1
|
Ten Winkel M, Salama H, Timrott K, Kleine M, Kleine-Doepke D, Raehder-Johnson S, Meisel H, Rahberi NN, Abdelhadi S, Rückert F, Reissfelder C, Honselmann KC, Braun R, Faerber B, Lapshyn H, Keck T, Uhl W, Belyaev O, Wellner UF, Bolm L. Patient-reported outcomes at three months after pancreatic surgery for benign and malignant diseases - A prospective observational study. Pancreatology 2024; 24:314-322. [PMID: 38310036 DOI: 10.1016/j.pan.2024.01.007] [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] [Received: 05/03/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND/OBJECTIVES Pancreatic surgery may have a long-lasting effect on patients' health status and quality of life (QoL). We aim to evaluate patient-reported outcomes (PRO) 3 months after pancreatic surgery. METHODS Patients scheduled for pancreatic surgery were enrolled in a prospective trial at five German centers. Patients completed PRO questionnaires (EQ-5D-5L, EORTC QLQ-PAN26, patient-reported happiness, and HADS-D), we report the first follow-up 3 months after surgery as an interim analysis. Statistical testing was performed using R software. RESULTS From 2019 to 2022 203 patients were enrolled, a three-month follow-up questionnaire was available in 135 (65.5 %). 77 (57.9 %) underwent surgery for malignant disease. Patient-reported health status (EQ-5D-5L) was impaired in 4/5 dimensions (mobility, self-care, usual activities, pain, discomfort) for patients with malignant and 3/5 dimensions (mobility, self-care, usual activities) for patients with benign disease 3 months after surgery (p < 0.05). Patients with malignant disease reported an increase in depressive symptoms, patients with benign disease had a decrease in anxiety symptoms (HADS-D; depression: 5.00 vs 6.51, p = 0.002; anxiety: 8.04 vs. 6.34, p = 0.030). Regarding pancreatic-disease-specific symptoms (EORTC-QLQ-PAN26), patients with malignant disease reported increased problems with taste, weight loss, weakness in arms and legs, dry mouth, body image and troubling side effects at three months. Patients with benign disease indicated more weakness in arms and legs, troubling side effects but less future worries at three months. CONCLUSION Patient-reported outcomes of patients undergoing pancreatic surgery for benign vs. malignant disease show important differences. Patients with malignant tumors report more severely decreased quality of life 3 months postoperatively than patients with benign tumors.
Collapse
Affiliation(s)
- Meike Ten Winkel
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Hussein Salama
- Department of Surgery, St. Joseph-Hospital, Ruhr University Bochum, Germany
| | - Kai Timrott
- Department of Surgery, University Hospital, Medical School Hannover, Germany
| | - Moritz Kleine
- Department of Surgery, University Hospital, Medical School Hannover, Germany; Department of Surgery, Vinzenz Hospital Hannover, Germany
| | | | | | | | - Nuh N Rahberi
- Department of Surgery, University Medical Center Mannheim, Germany
| | | | - Felix Rückert
- Department of Surgery, University Medical Center Mannheim, Germany; Department of Surgery, Diakonissen Hospital Speyer, Germany
| | | | - Kim C Honselmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Ruediger Braun
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Benedikt Faerber
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Hryhoriy Lapshyn
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany.
| | - Waldemar Uhl
- Department of Surgery, St. Joseph-Hospital, Ruhr University Bochum, Germany
| | - Orlin Belyaev
- Department of Surgery, St. Joseph-Hospital, Ruhr University Bochum, Germany
| | - Ulrich F Wellner
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Louisa Bolm
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| |
Collapse
|
2
|
Fauser D, Rimalis-Vogt E, Mattes J, Bethge M. Psychological interventions during breast cancer rehabilitation: a randomized controlled trial comparing structured short-term psychotherapy versus non-specific group discussion. BMC Cancer 2023; 23:1133. [PMID: 37990301 PMCID: PMC10664677 DOI: 10.1186/s12885-023-11576-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/27/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE Psycho-oncological treatment is recommended in cancer rehabilitation as it improves fatigue, anxiety, depression, and quality of life in breast cancer patients. The aim of our study was to compare a structured short-term psychotherapy and a non-specific group discussion provided during breast cancer rehabilitation. METHODS Breast cancer patients were randomly assigned to structured group short-term psychotherapy or a non-specific group discussion during breast cancer rehabilitation. The patients completed questionnaires at the beginning and end of rehabilitation and three months after rehabilitation. The primary outcome was anxiety. Secondary outcomes were depression, distress, fatigue and health-related quality of life domains. RESULTS In total, 160 patients (80 in both groups) were recruited and included in the analysis. There was no significant difference between both groups in the primary outcome anxiety at the end of rehabilitation (difference = -0.2; 95% CI -1.2 to 0.7) and three months after rehabilitation (difference = 0.2; 95% CI -0.9 to 1.3) and in any secondary outcome. Patients in the short-term psychotherapy group with high anxiety levels at baseline reported fewer depressive symptoms at the end of rehabilitation. CONCLUSIONS Our study showed no difference between structured short-term psychotherapy and a non-specific group discussion. Patients with high baseline anxiety levels were more likely to benefit from short-term structured psychotherapy. Early identification of this subgroup and symptoms of mental illness should occur after initial treatment in breast cancer patients in order to offer a structured treatment for anxiety and depressive symptoms during rehabilitation. TRIAL REGISTRATION German Clinical Trials Register (DRKS00017571; 08/07/2019).
Collapse
Affiliation(s)
- David Fauser
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | | | - Johannes Mattes
- VAMED Rehaklinik Ahrenshoop, Dorfstrasse 55, 18347, Ahrenshoop, Germany
| | - Matthias Bethge
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| |
Collapse
|
3
|
Eala MAB, Manlongat KD, Dee EC, Baticulon RE, Canal JPA. Mental health care for Filipino patients with cancer. Lancet Oncol 2021; 22:e531. [PMID: 34856141 DOI: 10.1016/s1470-2045(21)00570-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 01/07/2023]
Affiliation(s)
| | | | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronnie E Baticulon
- Division of Neurosurgery, Phillipine General Hospital, Manila 1000, Philippines
| | | |
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW Depression is a prevalent comorbidity in cancer that significantly increases the risk for numerous negative health outcomes. This review updates the current evidence base for management of depression in cancer, highlighting new research directions based on the inflammatory hypothesis of depression. RECENT FINDINGS Research on pharmacotherapy and psychotherapy for depression in cancer has shown mixed efficacy partly because of methodological issues arising from the phenomenology of depression in cancer. After decades of stagnancy, more recent high-quality clinical trials are beginning to provide an evidence base to guide treatment. Inflammatory cytokine-associated depression is a subtype of depression that may have particular relevance in cancer, opening new avenues to explore therapeutic targets and biobehavioral impacts of interventions, which may improve cancer outcomes. SUMMARY The continuum of severity in cancer-related depression is important to consider in management approaches. Choice of treatment should be personalized to the patient and their symptom profile as there is currently insufficient evidence to recommend any particular medication or psychotherapy over another. Psychological interventions should be considered first line for mild-to-moderate depression, and pharmacological treatment added for more severe depression, which can be optimally delivered within a collaborative care model. VIDEO ABSTRACT http://links.lww.com/YCO/A62.
Collapse
Affiliation(s)
- Aliza A Panjwani
- Division of Psychosocial Oncology, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network
| | - Madeline Li
- Division of Psychosocial Oncology, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
5
|
Belay W, Kaba M, Labisso WL, Tigeneh W, Sahile Z, Zergaw A, Ejigu A, Baheretibeb Y, Gufue ZH, Haileselassie W. The effect of interpersonal psychotherapy on quality of life among breast cancer patients with common mental health disorder: a randomized control trial at Tikur Anbessa Specialized Hospital. Support Care Cancer 2021; 30:965-972. [PMID: 34432169 DOI: 10.1007/s00520-021-06508-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the effect of interpersonal psychotherapy on anxiety, depression, and quality of life among breast cancer patients with mental health disorders at Tikur Anbessa Specialized Hospital, Ethiopia. METHODS A two-arm parallel randomized controlled trial study was conducted among 114 (n = 57 intervention, and n = 57 control group) breast cancer patients with common mental health disorder at the oncology center of Tikur Anbessa Specialized Hospital. The hospital anxiety and depression measurement scale was used to assess depression and anxiety disorder and a 30-item quality of life questionnaire was used to assess the quality of life. General linear model analysis was done, confounding factors were controlled, and p < 0.05 was used to declare statistical significance. RESULTS Patients in the intervention group showed a significant improvement in the anxiety (coefficient - 3.68; 95% CI - 5.67, - 1.69; p < 0.001), depression (coefficient - 3.22; 95% CI - 4.7, - 1.69; p < 0.001), physical functioning (coefficient 10.55; 95% CI 3.13, 17.98; p = 0.006), health-related quality of life (coefficient 21.85; 95% CI 14.1, 29.59; p < 0.001), insomnia (coefficient - 19.56; 95% CI - 31.87, - 7.25; p = 0.002), and fatigue (coefficient - 11.37; 95% CI - 21.49, - 1.24; p = 0.028) respectively. CONCLUSIONS The adapted Ethiopian version of interpersonal psychotherapy had improved anxiety, depression, and some domains of health-related quality of life. Hence, health programmers should consider incorporating it as a treatment option in oncology centers. TRIAL REGISTRATION NUMBER PACTR202011629348967 granted on 20 November 2020 which was retrospectively registered.
Collapse
Affiliation(s)
- Winini Belay
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Mirgissa Kaba
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wajana Lako Labisso
- Department of Pathology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondemagegnehu Tigeneh
- Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zekariyas Sahile
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Ababi Zergaw
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebe Ejigu
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yonas Baheretibeb
- Department of Psychiatry, School of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zenawi Hagos Gufue
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Werissaw Haileselassie
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
6
|
Jones JK, Evans JF, Barfield RC. The Utility of Verbal Therapy for Pediatric Cancer Patients and Survivors: Expressive Writing, Video Narratives, and Bibliotherapy Exercises. Front Pediatr 2021; 9:579003. [PMID: 33614548 PMCID: PMC7889798 DOI: 10.3389/fped.2021.579003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
Childhood cancer is a stressful experience. No pediatric patient, however, should be made to feel as if their concerns and feelings about their cancer experience must be bottled up inside. Importantly, talking and writing about one's illness has myriad implications for young cancer patients and survivors. The most salient of these may include increased understanding of one's condition as well as improved physical and cognitive symptoms (e.g., lowered depression, decreased anxiety, and an enhanced quality of life overall). This literature review explores three promising avenues for verbal therapy in the pediatric oncology setting: expressive writing, video narratives, and bibliotherapy exercises. Several recent studies, covering verbal therapy methods from illness blogging to book interventions, are referenced and discussed. Ultimately, we conclude that expressive writing, video narratives, and bibliotherapy exercises are valuable, feasible, inexpensive, and acceptable tools for patients and survivors of childhood cancer to facilitate self-expression-and to find meaning in the uncertainty and anxiety that cancer inherently fosters. We recommend that future studies investigate this theme so that we may improve quality of life and mental health for pediatric cancer patients and survivors worldwide.
Collapse
Affiliation(s)
- Jill K Jones
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States.,Duke Integrative Medicine, Durham, NC, United States
| | - John F Evans
- Duke Integrative Medicine, Durham, NC, United States
| | - Raymond C Barfield
- Memorial Health University Medical Center (Palliative Care), Savannah, GA, United States
| |
Collapse
|
7
|
Powell-Chandler A, Boyce K, James O, Scourfield L, Torkington J, Bisson J, Cornish JA. Psychological sequelae of colonic resections. Colorectal Dis 2020; 22:945-951. [PMID: 31981271 DOI: 10.1111/codi.14986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/15/2020] [Indexed: 02/08/2023]
Abstract
AIM The prevalence of anxiety, depression and post-traumatic stress disorder (PTSD) in the general population has been estimated to be 5.9%, 3.3% and 4.4% respectively. The aim of this study was to determine whether psychological problems are more prevalent following colorectal surgery. METHOD Patients who had undergone colorectal resection in a 2-year period across four centres were asked to complete validated screening questionnaires for anxiety, depression and PTSD (GAD-7, PHQ-9, PCL-5) 12-48 months after surgery. Risk factors were identified using multiple linear regression analysis. RESULTS After excluding those who had died or received palliative diagnoses, questionnaires were sent to 1150 patients. 371 responded (32.3% response rate); median age 67 (20-99) years; 51% were men. 58% of patients underwent surgery for cancer; 23% had emergency surgery. 28% of patients screened positive for at least one psychological condition, with 20% screening positive for anxiety, 22% for depression and 14% for PTSD. Patients who were younger, women, had surgery as an emergency, for benign conditions, had stomas and had critical care stay were more likely to have poorer psychological outcomes. Multiple linear regression found that only younger age (P = 0.000) and female gender (P = 0.048) were significant risk factors. CONCLUSION The prevalence of anxiety, depression and PTSD appears to be high in patients who have undergone colorectal surgery. Younger patients and women are particularly at risk. Further work is needed to determine how best to prevent, detect and treat people with adverse psychological outcomes following colorectal surgery.
Collapse
Affiliation(s)
| | - K Boyce
- Health Education and Improvement Wales, Cardiff, UK
| | - O James
- Health Education and Improvement Wales, Cardiff, UK
| | | | - J Torkington
- Cardiff University, Cardiff, UK.,University Hospital of Wales, Cardiff, UK
| | | | - J A Cornish
- Cardiff University, Cardiff, UK.,University Hospital of Wales, Cardiff, UK.,Royal Glamorgan Hospital, Llantrisant, UK
| | | |
Collapse
|
8
|
Brandl A, Katou S, Pallauf A, Pratschke J, Rau B, Goerling U. Psycho-oncological distress in patients with peritoneal surface malignancies treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur Surg 2019. [DOI: 10.1007/s10353-019-00614-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
9
|
Bachmann AS, Zaunbauer AC, Tolke AM, Siniatchkin M, Kluck C, Wiltfang J, Hertrampf K. Well-being and quality of life among oral cancer patients – Psychological vulnerability and coping responses upon entering initial treatment. J Craniomaxillofac Surg 2018; 46:1637-1644. [DOI: 10.1016/j.jcms.2018.05.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 04/26/2018] [Accepted: 05/22/2018] [Indexed: 10/16/2022] Open
|
10
|
Sanjida S, McPhail SM, Shaw J, Couper J, Kissane D, Price MA, Janda M. Are psychological interventions effective on anxiety in cancer patients? A systematic review and meta-analyses. Psychooncology 2018; 27:2063-2076. [DOI: 10.1002/pon.4794] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/31/2018] [Accepted: 06/03/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Saira Sanjida
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation; Queensland University of Technology; Brisbane Australia
| | - Steven M. McPhail
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation; Queensland University of Technology; Brisbane Australia
- Centre for Functioning and Health Research; Metro South Health; Brisbane Australia
| | - Joanne Shaw
- Psycho-oncology Co-operative Research Group, School of Psychology; The University of Sydney; Sydney Australia
| | - Jeremy Couper
- Mental Health, Justice Health, Alcohol and Drug Services; Canberra Australia
- Academic Unit of Psychiatry & Addiction Medicine; Australian National University Medical School, The Canberra Hospital; Canberra Australia
| | - David Kissane
- Department of Psychiatry; Monash University; Melbourne Australia
| | - Melanie A. Price
- Psycho-oncology Co-operative Research Group, School of Psychology; The University of Sydney; Sydney Australia
| | - Monika Janda
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation; Queensland University of Technology; Brisbane Australia
- Centre for Health Services Research; The University of Queensland; Brisbane Australia
| |
Collapse
|
11
|
Abstract
A person who faces the diagnosis of cancer is subjected to changes within his body, but also with regard to his view of himself and his social relationships. Cancer related psychological distress occurs frequently and has a different prevalence according to-among other factors-cancer type and stage of disease. The main psychiatric disturbances observed in patients with cancer are adjustment disorders and affective disorders (anxiety and depression), which in the majority of patients are due to stressors related to the occurrence and threat of the disease and pre-existing psychological vulnerabilities; however, they might also be a direct consequence of biological causes either resulting from bodily modifications induced by the cancer or from treatment side effects. This chapter provides theoretical and practical information on the main psychotherapeutic approaches for cancer patients, complemented by some reflections on their clinical and scientific evidence.
Collapse
Affiliation(s)
- Mirjam de Vries
- Service de Psychiatrie de Liaision, Département de Psychiatrie, Centre hospitalier universitaire vaudois, Rue du Bugnon 21, 1011, Lausanne, Switzerland.
| | - Friedrich Stiefel
- Service de Psychiatrie de Liaision, Département de Psychiatrie, Centre hospitalier universitaire vaudois, Rue du Bugnon 21, 1011, Lausanne, Switzerland
- Faculté de Biologie et Médecine, Université de Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| |
Collapse
|
12
|
Li M, Kennedy EB, Byrne N, Gérin-Lajoie C, Katz MR, Keshavarz H, Sellick S, Green E. Systematic review and meta-analysis of collaborative care interventions for depression in patients with cancer. Psychooncology 2016; 26:573-587. [PMID: 27643388 DOI: 10.1002/pon.4286] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 08/17/2016] [Accepted: 09/15/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Previous systematic reviews have found limited evidence for the effectiveness of pharmacological and psychological interventions for the management of depression in patients with cancer. This paper provides the first meta-analysis of newer collaborative care interventions, which may include both types of treatment, as well as integrated delivery and follow-up. Meta-analyses of pharmacological and psychological interventions are included as a comparison. METHODS A search of MEDLINE, EMBASE, PsycINFO, and the Cochrane Library from July 2005 to January 2015 for randomized controlled trials of depression treatments for cancer patients diagnosed with a major depressive disorder, or who met a threshold on a validated depression rating scale was conducted. Meta-analyses were conducted using summary data. RESULTS Key findings included eight reports of four collaborative care interventions, eight pharmacological, and nine psychological trials. A meta-analysis demonstrated that collaborative care interventions were significantly more effective than usual care (standardized mean difference = -0.49, p = 0.003), and depression reduction was maintained at 12 months. By comparison, short-term (up to 12 weeks), but not longer-term effectiveness was demonstrated for both pharmacological and psychological interventions. CONCLUSIONS Collaborative care interventions have newly emerged as multidisciplinary care delivery models, which may result in more long-term depression remission. This review also updates previous findings of modest evidence for the effectiveness of both pharmacological and psychological interventions for threshold depression in cancer patients. Research designs focusing on combined treatments and delivery systems may best further the limited evidence-base for the management of depression in cancer.
Collapse
Affiliation(s)
- Madeline Li
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Erin B Kennedy
- Cancer Care Ontario, Program in Evidence-based Care/McMaster University, Hamilton, Ontario, Canada
| | - Nelson Byrne
- Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga, Ontario, Canada
| | | | - Mark R Katz
- Stronach Regional Cancer Centre, Southlake Regional Health Centre, Ontario, Canada
| | - Homa Keshavarz
- Cancer Care Ontario, Program in Evidence-based Care/McMaster University, Hamilton, Ontario, Canada
| | - Scott Sellick
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Esther Green
- Nursing and Psychosocial Oncology, Cancer Care Ontario, Toronto, Ontario, Canada
| |
Collapse
|
13
|
Li M, Kennedy EB, Byrne N, Gérin-Lajoie C, Katz MR, Keshavarz H, Sellick S, Green E. Management of Depression in Patients With Cancer: A Clinical Practice Guideline. J Oncol Pract 2016; 12:747-56. [PMID: 27382000 DOI: 10.1200/jop.2016.011072] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE This report updates the Cancer Care Ontario Program in Evidence-Based Care guideline for the management of depression in adult patients with cancer. This guideline covers pharmacologic, psychological, and collaborative care interventions, with a focus on integrating practical management tools to assist clinicians in delivering appropriate treatments for depression in patients with cancer. METHODS Recommendations were developed by synthesizing information from extant guidelines and reviews and searching for randomized controlled trials from the date of database inception (1964 for MEDLINE and 1974 for EMBASE) to January 2015. Quality assessment of guidelines and systematic reviews were conducted by using the Appraisal of Guidelines for Research and Evaluation II (AGREE II), Assessment of Multiple Systematic Reviews (AMSTAR), and Cochrane Risk of Bias tools. Final recommendations were developed through a standardized Program in Evidence-Based Care multidisciplinary expert and knowledge user review process. RESULTS Two high-quality relevant clinical practice guidelines, eight pharmacologic trials, nine psychological trials, and eight collaborative care intervention trials composed the evidence base upon which the recommendations were developed. Eight specific recommendations were made to establish a standard of care for the management of depression in patients with cancer. The recommendations and practical management tools were reviewed as being well organized and helpful, although systemic barriers to implementation were identified. CONCLUSION This updated guideline supports the previous general recommendation that patients with cancer who have depression may benefit from psychological and/or pharmacologic interventions, without evidence for the superiority of any specific treatment over another. New recommendations for a collaborative care model that incorporates a stepped care approach suggest that multidisciplinary mental health care restructuring may be required for optimal management of depression.
Collapse
Affiliation(s)
- Madeline Li
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Erin B Kennedy
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Nelson Byrne
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Caroline Gérin-Lajoie
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Mark R Katz
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Homa Keshavarz
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Scott Sellick
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Esther Green
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| |
Collapse
|
14
|
Smith PR, Cope D, Sherner TL, Walker DK. Update on research-based interventions for anxiety in patients with cancer. Clin J Oncol Nurs 2015; 18 Suppl:5-16. [PMID: 25427605 DOI: 10.1188/14.cjon.s3.5-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anxiety may begin at the moment a person is diagnosed with cancer and may fluctuate throughout the cancer trajectory as physical illness improves or declines. The purpose of this article is to present current evidence for nurses to implement interventions to reduce anxiety in patients who have cancer. The PubMed and CINAHL® databases were searched to identify relevant citations addressing interventions that treat or prevent anxiety symptoms in patients with cancer. Based on available evidence, the interventions addressed herein are categorized according to the Putting Evidence Into Practice (PEP®) rating schema. Interventions include pharmacologic and nonpharmacologic approaches to care, and meet criteria for three PEP categories: likely to be effective, effectiveness not established (the largest category of results), or effectiveness unlikely.
Collapse
Affiliation(s)
- Patsy R Smith
- College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City
| | | | | | | |
Collapse
|
15
|
Zhang XD, Zhao QY, Fang Y, Chen GX, Zhang HF, Zhang WX, Yang XP. Perioperative comprehensive supportive care interventions for chinese patients with esophageal carcinoma: a prospective study. Asian Pac J Cancer Prev 2015; 14:7359-66. [PMID: 24460303 DOI: 10.7314/apjcp.2013.14.12.7359] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To assess the effects of perioperative comprehensive supportive care interventions on outcome of Chinese esophageal cancer patients in a prospective study. METHODS 60 patients with primary esophageal carcinoma were randomized into an intervention group (IG, n=31) and a control group (CG, n=29). The Chinese version of symptom checklist-90 (SCL-90) was adopted to assess their psychological status. The interventions, including health education, psychological support, stress management, coping strategies and behavior training, were carried out in 3 phases (preoperative, postoperative I and postoperative II), and psychological effects were thereafter evaluated accordingly before surgery, and 1 week, 4 weeks and 24 weeks post-surgery. Medical costs were estimated at discharge. Survival of patients was estimated each year post-surgery. General health status and satisfaction-with-hospital were surveyed by a follow-up questionnaire 4 years post-surgery. RESULTS All the subjects demonstrated higher scores in the preoperative phase than the normal range of Chinese population concerning 7 psychological domains including somatization, obsessive-compulsive, depression, anxiety, hostility, phobic anxiety and paranoid ideation. Although no significant difference was observed between the two groups at admission, the scores of IG, which tended to decrease at a faster rate, were generally lower than those of CG at weeks 1, 4 and 24 post-surgery. The length of hospital stay and medical costs of IG were significantly less than those of CG and satisfaction-with-hospital was better. However, there was no significant difference in 4-year survival or health status between two groups. CONCLUSIONS Appropriate perioperative comprehensive supportive care interventions help to improve the psychological state of Chinese patients with esophageal carcinoma, to reduce health care costs and to promote satisfaction of patients and their families with hospital.
Collapse
Affiliation(s)
- Xiao-Dan Zhang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China E-mail :
| | | | | | | | | | | | | |
Collapse
|
16
|
Fulcher CD, Kim HJ, Smith PR, Sherner TL. Putting evidence into practice: evidence-based interventions for depression. Clin J Oncol Nurs 2014; 18 Suppl:26-37. [PMID: 25427607 DOI: 10.1188/14.cjon.s3.26-37] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression is a distressing emotion that occurs during various times of the cancer trajectory. Depression often goes unrecognized and untreated, which can significantly affect cost, quality of life, and treatment adherence. The Oncology Nursing Society's Putting Evidence Into Practice depression project team reviewed current literature to identify evidence-based interventions to reduce depression in people with cancer. Pharmacologic and nonpharmacologic interventions were evaluated, and opportunities for nurses to integrate recommendations into practice are offered in this article.
Collapse
Affiliation(s)
| | - Hee-Ju Kim
- College of Nursing, Catholic University of Korea, Seoul
| | - Patsy R Smith
- College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City
| | | |
Collapse
|
17
|
Goerling U, Jaeger C, Walz A, Stickel A, Mangler M, van der Meer E. The efficacy of short-term psycho-oncological interventions for women with gynaecological cancer: a randomized study. Oncology 2014; 87:114-24. [PMID: 25012072 DOI: 10.1159/000362818] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/10/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We aimed to examine the efficacy of two psycho-oncological interventions in anxiety, depression, and self-perceived as well as physiological stress in inpatients with gynaecological cancer. METHODS Forty-five women were included in the trial. Thirty-five were categorized as being at high risk of anxiety and depression, and were randomized to either a single psycho-oncological therapy session or a single-session relaxation intervention. RESULTS A significant decrease in anxiety [mean (t0) = 12, mean (t1) = 7.47, p = 0.001] and depression [mean (t0) = 9.71, mean (t1) = 6.35, p < 0.001] was observed in the psycho-oncological intervention group. In the relaxation group, anxiety also significantly decreased [mean (t0) = 11.67, mean (t1) = 8.22, p = 0.003], whereas depression did not. A comparative analysis of both interventions showed a trend in favour of psycho-oncological therapy for the treatment of depression (F = 3.3, p = 0.078). However, self-reported stress (p = 0.031) and different objective stress parameters only significantly decreased in the relaxation group. CONCLUSIONS Psycho-oncological interventions should represent an essential part of interdisciplinary care for gynaecological cancer patients. Both types of intervention may reduce anxiety. However, the single psycho-oncological therapy session might be slightly more effective in treating depression, whereas the single-session relaxation intervention seems to have a stronger effect on physiological stress parameters.
Collapse
Affiliation(s)
- Ute Goerling
- Charité Comprehensive Cancer Center, Charité Universitätsmedizin, Berlin, Germany
| | | | | | | | | | | |
Collapse
|
18
|
Calderón J, Campla C, D'Aguzan N, Barraza S, Padilla O, Sánchez C, Palma S, González M. Prevalence of emotional symptoms in Chilean oncology patients before the start of chemotherapy: potential of the distress thermometer as an ultra-brief screening instrument. Ecancermedicalscience 2014; 8:437. [PMID: 24966889 PMCID: PMC4060959 DOI: 10.3332/ecancer.2014.437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Indexed: 01/06/2023] Open
Abstract
Emotional distress (ED) is greater for oncology patients in comparison with the general population, and this has implications for the quality of life of the patient and his/her family, adherence to the treatment, and eventually, survivorship. In general, the detection of these symptoms is low, which explains the need for detection systems appropriate to the clinical reality of the oncology team. The objective of this study is to evaluate for the first time the usefulness of an ultra-brief screening instrument [distress thermometer (DT)], in a group of Chilean oncology patients. A total of 166 outpatients were evaluated at the Cancer Center of the Pontificia Universidad Católica de Chile, before starting chemotherapy. Two screening instruments were applied: Hospital Anxiety and Depression Scale (HADS) and DT. The application of HADS resulted in a prevalence of 32.7% of anxiety symptoms (HADS-A ≥ 8), 15.7% of depression symptoms (HADS-D ≥ 8), and 39.8% had a total score of HADS-T ≥ 11. The DT resulted in the prevalence of 32.5% of distress or ED (DT ≥ 5). The validity of the DT was evaluated as a screening tool in comparison with HADS, observing, in relation to the anxiety scale (HADS-A), a sensitivity of 88.9% and specificity of 78.4% (DT ≥ 4); depression (HADS-D), a sensitivity of 69.2% and specificity of 74.3% (DT ≥ 5); and in relation to the total scale (HADS-T), a sensitivity of 68.2% and specificity of 73.0% (DT ≥ 4). This study demonstrates the elevated prevalence of emotional symptoms in Chilean oncology patients, before the start of chemotherapy, and confirms the potential of the DT as a brief screening instrument with easy application. The DT will allow the clinician to increase the detection threshold in the Chilean oncology population, intervene in a timely manner, and contribute to the comprehensive handling of the oncology patient without affecting the time needed for assistance.
Collapse
Affiliation(s)
- Jorge Calderón
- Psychiatry Department, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Cristóbal Campla
- Psychiatry Department, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Nicole D'Aguzan
- Psychiatry Department, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Soledad Barraza
- Cancer Center, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Oslando Padilla
- Department of Public Health, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Cesar Sánchez
- Cancer Center, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Silvia Palma
- Cancer Center, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Matías González
- Psychiatry Department, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| |
Collapse
|
19
|
The benefits of psychosocial interventions for cancer patients undergoing radiotherapy. Health Qual Life Outcomes 2013; 11:121. [PMID: 23866850 PMCID: PMC3721996 DOI: 10.1186/1477-7525-11-121] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 07/08/2013] [Indexed: 01/04/2023] Open
Abstract
Background Many patients with cancer experience depression and anxiety, and an associated decrease in quality of life (QOL) during radiation therapy (RT). The main objective of the study was to determine the benefits of psychosocial interventions for cancer patients who received RT. Methods Patients with cancer (n = 178) who agreed to participate in the study were randomized to the intervention arm (n = 89) or the control arm (n = 89). Patients in the intervention group received psychosocial care during RT, whereas the control group received RT only. The benefits of the intervention were evaluated using the Zung Self-rating Depression Scale (SDS) to measure depression, the Self-rating Anxiety Scale (SAS) to assess anxiety, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) to survey health-related QOL. The association between intervention and survival was also assessed. Results Patients randomly assigned to the intervention arm showed significant improvements on symptoms of depression (p < 0.05) and anxiety (p < 0.05), health-related QOL (p < 0.05) (i.e. better global health status, and physical and emotional functioning, and less insomnia) when compared with controls. In the subset analysis, female patients, those that received high dose irradiation, and those that underwent adjuvant chemotherapy could benefit more from psychosocial intervention. There was no difference between the two groups in disease-free survival (DFS) (2-year DFS 79.8% in the intervention arm and 76.4% in the control arm; p = 0.527) and overall survival (OS) (2-year OS 83.1% in the intervention arm and 84.3% in the control arm; p = 0.925) Conclusions Psychosocial intervention is a cost-effective approach that can improve a patient’s mood and QOL both during and after RT. However, the intervention was not found to reduce the risk of cancer recurrence and death. Trial registration ChiCTR-TRC-12002438
Collapse
|
20
|
Franchi G, Bulli F, Muraca MG, Maruelli A, Grechi E, Miccinesi G. Impact of a psycho-oncological rehabilitation intervention on psychological distress: the experience of CeRiOn (Oncological Rehabilitation Centre) Florence 2007-2010. Support Care Cancer 2013; 21:2381-6. [PMID: 23564074 DOI: 10.1007/s00520-013-1803-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 03/25/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Combining medical and psychological knowledge and accompanying patients in an individualised path, the Oncological Rehabilitation Centre of Florence (CeRiOn) aims at offering effective integrated rehabilitation interventions and at reducing psychological distress in cancer patients. In the present observational study, we measured the psychological distress at baseline and at the end of the completed rehabilitation processes. METHODS A total number of 627 cancer patients were treated by the psycho-oncological service at CeRiOn in 2007-2010. Among them, 99 (all women) participated in more than or equal to three sessions, were followed up for clinical and life status for at least 1 year and had a formal conclusion of their psychological rehabilitation process. For 98 cases, both a baseline and a follow-up measure of distress, by the Psychological Distress Inventory (PDI) and the Distress Thermometer (DT), were available. RESULTS Relevant before-after amelioration in this selected group of psychologically, highly suffering cancer patients has been shown. Almost all the patients (except 20%) received both group and individual psychological support. The average rehabilitation process lasted 1.7 years. Average distress evaluation decreased from a baseline of 34.7 to 26.4 (P < 0.001) according to PDI and from 5.9 to 2.2 according to DT (P < 0.001). CONCLUSIONS On average, quite a long psychological support time was necessary to complete the rehabilitation process. During this period, patients who had a formal conclusion of the psychological support received at CeRiOn showed a significant reduction of their distress.
Collapse
Affiliation(s)
- Giovanna Franchi
- The Italian League Against Tumors, Oncological Rehabilitation Centre (CeRiOn), Florence, Italy.
| | | | | | | | | | | |
Collapse
|
21
|
O'Hea EL, Cutillo A, Dietzen L, Harralson T, Grissom G, Person S, Boudreaux ED. Randomized controlled trial to test a computerized psychosocial cancer assessment and referral program: methods and research design. Contemp Clin Trials 2013; 35:15-24. [PMID: 23395772 DOI: 10.1016/j.cct.2013.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 01/22/2013] [Accepted: 02/01/2013] [Indexed: 11/30/2022]
Abstract
The National Cancer Coalition Network, National Cancer Institute, and American College of Surgeons all emphasize the need for oncology providers to identify, address, and monitor psychosocial needs of their patients. The Mental Health Assessment and Dynamic Referral for Oncology (MHADRO) is a patient-driven, computerized, psychosocial assessment that identifies, addresses, and monitors physical, psychological, and social issues faced by oncology patients. This paper presents the methodology of a randomized controlled trial (RCT) that tested the impact of the MHADRO on patient outcomes at 2, 6, and 12 months. Patient outcomes including overall psychological distress, depression, anxiety, functional disability, and use of psychosocial resources will be presented in future publications after all follow-up data is gathered. Eight hundred and thirty six cancer patients with heterogeneous diagnoses, across three comprehensive cancer centers in different parts of the United States, were randomized to the MHADRO (intervention) or an assessment-only control group. Patients in the intervention group were provided detailed, personalized reports and, when needed, referrals to mental health services; their oncology provider received detailed reports designed to foster clinical decision making. Those patients who demonstrated high levels of psychosocial problems were given the option to authorize that a copy of their report be sent electronically to a "best match" mental health professional. Demographic and patient cancer-related data as well as comparisons between patients who were enrolled and those who declined enrollment are presented. Challenges encountered during the RCT and strategies used to address them are discussed.
Collapse
Affiliation(s)
- Erin L O'Hea
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States
| | | | | | | | | | | | | |
Collapse
|
22
|
Yavuzsen T, Karadibak D, Cehreli R, Dirioz M. Effect of Group Therapy on Psychological Symptoms and Quality of Life in Turkish Patients with Breast Cancer. Asian Pac J Cancer Prev 2012; 13:5593-7. [DOI: 10.7314/apjcp.2012.13.11.5593] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
23
|
Hart SL, Hoyt MA, Diefenbach M, Anderson DR, Kilbourn KM, Craft LL, Steel JL, Cuijpers P, Mohr DC, Berendsen M, Spring B, Stanton AL. Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer. J Natl Cancer Inst 2012; 104:990-1004. [PMID: 22767203 DOI: 10.1093/jnci/djs256] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cancer patients are at increased risk for depression compared with individuals with no cancer diagnosis, yet few interventions target depressed cancer patients. METHODS Efficacy of psychotherapeutic and pharmacologic interventions for depression in cancer patients who met an entry threshold for depressive symptoms was examined by meta-analysis. Five electronic databases were systematically reviewed to identify randomized controlled trials meeting the selection criteria. Effect sizes were calculated using Hedges' g and were pooled to compare pre- and postrandomization depressive symptoms with a random effects model. Subgroup analyses tested moderators of effect sizes, such as comparison of different intervention modalities, with a mixed effects model. All statistical tests were two-sided. RESULTS Ten randomized controlled trials (six psychotherapeutic and four pharmacologic studies) met the selection criteria; 1362 participants with mixed cancer types and stages had been randomly assigned to treatment groups. One outlier trial was removed from analyses. The random effects model showed interventions to be superior to control conditions on reducing depressive symptoms postintervention (Hedges' g = 0.43, 95% confidence interval = 0.30 to 0.56, P < .001). In the four psychotherapeutic trials with follow-up assessment, interventions were more effective than control conditions up to 12-18 months after patients were randomly assigned to treatment groups (P < .001). Although each approach was more effective than the control conditions in improving depressive symptoms (P < .001), subgroup analyses showed that cognitive behavioral therapy appeared more effective than problem-solving therapy (P = .01), but not more effective than pharmacologic intervention (P = .07). CONCLUSIONS Our findings suggest that psychological and pharmacologic approaches can be targeted productively toward cancer patients with elevated depressive symptoms. Research is needed to maximize effectiveness, accessibility, and integration into clinical care of interventions for depressed cancer patients.
Collapse
Affiliation(s)
- Stacey L Hart
- Department of Psychology, University of California Los Angeles, CA 90095-1563, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Ferrandina G. Reply to Dr. Yavas's Letter to the Editor. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
25
|
Muñoz Alga MJ, Bernal García P. Abordaje de la ansiedad en pacientes diagnosticados de cáncer. PSICOONCOLOGIA 1970. [DOI: 10.5209/psic.54434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo: El diagnóstico de cáncer puede ser considerado como un potente estresor que puede provocar reacciones emocionales e incluso trastornos emocionales como por ejemplo, trastornos de ansiedad, del estado de ánimo o trastornos adaptativos. Dada la elevada frecuencia de patología ansiosa en pacientes con diagnóstico de cáncer, nuestro objetivo es revisar la eficacia de los tratamientos psicológicos utilizados para el abordaje de la sintomatología ansiosa en pacientes con cáncer.Método: Se ha realizado una búsqueda bibliográfica en la base de datos PubMed mediante los términos: . Se analizaron artículos científicos publicados desde febrero de 2007 hasta febrero de 2016, con pacientes oncológicos como población diana.Resultados: Se han analizado un total de 40 artículos, con homogeneidad en cuanto a diagnóstico, tipo de cáncer y sexo (mayoritariamente mujeres). 34 de los artículos demuestran ser efectivos en la reducción de la ansiedad. Las más utilizadas fueron el mindfulness, los enfoques cognitivo-conductuales y la relajación. Las terapias complementarias han demostrado resultados variables. Técnicas como el yoga fueron ineficaces.Conclusiones: Existen múltiples opciones no farmacológicas para lograr una reducción de la ansiedad en pacientes oncológicos. La mayoría de técnicas evaluadas demuestran eficacia para reducir la ansiedad e incluso conseguir otros beneficios como la reducción de sintomatología depresiva asociado al nuevo diagnóstico de cáncer o asociado a las intervenciones relacionadas con el cáncer.
Collapse
|