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Lin S, Zhou Z, Qi Y, Chen J, Xu G, Shi Y, Yu Z, Li M, Chai K. Depression promotes breast cancer progression by regulating amino acid neurotransmitter metabolism and gut microbial disturbance. Clin Transl Oncol 2024; 26:1407-1418. [PMID: 38194019 DOI: 10.1007/s12094-023-03367-3] [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: 03/28/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION Breast cancer (BC) is the most prevalent type of cancer and has the highest mortality among women worldwide. BC patients have a high risk of depression, which has been recognized as an independent factor in the progression of BC. However, the potential mechanism has not been clearly demonstrated. METHODS To explore the correlation and mechanism between depression and BC progression, we induced depression and tumor in BC mouse models. Depression was induced via chronic unpredictable mild stress (CUMS) and chronic restraint stress (CRS). Amino acid (AA) neurotransmitter-targeted metabonomics and gut microbiota 16S rDNA gene sequencing were employed in the mouse model after evaluation with behavioral tests and pathological analysis. RESULTS The tumors in cancer-depression (CD) mice grew faster than those in cancer (CA) mice, and lung metastasis was observed in CD mice. Metabonomics revealed that the neurotransmitters and plasma AAs in CD mice were dysregulated, namely the tyrosine and tryptophan pathways and monoamine neurotransmitters in the brain. Gut microbiota analysis displayed an increased ratio of Firmicutes/Bacteroides. In detail, the abundance of f_Lachnospiraceae and s_Lachnospiraceae increased, whereas the abundance of o_Bacteroidales and s_Bacteroides_caecimuris decreased. Moreover, the gut microbiota was more closely associated with AA neurotransmitters than with plasma AA. CONCLUSION Depression promoted the progression of BC by modulating the abundance of s_Lachnospiraceae and s_Bacteroides_caecimuris, which affected the metabolism of monoamine neurotransmitters in the brain and AA in the blood.
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Affiliation(s)
- Sisi Lin
- The Second School of Clinical Medical, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Cancer Prevention and Treatment Technology of Integrated Traditional Chinese and Western Medicine, Zhejiang Academy of Traditional Chinese Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, Zhejiang, China
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Zhe Zhou
- The Second School of Clinical Medical, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Cancer Prevention and Treatment Technology of Integrated Traditional Chinese and Western Medicine, Zhejiang Academy of Traditional Chinese Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, Zhejiang, China
| | - Yiming Qi
- The Second School of Clinical Medical, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Cancer Prevention and Treatment Technology of Integrated Traditional Chinese and Western Medicine, Zhejiang Academy of Traditional Chinese Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, Zhejiang, China
| | - Jiabing Chen
- The Second School of Clinical Medical, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Cancer Prevention and Treatment Technology of Integrated Traditional Chinese and Western Medicine, Zhejiang Academy of Traditional Chinese Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, Zhejiang, China
| | - Guoshu Xu
- The Second School of Clinical Medical, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Cancer Prevention and Treatment Technology of Integrated Traditional Chinese and Western Medicine, Zhejiang Academy of Traditional Chinese Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, Zhejiang, China
| | - Yunfu Shi
- The Second School of Clinical Medical, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Cancer Prevention and Treatment Technology of Integrated Traditional Chinese and Western Medicine, Zhejiang Academy of Traditional Chinese Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, Zhejiang, China
| | - Zhihong Yu
- The Second School of Clinical Medical, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Cancer Prevention and Treatment Technology of Integrated Traditional Chinese and Western Medicine, Zhejiang Academy of Traditional Chinese Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, Zhejiang, China
| | - Mingqian Li
- Zhejiang Provincial Key Laboratory of Cancer Prevention and Treatment Technology of Integrated Traditional Chinese and Western Medicine, Zhejiang Academy of Traditional Chinese Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, Zhejiang, China.
| | - Kequn Chai
- The Second School of Clinical Medical, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.
- Zhejiang Provincial Key Laboratory of Cancer Prevention and Treatment Technology of Integrated Traditional Chinese and Western Medicine, Zhejiang Academy of Traditional Chinese Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, Zhejiang, China.
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Lee E, Park Y, Li D, Rodriguez-Fuguet A, Wang X, Zhang WC. Antidepressant Use and Lung Cancer Risk and Survival: A Meta-analysis of Observational Studies. CANCER RESEARCH COMMUNICATIONS 2023; 3:1013-1025. [PMID: 37377607 PMCID: PMC10259481 DOI: 10.1158/2767-9764.crc-23-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/14/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023]
Abstract
Recent preclinical studies have linked antidepressants (AD) to their potential anticancer effects in multiple cancers, but the impact on lung cancer remains unclear. This meta-analysis examined the associations between ADs and lung cancer incidence and survival. The Web of Science, Medline, CINAHL, and PsycINFO databases were searched to identify eligible studies published by June 2022. We conducted a meta-analysis using a random-effects model to compare the pooled risk ratio (RR) and 95% confidence interval (CI) in those treated with or without ADs. Heterogeneity was examined using Cochran Q test and inconsistency I2 statistics. The methodologic quality of the selected studies was assessed using the Newcastle-Ottawa Scale for observational studies. Our analysis, including 11 publications involving 1,200,885 participants, showed that AD use increased lung cancer risk by 11% (RR = 1.11; 95% CI = 1.02-1.20; I2 = 65.03%; n = 6) but was not associated with overall survival (RR = 1.04; 95% CI = 0.75-1.45; I2 = 83.40%; n = 4). One study examined cancer-specific survival. Subgroup analysis showed that serotonin and norepinephrine reuptake inhibitors (SNRIs) were associated with an increased lung cancer risk by 38% (RR = 1.38; 95% CI = 1.07-1.78; n = 2). The quality of selected studies was good (n = 5) to fair (n = 6). Our data analysis suggests that SNRIs were associated with an elevated risk of lung cancer, raising concerns regarding the use of AD treatment in patients vulnerable to lung cancer. The effects of ADs-particularly SNRIs-and their interplay with cigarette use and lung cancer risk in vulnerable patients merits further study. Significance In this meta-analysis of 11 observational studies, we found evidence of a statistically significant association between the use of certain ADs and lung cancer risk. This effect merits further study, particularly as it relates to known environmental and behavioral drivers of lung cancer risk, such as air pollution and cigarette smoke.
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Affiliation(s)
- Eunkyung Lee
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida
| | - Yongho Park
- College of Medicine, University of Central Florida, Orlando, Florida
| | - David Li
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida
| | - Alice Rodriguez-Fuguet
- Department of Cancer Division, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida
| | - Xiaochuan Wang
- School of Social Work, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida
| | - Wen Cai Zhang
- Department of Cancer Division, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida
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Pre-existing and new-onset depression among patients undergoing esophageal cancer surgery: a nationwide cohort study in South Korea. Esophagus 2023; 20:55-62. [PMID: 35904644 DOI: 10.1007/s10388-022-00947-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/13/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Esophageal cancer is believed to be related to psychological stress. This study aimed to examine the prevalence and risk factors for new-onset depression after esophageal cancer surgery among patients who had no pre-existing depression. In addition, we examined whether pre-existing depression affected postoperative 1-year mortality. METHODS The National Health Insurance Service database in South Korea was used for data extraction in this population-based cohort study. This study included all adult patients diagnosed with esophageal cancer who underwent esophageal surgery between January 1, 2011, and December 31, 2018. RESULTS A total of 7039 adult patients who underwent esophageal cancer surgery at 95 South Korean hospitals were included in the analyses. Of the total, 608 patients (8.6%) were diagnosed with new-onset depression within 1 year after esophageal cancer surgery. Female sex, adjuvant chemotherapy, increased Charlson comorbidity index, pre-existing anxiety disorder, and pre-existing insomnia disorder were potential risk factors for new-onset depression. In multivariable Cox regression analysis, the pre-existing depression group showed a 1.27-fold (hazard ratio: 1.27; 95% confidence interval: 1.08-1.48; P = 0.004) higher risk of 1-year all-cause mortality than those who had no pre-existing depression. CONCLUSION In South Korea, 8.6% of patients are newly diagnosed with depression after esophageal cancer surgery, and some potential risk factors have been identified. Moreover, pre-existing depression was associated with increased 1-year all-cause mortality. Patients with esophageal cancer and pre-existing depression may be at high risk, requiring interventions after esophageal cancer surgery.
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Chen Y, Sun L, Xiao H, Zheng J, Lin X. Evaluation of a WeChat-based Dyadic Life Review Program for people with advanced cancer and family caregivers: A mixed-method feasibility study. Palliat Med 2022; 36:498-509. [PMID: 35184629 DOI: 10.1177/02692163211066736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cancer not only affects cancer patients' quality of life but also their family caregivers'. A WeChat-based Dyadic Life Review Program was developed by our research team for people with advanced cancer and their family caregivers to improve their quality of life. AIM To explore the feasibility and preliminary effects of the WeChat-based Dyadic Life Review Program on people with advanced cancer and their family caregivers. METHODS A feasibility randomized controlled trial was conducted. Both quantitative and qualitative data were collected. A total of 47 advanced cancer patient-family caregiver dyads was recruited. Twenty-six dyads were randomized into the experimental group, and 21 dyads into the control group. The experimental group engaged in the WeChat-based Dyadic Life Review Program twice a week for 4 weeks. RESULTS For qualitative results, five themes emerged: (1) accepting and enjoying the program; (2) increasing communication with one another; (3) feeling grateful for each other; (4) providing emotional support to each other; and (5) releasing caregivers' stress. In terms of quantitative results, quality of life (Z = -4.06, p < 0.001; t = 4.30, p < 0.001), family adaptability(Z = -3.01, p = 0.003; Z = -3.29, p = 0.001), and family cohesion(Z = -4.14, p < 0.001; Z = -3.88, p < 0.001) of people with advanced cancer and family caregivers were improved, and family caregivers' care burden (t = -2.50, p = .018) was decreased in the experimental group compared with the control group post-test. CONCLUSIONS The WeChat-based Dyadic Life Review Program is feasible and acceptable for people with advanced cancer and their family caregivers. It has the potential to improve their quality of life, adaptability and cohesion, and reduce family caregivers' care burden.
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Affiliation(s)
- Ying Chen
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Lijun Sun
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Huimin Xiao
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Jianwei Zheng
- Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Xiaoyan Lin
- Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
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Li R, Su L, Hua Y, Ye JR, Song XR, Tian J, Song JH, Hong JS. Anxiety and depression status prior to radiotherapy in patients with nasopharyngeal carcinoma and its effect on acute radiation toxicities. Eur J Cancer Care (Engl) 2021; 30:e13487. [PMID: 34219307 DOI: 10.1111/ecc.13487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/27/2021] [Accepted: 06/15/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The objective of this work is to explore anxiety and depression status prior to radiotherapy in patients with nasopharyngeal carcinoma (NPC) and its effect on acute radiation toxicities. METHODS A total of 267 NPC patients were enrolled between August 2013 and September 2016. The anxiety and depression status of the patients prior to radiotherapy was evaluated using the Hospital Anxiety and Depression Scale. Acute radiation toxicities were assessed weekly and recorded according to the Common Terminology Criteria for Adverse Events version 4.0. Logistic regression analysis was used to identify the predictive factors for acute radiation toxicities. RESULTS The rates of anxiety and depression status prior to radiotherapy were 35.2% and 25.5%, respectively. Anxiety was a significant predictor of vomiting (P = 0.001, OR = 2.874) and dysphagia (P = 0.029, OR = 2.080). Depression was a significant predictor of dysgeusia (P = 0.030, OR = 2.957). In addition, age was a significant predictor of dysphagia (P = 0.001, OR = 1.131). CONCLUSIONS Anxiety and depression status prior to radiotherapy aggravate acute radiation toxicities in patients with NPC. Assessment of the anxiety and depression status and appropriate interventions should be an integral part of treatment to relieve radiation injury during intensity-modulated radiotherapy.
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Affiliation(s)
- Rong Li
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Li Su
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Key Laboratory of Radiation Biology of Fujian higher education institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Fujian Provincial Key Laboratory of Precision Medicine for Cancer, Fujian Medical University, Fuzhou, China
| | - Yangjingling Hua
- Public health department, Xiamen Center for Disease Control and Prevention, Xiamen, China
| | - Jin-Ru Ye
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiu-Rong Song
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jun Tian
- Department of Epidemiology and Health Statistics, Fujian Medical University, Fuzhou, China
| | - Ji-Hong Song
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Jin-Sheng Hong
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Key Laboratory of Radiation Biology of Fujian higher education institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Chen L, Li X, Li C, Zou C. Antidepressant use and colorectal cancer morbidity and mortality: A dose-response meta analysis. Medicine (Baltimore) 2020; 99:e20185. [PMID: 32481383 DOI: 10.1097/md.0000000000020185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
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.
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Affiliation(s)
| | - Xun Li
- Department of Clinical laboratory, The Second Clinical Medical College, Yangtze University, Jingzhou, China
| | - Chengbin Li
- Department of Clinical laboratory, The Second Clinical Medical College, Yangtze University, Jingzhou, China
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Childers J, Arnold B. The Inner Lives of Doctors: Physician Emotion in the Care of the Seriously Ill. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:29-34. [PMID: 31746722 DOI: 10.1080/15265161.2019.1674409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Elisabeth Kübler-Ross' seminal 1969 work, On Death and Dying, opened the door to understanding individuals' emotional experiences with serious illness and dying. Patient's emotions, however, are only half the story in the patient-physician relationship. In recent years physicians' emotional reactions have gotten more attention. These sometimes-unacknowledged emotions influence how we approach our work, including life and death decisions. This article reviews some of the main emotions physicians experience when caring for seriously ill and dying patients and the challenges physicians face in regulating their emotions in a professional setting. We also discuss some of the ways that physician emotion may influence medical decision-making and contribute to conflict. Attention to the emotional level of physician experience may promote better care.
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Abstract
ABSTRACTObjective:Our aim was to identify the themes that arise when applying adapted meaning-centered group psychotherapy (MCGP) in Spanish-speaking advanced cancer patients. METHOD A mixed qualitative-quantitative analysis was performed on the transcripts of interviews with 22 advanced cancer patients who had been assigned to three MCGP subgroups. RESULTS We found six new emergent themes in addition to the originally constructed themes of MCGP. Threat and uncertainty were the two most frequent emergent issues for our Spanish patients. SIGNIFICANCE OF RESULTS The implementation of MCGP in Spanish patients validated the themes proposed by Breitbart and colleagues' foundational work on MCGP and also suggested new issues relevant to patient well-being (classified as "emergent themes"). Taking our findings into account, we propose that these new themes be considered in the Spanish adaptation of MCGP as well as in future adaptations of this form of psychotherapy in treating Latin American patients.
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Scherrens AL, Roelands M, Van den Block L, Deforche B, Deliens L, Cohen J. What influences intentions to request physician-assisted euthanasia or continuous deep sedation? DEATH STUDIES 2018; 42:491-497. [PMID: 29173079 DOI: 10.1080/07481187.2017.1386734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The increasing prevalence of euthanasia in Belgium has been linked to changing attitudes. Using National health survey data (N = 9651), we investigated Belgian adults' intention to ask a physician for euthanasia or continuous deep sedation in the hypothetical scenario of a terminal illness and examined its connection to sociodemographic and health characteristics. Respectively, 38.3 and 25.8% could envisage asking for euthanasia and continuous deep sedation. Those with very bad to fair subjective health and with depression more likely had an intention to ask for euthanasia, which suggests need for attention in the evaluation of requests from specific patient groups.
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Affiliation(s)
- Anne-Lore Scherrens
- a Department of Family Medicine and Chronic Care, End-of-Life Care Research Group , Vrije Universiteit Brussel (VUB) and Ghent University , Brussels , Belgium
- b Department of Public Health , Ghent University , Ghent , Belgium
| | - Marc Roelands
- c Department of Public Health Care, Research Group Mental Health and Wellbeing , Vrije Universiteit Brussel (VUB) , Brussels , Belgium
| | - Lieve Van den Block
- a Department of Family Medicine and Chronic Care, End-of-Life Care Research Group , Vrije Universiteit Brussel (VUB) and Ghent University , Brussels , Belgium
| | | | - Luc Deliens
- a Department of Family Medicine and Chronic Care, End-of-Life Care Research Group , Vrije Universiteit Brussel (VUB) and Ghent University , Brussels , Belgium
- d Department of Medical Oncology , Ghent University , Ghent , Belgium
| | - Joachim Cohen
- a Department of Family Medicine and Chronic Care, End-of-Life Care Research Group , Vrije Universiteit Brussel (VUB) and Ghent University , Brussels , Belgium
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Cheng Y, Qiao Z, Dang C, Zhou B, Li S, Zhang W, Jiang J, Song Y, Zhang J, Diao D. p38 predicts depression and poor outcome in esophageal cancer. Oncol Lett 2017; 14:7241-7249. [PMID: 29344159 PMCID: PMC5754885 DOI: 10.3892/ol.2017.7129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/09/2017] [Indexed: 01/12/2023] Open
Abstract
p38 mitogen-activated protein kinase (MAPK) signaling has been implicated in the cancer development and progression. However, the precise mechanism of this association remains unknown. The aim of the present study was to evaluate the association between p38 and cancer progression, including investigations into the effects on cell proliferation, resistance to thalidomide, indoleamine 2,3-dioxygenase (IDO) expression and prognosis in patients with esophageal cancer. The present retrospective study included patients with stage I–III esophageal cancer. A total of 228 patients with esophageal cancer were recruited to analyze the expression of phosphorylated (p)-p38 and IDO in tumor, and normal tissues through immunohistochemistry. Depression status was measured using the Zung Self-Rating Depression Scale. P38 cDNA was transfected into esophageal cancer cells to assess tumor cell viability, sensitivity to thalidomide treatment and IDO gene expression. Western blotting and flow cytometry was used to analyze protein expression alterations, and apoptosis in esophageal cancer cells. P-p38 protein was expressed in 68.9% of cancer tissues, and was significantly associated with depressive symptoms, tumor recurrence and poor survival of patients. In vitro experiments revealed that the expression of p-p38 induced esophageal cancer Eca-109 and TE-1 cell viability, and resistance to thalidomide treatment, as well as in the expression of IDO without the application of lipopolysaccharides. Further follow-up of patients revealed that depression was also an independent factor for early recurrence and overall survival rate. Altered p38 MAPK expression was associated with poor outcome in patients with esophageal cancer. p38 may be a potential biomarker for the prediction of depressive symptoms and prognosis in patients with esophageal cancer.
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Affiliation(s)
- Yao Cheng
- Department of Thoracic Surgery, The Second Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710004, P.R. China
| | - Zhe Qiao
- Department of Thoracic Surgery, The Second Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710004, P.R. China
| | - Chengxue Dang
- Department of Surgical Oncology, The First Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710061, P.R. China
| | - Bin Zhou
- Department of Thoracic Surgery, The Second Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710004, P.R. China
| | - Shaomin Li
- Department of Thoracic Surgery, The Second Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710004, P.R. China
| | - Wei Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710004, P.R. China
| | - Jiantao Jiang
- Department of Thoracic Surgery, The Second Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710004, P.R. China
| | - Yongchun Song
- Department of Surgical Oncology, The First Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710061, P.R. China
| | - Jin Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710004, P.R. China
| | - Dongmei Diao
- Department of Surgical Oncology, The First Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710061, P.R. China
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Penman J. Finding Paradise Within: How Spirituality Protects Palliative Care Clients and Caregivers From Depression. J Holist Nurs 2017; 36:243-254. [DOI: 10.1177/0898010117714665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aims of this article are to explore the experience of depression among palliative care clients and caregivers, describe the strategies they use in coping with depression, and clarify the role of spirituality in preventing and/or overcoming depression. This article discusses an aspect of the findings of a larger doctoral study that explored the nature of spirituality and spiritual engagement from the viewpoint of individuals with life-limiting conditions and their caregivers. van Manen’s phenomenology was used in the study. The data generated from the doctoral study were subjected to secondary analysis to uncover the experience of depression. The methodology underpinning the secondary analysis was phenomenology also by van Manen. Fourteen clients and caregivers from across regional and rural South Australia informed the study. Data collection involved in-depth nonstructured home-based interviews that were audiotaped and transcribed verbatim. The findings highlighted relate to participants succumbing to depression, but having spiritual beliefs and practices helped them cope. One of the most insightful understanding was the role spirituality played in protecting individuals from depression, encapsulated in the theme “finding paradise within.” Spirituality, understood from a religious or secular perspective, must be embedded in palliative care as it assisted in preventing and overcoming depression.
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Diaz-Frutos D, Baca-Garcia E, García-Foncillas J, López-Castroman J. Predictors of psychological distress in advanced cancer patients under palliative treatments. Eur J Cancer Care (Engl) 2016; 25:608-15. [DOI: 10.1111/ecc.12521] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2016] [Indexed: 11/30/2022]
Affiliation(s)
- D. Diaz-Frutos
- Department of Psychiatry and Clinical Psychology; Fundación Jiménez Díaz Hospital; Autonoma University of Madrid (UAM); Madrid Spain
- Department of Oncology; Fundación Jiménez Díaz Hospital; Autonoma University of Madrid (UAM); Madrid Spain
- Spanish Association Against Cancer (AECC); Barcelona Spain
| | - E. Baca-Garcia
- Department of Psychiatry and Clinical Psychology; Fundación Jiménez Díaz Hospital; Autonoma University of Madrid (UAM); Madrid Spain
| | - J. García-Foncillas
- Department of Oncology; Fundación Jiménez Díaz Hospital; Autonoma University of Madrid (UAM); Madrid Spain
| | - J. López-Castroman
- Department of Psychiatry and Clinical Psychology; Fundación Jiménez Díaz Hospital; Autonoma University of Madrid (UAM); Madrid Spain
- Department of Emergency Psychiatry; CHRU Montpellier; Montpellier France
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Mandizadza EJR, Chidarikire S. A Phenomenological Study into the Role of Spirituality and Religiousness in the Mental Health of People with Cancer in Zimbabwe. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2016. [DOI: 10.1080/19349637.2015.1100972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Yennurajalingam S, Williams JL, Chisholm G, Bruera E. Effects of Dexamethasone and Placebo on Symptom Clusters in Advanced Cancer Patients: A Preliminary Report. Oncologist 2016; 21:384-90. [PMID: 26888692 DOI: 10.1634/theoncologist.2014-0260] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 01/11/2016] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Advanced cancer patients frequently experience debilitating symptoms that occur in clusters, but few pharmacological studies have targeted symptom clusters. Our objective was to examine the effects of dexamethasone on symptom clusters in patients with advanced cancer. METHODS We reviewed the data from a previous randomized clinical trial to determine the effects of dexamethasone on cancer symptoms. Symptom clusters were identified according to baseline symptoms by using principal component analysis. Correlations and change in the severity of symptom clusters were analyzed after study treatment. RESULTS A total of 114 participants were included in this study. Three clusters were identified: fatigue/anorexia-cachexia/depression (FAD), sleep/anxiety/drowsiness (SAD), and pain/dyspnea (PD). Changes in severity of FAD and PD significantly correlated over time (at baseline, day 8, and day 15). The FAD cluster was associated with significant improvement in severity at day 8 and day 15, whereas no significant change was observed with the SAD cluster or PD cluster after dexamethasone treatment. CONCLUSION The results of this preliminary study suggest significant correlation over time and improvement in the FAD cluster at day 8 and day 15 after treatment with dexamethasone. These findings suggest that fatigue, anorexia-cachexia, and depression may share a common pathophysiologic basis. Further studies are needed to investigate this cluster and target anti-inflammatory therapies.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet L Williams
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gary Chisholm
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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15
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Jung M. Determinants of health information-seeking behavior: implications for post-treatment cancer patients. Asian Pac J Cancer Prev 2015; 15:6499-504. [PMID: 25169477 DOI: 10.7314/apjcp.2014.15.16.6499] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Health information-seeking behavior (HISB) is active need-fulfillment behavior whereby health information is obtained from diverse sources, such as the media, and has emerged as an important issue within the transforming medical environment and the rise of medical consumers. However, little is known about the factors that affect HISB and its associations, and the health outcome of HISB. The aim of this study was to examine individual and social contextual factors associated with HISB and to systematically review their effects on health status among post- treatment cancer patients. Individual determinants of HISB included demographic factors, psychosocial factors, perceived efficacy and norms, and health beliefs. Contextual determinants of HISB encompassed community characteristics, neighborhood social capital, and media advocacy. Improving through factors on these two levels, HISB raised individuals' self-care management skills and medical treatment compliance, and enhanced shared decision-making and medical treatment satisfaction. Moreover, because HISB can differ according to individuals' social contextual conditions, it can give rise to communication inequalities. Because these can ultimately lead to health disparities between groups, social interest in HISB and balanced HISB promotion strategies are necessary.
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Affiliation(s)
- Minsoo Jung
- Department of Health Science, Dongduk Women's University, Seoul, South Korea E-mail :
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16
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Zhao L, Li X, Zhang Z, Song C, Guo C, Zhang Y, Zhang Y, Li L, Lu G, Zheng G, Wang K, Pei W, Han L. Prevalence, correlates and recognition of depression in Chinese inpatients with cancer. Gen Hosp Psychiatry 2014; 36:477-82. [PMID: 24961793 DOI: 10.1016/j.genhosppsych.2014.05.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 04/18/2014] [Accepted: 05/01/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine the prevalence, correlates and recognition rates of depressive disorders (DDs) in Chinese inpatients with cancer. METHODS Four hundred and sixty cancer inpatients were recruited from the oncology ward of a university hospital in Beijing, China. Patients were interviewed with a Chinese version of the Mini International Neuropsychiatric Interview 5.0 by eight trained psychiatrists. Case records of inpatients with DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) DDs were reviewed to determine whether treating oncologists made a diagnosis of depression, prescribed antidepressant medications and/or recommended psychiatric consultation/referral. RESULTS The 1-month prevalence rates (95% confidence intervals) of DDs and major depressive disorder (MDD) were 25.9% (21.9%-29.9%) and 12.6% (9.6%-15.6%), respectively. In our multiple logistic regression analysis, being unmarried [odds ratio (OR)=1.41], cancer stage of metastasis (OR=2.35), time since cancer diagnosis ≤20 months (OR=2.05), frequent pain (OR=1.99~6.83) and being scored between two and four on the Eastern Cooperative Oncology Group Scale (OR=2.25~4.97) were independently associated with depression. Only 6.9% of patients with MDD were recognized by treating oncologists. CONCLUSIONS DDs are very common among Chinese inpatients with cancer. The high prevalence rate and low recognition rate of depression in cancer patients indicate a pressing need for routine screening, evaluation and treatment of depression in this patient population.
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Affiliation(s)
- Libo Zhao
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Xiurong Li
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Zhiguo Zhang
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Chunqing Song
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Caihong Guo
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yinghua Zhang
- Department of Interventional Radiology, Beijing You'an Hospital, Capital Medical University Beijing, China
| | - Ying Zhang
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Li Li
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Guilong Lu
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Guowen Zheng
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Kesong Wang
- Department of Oncology, Beijing Shunyi Hospital, Beijing, China
| | - Wenzhong Pei
- Department of Oncology, The Luhe Teaching Hospital of the Capital Medical University, Beijing, China
| | - Lei Han
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China.
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17
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Riblet N, Larson R, Watts BV, Holtzheimer P. Reevaluating the role of antidepressants in cancer-related depression: a systematic review and meta-analysis. Gen Hosp Psychiatry 2014; 36:466-73. [PMID: 24950919 DOI: 10.1016/j.genhosppsych.2014.05.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 05/08/2014] [Accepted: 05/13/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Prior reviews evaluating the role of antidepressants in cancer-related depression have drawn conflicting conclusions. These reviews have also not explored differences in efficacy and tolerability between antidepressants. We conducted a meta-analysis to address these limitations. METHOD We searched Medline (1948-2013), the Cochrane Library (1800-2013), the Cumulative Index to Nursing and Allied Health Literature (1986-2013), ClinicalTrials.gov (2013) and meeting abstracts. We included randomized trials comparing antidepressants to placebo or no treatment for cancer-related depression. We used random effects to calculate standardized mean differences (SMD). RESULTS Of 5178 potentially eligible citations, 9 trials (1169 subjects) met inclusion criteria. Trials of mianserin found a robust reduction in depression scores at ≥4 weeks of treatment (SMD: 0.60, 95% confidence interval (CI): 0.24-0.95). Similar, but less robust, results were observed with paroxetine (SMD: 0.22, 95% CI: 0.01-0.42) and fluoxetine (SMD 0.34, 95% CI: 0.02-0.66). Conversely, there was no advantage with amitriptyline or desipramine. Compared to placebo, the odds of dropping out due to side effect were higher with fluoxetine and paroxetine and lower with mianserin. Methodological quality was moderate. CONCLUSIONS Paroxetine, fluoxetine and mianserin improve cancer-related depression but may vary in efficacy and tolerability. High-quality, randomized trials of newer antidepressant agents are needed to identify optimal treatments for managing cancer-related depression.
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Affiliation(s)
- Natalie Riblet
- The Dartmouth Institute for Health Policy and Clinical Practice, 30 Lafayette Drive, Lebanon, NH 03766; Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03766.
| | - Robin Larson
- The Dartmouth Institute for Health Policy and Clinical Practice, 30 Lafayette Drive, Lebanon, NH 03766; White River Junction VA Medical Center, 215 North Main Street, White River Junction, VT 05009; Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH 03755
| | - Bradley V Watts
- White River Junction VA Medical Center, 215 North Main Street, White River Junction, VT 05009; Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH 03755
| | - Paul Holtzheimer
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03766; White River Junction VA Medical Center, 215 North Main Street, White River Junction, VT 05009; Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH 03755
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18
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Qin P, Hawton K, Mortensen PB, Webb R. Combined effects of physical illness and comorbid psychiatric disorder on risk of suicide in a national population study. Br J Psychiatry 2014; 204:430-5. [PMID: 24578445 DOI: 10.1192/bjp.bp.113.128785] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND People with physical illness often have psychiatric disorder and this comorbidity may have a specific influence on their risk of suicide. AIMS To examine how physical illness and psychiatric comorbidity interact to influence risk of suicide, with particular focus on relative timing of onset of the two types of illness. METHOD Based on the national population of Denmark, individual-level data were retrieved from five national registers on 27 262 suicide cases and 468 007 gender- and birth-date matched living controls. Data were analysed using conditional logistic regression. RESULTS Both suicides and controls with physical illness more often had comorbid psychiatric disorder than their physically healthy counterparts. Although both physical and psychiatric illnesses constituted significant risk factors for suicide, their relative timing of onset in individuals with comorbidity significantly differentiated the associated risk of suicide. While suicide risk was highly elevated when onsets of both physical and psychiatric illness occurred close in time to each other, regardless which came first, psychiatric comorbidity developed some time after onset of physical illness exacerbated the risk of suicide substantially. CONCLUSIONS Suicide risk in physically ill people varies substantially by presence of psychiatric comorbidity, particularly the relative timing of onset of the two types of illness. Closer collaboration between general and mental health services should be an essential component of suicide prevention strategies.
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Affiliation(s)
- Ping Qin
- Ping Qin, MD, PhD, National Centre for Register-based Research, Aarhus University, Denmark, and National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway; Keith Hawton, DSc, DM, Centre for Suicide Study, Department of Psychiatry, Oxford University, UK; Preben Bo Mortensen, MD, DrMedSc, National Centre for Register-based Research, Aarhus University, Denmark; Roger Webb, MSc, PhD, Centre for Mental Health and Risk, University of Manchester, UK
| | - Keith Hawton
- Ping Qin, MD, PhD, National Centre for Register-based Research, Aarhus University, Denmark, and National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway; Keith Hawton, DSc, DM, Centre for Suicide Study, Department of Psychiatry, Oxford University, UK; Preben Bo Mortensen, MD, DrMedSc, National Centre for Register-based Research, Aarhus University, Denmark; Roger Webb, MSc, PhD, Centre for Mental Health and Risk, University of Manchester, UK
| | - Preben Bo Mortensen
- Ping Qin, MD, PhD, National Centre for Register-based Research, Aarhus University, Denmark, and National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway; Keith Hawton, DSc, DM, Centre for Suicide Study, Department of Psychiatry, Oxford University, UK; Preben Bo Mortensen, MD, DrMedSc, National Centre for Register-based Research, Aarhus University, Denmark; Roger Webb, MSc, PhD, Centre for Mental Health and Risk, University of Manchester, UK
| | - Roger Webb
- Ping Qin, MD, PhD, National Centre for Register-based Research, Aarhus University, Denmark, and National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway; Keith Hawton, DSc, DM, Centre for Suicide Study, Department of Psychiatry, Oxford University, UK; Preben Bo Mortensen, MD, DrMedSc, National Centre for Register-based Research, Aarhus University, Denmark; Roger Webb, MSc, PhD, Centre for Mental Health and Risk, University of Manchester, UK
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19
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Fisher KA, Seow H, Brazil K, Freeman S, Smith TF, Guthrie DM. Prevalence and risk factors of depressive symptoms in a Canadian palliative home care population: a cross-sectional study. BMC Palliat Care 2014; 13:10. [PMID: 24636452 PMCID: PMC4003817 DOI: 10.1186/1472-684x-13-10] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 03/03/2014] [Indexed: 01/06/2023] Open
Abstract
Background Depression in palliative care patients is important because of its intrinsic burden and association with elevated physical symptoms, reduced immunity and increased mortality risk. Identifying risk factors associated with depression can enable clinicians to more readily diagnose it, which is important since depression is treatable. The purpose of this cross-sectional study was to determine the prevalence of depressive symptoms and risk factors associated with them in a large sample of palliative home care patients. Methods The data come from interRAI Palliative Care assessments completed between 2006 and 2012. The sample (n = 5144) consists of adults residing in Ontario (Canada), receiving home care services, classified as palliative, and not experiencing significant cognitive impairment. Logistic regression identified the risk factors associated with depressive symptoms. The dependent variable was the Depression Rating Scale (DRS) and the independent variables were functional indicators from the interRAI assessment and other variables identified in the literature. We examined the results of the complete case and multiple imputation analyses, and found them to be similar. Results The prevalence of depressive symptoms was 9.8%. The risk factors associated with depressive symptoms were (pooled estimates, multiple imputation): low life satisfaction (OR = 3.01 [CI = 2.37-3.82]), severe and moderate sleep disorders (2.56 [2.05-3.19] and 1.56 [1.18-2.06]), health instability (2.12 [1.42-3.18]), caregiver distress 2.01 [1.62-2.51]), daily pain (1.73 [1.35-2.22]), cognitive impairment (1.45 [1.13-1.87]), being female (1.37 [1.11-1.68]), and gastrointestinal symptoms (1.27 [1.03-1.55]). Life satisfaction mediated the effect of prognostic awareness on depressive symptoms. Conclusions The prevalence of depressive symptoms in our study was close to the median of 10-20% reported in the palliative care literature, suggesting they are present but by no means inevitable in palliative patients. Most of the factors associated with depressive symptoms in our study are amenable to clinical intervention and often targeted in palliative care programs. Designing interventions to address them can be challenging, however, requiring careful attention to patient preferences, the spectrum of comorbid conditions they face, and their social supports. Life satisfaction was one of the strongest factors associated with depressive symptoms in our study, and is likely to be among the most challenging to address.
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Affiliation(s)
- Kathryn A Fisher
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON K8S 4L8, Canada.
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20
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Depressive disorder in the last phase of life in patients with cardiovascular disease, cancer, and COPD: data from a 20-year follow-up period in general practice. Br J Gen Pract 2014; 63:e303-8. [PMID: 23643227 DOI: 10.3399/bjgp13x667150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Depression is assumed to be common in chronically ill patients during their last phase of life and is associated with poorer outcomes. The prevalence of depression is widely varying in previous studies due to the use of different terminology, classification, and assessment methods. AIM To explore the reported incidence of depressive disorder, as registered in the last phase of life of patients who died from cardiovascular disease, cancer or COPD, in a sample of primary care patients. DESIGN AND SETTING A historic cohort study, using a 20-year period registration database of medical records in four Dutch general practices (a dynamic population based on the Continuous Morbidity Registration database). METHOD Medical history of the sample cohort was analysed for the diagnosis of a new episode of depressive disorder and descriptive statistics were used. RESULTS In total 982 patients were included, and 19 patients (1.9%) were diagnosed with a new depressive disorder in the last year of their life. The lifetime prevalence of depressive disorder in this sample was 8.2%. CONCLUSION The incidence of depressive disorder in the last phase of life is remarkably low in this study. These data were derived from actual patient care in general practice. Psychiatric diagnoses were made by GPs in the context of both patient needs and delivered care. A broader concept of depression in general practice is recommended to improve the diagnosis and treatment of mood disorders in patients in the last phase of life.
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21
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Roberts D, Appleton L, Calman L, Large P, Grande G, Lloyd-Williams M, Walshe C. Protocol for a longitudinal qualitative interview study: maintaining psychological well-being in advanced cancer--what can we learn from patients' and carers' own coping strategies? BMJ Open 2013; 3:e003046. [PMID: 23794566 PMCID: PMC3693411 DOI: 10.1136/bmjopen-2013-003046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/08/2013] [Accepted: 05/10/2013] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION People with advanced cancer and their carers experience stress and uncertainty which affects the quality of life and physical and mental health. This study aims to understand how patients and carers recover or maintain psychological well-being by exploring the strategies employed to self-manage stress and uncertainty. METHODS AND ANALYSIS A longitudinal qualitative interview approach with 30 patients with advanced cancer and 30 associated family or informal carers allows the exploration of contexts, mechanisms and outcomes at an individual level. Two interviews, 4-12 weeks apart, will not only enable the exploration of individuals' evolving coping strategies in response to changing contexts but also how patients' and carers' strategies inter-relate. Patient and Carer focus groups will then consider how the findings may be used in developing an intervention. Recruiting through two major tertiary cancer centres in the North West and using deliberately broad and inclusive criteria will enable the sample to capture demographic and experiential breadth. ETHICS AND DISSEMINATION The research team will draw on their considerable experience to ensure that the study is sensitive to a patient and carer group, which may be considered vulnerable but still values being able to contribute its views. Public and patient involvement (PPI) is integral to the design and is evidenced by: a research advisory group incorporating patient and carers, prestudy consultations with the PPI group at one of the study sites and a user as the named applicant. The study team will use multiple methods to disseminate the findings to clinical, policy and academic audiences. A key element will be engaging health professionals in patient and carer ideas for promoting self-management of psychological well-being. The study has ethical approval from the North West Research Ethics Committee and the appropriate NHS governance clearance. REGISTRATION National Institute for Health Research (NIHR) Clinical Studies Portfolio, UK Clinical Research Network (UKCRN) Study number 11725.
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Affiliation(s)
- Diane Roberts
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | - Lynn Calman
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Paul Large
- Clatterbridge Cancer Centre, Wirral, Merseyside, UK
| | - Gunn Grande
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mari Lloyd-Williams
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Catherine Walshe
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Rane PB, Sambamoorthi U, Madhavan S. Depression Treatment in Individuals with Cancer: A Comparative Analysis with Cardio-Metabolic Conditions. Health Psychol Res 2013; 1:e2. [PMID: 26973891 PMCID: PMC4768604 DOI: 10.4081/hpr.2013.e2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 11/18/2012] [Accepted: 11/20/2012] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Pallavi B Rane
- Department of Pharmaceutical Systems & Policy, School of Pharmacy, West Virginia University, Morgantown , WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems & Policy, School of Pharmacy, West Virginia University, Morgantown , WV, USA
| | - Suresh Madhavan
- Department of Pharmaceutical Systems & Policy, School of Pharmacy, West Virginia University, Morgantown , WV, USA
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Warmenhoven F, van Weel C, Vissers K, Prins J. Screening Instruments for Depression in Advanced Cancer Patients: What Do We Actually Measure? Pain Pract 2012; 13:467-75. [DOI: 10.1111/papr.12012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 10/03/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Franca Warmenhoven
- Department of Primary and Community Care; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Chris van Weel
- Department of Primary and Community Care; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Judith Prins
- Department of Medical Psychology; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
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24
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Warmenhoven F, van Rijswijk E, van Hoogstraten E, van Spaendonck K, Lucassen P, Prins J, Vissers K, van Weel C. How family physicians address diagnosis and management of depression in palliative care patients. Ann Fam Med 2012; 10:330-6. [PMID: 22778121 PMCID: PMC3392292 DOI: 10.1370/afm.1373] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 09/29/2011] [Accepted: 10/17/2011] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Depression is highly prevalent in palliative care patients. In clinical practice, there is concern about both insufficient and excessive diagnosis and treatment of depression. In the Netherlands, family physicians have a central role in delivering palliative care. We explored variation in family physicians' opinions regarding the recognition, diagnosis, and management of depression in palliative care patients. METHODS We conducted a focus group study in a sample of family physicians with varied practice locations and varying expertise in palliative care. Transcripts were analyzed independently by 2 researchers using constant comparative analysis in ATLAS.ti. RESULTS In 4 focus group discussions with 22 family physicians, the physicians described the diagnostic and therapeutic process for depression in palliative care patients as a continuous and overlapping process. Differentiating between normal and abnormal sadness was viewed as challenging. The physicians did not strictly apply criteria of depressive disorder but rather relied on their clinical judgment and strongly considered patients' context and background factors. They indicated that managing depression in palliative care patients is mainly supportive and nonspecific. Antidepressant drugs were seldom prescribed. The physicians described difficulties in diagnosing and treating depression in palliative care, and gave suggestions to improve management of depression in palliative care patients in primary care. CONCLUSIONS Family physicians perceive the diagnosis and management of depression in palliative care patients as challenging. They rely on open communication and a long-standing physician-patient relationship in which the patient's context is of great importance. This approach fits with the patient-centered care that is promoted in primary care.
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Affiliation(s)
- Franca Warmenhoven
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, The Netherlands.
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25
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Low prevalence of depressive disorder in ambulatory advanced cancer patients using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1). J Affect Disord 2012; 136:1209-11. [PMID: 22154709 DOI: 10.1016/j.jad.2011.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 11/17/2011] [Accepted: 11/17/2011] [Indexed: 11/23/2022]
Abstract
Depressive disorder is assumed to be highly prevalent in advanced cancer patients, but the diagnosis of depressive disorder in patients with advanced cancer is difficult. The more robust the assessment instrument to diagnose depressive disorder is, the lower the reported prevalence of depressive disorder in advanced cancer patients. This study confirms a low prevalence of depressive disorder (3%) in 64 advanced cancer outpatients using a robust structured clinical assessment (SCAN 2.1). Furthermore, in this article we discuss possible implications of using predefined psychiatric labeling in the assessment of mood symptoms in advanced cancer patients.
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A review of the literature on multiple symptoms, their predictors, and associated outcomes in patients with advanced cancer. Palliat Support Care 2011; 9:81-102. [PMID: 21352621 DOI: 10.1017/s147895151000057x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The findings from several studies suggest that palliative care patients with advanced cancer experience multiple symptoms, and that these symptoms may be related to demographic and clinical factors as well as to patient outcomes. However, no systematic review has summarized the findings from studies that assessed multiple symptoms, predictors, and outcomes in these patients. The purposes of this review, focused on palliative care patients with advanced cancer, are to: 1) describe the relationships among multiple symptoms; 2) describe the predictors of multiple symptoms; and 3) describe the relationships between multiple symptoms and patient outcomes. METHOD Comprehensive literature searches were completed using the following databases: PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsychInfo. The key words: cancer or advanced cancer or neoplasm, AND palliative care or terminal care or hospice or end-of-life, AND symptoms or multiple symptoms or symptom clusters were combined. RESULTS Twenty-two studies met the inclusion criteria and examined at least one of our purposes. The majority of these studies were descriptive and used one of four common symptom assessment scales. Fifty-six different signs and symptoms were evaluated across various dimensions (i.e., prevalence, severity, distress, frequency, control). Pain, dyspnea, and nausea were the only symptoms measured in all 22 studies. Relationships among concurrent symptoms were examined in nine studies. Relationships among symptoms and predictors (i.e., demographics, cancer type, healthcare delivery environment) were examined in seven studies. Relationships among symptoms and outcomes (i.e., functional status, psychological status, quality-of-life, survival time) were examined in 14 studies. Significant methodological variation was found among these studies. SIGNIFICANCE OF RESULTS It is difficult to draw conclusions about the relationships among multiple symptoms, predictors, and outcomes due to the heterogeneity of these studies. Future research is needed to determine which symptoms and symptom dimensions to assess in order to better understand how multiple symptoms relate to each other as well to as predictors and outcomes in palliative care patients with advanced cancer.
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