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Pergolizzi J, LeQuang JAK, Coluzzi F, Magnusson P, Lara-Solares A, Varrassi G. Considerations for Pain Assessments in Cancer Patients: A Narrative Review of the Latin American Perspective. Cureus 2023; 15:e40804. [PMID: 37489190 PMCID: PMC10363018 DOI: 10.7759/cureus.40804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/21/2023] [Indexed: 07/26/2023] Open
Abstract
Cancer incidence in Latin America is lower than in Europe or the United States but morbidity and mortality rates are disproportionately high. A barrier to adequate pain control is inadequate pain assessment, which is a relatively easy and inexpensive metric. The objective of this narrative review is to describe pain assessment for cancer patients in Latin America. Cultural factors may influence pain perception, including contextualizing pain as noble or natural suffering and aspects of what is now called "spiritual pain." Unlike other painful conditions, cancer pain may be strongly associated with existential fear, psychosocial distress, anxiety, and spiritual concerns. Pain assessment allows not just quantification of pain intensity but may elucidate pain mechanisms involved or psychosocial aspects that may color the pain. Many current pain assessment instruments capture only pain intensity, which is but one aspect of the pain experience; some have expanded to include functional assessments, mental health status evaluations, and quality of life metrics. A quality-of-life assessment may be appropriate for cancer patients since chronic pain can severely impact function, which can in turn create a vicious cycle by exacerbating pain. The incidence of cancer in Latin America is expected to increase in the ensuing years. Better pain assessment and clinician education are needed to help manage pain in this large and growing patient population.
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Affiliation(s)
| | | | - Flaminia Coluzzi
- Medical and Surgical Sciences, Sapienza University of Rome, Rome, ITA
| | | | - Argelia Lara-Solares
- Pain and Palliative Care, National Institute of Medical and Nutritional Sciences, Mexico City, MEX
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Czerw A, Religioni U, Szymański F, Nieradko-Heluszko A, Mękal D, Hering D, Kowalczuk A, Merks P, Borowska M, Bogdan M, Pajewska M. Normalization of the Mini-MAC (Mental Adjustment to Cancer) Questionnaire among Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312603. [PMID: 34886329 PMCID: PMC8656664 DOI: 10.3390/ijerph182312603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 11/16/2022]
Abstract
Cancer is associated with discomfort and many changes in patients’ lives to which they must adapt. The main objective of the study was to assess the use of the mini-MAC questionnaire scale among persons diagnosed with malignant cancer and to develop standards allowing differentiation of patients with diagnosed cancer in terms of their style of adjustment to the disease. The mini-MAC questionnaire is a widely used tool in assessing coping strategies among cancer patients. Sten standards have been developed to determine the level of results on the questionnaire scales in the low–average–high categories. The study included 1187 patients diagnosed with malignant cancer who are covered by outpatient care at the Maria Sklodowska-Curie Institute—Oncology Center in Warsaw. The questionnaire concerning mental adjustment to cancer was used (mini-MAC). Patients with cancer most often adopt strategies of fighting spirit and positive reevaluation. The variables that differentiate the results most significantly include gender, presence of metastasis, and the state of undergoing chemotherapy. The mini-MAC questionnaire should be a tool for psycho-oncological diagnosis of patients’ attitudes towards cancer. The obtained results indicate that cancer patients are characterized by their constructive style of adjustment to the disease.
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Affiliation(s)
- Aleksandra Czerw
- Department of Health Economics and Medical Law, Medical University of Warsaw, 02-091 Warsaw, Poland;
- Department of Economic and System Analyses, National Institute of Public Health—NIH—National Research Institute, 00-791 Warsaw, Poland;
- Correspondence:
| | - Urszula Religioni
- Collegium of Business Administration, Warsaw School of Economics, 02-513 Warsaw, Poland;
| | - Filip Szymański
- Departament of Civilization Diseases, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, Kazimierza Woycickiego 1 Street, 01-938 Warsaw, Poland;
| | - Agnieszka Nieradko-Heluszko
- Subdepartment of Social Medicine and Public Health, Department of Social Medicine, Pomeranian Medical University in Szczecin, 70-103 Szczecin, Poland;
| | - Dominika Mękal
- Department of Oncological Prevention, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, 80-211 Gdansk, Poland;
| | | | - Piotr Merks
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, 01-938 Warszawa, Poland;
| | - Mariola Borowska
- Department of Health Economics and Medical Law, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Magdalena Bogdan
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-007 Warsaw, Poland;
| | - Monika Pajewska
- Department of Economic and System Analyses, National Institute of Public Health—NIH—National Research Institute, 00-791 Warsaw, Poland;
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Tsai PL, Kuo TT, Ku CH, Liao GS, Lin CK, Pan HH. Self-Esteem as a Predictor of Mental Adjustment in Patients with Breast Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312588. [PMID: 34886314 PMCID: PMC8656551 DOI: 10.3390/ijerph182312588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
Abstract
This study aimed to explore the relationship between self-esteem and mental adjustment and examine the directional effects in patients with breast cancer using path modeling. This was a cross-sectional, descriptive, and correlational study. A total of 128 patients with breast cancer were selected through convenience sampling at a medical center in northern Taiwan. They completed a basic characteristics questionnaire, the Memorial Symptom Assessment Scale short form, the Rosenberg Self-Esteem Scale, and the mini-Mental Adjustment to Cancer Scale. Descriptive statistics, regression analysis, and path analysis were used to analyze the data. The results showed that higher self-esteem was associated with better mental adjustment (β = 0.9, 95% confidence interval 0.6~1.3, p < 0.001). Age, religious beliefs, employment, cancer stage, and symptom distress were correlated with mental adjustment. Path modeling demonstrated that self-esteem, cancer stage, performance status, and symptom distress directly affected mental adjustment in patients with breast cancer. These findings suggest that health professionals should evaluate self-esteem, performance status, and symptom distress in patients with breast cancer immediately upon admission. This can facilitate early implementation of relevant nursing interventions and, consequently, improve self-esteem and symptom distress and increase mental adjustment in these patients.
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Affiliation(s)
- Pei-Ling Tsai
- Department of Nursing, Tri-Service General Hospital, Taipei City 11490, Taiwan;
| | - Ting-Ting Kuo
- Emergency Room, Department of Nursing, Cheng Hsin General Hospital, Taipei City 112401, Taiwan;
| | - Chih-Hung Ku
- School of Public Health, National Defense Medical Center, Taipei City 11490, Taiwan;
| | - Guo-Shiou Liao
- General Surgery, Division of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan;
| | - Chi-Kang Lin
- Department of Gynecology and Obstetrics, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan;
| | - Hsueh-Hsing Pan
- Department of Nursing, Tri-Service General Hospital, Taipei City 11490, Taiwan;
- School of Nursing, National Defense Medical Center, Taipei City 11490, Taiwan
- Correspondence: ; Tel.: +886-2-87923100 (ext. 18776)
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Ragala MEA, El Hilaly J, Amaadour L, Omari M, AsriI AEL, Atassi M, Benbrahim Z, Mellas N, Rhazi KEL, Halim K, Zarrouq B. Validation of Mini-Mental Adjustment to Cancer scale in a Moroccan sample of breast cancer women. BMC Cancer 2021; 21:1042. [PMID: 34544362 PMCID: PMC8454091 DOI: 10.1186/s12885-021-08755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 09/06/2021] [Indexed: 12/24/2022] Open
Abstract
Background The Mini-Mental Adjustment to Cancer Scale (Mini-MAC) instrument is commonly used worldwide by professionals of oncology, but the scale has not, up to date, been validated in Arabic and Moroccan context, and there is an absence of data in the Moroccan population. This study aims to validate the Mini-MAC, translated and adapted to the Arabic language and Moroccan culture, in women with breast cancer. Methods Data were analyzed in two successive phases. First, exploratory factor analysis (EFA) was used to assess the factor structure in the pilot sample (N = 158). Then, this structure was confirmed in the validation sample (N = 203) using confirmatory factor analysis (CFA). Results Confirmatory factor analysis confirmed Watson’s original structure underlying the Mini-MAC items: Helpless/Hopeless, Anxious Preoccupation, Fighting Spirit, Cognitive Avoidance, and Fatalism. Absolute, incremental, and parsimonious fit indices showed a highly significant level of acceptance confirming a good performance of the measurement model. The instrument showed sufficient reliability and convergent validity demonstrated by acceptable values of composite reliability (CR =0.93–0.97), and average variance extracted (AVE = 0.66–0.93), respectively. The square roots of AVE were higher than factor-factor pairs correlations, and the Heterotrait-Monotrait ratio of correlations values were lesser than 0.85, indicating acceptable discriminant validity. Conclusions reliability; and both convergent and discriminant validity tests indicated that the Arabic version of the Mini-MAC had a good performance and may serve as a valid tool measuring psychological responses to cancer diagnosis and treatment.
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Affiliation(s)
- Mohammed El Amine Ragala
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health & Quality of Life, Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, P. B 1796 Atlas, 30003, Fez, Morocco.,Teachers Training College (Ecole Normale Superieure), Department of Biology and Geology, Sidi Mohamed Ben Abdellah University, P. B 5206 Bensouda, 30030, Fez, Morocco
| | - Jaouad El Hilaly
- Laboratory of Pedagogical and Didactic Engineering of Sciences and Mathematics, Regional Center of Education and Training (CRMEF) of Fez. Rue Koweit, P.B 49 Agdal, 30050, Fes, Morocco.,R.N.E Laboratory, Multidisciplinary Faculty of Taza, Sidi Mohamed Ben Abdellah University, P. B 1223, Route Oujda, 35000, Fez, Morocco
| | - Lamiae Amaadour
- Medical Oncology Department, Hassan II University Hospital, Route Sidi Harazem, 30070, Fez, Morocco
| | - Majid Omari
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health & Quality of Life, Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, P. B 1796 Atlas, 30003, Fez, Morocco.,Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, 2.200 Route Sidi Harazem, 30070, Fez, KM, Morocco
| | - Achraf E L AsriI
- Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, 2.200 Route Sidi Harazem, 30070, Fez, KM, Morocco
| | - Mariam Atassi
- Laboratory of Epidemiology, Clinical Research, and Public Health, Faculty of Medicine and Pharmacy, Mohamed I University, BP724 Hay Al Quods, 60000, Oujda, Morocco.,Mohamed VI University Hospital, Oujda, Morocco
| | - Zineb Benbrahim
- Medical Oncology Department, Hassan II University Hospital, Route Sidi Harazem, 30070, Fez, Morocco
| | - Nawfel Mellas
- Medical Oncology Department, Hassan II University Hospital, Route Sidi Harazem, 30070, Fez, Morocco
| | - Karima E L Rhazi
- Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, 2.200 Route Sidi Harazem, 30070, Fez, KM, Morocco
| | - Karima Halim
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health & Quality of Life, Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, P. B 1796 Atlas, 30003, Fez, Morocco.,Teachers Training College (Ecole Normale Superieure), Department of Human and Social Sciences - Education Sciences, Sidi Mohamed Ben Abdellah University, P. B 5206 Bensouda, 30030, Fez, Morocco
| | - Btissame Zarrouq
- Teachers Training College (Ecole Normale Superieure), Department of Biology and Geology, Sidi Mohamed Ben Abdellah University, P. B 5206 Bensouda, 30030, Fez, Morocco. .,Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, 2.200 Route Sidi Harazem, 30070, Fez, KM, Morocco.
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Mental Adjustment as a Predictor of Comprehensive Quality of Life Outcome among Patients with Terminal Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094926. [PMID: 34063167 PMCID: PMC8125235 DOI: 10.3390/ijerph18094926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/24/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022]
Abstract
Using path modeling, this study aimed to explore whether mental adjustment was directly or indirectly related to comprehensive quality of life outcome (CoQoLO) among patients with terminal cancer. We conducted a cross-sectional designed study among patients with terminal cancer who underwent convenience sampling at our northern Taiwan clinic from August 2019 to August 2020. Patient characteristics data were collected via structured questionnaires, namely, the Mini-Mental Adjustment to Cancer Scale and the Comprehensive Quality of Life Outcome Inventory. Descriptive statistics and regression analyses were used to examine the relationship between mental adjustment and CoQoLO. Path analysis described the dependencies among variables. For the 117 enrolled patients analyzed, MAC (β = 1.2, 95% confidence interval (CI) = 0.8–1.6, p < 0.001) and living with others (β = 19.9, 95% CI = 4.1–35.7, p = 0.015) were significant predictors and correlated positively with a CoQoLO score. Path modeling showed that the patients’ mental adjustment, economic status, perceived disease severity, palliative prognostic index, and symptom severity directly affected their CoQoLO. Our results indicate that the higher the mental adjustment, the better the CoQoLO among patients with terminal cancer. Thus, nurses need to assess mental adjustment levels when patients are hospitalized and accordingly develop interventions to improve the terminally ill patients’ mental adjustment to the final stages of cancer, thereby helping them to achieve good CoQoLO.
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Hernández R, Calderon C, Carmona-Bayonas A, Rodríguez Capote A, Jara C, Padilla Álvarez A, Gómez-Camacho MDLN, Beato C, Castelo B, Majem M, Muñoz MDM, Ivars A, Mangas-Izquierdo M, Rogado-Revuelta J, Jimenez-Fonseca P. Differences in coping strategies among young adults and the elderly with cancer. Psychogeriatrics 2019; 19:426-434. [PMID: 30723983 DOI: 10.1111/psyg.12420] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/06/2018] [Accepted: 12/31/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Coping with cancer and the oncologist-patient relationship can vary depending on the patient's age. Our aim is to examine and compare young and elderly adults with non-metastatic, resected cancer. METHODS Two groups of patients were selected, young (< 40 years) and elderly (> 70) with a diagnosis of non-metastatic, resected cancer requiring adjuvant chemotherapy from a pre-exiting, national database (NEOCOPING Study). Epidemiological variables were collected and subjects' emotional responses, perceptions of the physician-patient relationship, support network, fears, and regret about the decision to receive chemotherapy were assessed with questionnaires validated in previous studies: Mini-Mental Adjustment to Cancer, Brief Summary Inventory (18 items), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-C30, Shared Decision-Making Questionnaire-Physician's version, Shared Decision-Making Questionnaire-Patient's version, and Informed Risk (physician and patient versions). RESULTS Data from 46 young and 46 elderly participants were collected. The most common neoplasms in both groups were breast (50%) and colorectal (22%). The younger adults had a higher level of education and were actively employed (72% vs. 7%). The leading coping strategy in the younger cohort was hope, and resignation among the elderly. Young adults sought more social support and the impact of diagnosis was more negative for them than for older individuals. No significant differences were detected in quality of life; both age groups demanded more time at their first visit with the doctor, while the older group exhibited greater satisfaction with shared decision-making. At the end of adjuvant chemotherapy, neither age group regretted their decision to receive said treatment. CONCLUSION Higher levels of education, greater demands of the labour market, and the advent of the age of information have entailed drastic changes in the physician-patient relationship paradigm. This is especially true in the younger cancer patient population, who require more information and active participation in decision-making, can display more anxiety about their diagnosis, but also greater capacity to fight.
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Affiliation(s)
- Raquel Hernández
- Department of Medical Oncology, University Hospital of the Canary Islands, Tenerife, Spain
| | - Caterina Calderon
- Department of Clinical Psychology and Psychobiology. Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | | | | | - Carlos Jara
- Department of Medical Oncology, University Hospital Fundación Alcorcón, Universidad Rey Juan Carlos, Madrid, Spain
| | - Airam Padilla Álvarez
- Department of Medical Oncology, University Hospital of the Canary Islands, Tenerife, Spain
| | | | - Carmen Beato
- Department of Medical Oncology, Hospital Grupo Quirón, Sevilla, Spain
| | - Beatriz Castelo
- Department of Medical Oncology, University Hospital La Paz, Madrid, Spain
| | - Margarita Majem
- Department of Medical Oncology, University Hospital Santa Creu and Sant Pau, Barcelona, Spain
| | | | - Alejandra Ivars
- Department of Medical Oncology, Morales Meseguer University Hospital, Murcia, Spain
| | | | | | - Paula Jimenez-Fonseca
- Department of Medical Oncology, University Hospital Central of Asturias, Oviedo, Spain
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Coping strategies and depressive symptoms in cancer patients. Clin Transl Oncol 2019; 22:330-336. [DOI: 10.1007/s12094-019-02123-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/19/2019] [Indexed: 10/26/2022]
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Andreu Vaillo Y, Murgui Pérez S, Martínez López P, Romero Retes R. Mini-Mental Adjustment to Cancer Scale: Construct validation in Spanish breast cancer patients. J Psychosom Res 2018; 114:38-44. [PMID: 30314577 DOI: 10.1016/j.jpsychores.2018.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/07/2018] [Accepted: 09/07/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The Mini-Mental Adjustment to Cancer Scale (MiniMAC) is widely used to evaluate cancer patients' psychological responses to diagnosis and treatment. Validation studies of the scale have shown inconsistency in the obtained factor structures. The aim of this study was to explore the factor structure, using Confirmatory Factor Analysis (CFA), and other psychometric properties of the MiniMAC in Spanish breast cancer patients. METHODS A sample of 368 women with breast cancer completed the MiniMAC and the 18 items version of the Brief Symptom Inventory (BSI-18). RESULTS The original pentafactorial model and three additional models derived from the empirical research -two first-order structures with four and three factors, and a second-order bifactorial structure- were tested. The five-factor model showed the best model fit and largely replicated the original MiniMAC's subscales. Five factors had acceptable reliability and showed modest correlations with emotional distress in the expected direction. CONCLUSIONS The Spanish version of the MiniMAC has a satisfactory overall performance and serves as a brief, reliable and valid tool measuring cognitive appraisals and ensuing reactions to cancer.
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Affiliation(s)
- Yolanda Andreu Vaillo
- Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, Spain.
| | | | - Paula Martínez López
- Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, Spain
| | - Rocío Romero Retes
- Psychology Unit, Fundación Instituto Valenciano de Oncologia - FIVO, Valencia, Spain
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