations between depression and antidepressant use and pre-cancer lifestyle factors, clinical factors and treatment factors. The study results may help point toward vulnerable groups of patients at risk of depression.

Abstract

We investigated the risk of depression in colorectal cancer (CRC) patients and associated risk factors. The 1324 patients with CRC and 6620 matched cancer-free participants from the Diet, Cancer and Health study were followed for up to 16 years for either a first hospitalization for depression or antidepressant prescription after diagnosis of CRC cancer or study entry date. Information on the outcome and covariates was retrieved from the Danish Colorectal Cancer Group database, the national health registries and questionnaires. Cumulative incidence of depression was estimated, and Cox regression models were used to evaluate the association between risk factors and depression incidence. During follow-up, 191 (14.4%) patients with CRC and 175 (2.6%) cancer-free comparison persons experienced depression. After adjustments, in the first year after cancer diagnosis, patients with CRC had a 12-fold higher hazard compared with the cancer-free population (HR, 12.01; 95% CI, 7.89–18.28). The risk decreased during follow-up but remained significantly elevated with an HR of 2.65 (95% CI, 1.61–4.36) after five years. Identified risk factors were presence of comorbidities, advanced disease stage and use of radiotherapy, while life style factors (pre-cancer or at diagnosis) and chemotherapy did not seem to contribute to the increased risk.

Psychosocial care for cancer survivors: A systematic literature review on the role of general practitioners

OBJECTIVE

To explore the general practitioners (GP's) role in providing psychosocial care for cancer survivors through a systematic literature review.

METHODS

We searched MEDLINE, EMBASE, PsycINFO, and CINAHL and included the studies that complied with the predefined inclusion and exclusion criteria. At least two independent reviewers performed the quality appraisal and data extraction.

RESULTS

We included 33 (five qualitative, 19 observational, and nine intervention) studies; the majority of these studies focused on care for depression and anxiety (21/33). Cancer survivors were more likely to contact their GP for psychosocial problems compared with noncancer controls. Survivors were more likely to use antidepressants compared with controls, although 71% of survivors preferred depression treatment to be "talking therapy only." Overall, GPs and patients mostly agreed that GPs are the preferred healthcare provider to manage psychosocial problems. The major exception is a survivor's fear of recurrence-here, the oncologist was the preferred healthcare provider. Only two interventions effectively decreased depression or anxiety; these studies included patients who had a clinical indication for psychosocial care, were specifically designed for decreasing depression/anxiety, and consisted of a multidisciplinary team approach. The other interventions evaluated GP-led follow-up for cancer survivors and found that this did not impact the patients' levels of anxiety, depression, or distress neither negatively nor positively.

CONCLUSIONS

Cancer survivors often prefer psychosocial care by their GP, and GPs generally consider they are well placed to provide this care. Although evidence on the effectiveness of psychosocial care by GPs is limited, an active multidisciplinary team approach seems key.

Associations between breast cancer survivorship and adverse mental health outcomes: A matched population-based cohort study in the United Kingdom

BACKGROUND

Breast cancer is the most common cancer diagnosed in women globally, and 5-year net survival probabilities in high-income countries are generally >80%. A cancer diagnosis and treatment are often traumatic events, and many women struggle to cope during this period. Less is known, however, about the long-term mental health impact of the disease, despite many women living several years beyond their breast cancer and mental health being a major source of disability in modern societies. The objective of this study was to quantify the risk of several adverse mental health-related outcomes in women with a history of breast cancer followed in primary care in the United Kingdom National Health Service, compared to similar women who never had cancer.

METHODS AND FINDINGS

We conducted a matched cohort study using data routinely collected in primary care across the UK to quantify associations between breast cancer history and depression, anxiety, and other mental health-related outcomes. All women with incident breast cancer in the Clinical Practice Research Datalink (CPRD) GOLD primary care database between 1988 and 2018 (N = 57,571, mean = 62 ± 14 years) were matched 1:4 to women with no prior cancer (N = 230,067) based on age, primary care practice, and eligibility of the data for linkage to hospital data sources. Cox models were used to estimate associations between breast cancer survivorship and each mental health-related outcome, further adjusting for diabetes, body mass index (BMI), and smoking and drinking status at baseline. Breast cancer survivorship was positively associated with anxiety (adjusted hazard ratio (HR) = 1.33; 95% confidence interval (CI): 1.29-1.36; p < 0.001), depression (1.35; 1.32-1.38; p < 0.001), sexual dysfunction (1.27; 1.17-1.38; p < 0.001), and sleep disorder (1.68; 1.63-1.73; p < 0.001), but not with cognitive dysfunction (1.00; 0.97-1.04; p = 0.88). Positive associations were also found for fatigue (HR = 1.28; 1.25-1.31; p < 0.001), pain (1.22; 1.20-1.24; p < 0.001), receipt of opioid analgesics (1.86; 1.83-1.90; p < 0.001), and fatal and nonfatal self-harm (1.15; 0.97-1.36; p = 0.11), but CI was wide, and the relationship was not statistically significant for the latter. HRs for anxiety and depression decreased over time (p-interaction <0.001), but increased risks persisted for 2 and 4 years, respectively, after cancer diagnosis. Increased levels of pain and sleep disorder persisted for 10 years. Younger age was associated with larger HRs for depression, cognitive dysfunction, pain, opioid analgesics use, and sleep disorders (p-interaction <0.001 in each case). Limitations of the study include the potential for residual confounding by lifestyle factors and detection bias due to cancer survivors having greater healthcare contact.

CONCLUSIONS

In this study, we observed that compared to women with no prior cancer, breast cancer survivors had higher risk of anxiety, depression, sleep problems, sexual dysfunction, fatigue, receipt of opioid analgesics, and pain. Relative risks estimates tended to decrease over time, but anxiety and depression were significantly increased for 2 and 4 years after breast cancer diagnosis, respectively, while associations for fatigue, pain, and sleep disorders were elevated for at least 5-10 years after diagnosis. Early diagnosis and increased awareness among patients, healthcare professionals, and policy makers are likely to be important to mitigate the impacts of these raised risks.

Physical functional limitations and psychological distress in people with and without colorectal cancer: findings from a large Australian study

PURPOSE

To quantify physical disability and psychological distress in people with and without colorectal cancer (CRC).

METHODS

Questionnaire data (2006-2009) from 267,153 Australian general population members aged ≥ 45 years participating in the 45 and Up Study (n = 213,231 following exclusions) were linked to cancer registry and hospital admission data, to ascertain CRC status. Modified Poisson regression estimated adjusted prevalence ratios (PRs) for physical disability and psychological distress in participants with CRC versus those without.

RESULTS

Compared with participants without CRC (n = 210,836), CRC survivors (n = 2395) had significantly higher physical disability prevalence (11.9% versus 19.5%, respectively), PR = 1.11 (95% CI = 1.03-1.20); and a similar prevalence of distress (23.1% versus 20.2%), PR = 1.03 (0.94-1.20). Adverse outcomes were associated with certain clinical characteristics. Compared with participants without CRC, CRC survivors diagnosed 5-< 10 and ≥ 10 years, with regional spread, and without recent cancer treatment had broadly similar outcomes; survivors with metastatic CRC and recent treatment had 30-60% higher prevalence of disability and distress. Compared with participants with neither CRC nor disability, PRs for distress were 4.71 (4.22-5.26) for those with disability and CRC; and 4.22 (4.13-4.31) for those with disability without CRC.

CONCLUSIONS

Physical disability is elevated in CRC survivors. Psychological distress is elevated 4- to 5-fold with disability, regardless of CRC diagnosis, with lesser increases around diagnosis and treatment.

IMPLICATIONS FOR CANCER SURVIVORS

CRC survivors with less advanced disease and who have not been recently diagnosed or treated have physical disability and psychological distress comparable to the general population. Survivors with disability are at particularly high risk of psychological distress.

Antidepressant use and colorectal cancer morbidity and mortality: A dose-response meta analysis

The risk of colorectal cancer associated to antidepressant use remains unclear. The purpose of this meta-analysis was to investigate the risk of colorectal cancer associated to antidepressant use.Medline, Embase, Web of Science, and Cochrane Database were accessed from the dates of their establishment to October 2018, to collect study of antidepressant use and colorectal cancer morbidity and mortality. Then a meta-analysis was conducted using Stata 12.0 software.A total of 11 publications involving 109,506 participants were included. The meta-analysis showed that antidepressant use was not associated with colorectal cancer morbidity (relevant risk (RR): 0.97; 95% confidence interval (CI): 0.94-1.01) and mortality (RR: 1.08; 95% CI: 0.99-1.17). Subgroup analysis showed selective serotonin reuptake inhibitor (RR: 0.99; 95% CI: 0.96-1.03) or serotonin norepinephrine reuptake inhibitor (RR: 1.04; 95% CI: 0.86-1.26) were not associated with colorectal cancer risk; however, TCA was associated with colorectal cancer risk decrement (RR: 0.92; 95% CI: 0.87-0.98). Furthermore, the results also showed that antidepressant use was not associated with colorectal cancer risk in Europe and North America (RR: 0.97; 95% CI: 0.92-1.02) and Asia (RR: 1.00; 95% CI: 0.95-1.26). Additionally, a dose-response showed per 1 year of duration of antidepressant use incremental increase was not associated with colorectal cancer risk (RR: 0.96; 95% CI: 0.87-1.09).Evidence suggests that antidepressant use was not associated with colorectal cancer morbidity and mortality. The cumulative duration of antidepressant use did not utilized played critical roles.

Dietary interventions for adult cancer survivors

BACKGROUND

International dietary recommendations include guidance on healthy eating and weight management for people who have survived cancer; however dietary interventions are not provided routinely for people living beyond cancer.

OBJECTIVES

To assess the effects of dietary interventions for adult cancer survivors on morbidity and mortality, changes in dietary behaviour, body composition, health-related quality of life, and clinical measurements.

SEARCH METHODS

We ran searches on 18 September 2019 and searched the Cochrane Central Register of Controlled trials (CENTRAL), in the Cochrane Library; MEDLINE via Ovid; Embase via Ovid; the Allied and Complementary Medicine Database (AMED); the Cumulative Index to Nursing and Allied Health Literature (CINAHL); and the Database of Abstracts of Reviews of Effects (DARE). We searched other resources including reference lists of retrieved articles, other reviews on the topic, the International Trials Registry for ongoing trials, metaRegister, Physicians Data Query, and appropriate websites for ongoing trials. We searched conference abstracts and WorldCat for dissertations.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that recruited people following a cancer diagnosis. The intervention was any dietary advice provided by any method including group sessions, telephone instruction, written materials, or a web-based approach. We included comparisons that could be usual care or written information, and outcomes measured included overall survival, morbidities, secondary malignancies, dietary changes, anthropometry, quality of life (QoL), and biochemistry.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodological procedures. Two people independently assessed titles and full-text articles, extracted data, and assessed risk of bias. For analysis, we used a random-effects statistical model for all meta-analyses, and the GRADE approach to rate the certainty of evidence, considering limitations, indirectness, inconsistencies, imprecision, and bias.

MAIN RESULTS

We included 25 RCTs involving 7259 participants including 977 (13.5%) men and 6282 (86.5%) women. Mean age reported ranged from 52.6 to 71 years, and range of age of included participants was 23 to 85 years. The trials reported 27 comparisons and included participants who had survived breast cancer (17 trials), colorectal cancer (2 trials), gynaecological cancer (1 trial), and cancer at mixed sites (5 trials). For overall survival, dietary intervention and control groups showed little or no difference in risk of mortality (hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.77 to 1.23; 1 study; 3107 participants; low-certainty evidence). For secondary malignancies, dietary interventions versus control trials reported little or no difference (risk ratio (RR) 0.99, 95% CI 0.84 to 1.15; 1 study; 3107 participants; low-certainty evidence). Co-morbidities were not measured in any included trials. Subsequent outcomes reported after 12 months found that dietary interventions versus control probably make little or no difference in energy intake at 12 months (mean difference (MD) -59.13 kcal, 95% CI -159.05 to 37.79; 5 studies; 3283 participants; moderate-certainty evidence). Dietary interventions versus control probably led to slight increases in fruit and vegetable servings (MD 0.41 servings, 95% CI 0.10 to 0.71; 5 studies; 834 participants; moderate-certainty evidence); mixed results for fibre intake overall (MD 5.12 g, 95% CI 0.66 to 10.9; 2 studies; 3127 participants; very low-certainty evidence); and likely improvement in Diet Quality Index (MD 3.46, 95% CI 1.54 to 5.38; 747 participants; moderate-certainty evidence). For anthropometry, dietary intervention versus control probably led to a slightly decreased body mass index (BMI) (MD -0.79 kg/m², 95% CI -1.50 to -0.07; 4 studies; 777 participants; moderate-certainty evidence). Dietary interventions versus control probably had little or no effect on waist-to-hip ratio (MD -0.01, 95% CI -0.04 to 0.02; 2 studies; 106 participants; low-certainty evidence). For QoL, there were mixed results; several different quality assessment tools were used and evidence was of low to very low-certainty. No adverse events were reported in any of the included studies.

AUTHORS' CONCLUSIONS

Evidence demonstrated little effects of dietary interventions on overall mortality and secondary cancers. For comorbidities, no evidence was identified. For nutritional outcomes, there was probably little or no effect on energy intake, although probably a slight increase in fruit and vegetable intake and Diet Quality Index. Results were mixed for fibre. For anthropometry, there was probably a slight decrease in body mass index (BMI) but probably little or no effect on waist-to-hip ratio. For QoL, results were highly varied. Additional high-quality research is needed to examine the effects of dietary interventions for different cancer sites, and to evaluate important outcomes including comorbidities and body composition. Evidence on new technologies used to deliver dietary interventions was limited.

Identification of mental health and quality of life outcomes in primary care databases in the UK: a systematic review

OBJECTIVES

To summarise the definitions and combinations of codes used to identify outcomes of anxiety, depression, fatigue, cognitive dysfunction (including mild cognitive dysfunction and dementia), sexual dysfunction, pain, sleep disorders, and fatal and non-fatal self-harm in studies using electronic health records from primary care databases in the UK.

DESIGN

Systematic review.

DATA SOURCES

Medline, Embase and lists of publications of the main primary care databases in the UK.

ELIGIBILITY CRITERIA

Included data from a UK primary care database and studied outcome(s) of interest.

DATA EXTRACTION AND SYNTHESIS

We abstracted information on the outcomes definition and codelists. When necessary, authors were contacted to request codelists.

RESULTS

120 studies were eligible. Codelists were available for 17/42 studies of depression; 21/41 studies of fatal and non-fatal self-harm; 17/27 studies of dementia/cognitive dysfunction; 5/12 studies of anxiety; 4/8 studies of pain; 3/6 studies of fatigue and sexual dysfunction; 1/2 studies of sleep disorders. Depression was most often defined using codes for diagnoses (37/42 studies) and/or antidepressants prescriptions (21/42 studies); six studies reported including symptoms in their definition. Anxiety was defined with codes for diagnoses (12/12 studies); four studies also reported including symptoms. Fatal self-harm was ascertained in primary care data linked to the Office for National Statistics mortality database in nine studies. Most studies of cognitive dysfunction included Alzheimer's disease, and vascular and frontotemporal dementia. Fatigue definitions varied little, including chronic fatigue syndrome, neurasthenia and postviral fatigue syndrome. All studies of sexual dysfunction focused on male conditions, principally erectile dysfunction. Sleep disorders included insomnia and hypersomnia. There was substantial variability in the codelists; validation was carried out i21/120 studies.

CONCLUSIONS

There is a need for standardised definitions and validated list of codes to assess mental health and quality of life outcomes in primary care databases in the UK.

Purchases of antidepressants after cancer at a young age in Finland

According to previous studies, childhood cancer survivors have an elevated risk for late mental health effects. However, only few studies exist on young adulthood (YA) cancer survivors' mental health outcomes. In our study, we examined first time antidepressant (AD) medication purchases of childhood and YA cancer patients compared to siblings. The first time AD medication purchases of 7,093 cancer patients aged 0-34 years at diagnosis and a sibling cohort (N = 26,882) were retrieved from the Social Insurance Institution of Finland (Kela) since 1.1.1993. Cancer patients diagnosed between 1.1.1994 and 31.12.2004 were identified from the Finnish Cancer Registry and sibling controls via the Population Registry Centre. Statistical analyses were performed via the Cox regression model, and the hazard ratios (HR) were adjusted for age and gender. Increased hazard ratios for AD purchases were found in the younger (0-19 years at cancer diagnosis) [HR 5.2, 95%CI (3.7-7.2)] and older (age 20-34 years at cancer diagnosis) [HR 4.5, 95%CI (3.9-5.2)] cancer patient groups compared to siblings. The gender effect was similar in patients and controls, showing that females have higher risk for AD purchases than males. Males in the younger patient group had highest HR (5.6) for AD purchases compared to siblings. Patients with sarcoma or CNS tumor in the younger age group and leukemia or CNS malignancy in the older age group had the highest risk for AD medication purchases. The frequency and risk for AD purchases has been increasing during recent decades in both cancer patient age groups compared to siblings. Thus, cancer patients' psychological support should be properly assessed already after primary treatment. Certain diagnostic groups as well as female patients may require more psychological support than others.

Associations Between Breast Cancer Survivorship and Adverse Mental Health Outcomes: A Systematic Review

Background

We aimed to systematically review the evidence on adverse mental health outcomes in breast cancer survivors (≥1 year) compared with women with no history of cancer.

Methods

Studies were identified by searching MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Social Sciences Citation Index, and through backward citation tracking. Two researchers selected the studies, extracted data, and assessed the risk of bias.

Results

Sixty studies were included. Of 38 studies of depression, 33 observed more depression in breast cancer survivors; this was statistically significant in 19 studies overall, including six of seven where depression was ascertained clinically, three of four studies of antidepressants, and 13 of 31 that quantified depressive symptoms. Of 21 studies of anxiety, 17 observed more anxiety in breast cancer survivors, statistically significant in 11 studies overall, including two of four with clinical/prescription-based outcomes, and in eight of 17 of anxiety symptoms. Breast cancer survivors also had statistically significantly increased symptoms/frequency of neurocognitive dysfunction (18 of 24 studies), sexual dysfunctions (5 of 6 studies), sleep disturbance (5 of 5 studies), stress-related disorders/PTSD (2 of 3 studies), suicide (2 of 2 studies), somatisation (2 of 2 studies), and bipolar and obsessive-compulsive disorders (1 of 1 study each). Studies were heterogeneous in terms of participants' characteristics, time since diagnosis, ascertainment of outcomes, and measures reported. Approximately one-half of the studies were at high risk of selection bias and confounding by socio-economic status.

Conclusions

There is compelling evidence of an increased risk of anxiety, depression and suicide, and neurocognitive and sexual dysfunctions in breast cancer survivors compared with women with no prior cancer. This information can be used to support evidence-based prevention and management strategies. Further population-based and longitudinal research would help to better characterize these associations.

Virtual reality as a distraction technique for pain and anxiety among patients with breast cancer: A randomized control trial

Objective

The goal of this study was to assess the effectiveness of immersive virtual reality (VR) distraction technology in reducing pain and anxiety among female patients with breast cancer.

Method

A randomized control trial design was used with a sample of 80 female patients with breast cancer at a specialized cancer center in Jordan. Participants were randomly assigned into intervention and comparison groups.

Result

The study findings showed that one session of the immersive VR plus morphine made a significant reduction in pain and anxiety self-reported scores, compared with morphine alone, in breast cancer patients.

Significance of results

Immersive VR is an effective distraction intervention for managing pain and anxiety among breast cancer patients. Using immersive VR as an adjuvant intervention is more effective than morphine alone in relieving pain and anxiety; furthermore, VR is a safe intervention more than pharmacological treatment.

Non-cancer drug consumption during the early trajectory of lymphoma survivorship

PURPOSE

This study explored the use of non-cancer drugs in lymphoma survivors during the early trajectory (0 to 2 years) of cancer survivorship and determined the factors that influenced this consumption.

METHODS

Between January and March 2014, a cross-sectional survey was conducted to assess drug consumption in adult lymphoma survivors at the Toulouse University Hospital. This study was based on a questionnaire consisting of ten open questions related to medical prescription and/or self-medication occurring within the last 3 months.

RESULTS

A total of 83/103 lymphoma survivors returned the questionnaire. This study showed that 91.6% of patients were drug consumers (about twice more than the general French population). Twenty percent of patients were treated with≥5 drugs. Overall drug consumption mainly concerned analgesics, anti-inflammatory drugs and psychotropics. The presence of comorbidity, urban residence and female gender were associated with overall drug consumption. Moreover, half of survivors required at least one self-medication. Finally, only seven survivors (8.4%) reported no use of any medication.

CONCLUSION

This study shows that, at least during the early trajectory of cancer survivorship, lymphoma patients are heavily treated with non-cancer drug therapy. This drug consumption profile may have serious implications in terms of safety, overall benefit and health economics.

What are colorectal cancer survivors' preferences for dietary advice? A best-worst discrete choice experiment

PURPOSE

Studies on healthy lifestyle interventions in survivors of colorectal cancer have been disappointing, demonstrating only modest changes. This study aims to quantify people's preferences for different aspects of dietary intervention.

METHOD

A best-worst discrete choice experiment was designed and incorporated into a questionnaire including participants' characteristics and a self-assessment of lifestyle.

RESULTS

The response rate was 68% and 179 questionnaires were analysed. When analysing aggregate preferences, the modes of information provision selected as the most preferred were "face-to-face" (willingness to pay (WTP) £63.97, p ≤ 0.001) and "telephone" (WTP £62.36, p < 0.001) discussions whereas group discussions were preferred least (WTP -£118.96, p ≤ 0.001). Scenarios that included hospitals were most preferred (WTP £17.94, p = 0.031), and the favoured provider was bowel cancer nurses (WTP £75.11, p ≤ 0.001). When investigating preference heterogeneity, three sub-groups were identified: Firstly, "technophiles" preferring email (WTP £239.60, p ≤ 0.001) were male, were younger and had fewer risk factors. Secondly, a "one-to-one" group had strong preference for interventions over the telephone or at their local doctors and were older (WTP £642.13, p ≤ 0.001). Finally, a "person-centred" group preferred face-to-face individual or group sessions (WTP £358.79, p < 0.001) and had a high risk lifestyle.

CONCLUSION

For survivors of colorectal cancer, there is not one approach that suits all when it comes to providing dietary advice.

IMPLICATIONS FOR CANCER SURVIVORS

This is important information to consider when planning healthy lifestyle interventions which include dietary advice for survivors of colorectal cancer. Aligning services to individuals' preferences has the potential to improve patient experience and outcomes by increasing uptake of healthy lifestyle advice services and promoting a more tailored approach to dietary modifications, acknowledging sub-groups of people within the total population of colorectal cancer survivors.

Risk of mood disorders in patients with colorectal cancer

BACKGROUND

To assess the risk of mood disorders among patients with colorectal cancer (CRC), a population-based cohort study was performed using the Taiwanese National Health Insurance Research Database.

METHODS

The study cohort included 27242 patients diagnosed with CRC between January 1, 2000 and December 31, 2010. Four insurants from the general population without CRC were frequency matched to each case by age, sex, and index year/month to create the control group. Cox's proportional hazard regression model with hazard ratios (HRs) and 95% confidence intervals (CIs) was conducted to estimate the impact of CRC on the risk of mood disorders.

RESULTS

Patients with CRC exhibited a significantly higher risk of developing mood disorders (adjusted HR=3.05, 95% CI=2.89-3.20) compared with the control group. This phenomenon was also observed for each type of mood disorder (depression, bipolar disease and anxiety), as well as across different subgroups by patient characteristics. However, a follow-up time longer than 1 year was more likely to have significantly increased risks, and we unexpectedly found that some treatments in CRC patients tended to have a decreased risk of anxiety compared to their counterparts.

CONCLUSION

The findings of this population-based cohort study suggest that patients with CRC are at a higher risk of mood disorders, especially when follow-up time is longer than 1 year, but various treatments may inversely affect this association.

Anxiety Reduction Among Breast-Cancer Survivors Receiving Hypnotic Relaxation Therapy for Hot Flashes

Anxiety is common among breast-cancer survivors. This analysis examined the effect of a hypnotic relaxation therapy, developed to reduce hot flashes, on anxiety levels of female breast-cancer survivors. Anxiety was assessed using a numeric analog scale and the Hospital Anxiety and Depression Scale-Anxiety subscale. Significant reductions in anxiety were found from pre- to postintervention for each weekly session and were predictive of overall reductions in anxiety from baseline to after the last intervention. In this analysis, hypnotizability did not significantly predict for anxiety reductions measured before and after each session or from baseline to exit. These data provide initial support for the use of hypnotic relaxation therapy to reduce anxiety among breast-cancer survivors.

Factors Associated with Depression Assessed by the Patient Health Questionnaire-2 in Long-Term Cancer Survivors

Background

This cross-sectional study aimed to evaluate the prevalence of depressive disorders and factors associated in long-term cancer survivors.

Methods

A total of 702 long-term cancer survivors over 5-years in remission were recruited in a university-affiliated tertiary hospital in Korea. Self-report using the Patient Health Questionnaire-2 and the Fatigue Severity Scale assessed depression and fatigue, respectively. Demographic characteristics, cancer-related clinical characteristics, comorbidity, health behaviors, and physical symptoms were assessed through the review of medical records or a structured self-administered questionnaire.

Results

We identified 26.1% of patients who had a depressed mood or displayed a loss of interest. The most prevalent primary site of cancer was the stomach (65.2%), followed by lung, breast, colorectal, and thyroid cancer. We also found that 5.7% of subjects experienced double or triple primary cancers. Larger proportion among depressive group (89.1%) complained at least one physical problem than among non-depressive group (53.2%). Physical symptoms including sleep problems, dry mouth, indigestion, pain, decreased appetite, and febrile sense were more frequent in the depressive group than in the non-depressive group. The Fatigue Severity Scale scores were higher in the depressive group than in the non-depressive group (P<0.001). Multiple logistic regression analysis showed that the highest tertile level of fatigue (odds ratio, 7.31; 95% confidence interval, 3.81–14.02) was associated with the increased risk of depression.

Conclusion

These findings suggest that careful concern about depression is necessary in long-term cancer survivors. Fatigue may be a surrogate sign for depression, and warrants further evaluation.

ReCAP: Would Women With Breast Cancer Prefer to Receive an Antidepressant for Anxiety or Depression From Their Oncologist?

PURPOSE

Patient treatment preferences for the management of anxiety and depression influence adherence to treatment and treatment outcomes, yet the preferences of patients with breast cancer for provider-specific pharmacologic management of anxiety and depression is unknown. This study examined the antidepressant prescriber preferences of patients with breast cancer and their preferences for treatment by a mental health professional.

METHODS

Patients with breast cancer (stages 0 to IV) were asked two questions: “Would you be willing to have your oncologist treat your depression or anxiety with an antidepressant medication if you were to become depressed or anxious at any point during your treatment?” and “Would you prefer to be treated by a psychiatrist or mental health professional for problems with either anxiety or depression?” In addition, the Distress Thermometer and Problem List, Hospital Anxiety and Depression Scale, Risky Families Questionnaire, and demographic information were assessed.

RESULTS

One hundred twenty-five participants completed the study. A total of 60.4% were willing to accept an antidepressant from an oncologist, and 26.3% preferred treatment by a mental health professional. The 77.3% who were willing to receive an antidepressant from their oncologist reported either no preference or that treatment by a mental health professional did not matter (P = .01). Participants taking antidepressants (P = .02) or reporting high chronic stress (P = .03) preferred a mental health professional.

CONCLUSION

The majority of patients accepted antidepressant prescribing by their oncologist; only a minority preferred treatment by a mental health professional. These findings suggest that promoting education of oncologists to assess psychological symptoms and manage anxiety and depression as a routine part of an outpatient visit is beneficial

A systematic review and meta-analysis of prescribing practices of antidepressants in cancer patients

BACKGROUND

Antidepressants are commonly used for the pharmacological treatment of depression. We aimed to summarise the prevalence of antidepressant prescription to cancer patients, and differences by study or patient characteristics.

METHODS

PubMed, Embase, Web of Science, Scopus and psychINFO were searched using keywords 'psychotropic', 'antidepressants', 'prescription' and 'cancer'. Prevalence of antidepressants, type, dose and follow-up of antidepressants and prescriber details were extracted.

RESULTS

Overall, 1537 articles between 1979 and February 2015 were found, 38 met the inclusion criteria and were reviewed according to PRISMA guidelines. The prevalence rate of prescribing antidepressants to cancer patients was 15.6% (95% CI = 13.3-18.3). Prescription was significantly less common in studies from Asia (7.4%; 95% CI = 4.3-12.5), more common in female (22.6%; 95% CI = 16.0-31.0) or breast cancer patients (22.6%; 95% CI = 16.0-30.9). Selective serotonin reuptake inhibitors were the most frequently prescribed antidepressants. General practitioners and psychiatrists, followed by oncologists, were identified as the major providers of antidepressant prescriptions to cancer patients. Few studies reported the exact dose, length of time drugs were prescribed for or follow-up regimens.

CONCLUSIONS

There is considerable variation in the prescribing patterns of antidepressants across the world, with few studies reporting robust data on exact dose or follow-up regimens. Prospective studies that monitor antidepressant prescribing, including details of reasons for prescribing and the healthcare providers involved, dose, change in dose or type of medication and follow-up are needed to ascertain whether patients are being treated optimally and if side effects or drug-drug interactions are identified and managed. Copyright © 2016 John Wiley & Sons, Ltd.

Knowledge and awareness of long-term and late treatment consequences amongst colorectal cancer survivors: A qualitative study

PURPOSE

To describe patient knowledge and awareness of long-term and late onset treatment consequences amongst colorectal cancer survivors.

METHODS

Semi-structured qualitative interviews were conducted with 19 colorectal cancer survivors at least 12 months post-treatment. Interviews were audio-recorded, transcribed into NVivo 10 software and analysed using the framework method.

RESULTS

Participants were aware of disease recurrence but not many other treatment consequences; change in bowel habit and impact on diet were common and had significant impact, yet many felt they had not received 'warning', considering it a gap in both information and support. Participants expressed preference to know about possible consequences early on and were willing to engage in education and support if offered. Information overload, timing of information provision and unequipped health care professionals were considered barriers to awareness.

CONCLUSION

Improvement in information provision, management of expectations and support around bowel function would facilitate patient self-empowerment and could improve holistic management of health and well-being after cancer.

Risk of Developing Depressive Disorders following Hepatocellular Carcinoma: A Nationwide Population-Based Study

BACKGROUND & AIMS

To evaluate the risk of depressive disorders among patients with Hepatocellular Carcinoma (HCC) using the National Health Insurance Research Database (NHIRD) in Taiwan.

METHODS

We conducted a retrospective study of a newly diagnosed HCC cohort of 55,973 participants who were selected from the NHIRD. Patients were observed for a maximum of 6 years to determine the rates of newly onset depressive disorders, and Cox regression was used to identify the risk factors associated with depressive disorders in HCC patients.

RESULTS

Of the total 55,973 HCC patients, 1,041 patients (1.86%) were diagnosed with depressive disorders during a mean (SD) follow-up period of 1.1 (1.2) years. The Cox multivariate proportional hazards analysis showed that age of 40-59 (HR 1.376, 95% CI 1.049-1.805, p = 0.021), age of 60-79 (HR 1.341, 95% CI 1.025-1.753, p = 0.032), women (HR 1.474 95% CI 1.301-1.669, p < 0.001), metastasis (HR 1.916, 95% CI 1.243-2.953, p = 0.003), and HCV (HR 1.445, 95% CI 1.231-1.697, p < 0.001) were independent risk factors for developing depressive disorders.

CONCLUSIONS

Our study indicated a subsequent risk of depressive disorders in patients with HCC, and the risk increased for those with female gender, aged 40 to 59, aged 60 to 79, with metastasis, or with HCV. Psychological evaluation and support are two critical issues in these HCC patients with the risk factors.

Comparison of psychotropic prescriptions between oncology and cardiology inpatients: result from a pharmacy database in a teaching hospital in Malaysia

OBJECTIVE

To examine the prescription rates in cancer patients of three common psychotropic drugs: anxiolytic/ hypnotic, antidepressant and antipsychotic.

MATERIALS AND METHODS

In this retrospective cohort study, data were extracted from the pharmacy database of University Malaya Medical Center (UMMC) responsible for dispensing records of patients stored in the pharmacy's Medication Management and Use System (Ascribe). We analyzed the use of psychotropics in patients from the oncology ward and cardiology from 2008 to 2012. Odds ratios (ORs) were adjusted for age, gender and ethnicity.

RESULTS

A total of 3,345 oncology patients and 8,980 cardiology patients were included. Oncology patients were significantly more often prescribed psychotropic drugs (adjusted OR: anxiolytic/hypnotic=5.55 (CI: 4.64-6.63); antidepressants=6.08 (CI: 4.83-7.64) and antipsychotics=5.41 (CI: 4.17-7.02). Non-Malay female cancer patients were at significantly higher risk of anxiolytic/hypnotic use.

CONCLUSIONS

Psychotropic drugs prescription is common in cancer patients. Anxiolytic/hypnotic prescription rates are significantly higher in non-Malay female patients in Malaysia.

Baseline and follow-up association of the MAX-PC in Men with newly diagnosed prostate cancer

OBJECTIVE

The objective of this paper is to conduct a prospective, longitudinal study employing the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) to examine the baseline and follow-up association of prostate cancer (PCa)-specific anxiety, health-related quality of life (HRQOL), and PCa aggressiveness in men with newly-diagnosed PCa undergoing prostatectomy at our institution.

METHODS

From our prospective PCa registry, we identified a total of 350 men with newly-diagnosed PCa who completed the MAX-PC and the Expanded Prostate Cancer Index Composite (EPIC) at baseline and one-year following surgery. Scores on both measures were compared with clinical measure and demographics using the Wilcoxon Rank Sum, Fisher's exact, and Cochran-Armitage Trend tests. Spearman test was used to assess correlation at between the MAX-PC and EPIC at baseline and one-year.

RESULTS

Baseline overall MAX-PC measures were correlated with measures at one-year (r=0.5479, p<0.001). Those reporting high anxiety at one-year were more likely to have Gleason score>6 (p=0.004), T-Stage ≥ 2C disease (p=0.004), and a postoperative prostate-specific antigen (PSA)>0.1 (p=0.002); however, this did not apply to all anxious patients. Baseline EPIC sexual function scores were predictive of follow-up EPIC sexual function scores as well (r=0.5790, p<0.001). Depression was noted as a problem in 16% of patients at follow-up.

CONCLUSIONS

Our data suggests that the MAX-PC could be used at baseline as a tool to determine who may benefit from psychological intervention pre-PCa and post-PCa treatment. In terms of individualized medicine, behavioral therapy may be the most beneficial in improving HRQOL for younger patients, those with advanced stage disease, and more specifically those whose anxiety outweighs their actual prognosis.

Acupressure and anxiety in cancer patients

Background:

Anxiety has negative effects on mental and physical performance, quality of life, duration of hospitalization, and even on the treatment of patients with cancer.

Objectives:

Today acupressure is widely used to treat anxiety. Thus, the present study aimed to investigate the effects of acupressure on anxiety in patients with cancer.

Patients and Methods:

A double-blind randomized clinical trial was conducted on 85 patients hospitalized with 3 groups including acupressure group (n = 27), sham group (n = 28), and control group (n = 30) in the hematologic ward of Shahid Beheshti Hospital of Hamadan, Iran, in 2013. The sampling permuted-block randomization with triple block was used. The anxiety of the patients in the experimental, sham, and control groups were measured with Spielberger’s State-Trait Anxiety Inventory (STAI). Then, real acupressure was performed in the experimental group and fake acupressure in the sham group, and only routine care was provided for the control group. Anxiety of the patients was also assessed at 5 and 10 days after the intervention. Statistical analysis of the data was performed by SPSS software using repeated measures analysis of variance (ANOVA) and post hoc least significant difference (LSD) test.

Results:

According to the findings, the mean level of anxiety before the intervention between groups were matched (P > 0.05). Acupressure had a significant influence on the anxiety in the experimental group at 5 (45.30 ± 7.14) and 10 days (43.48 ± 6.82) after the intervention (P < 0.05). However, it did not have a significant impact on their covert anxiety (45.48 ± 7.92 at 5^th day vs 45.63 ± 8.08 at 10th day, P > 0.05). No significant differences were observed in the fake points regarding overt and covert anxiety of patients in the sham group (overt anxiety; 47.57 ± 7.85 at 5^th day vs. 46.71 ± 7.32 at 10^th day, P > 0.05) (covert anxiety; 47.96 ± 6.33 at 5^th day vs. 46.89 ± 6.94 at 10^th day, P > 0.05). Moreover, the routine care provided for the control group did not have any effect on the overt and covert anxiety of the patients (P > 0.05).

Conclusions:

Acupressure is recommended as a complementary therapy to reduce anxiety in patients with cancer because of its low cost, safety, and simplicity.

The association between prostate cancer and mood disorders: a nationwide population-based study in Taiwan

BACKGROUND

This study identified possible risk factors for newly diagnosed mood disorders, including depressive and bipolar disorders, in prostate cancer patients.

METHODS

From 2000 to 2006, two cohorts were evaluated on the occurrence of mood disorder diagnosis and treatment. For the first cohort, data of patients diagnosed with prostate cancer was obtained from the Taiwan National Health Insurance (NHI) Research Database. As the second cohort, a cancer-free comparison group was matched for age, comorbidities, geographic region, and socioeconomic status.

RESULTS

Final analyses involved 12,872 men with prostate cancer and 12,872 matched patients. Increased incidence of both depressive (IRR 1.52, 95% CI 1.30-1.79, P <0.001) and bipolar disorder (IRR 1.84, 95% CI 1.25-2.74, P = 0.001) was observed among patients diagnosed with prostate cancer. Multivariate matched regression models show that cerebrovascular disease (CVD) and radiotherapy treatment could be independent risk factors for developing subsequent depressive and bipolar disorders.

CONCLUSION

We observed that the risk of developing newly diagnosed depressive and bipolar disorders is higher among Taiwanese prostate cancer patients. Clinicians should be aware of the possibility of increased depressive and bipolar disorders among prostate cancer patients in Taiwan. A prospective study is necessary to confirm these findings.

Increased risk for depression after breast cancer: a nationwide population-based cohort study of associated factors in Denmark, 1998-2011

PURPOSE

To investigate the risk for first depression, assessed as incident hospital contacts for depression and incident use of antidepressants, among women with breast cancer.

PATIENTS AND METHODS

Danish national registries were used to identify 1,997,669 women with no diagnosis of cancer or a major psychiatric disorder. This cohort was followed from 1998 to 2011 for a diagnosis of breast cancer and for the two outcomes, hospital contact for depression and redeemed prescriptions for antidepressants. Rate ratios for incident hospital contacts for depression and incident use of antidepressants were estimated with Poisson regression models. Multivariable Cox regression was used to evaluate factors associated with the two outcomes among patients with breast cancer.

RESULTS

We identified 44,494 women with breast cancer. In the first year after diagnosis, the rate ratio for a hospital contact for depression was 1.70 (95% CI 1.41 to 2.05) and that for use of antidepressants was 3.09 (95% CI 2.95 to 3.22); these rate ratios were significantly increased after 3 and 8 years, respectively. Comorbidity, node-positive disease, older age, basic and vocational educational levels, and living alone were associated with use of antidepressants.

CONCLUSION

Women with breast cancer are at long-term increased risk for first depression, including both severe episodes leading to hospital contact and use of antidepressants. Clinicians should be aware that the risk is highest in women with comorbid conditions, node-positive disease, and age of 70 years or more. We found no clear association between type of surgery or adjuvant treatment and risk for depression.

Anxiety and depressive disorders among patients with esophageal cancer in Taiwan: a nationwide population-based study

BACKGROUND

The comorbidity of depression with anxiety disorders is associated with poorer treatment outcomes, worse quality of life, poorer adherence to treatment, and greater suicide risk in cancer patients.

OBJECTIVE

To assess the risk of comorbid anxiety and depressive disorders after the diagnosis of esophageal cancer compared with a matched cohort by using the Taiwan National Health Insurance Research Database (NHIRD).

METHODS

We conducted a retrospective study of 28,454 patients (14,227 patients with esophageal cancer and 14,227 matched patients) who were selected from the NHIRD. Patients were observed for a maximum of 12 years to determine the incidence of new-onset anxiety and depressive disorders for which antidepressants had been prescribed. A Cox regression analysis was performed to identify the risk factors associated with anxiety and depressive disorders in esophageal cancer patients.

RESULTS

The cumulative incidence of anxiety and depressive disorders in the esophageal cancer patients was significantly higher than that in the matched cohort (P < .001). The adjusted hazard ratio (HR) was 2.24 (95 % confidence interval, CI = 1.95-2.56, P < .001) in the esophageal cancer cohort compared with the matched cohort. Independent risk factors for developing anxiety and depressive disorders among the patients with esophageal cancer included cirrhosis, cerebrovascular disease, and surgical treatment.

CONCLUSION

Esophageal cancer may be a prominent risk factor for anxiety and depressive disorders. Based on our data, we suggest that attention should be focused on esophageal cancer patients with comorbid cirrhosis and cerebrovascular disease and those who have received surgical interventions.

Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis

BACKGROUND

Cancer survival has improved in the past 20 years, affecting the long-term risk of mood disorders. We assessed whether depression and anxiety are more common in long-term survivors of cancer compared with their spouses and with healthy controls.

METHODS

We systematically searched Medline, PsycINFO, Embase, Science Direct, Ingenta Select, Ovid, and Wiley Interscience for reports about the prevalence of mood disorders in patients diagnosed with cancer at least 2 years previously. We also searched the records of the International Psycho-oncology Society and for reports that cited relevant references. Three investigators independently extracted primary data. We did a random-effects meta-analysis of the prevalences of depression and anxiety in cancer patients compared with spouses and healthy controls.

FINDINGS

Our search returned 144 results, 43 were included in the main analysis: for comparisons with healthy controls, 16 assessed depression and ten assessed anxiety; of the comparisons with spouses, 12 assessed depression and five assessed anxiety. The prevalence of depression was 11·6% (95% CI 7·7-16·2) in the pooled sample of 51 381 cancer survivors and 10·2% (8·0-12·6) in 217 630 healthy controls (pooled relative risk [RR] 1·11, 95% CI 0·96-1·27; p=0·17). The prevalence of anxiety was 17·9% (95% CI 12·8-23·6) in 48 964 cancer survivors and 13·9% (9·8-18·5) in 226 467 healthy controls (RR 1·27, 95% CI 1·08-1·50; p=0·0039). Neither the prevalence of depression (26·7% vs 26·3%; RR 1·01, 95% CI 0·86-1·20; p=0·88) nor the prevalence of anxiety (28·0% vs 40·1%; RR 0·71, 95% CI 0·44-1·14; p=0·16) differed significantly between cancer patients and their spouses.

INTERPRETATION

Our findings suggest that anxiety, rather than depression, is most likely to be a problem in long-term cancer survivors and spouses compared with healthy controls. Efforts should be made to improve recognition and treatment of anxiety in long-term cancer survivors and their spouses.

FUNDING

None.

Incidence and risk of mood disorders in patients with breast cancers in Taiwan: a nationwide population-based study

OBJECTIVE

The objective of this study is to assess the incidence and risk of mood disorders, including major depression, anxiety, and bipolar disorders, in Taiwanese patients after the diagnosis of breast cancer compared with a matched cohort.

METHODS

From January 2000 to December 2005, 26,629 newly diagnosed breast cancer patients were enrolled by the Taiwan National Health Insurance program database. The control cohort was selected randomly from 1,000,000 National Health Insurance beneficiaries from a population of 21,400,826 enrolled throughout Taiwan. Each patient was matched with one subject without breast cancer by age, sex, and presence of comorbidities with the same diagnosis index date. The diagnosis of mood disorders was defined by compatible International Classification of Diseases, 9th revision, clinical modification codes plus the prescription of antidepressants for at least 30 days.

RESULTS

The overall incidence rate ratio of mood disorders was 1.33 (95% CI 1.28-1.39, p < 0.001) in the breast cancer cohort compared with the matched cohort. The incidence rate ratios for specific mood disorders were 2.06 for bipolar disorder (95% CI 1.37-3.15 p = 0.0003), 1.94 for major depressive disorder (95% CI 1.76-2.13 p < 0.001), and 1.22 for anxiety (95% CI 1.16-1.27 p < 0.001). Independent risk factors for developing mood disorders included breast cancer, as well as age, hypertension, chronic obstructive pulmonary disease, autoimmune disease, ischemic heart disease, and cerebrovascular disease.

CONCLUSIONS

Breast cancer is a prominent risk factor for mood disorders, including major depressive disorder, anxiety, and bipolar disorder. The impact is most potent in the first year after diagnosis. Psychological support is a critical issue in these patients.

Depression Treatment in Individuals with Cancer: A Comparative Analysis with Cardio-Metabolic Conditions

A clear picture of the current state of nation-wide depression treatment practices in individuals with cancer and depression does not exist in the United States (US). Therefore, the primary objective of this study was to examine rates of any depression treatment among individuals with cancer and depression in the US. To better understand the relationship between any treatment for depression and presence of cancer, we used a comparison group of individuals with cardio-metabolic conditions owing to the similar challenges faced in management of depression in individuals with these conditions. We used a retrospective cross-sectional design and data from multiple years of the Medical Expenditure Panel Survey, a nationally representative household-survey on healthcare utilization and expenditures. Study sample consisted of adults aged 21 or older with self-reported depression and cancer (n=528) or self-reported depression and diabetes, heart disease or hypertension (n=1643). Depression treatment comprised of any use of antidepressants and/or any use of mental health counseling services. Treatment rates for depression were 78.0% and 81.7% among individuals with cancer and cardio-metabolic conditions respectively. After controlling for socio-demographic, access-to-care, number of physician-visits, health-status, and lifestyle risk-factors related variables; individuals with cancer were less likely to report any treatment for depression (Adjusted Odds Ratio=0.67; 95% Confidence Interval=0.49, 0.92) compared to individuals with cardio-metabolic conditions (P≤0.01). Our findings highlight the possibility that competing demands may crowd out treatment for depression and that cancer diagnosis may be a barrier to depression treatment.

Incidence and drug treatment of emotional distress after cancer diagnosis: a matched primary care case-control study

BACKGROUND

Emotional distress is common in cancer patients. This study aimed to describe, in the year after a cancer diagnosis: the incidence of anxiety, depression and excessive alcohol use; the pattern of these diagnoses and treatment over time; and the nature and duration of the prescribed treatment.

METHODS

A matched case-control study was conducted using routinely collected primary care data from 173 Scottish general practices. A presumptive diagnosis of emotional distress (anxiety, depression and/or excessive alcohol use) was based on prescription data or diagnostic code. Prescriptions for psychotropic drugs were described in terms of drug class, volume and treatment duration.

RESULTS

In total, 7298 cancer cases and 14 596 matched-controls were identified. Overall, 1135 (15.6%) cases and 201 (1.4%) controls met criteria for emotional distress (odds ratio 13.7, 95% confidence interval 11.6-16.1). Psychotropic drugs were prescribed in the 6 months following initial cancer diagnosis for 1066 (14.6%) cases and 161 (1.1%) controls. The volume and duration of anxiolytic and antipsychotic prescribing was significantly different between cases and controls.

CONCLUSION

This study quantified the higher incidence of new emotional distress in cancer patients in the first year post diagnosis. Clinicians should be aware of the possibility of emotional distress at any time in the year after cancer diagnosis.

For which health problems do cancer survivors visit their General Practitioner?

Primary health care use of cancer patients is increased, even years after active treatment. Insight into the reasons for this could help in developing and improving guidelines and planning of health care, which is important given the expected increase in cancer survivors. Using data from the Netherlands Information Network of Primary Care, we selected 1256 adult breast cancer, 503 prostate cancer and 487 colorectal cancer patients diagnosed between 2001 and 2006. We compared diseases and complaints for which they contacted their General Practitioner (GP) 2-5 years after diagnosis to age and sex matched non-cancer controls from the same practice. Cancer patients consulted their GP more often than controls for acute symptoms such as abdominal pain and fatigue (18% more in breast cancer, 26% more in prostate cancer) and infections, such as cystitis or respiratory infections (45% in breast cancer and 17% in colorectal cancer). Consultations for chronic diseases and psychosocial problems were slightly increased: breast cancer patients had more contacts related to diabetes (55%), sleep disturbance (60%) and depression (64%), prostate cancer patients had more contacts related to hypertension (53) and chronic obstructive pulmonary disease (COPD, 34%). Adverse drug effects were almost twice as often observed in prostate and colorectal cancer patients than in controls. Fear of cancer recurrence was noted as the reason for consulting the GP in only 20 patients. Concluding, increased primary health care use in cancer survivors is mostly related to common infections and acute symptoms, which may be due to direct effects of cancer treatment or increased health concerns.

Evaluation of the association of prostate cancer-specific anxiety with sexual function, depression and cancer aggressiveness in men 1 year following surgical treatment for localized prostate cancer

BACKGROUND

Cancer-specific anxiety (CSA) can affect treatment decisions and is common in men following surgery for prostate cancer (PCa). We hypothesized that CSA is also associated with factors affecting quality of life. Herein, we examine the association of CSA with psychosocial factors and PCa aggressiveness in a cohort of men 1 year after prostatectomy for localized PCa.

METHODS

From our prospective PCa Registry, we identified 365 men who underwent prostatectomy for localized PCa who completed the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) and Expanded Prostate Cancer Index Composite at 1-year follow-up. We evaluated the association of scores on the MAX-PC with demographics, clinicopathologic features, sexual function, and depression scores using Wilcoxon Rank Sum and Kendall's tau correlation tests.

RESULTS

Higher scores on the MAX-PC (i.e., higher anxiety) are associated with younger age (p < 0.01) and non-Caucasian race (p < 0.01). Men with higher MAX-PC scores also reported poor sexual satisfaction/function (p < 0.01) and increasing depressive symptoms (p < 0.01). Finally, although higher anxiety is associated with several pathologic features of aggressiveness (stage, positive margins, PSA at 1 year; all p-values < 0.01), we noted several men with clinically indolent disease who reported significant anxiety.

CONCLUSIONS

Our data suggest that higher levels of CSA are associated with poor sexual function and increased depressive symptoms 1 year after prostatectomy. Moreover, we noted demographic and pathologic features associated with higher CSA as well. If confirmed, our data support development of models to predict men at high risk of CSA following PCa surgery and targeted referral for additional counseling.

Excess of health care use in general practice and of comorbid chronic conditions in cancer patients compared to controls

Background

The number of cancer patients and the number of patients surviving initial treatments is expected to rise. Traditionally, follow-up monitoring takes place in secondary care. The contribution of general practice is less visible and not clearly defined.

This study aimed to compare healthcare use in general practice of patients with cancer during the follow-up phase compared with patients without cancer. We also examined the influence of comorbid conditions on healthcare utilisation by these patients in general practice.

Methods

We compared health care use of N=8,703 cancer patients with an age and gender-matched control group of patients without cancer from the same practice. Data originate from the Netherlands Information Network of General Practice (LINH), a representative network consisting of 92 general practices with 350,000 enlisted patients. Health care utilisation was assessed using data on contacts with general practice, prescription and referral rates recorded between 1/1/2001 and 31/12/2007. The existence of additional comorbid chronic conditions (ICPC coded) was taken into account.

Results

Compared to matched controls, cancer patients had more contacts with their GP-practice (19.5 vs. 11.9, p<.01), more consultations with the GP (3.5 vs. 2.7, p<.01), more home visits (1.6 vs. 0.4, p<.01) and they got more medicines prescribed (18.7 vs. 11.6, p<.01) during the follow-up phase. Cancer patients more often had a chronic condition than their matched controls (52% vs. 44%, p<.01). Having a chronic condition increased health care use for both patients with and without cancer. Cancer patients with a comorbid condition had the highest health care use.

Conclusion

We found that cancer patients in the follow-up phase consulted general practice more often and suffered more often from comorbid chronic conditions, compared to patients without cancer. It is expected that the number of cancer patients will rise in the years to come and that primary health care professionals will be more involved in follow-up care. Care for comorbid chronic conditions, communication between specialists and GPs, and coordination of tasks then need special attention.

Primary Health and Supportive Care Needs of Long-Term Cancer Survivors: A Questionnaire Survey

Purpose

There are 1.2 million long-term cancer survivors in the United Kingdom. Existing research on the health and supportive care needs of these survivors is sparse and inconclusive. This study investigated health status, psychological morbidity, and supportive care needs in long-term cancer survivors in the United Kingdom.

Methods

Five to 16 years after diagnosis, 1,275 eligible survivors of breast, colorectal, and prostate cancers were approached to participate in a questionnaire survey. The questionnaire explored health status (European Quality of Life–5 Dimensions), psychological morbidity (Hospital Anxiety and Depression Scale), and supportive care needs (Cancer Survivors' Unmet Needs Measure). Data were analyzed by type of cancer and time since diagnosis. Logistic regression was used to identify predictors of unmet supportive care needs.

Results

The response rate was 51.7% (659 survivors). Overall health status and levels of psychological morbidity were consistent with population norms. At least one unmet supportive care need was reported by 47.4% of survivors, but overall numbers of unmet needs were low (mean, 2.8; standard deviation, 4.8). The most frequently endorsed unmet need was for help to manage concerns about cancer recurrence. Trait anxiety (P < .001), nondischarged status (P < .01), dissatisfaction with discharge (P < .01), and receipt of hormonal therapy (P < .01) were predictive of unmet supportive care needs.

Conclusion

The findings suggest a majority of long-term breast, colorectal, and prostate cancer survivors who have no signs of recurrence report good health and do not have psychological morbidity or large numbers of unmet supportive care needs. A minority of long-term survivors may benefit from ongoing support. The identification and support of those long-term survivors with ongoing needs is a key challenge for health care professionals.