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Jrad AIS, Yi Y, Yoon B, Cho E, Cho IK, Lee D, Kim J, Chung S, Kim JH. Dysfunctional Self-Focus and Fear of Progression in Cancer Patients Mediated by Depression, Anxiety, and Dysfunctional Sleep Beliefs. Psychiatry Investig 2024; 21:506-512. [PMID: 38810999 PMCID: PMC11136582 DOI: 10.30773/pi.2023.0354] [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: 10/09/2023] [Revised: 01/08/2024] [Accepted: 02/19/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVE This study explores whether cancer patients' dysfunctional self-focus is a significant contributor to their fear of progression. In addition, we investigated whether their psychiatric symptoms such as depression, anxiety, and dysfunctional beliefs about sleep may mediate the relationship between these factors. METHODS We conducted a retrospective medical records review of 196 cancer patients who visited the Stress Management Clinic for the first time from March to September 2022. Their demographic information and responses to rating scales such as the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Dysfunctional Self-focus Attribution Scale (DSAS), Patient Health Questionnaire-9 Items (PHQ-9), State subcategory of the State and Trait of Anxiety Inventory (STAI-S), Insomnia Severity Index (ISI), Cancer-related Dysfunctional Beliefs about Sleep scale (C-DBS), and numeric rating scales of pain and fatigue were collected. RESULTS A high FoP-Q-SF score was significantly correlated with high PHQ-9 (r=0.60), STAI-S (r=0.38), ISI (r=0.34), C-DBS (r=0.47), pain (r=0.24), fatigue (r=0.37), and DSAS (r=0.58, all p<0.001). A linear regression analysis showed that the FoP-Q-SF score was significantly predicted by younger age (β=-0.13, p=0.011), PHQ-9 (β=0.36, p<0.001), STAI-S (β=0.18, p=0.001), C-DBS (β=0.22, p<0.001), and DSAS (β=0.25, p<0.001). A mediation analysis showed that dysfunctional self-focus directly influenced patients' fear of progression. In addition, cancer patients' depression, anxiety, and cancer-related dysfunctional beliefs about sleep mediated this relationship. CONCLUSION We observed that dysfunctional self-focus may influence cancer patients' fear of progression, mediated by depression, anxiety, and cancer-related dysfunctional beliefs about sleep.
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Affiliation(s)
| | - Youngseok Yi
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byeongha Yoon
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eulah Cho
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Inn-Kyu Cho
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dongin Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jiyoung Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hye Kim
- Department of Clinical Nursing, University of Ulsan, Seoul, Republic of Korea
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Boyse JB, Sharpe L, Richmond B, Dear B, Dudeney J, Sesel AL, Menzies RE. Benign or painful? The interpretation of pain and fear of progression in rheumatoid arthritis. Pain 2024; 165:838-847. [PMID: 37889599 DOI: 10.1097/j.pain.0000000000003081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/14/2023] [Indexed: 10/29/2023]
Abstract
ABSTRACT People with chronic pain tend to interpret ambiguous information as health-related, more so than people without. In this study, we aimed to investigate whether people with rheumatoid arthritis (RA) exhibit this interpretation bias and whether it is associated with fear of disease progression (FoP). The interpretation biases of people with RA (n = 164) were compared with an age- and gender-matched control group. We hypothesized that (1) people with RA would have larger interpretation biases than people without; (2) those who scored in the clinical range for FoP would have larger interpretation bias than those who did not; (3) interpretation bias would moderate the relationship between pain severity and FoP; and (4) interpretation bias would explain variance in FoP above and beyond other established predictors. Our results confirmed that people with RA were more likely to interpret ambiguous information as health-related compared with people without RA. This effect was more pronounced for the RA subgroup with clinically significant FoP than those scoring in the normal range. We did not find evidence to suggest interpretation bias moderated the relationship between pain and FoP or that FoP added to the variance of other known predictors. Our results indicate that interpretation bias is common amongst people with RA and is associated with FoP. Further research is required to illuminate the exact nature of this relationship.
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Affiliation(s)
- Jack B Boyse
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Bethany Richmond
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Blake Dear
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Joanne Dudeney
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Amy-Lee Sesel
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Rachel E Menzies
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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Yeom CW, Ha H, Hahm BJ, Hee Lee S, Joong Kim N, Shim EJ. Is fear of disease progression associated with antiretroviral therapy adherence in persons with HIV/AIDS? J Health Psychol 2024:13591053231224177. [PMID: 38251645 DOI: 10.1177/13591053231224177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
We examined the mediating role of depression and anxiety on the relationship between fear of disease progression (FoP) and antiretroviral therapy (ART) adherence and the moderating role of social support in the FoP-depression/anxiety-ART adherence relationship in persons with HIV/AIDS (PWHA). 202 PWHA completed self-report measures. Simple mediation and moderated mediation analyses were performed. FoP was directly and negatively associated with ART adherence, and the mediating role of depression in this relationship was significant. Indirect effect of FoP mediated by anxiety on ART adherence was not significant. The moderating effect of social support was significant in the FoP-depression pathway, while the indirect effect of FoP on ART adherence mediated by depression was greatest at a higher level of social support and lower level of FoP. The results suggest the relevance of high FoP and depression-mediated FoP in ART adherence and social support may attenuate the negative impact of FoP.
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Affiliation(s)
- Chan-Woo Yeom
- Uijeongbu Eulji Medical Center, Republic of Korea
- Eulji University School of Medicine, Republic of Korea
| | - Hyeju Ha
- Pusan National University, Republic of Korea
| | - Bong-Jin Hahm
- Seoul National University College of Medicine, Republic of Korea
- Seoul National University Hospital, Republic of Korea
| | - Sun Hee Lee
- Pusan National University School of Medicine and Medical Research Institute, Republic of Korea
- Pusan National University Hospital, Republic of Korea
| | - Nam Joong Kim
- Seoul National University College of Medicine, Republic of Korea
- Seoul National University Hospital, Republic of Korea
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Coutts-Bain D, Sharpe L, Russell H. Death anxiety predicts fear of Cancer recurrence and progression in ovarian Cancer patients over and above other cognitive factors. J Behav Med 2023; 46:1023-1031. [PMID: 37306857 PMCID: PMC10577099 DOI: 10.1007/s10865-023-00422-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023]
Abstract
Death anxiety is understudied in people with cancer, especially in relation to fear of cancer recurrence (FCR) and fear of progression (FOP). The present study aimed to identify if death anxiety can predict FCR and FOP over and above other known theoretical predictors. One hundred and seventy-six participants with ovarian cancer were recruited for an online survey. We included theoretical variables, such as metacognitions, intrusive thoughts about cancer, perceived risk of recurrence or progression, and threat appraisal, in regression analyses to predict FCR or FOP. We investigated whether death anxiety added to the variance over and above these variables. Correlational analyses demonstrated that death anxiety is more strongly associated with FOP than FCR. The hierarchical regression including the theoretical variables described above predicted 62-66% of variance in FCR and FOP. In both models, death anxiety predicted a small but statistically significant unique variance in FCR and FOP. These findings draw attention to the importance of death anxiety in understanding FCR and FOP in people with a diagnosis of ovarian cancer. They also suggest that elements of exposure and existentialist therapies may be relevant in treating FCR and FOP.
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Affiliation(s)
- D Coutts-Bain
- School of Psychology, The University of Sydney, Sydney, NSW, 2050, Australia
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, NSW, 2050, Australia.
| | - H Russell
- Ovarian Cancer Australia, Melbourne, VIC, Australia
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Hasannezhad Reskati M, Elyasi F, Hosseini SH, Shafizad M, Hedayatizadeh-Omran A, Alizadeh-Navaei R, Khosravi S, Asghari Mashhadi Kolaei M, Froelicher ES, Sharif Nia H. The Psychometric Properties of the Fear of Progression Questionnaire (FoP-Q) for Cancer Patients in Iran. J Gastrointest Cancer 2023; 54:855-866. [PMID: 36253515 DOI: 10.1007/s12029-022-00875-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Fear of progression or recurrence is assumed as a rational response to the threat of cancers and types of cancer treatment. However, the elevated levels of fear in cancer patients can become dysfunctional. Therefore, a valid and reliable questionnaire is unquestionably required for this purpose. This study aimed to translate the Fear of Progression Questionnaire and evaluate its psychometric properties for patients with gastrointestinal cancers in Iran. METHODS In this study with a methodological research design, a total number of 430 patients affected with gastrointestinal cancers referring to Northern Iran completed the 43-item Fear of Progression Questionnaire. The psychometric properties of the questionnaire were evaluated, including the face validity and content validity. Then construct validity was assessed using exploratory and confirmatory factor analyses. Finally, the reliability was assessed using internal consistency (Cronbach's alpha) and stability (intraclass correlation coefficient). RESULTS Based on the result of the face and content validity, no items were revised and removed. The five extracted factors included were emotional response, employment, and loss of independence, economy/family, and coping. These factors explained 37% of the total variance of Fear of Progression Questionnaire. Reliability (by Cronbach's alpha) and stability (test retest was evaluated by intraclass correlation coefficient) were more than 0.7. CONCLUSION The study results revealed that the Persian version of the Fear of Progression Questionnaire had acceptable reliability and validity for cancer patients in Iran. Emotional responses explained the most variance of the concept of fear of progression among cancer patients.
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Affiliation(s)
- Maryam Hasannezhad Reskati
- Phd Educational Psychology, Research Ethics Committee, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Forouzan Elyasi
- Sexual and Reproductive Health Research Center, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Psychiatry, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Hamzeh Hosseini
- Psychiatry and Behavioral Sciences Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Misagh Shafizad
- Gastrointestinal cancer research center, Non-communicable diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Akbar Hedayatizadeh-Omran
- Gastrointestinal cancer research center, Non-communicable diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal cancer research center, Non-communicable diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sahar Khosravi
- Hematology, Oncology and Stem Cell Transplantation Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Erika Sivarajan Froelicher
- Department of Physiological Nursing, Department of Epidemiology & Biostatistics, Schools of Nursing and Medicine, University of California San Francisco, San Francisco, CA, 94143-0610, USA
| | - Hamid Sharif Nia
- Traditional and Complementary Medicine Research Center, Addiction Institute, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran.
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Göbel P, Kuba K, Götze H, Mehnert-Theuerkauf A, Spitzer C, Hartung T, Esser P. Interconnectivity of fear of progression and generalized anxiety - Network analysis among a sample of hematological cancer survivors. Support Care Cancer 2023; 31:238. [PMID: 36973563 PMCID: PMC10042941 DOI: 10.1007/s00520-023-07701-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Fear of cancer progression and recurrence (FoP) and generalized anxiety disorder (GAD) are syndromes commonly seen in cancer patients. This study applied network analysis to investigate how symptoms of both concepts are interconnected. METHODS We used cross-sectional data from hematological cancer survivors. A regularized Gaussian graphical model including symptoms of FoP (FoP-Q) and GAD (GAD-7) was estimated. We investigated (i) the overall network structure and (ii) tested on pre-selected items whether both syndromes could be differentiated based on their worry content (cancer related vs. generalized). For this purpose, we applied a metric named bridge expected influence (BEI). Lower values mean that an item is only weakly connected with the items of the other syndrome, which can be an indication of its distinctive characteristic. RESULTS Out of 2001 eligible hematological cancer survivors, 922 (46%) participated. The mean age was 64 years and 53% were female. The mean partial correlation within each construct (GAD: r = .13; FoP: r = .07) was greater than between both (r = .01). BEI values among items supposed to discriminate between the constructs (e.g., worry about many things within GAD and fear not to endure treatment within FoP) were among the smallest so our assumptions were confirmed. CONCLUSIONS Our findings based on the network analysis support the hypothesis that FoP and GAD are different concepts within oncology. Our exploratory data needs to be validated in future longitudinal studies.
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Affiliation(s)
- Philipp Göbel
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany.
| | - Katharina Kuba
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Heide Götze
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Tim Hartung
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
- Klinik Und Hochschulambulanz Für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Esser
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
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Beck S, Whitaker K, Cropley M. Is rumination associated with psychological distress after a cancer diagnosis? A systematic review. J Psychosoc Oncol 2023; 41:584-609. [PMID: 36604965 DOI: 10.1080/07347332.2022.2145925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: The aim of this work was to review evidence on the association between psychological rumination and distress in those diagnosed with cancer. Methods: Six databases were searched for studies exploring rumination alongside overall assessments of psychological distress, depression, anxiety, or stress. Results: Sixteen studies were identified. Rumination was associated with distress cross-sectionally and longitudinally. However, once baseline depression was controlled for, the association was no longer seen. The emotional valence of ruminative thoughts and the style in which they were processed, rather than their topic, was associated with distress. Brooding and intrusive rumination were associated with increased distress, deliberate rumination had no association, and reflection/instrumentality had mixed findings. Conclusions: This review highlights that it is not necessarily the topic of content, but the style and valence of rumination that is important when considering its association with distress. The style of rumination should be the target of clinical intervention, including brooding and intrusion.
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Affiliation(s)
- Sarah Beck
- School of Psychology, University of Surrey, Guildford, UK
| | | | - Mark Cropley
- School of Psychology, University of Surrey, Guildford, UK
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Folkerts AK, Haarmann L, Nielsen J, Saliger J, Eschweiler M, Karbe H, Allert N, Vida V, Trenkwalder C, Kruse A, Oelsner H, Ebersbach G, Kalbe E. Fear of Progression is Determined by Anxiety and Self-Efficacy but not Disease-Specific Parameters in Patients with Parkinson's Disease: Preliminary Data from a Multicenter Cross-Sectional Study. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2543-2553. [PMID: 36189603 DOI: 10.3233/jpd-223314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Fear of progression (FoP) is a reactive, conscious concern about chronic disease progression and its consequences which may limit quality of life substantially. Only one study has examined FoP in Parkinson's disease (PD), showing the second highest FoP scores among chronic diseases. OBJECTIVE To examine FoP prevalence and to exploratorily analyze determinants of FoP in PD. METHODS Within a multicenter cross-sectional study, 120 PD inpatients (age: 64.45±9.20; 60.8% male; UPDRS-III: 28.86±16.12) were examined with the FoP questionnaire (FoP-Q; max. 20 points). Stepwise multiple linear regression analysis examined sociodemographic, clinical, and (neuro-) psychological determinants of FoP. RESULTS With a mean FoP-Q score of 8.08±2.17, 63.0% of the patients were classified with moderate FoP and 17.6% with dysfunctional (i.e., severe) FoP. The highest scores were shown for the subscale 'loss of autonomy'. Increased levels of anxiety, less self-efficacy, female gender, current employment, and lower health literacy were identified as significant determinants associated with FoP. CONCLUSION With more than 80% of patients showing moderate to dysfunctional FoP, it must be regarded as a frequent symptom in PD, which needs to be further understood and addressed in clinical practice. Clinical parameters like PD duration and severity were no determinants for FoP, indicating that FoP awareness must be considered by professionals at all disease stages.
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Affiliation(s)
- Ann-Kristin Folkerts
- Department of Medical Psychology
- Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics andIntervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lena Haarmann
- Department of Medical Psychology
- Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics andIntervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jörn Nielsen
- Department of Medical Psychology
- Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics andIntervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Neurological Rehabilitation Centre Godeshoehee.V., Bonn, Germany
| | - Jochen Saliger
- Neurological Rehabilitation Centre Godeshoehee.V., Bonn, Germany
| | | | - Hans Karbe
- Neurological Rehabilitation Centre Godeshoehee.V., Bonn, Germany
| | - Niels Allert
- Neurological Rehabilitation Centre Godeshoehee.V., Bonn, Germany
| | - Viktoria Vida
- Department of Medical Psychology
- Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics andIntervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Claudia Trenkwalder
- Center of Parkinsonism and Movement Disorders, Paracelsus-Elena Hospital, Kassel, Germany.,Department of Neurosurgery, University Medical Center, Goettingen, Germany
| | - Annika Kruse
- Center of Parkinsonism and Movement Disorders, Paracelsus-Elena Hospital, Kassel, Germany
| | | | | | - Elke Kalbe
- Department of Medical Psychology
- Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics andIntervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Fodor LA, Todea D, Podina IR. Core Fear of Cancer recurrence symptoms in Cancer Survivors: a network approach. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Yang Y, Sun H, Luo X, Li W, Yang F, Xu W, Ding K, Zhou J, Liu W, Garg S, Jackson T, Chen Y, Xiang YT. Network connectivity between fear of cancer recurrence, anxiety, and depression in breast cancer patients. J Affect Disord 2022; 309:358-367. [PMID: 35472477 DOI: 10.1016/j.jad.2022.04.119] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Fear of cancer recurrence (FCR), anxiety, and depression are common psychological disturbances that frequently occur together among cancer patients. This study investigated network connectivity between FCR, anxiety, and depressive symptoms in a large representative sample of breast cancer patients. METHODS This was a multicenter, cross-sectional study of 803 women with breast cancer. All participants completed the 4-item FCR scale, Generalized Anxiety Disorder Scale (GAD-7), and Patient Health Questionnaire (PHQ-9). Network analysis was conducted to investigate the network structure, central symptoms, bridge symptoms, and network stability of these disturbances. RESULTS The generated network model indicated that anxiety and depression symptom communities were well-connected with each other, while FCR emerged as a distinct cluster with only a few weak links to anxiety and depression communities. Depressive and anxiety symptoms were more central than FCR symptoms were in the model. 'Having trouble relaxing' (#GAD4, strength = 1.147) was the most central node within the whole network, and 'strong feelings about recurrence' (#FCR4, strength = 0.531) was the least central node. Several anxiety symptoms (e.g., 'feeling afraid', 'uncontrollable worry', and 'restlessness') acted as important bridging symptoms connecting FCR, depression and anxiety communities. 'Uncontrollable worry' (#GAD2) had the highest node-specific predictive betweenness value. The network stability of this model was high. CONCLUSION Depression and anxiety symptoms are highly interactive with each other among women with breast cancer. Conversely, FCR may have attenuated relations with anxiety and depression communities and emerged as a relatively independent, unique experience. Anxiety symptoms, particularly 'uncontrollable worry', acted as important trans-diagnostic symptoms that connected different communities. Findings suggested interventions to alleviate excessive worries and enhance feelings of personal control might be helpful in preventing or reducing related symptoms of FCR, anxiety and depression.
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Affiliation(s)
- Yuan Yang
- Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510080, China
| | - Hengwen Sun
- Department of Radiotherapy, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Xian Luo
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
| | - Wengao Li
- Department of Psychiatry, 999 Brain Hospital, Guangzhou 510515, China
| | - Fan Yang
- Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510080, China
| | - Wenjing Xu
- Department of Radiotherapy, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
| | - Kairong Ding
- Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510080, China; Department of Psychology, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Jiangyan Zhou
- Department of Psychiatry, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Wenting Liu
- School of Nursing, Southern Medical University, Guangzhou 510515, China
| | - Samradhvi Garg
- School of Health in Social Science, University of Edinburgh, Edinburgh EH8 9BL, UK
| | - Todd Jackson
- Department of Psychology, University of Macau, Macao SAR, China
| | - Yu Chen
- School of Nursing, Southern Medical University, Guangzhou 510515, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China; Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China.
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Meaning in Life and the Acceptance of Cancer: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095547. [PMID: 35564946 PMCID: PMC9104184 DOI: 10.3390/ijerph19095547] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 12/04/2022]
Abstract
Meaning in life and acceptance of cancer are critical for patients to adjust to a cancer diagnosis and to improve psychological wellbeing. Little is known about the relationship between meaning in life and the acceptance of cancer. This study provides a systematic review of the associations between meaning in life and the acceptance of cancer in cancer patients. CINAHL, MEDLINE, PsycINFO, and SCOPUS databases were searched until 15 March 2021. Studies were included if they quantitatively examined the association between meaning in life and the acceptance of cancer in adult cancer patients/survivors and if they were published in peer-reviewed journals or in books. The study quality was assessed using Joanna Briggs Institute critical appraisal tools. Of the 4907 records identified through database searches, only 3 studies quantitatively examined the associations between meaning in life and the acceptance of cancer. The total sample involved 464 women with cancer. All three studies reported positive correlations between meaning in life and the acceptance of cancer (ranging from r = 0.19 to r = 0.38), whereas meaning in life did not predict the acceptance of cancer. Overall, the meaning in life–acceptance relationship has not been sufficiently investigated, though it has relevant theoretical and clinical implications for coping with cancer. High-quality studies are needed to better understand the relationship between meaning in life and the acceptance of cancer.
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12
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Dinkel A, Marten-Mittag B, Kremsreiter K. Association Between Daily Worry, Pathological Worry, and Fear of Progression in Patients With Cancer. Front Psychol 2021; 12:648623. [PMID: 34456783 PMCID: PMC8384960 DOI: 10.3389/fpsyg.2021.648623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Fear of progression (FoP), or fear of cancer recurrence (FCR), is characterized by worries or concerns about negative illness-related future events. Actually, to worry is a common cognitive process that, in its non-pathological form, belongs to daily life. However, worry can also become pathological appearing as a symptom of mental disorders. This study aimed at investigating the associations among daily worry, pathological worry, and FoP in patients with cancer. Methods: This is a cross-sectional study that includes 328 hospitalized patients with cancer. Patients filled out the FoP Questionnaire (FoP-Q), the Worry Domains Questionnaire (WDQ) for the assessment of daily worry, and the Penn State Worry Questionnaire (PSWQ) for the assessment of pathological worry. Depressive, anxiety, and somatic symptoms were measured with modules of the Patient Health Questionnaire [Patient Health Questionnaire-Depressive Symptoms (PHQ-2), Generalized Anxiety Disorder-2 (GAD-2), and Patient Health Questionnaire-Somatic Symptoms (PHQ-15)]. Furthermore, a structured clinical interview was conducted for the assessment of anxiety disorders. The hierarchical multiple linear regression analysis was used to identify factors independently associated with FoP. Results: Mean age of the participants was M = 58.5 years (SD = 12.8), and 64.6% were men. FoP and worry were significantly intercorrelated (r = 0.58–0.78). The level of FoP was most strongly associated with daily worry (β = 0.514, p < 0.001), followed by pathological worry (β = 0.221, p < 0.001). Further significant determinants were younger age and depressive and anxiety symptoms. Clinical variables were not independently associated with FoP. The final model explained 74% of the variance. Discussion: Fear of progression is strongly associated with daily worry and pathological worry. These results bring up the question of whether FoP is an expression of a general tendency to worry. Whether a general tendency to worry, in fact, represents an independent vulnerability factor for experiencing FCR/FoP needs to be investigated in a longitudinal research design.
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Affiliation(s)
- Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Birgitt Marten-Mittag
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Katrin Kremsreiter
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, University Medical Center Mannheim, Mannheim, Germany
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13
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Meissner VH, Olze L, Schiele S, Ankerst DP, Jahnen M, Gschwend JE, Herkommer K, Dinkel A. Fear of cancer recurrence and disease progression in long-term prostate cancer survivors after radical prostatectomy: A longitudinal study. Cancer 2021; 127:4287-4295. [PMID: 34358337 DOI: 10.1002/cncr.33836] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 04/08/2021] [Accepted: 05/03/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although fear of cancer recurrence (FCR) or disease progression is among the most endorsed unmet needs and concerns of cancer survivors, research on the course of FCR in long-term survivors is scarce. The objective of this study was to assess longitudinally the prevalence and predictors of FCR in long-term prostate cancer (PCa) survivors. METHODS In all, 2417 survivors from the multicenter German Familial Prostate Cancer Database completed the Fear of Progression Questionnaire-Short Form on average 7 years (T1 in 2010) after radical prostatectomy and at follow-up 9 years later (T2 in 2019). Hierarchical multivariable logistic regression was used to assess predictors of FCR at follow-up. RESULTS The mean age at the initial assessment was 69.5 years (standard deviation, 5.9 years); 6.5% and 8.4% of patients reported clinical FCR at the initial assessment (T1) and at the follow-up (T2), respectively. In a multivariable analysis controlling for concurrent associations, longitudinal predictors of FCR 9 years later included a lower level of education (odds ratio [OR], 4.35; 95% confidence interval [CI], 2.33-8.33), years since radical prostatectomy (OR, 1.10; 95% CI, 1.03-1.18), biochemical recurrence (OR, 1.67; 95% CI, 1.02-2.72), no current adjuvant therapy (OR, 2.38; 95% CI, 1.19-4.76), FCR (OR, 10.75; 95% CI, 6.18-18.72), and anxiety (OR, 1.35; 95% CI, 1.06-1.72). CONCLUSIONS FCR remains a burden to certain PCa survivors even many years after their diagnosis and treatment. Health care professionals should monitor for FCR and identify patients at risk to provide appropriate psychosocial care because FCR is leading to limitations in quality of life and psychological well-being.
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Affiliation(s)
- Valentin H Meissner
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lisa Olze
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Schiele
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Donna P Ankerst
- Departments of Mathematics and Life Science Systems, Technical University of Munich, Garching, Germany
| | - Matthias Jahnen
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kathleen Herkommer
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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Ernst J, Friedrich M, Vehling S, Koch U, Mehnert-Theuerkauf A. Cancer-Related Distress: How Often Does It Co-occur With a Mental Disorder? - Results of a Secondary Analysis. Front Psychol 2021; 12:660588. [PMID: 34248754 PMCID: PMC8260981 DOI: 10.3389/fpsyg.2021.660588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/01/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives The Distress Thermometer (DT) is a validated and widely used screening tool to identify clinically relevant distress in cancer patients. It is unclear, to which extend subjectively perceived distress measured by the DT is related to objective burden (mental disorder). We therefore examine the co-occurrence of a mental disorder for different DT thresholds and explore the diagnostic properties of the DT in detecting a mental disorder. Methods In this multicenter cross-sectional study, we included 4,020 patients with mixed cancer diagnoses. After selection of relevant cases, weighting procedure and imputation of missing data we evaluated the data of N = 3,212 patients. We used the DT to assess perceived distress and the standardized Composite International Diagnostic Interview for Oncology (CIDI-O) to assess the 4-week prevalence of mental disorders. The association between distress and any mental disorder (MD) is calculated using Pearson correlations. Relative risks for MD in patients with/without distress and the co-occurrence of distress and MD were calculated with Poisson regression. To assess the operating characteristics between distress and MD, we present the area under the curve (AUC). Results 22.9% of the participants had a cut-off DT level of ≥5 and were affected by MD. Each level of distress co-occurs with MD. The proportion of patients diagnosed with MD was not greater than the proportion of patients without MD until distress levels of DT = 6 were reached. The correlation between DT and MD was r = 0.27. The ROC-analysis shows the area under curve (AUC) = 0.67, which is classified as unsatisfactory. With increasing distress severity, patients are not more likely to have a mental disorder. Conclusion Our results suggests viewing and treating cancer-related distress as a relatively distinct psychological entity. Cancer-related distress may be associated with an increased risk for a mental disorder and vice versa, but the overlap of both concepts is very moderate.
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Affiliation(s)
- Jochen Ernst
- Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany
| | - Sigrun Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany
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Bisseling EM, Compen FR, Schellekens MPJ, Thewes B, Speckens AEM, van der Lee ML. Exploring Fear of Cancer Recurrence in a Sample of Heterogeneous Distressed Cancer Patients with and Without a Psychiatric Disorder. J Clin Psychol Med Settings 2021; 28:419-426. [PMID: 34138447 PMCID: PMC8458175 DOI: 10.1007/s10880-021-09776-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 11/29/2022]
Abstract
Fear of Cancer Recurrence (FCR) is a concern among cancer patients. Recent insights suggest that FCR should be viewed as a distinct syndrome. However, few studies have explored its overlap with psychiatric morbidity. We examined this overlap in a sample of distressed cancer patients. Self-referred patients (n = 245) were assessed with the Structured Clinical Interview for DSM-IV-TR Axis-I disorders and the Fear of Cancer Recurrence Inventory-Short Form. Proportions of patients with and without a psychiatric disorder meeting validated cut-offs for screening and clinically relevant FCR were compared. The prevalence of psychiatric disorders was 36%. Clinically relevant FCR was found in 198 patients (81%). Patients with a current psychiatric disorder reported clinically relevant FCR more frequently (89%) compared to those with no disorder (77%). Of patients reporting clinically relevant FCR, the majority (61%) did not additionally meet the criteria for a psychiatric disorder. These findings suggest that there should be particular attention for patients with elevated levels of FCR, warranting FCR-specific treatment. Trial registry number Clinicaltrials.gov NCT02138513
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Affiliation(s)
- Else M Bisseling
- Department of Psychiatry, Radboud University Medical Centre, 6525, EX, Nijmegen, The Netherlands. .,Department of Psychiatry, Radboud University Medical Centre for Mindfulness, Reinier Postlaan, Postbus 9101, 6500, HB, Nijmegen, The Netherlands. .,Centre for Psycho-Oncology, Scientific Research Department, Helen Dowling Institute, 3723, MB, Bilthoven, The Netherlands.
| | - Félix R Compen
- Department of Psychiatry, Radboud University Medical Centre, 6525, EX, Nijmegen, The Netherlands.,Department of Psychiatry, Radboud University Medical Centre for Mindfulness, Reinier Postlaan, Postbus 9101, 6500, HB, Nijmegen, The Netherlands
| | - Melanie P J Schellekens
- Department of Psychiatry, Radboud University Medical Centre, 6525, EX, Nijmegen, The Netherlands.,Department of Psychiatry, Radboud University Medical Centre for Mindfulness, Reinier Postlaan, Postbus 9101, 6500, HB, Nijmegen, The Netherlands.,Centre for Psycho-Oncology, Scientific Research Department, Helen Dowling Institute, 3723, MB, Bilthoven, The Netherlands
| | - Belinda Thewes
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia
| | - Anne E M Speckens
- Department of Psychiatry, Radboud University Medical Centre, 6525, EX, Nijmegen, The Netherlands.,Department of Psychiatry, Radboud University Medical Centre for Mindfulness, Reinier Postlaan, Postbus 9101, 6500, HB, Nijmegen, The Netherlands
| | - Marije L van der Lee
- Centre for Psycho-Oncology, Scientific Research Department, Helen Dowling Institute, 3723, MB, Bilthoven, The Netherlands.,Department of Medical and Clinical Psychology, School of Social and Behavioral Sciences, Tilburg University, Warandelaan 2, 5037, AB Tilburg, The Netherlands
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Youssef Y, Mehnert-Theuerkauf A, Götze H, Friedrich M, Esser P. Rapid screener for the assessment of fear of progression in cancer survivors: The Fear of progression-Questionnaire Rapid Screener. Eur J Cancer Care (Engl) 2021; 30:e13400. [PMID: 33459435 DOI: 10.1111/ecc.13400] [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: 07/25/2020] [Revised: 11/24/2020] [Accepted: 12/23/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Fear of progression (FoP) among cancer survivors can adversely affect all areas of life. Existing instruments are too long for implementation in routine care. Therefore, we developed and tested a rapid screener for FoP (FoP-Q-RS). METHODS Data were derived from a register-based study among cancer survivors. The 12-item short form of the Fear-of-Progression Questionnaire (FoP-Q-SF) served as item-pool. Confirmatory factor analysis (CFA) was applied to determine (a) fit indices including comparative fit index (CFI) and standardised root mean square residual (SRMR) and (b) measures of reliability including composite reliability (CR). Fit indices were compared to the FoP-Q-SF. Sensitivity and specificity were calculated to recommend a cut-off (criterion: GAD-7 score ≥10). RESULTS One thousand two cancer survivors participated (response rate: 53%). We selected five items for the FoP-Q-RS. CFA indicated acceptable fit (CFI = 0.936; SRMR = 0.048) and reliability (CR = 0.793). Fit indices were better than for the FoP-Q-SF. The cut-off ≥12 showed optimal balance between sensitivity (72%) and specificity (70%), the cut-off ≥10 revealed higher sensitivity (86%) with still tolerable specificity (52%). CONCLUSION The FoP-Q-RS shows good psychometric properties and may be applied in routine care. Further studies on preferable cut-offs and other populations are needed.
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Affiliation(s)
- Yasmin Youssef
- Department of Medical Psychology and Medical Sociology, University Medical Centre Leipzig, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Centre Leipzig, Leipzig, Germany
| | - Heide Götze
- Department of Medical Psychology and Medical Sociology, University Medical Centre Leipzig, Leipzig, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, University Medical Centre Leipzig, Leipzig, Germany
| | - Peter Esser
- Department of Medical Psychology and Medical Sociology, University Medical Centre Leipzig, Leipzig, Germany
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Erbacher G, Bertsch T. Lipoedema and Pain: What is the role of the psyche? – Results of a pilot study with 150 patients with Lipoedema. PHLEBOLOGIE 2020. [DOI: 10.1055/a-1238-6657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Introduction The present exploratory study is the first so far to investigate the psychological stress in the period before the development of pain symptoms typical for lipoedema.
Methods 150 patients diagnosed with lipoedema syndrome were questioned in semi-structured interviews about psychological stress and were diagnosed with psychological disorders according to ICD-10 criteria. The development of the symptoms typical for lipoedema was recorded in a second interview. Both interviews were blended together in collaboration with the patients, this means Lipoedema-associated pain and psychological stress were related to time.
Result Exactly 80 % of the patients diagnosed with lipedema show a high level of psychological distress immediately before the onset of lipedema-associated symptoms! In this study, mental distress was defined as the presence of a manifest mental disorder (ICD 10 F diagnosis) such as Depression, eating disorder or post-traumatic stress disorder and/or serious psychological distress such as burnout syndrome or chronic stress.
Summary These results contradict a widespread statement that all psychological problems of patients with the diagnosis lipoedema syndrome are caused solely by lipoedema, that lipoedema even causes the patient’s mental disorder.Moreover, depression and posttraumatic stress disorders are significantly related to the maximum pain intensity estimated by patients in everyday life. This demonstrates that it is imperative to rethink lipoedema therapy and to implement a psychosocial pillar in an overall therapy concept.
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Affiliation(s)
- Gabriele Erbacher
- Foeldi Clinic Hinterzarten, European Centre for Lymphology
- Dipl.-Psychologin, Psychologische Psychotherapeutin, Supervisorin (hsi)
| | - Tobias Bertsch
- Foeldi Clinic Hinterzarten, European Centre for Lymphology
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18
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Hall DL, Park ER, Cheung T, Davis RB, Yeh GY. A Pilot Mind-Body Resiliency Intervention Targeting Fear of Recurrence among Cancer Survivors. J Psychosom Res 2020; 137:110215. [PMID: 32818720 PMCID: PMC7873146 DOI: 10.1016/j.jpsychores.2020.110215] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/13/2020] [Accepted: 08/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Interventions for fear of recurrence (FOR) of cancer have nominal effects, perhaps due to limited integration of empirically supported skills. This pilot trial tested the acceptability and feasibility of a multimodal, mind-body resiliency intervention targeting FOR among survivors of various cancers. METHODS Early stage cancer survivors 3-30 months post-treatment were recruited to participate in an eight-session in-person mind-body resiliency group intervention that taught relaxation skills, cognitive-behavioral techniques, healthy lifestyle behaviors, mindfulness meditation, and positive psychology skills all targeted for FOR. Primary outcomes were feasibility (enrollment rate, session attendance, survey completion, skills practice) and acceptability (enjoyableness, convenience, helpfulness, relevance). Patient-reported outcomes (FOR, uncertainty intolerance, cancer-related uncertainty, perceived stress, resiliency, positive affect, and coping skills) were collected at baseline, post-intervention, +1 month, and +3 months. Exit interviews assessed survivors' reported benefits. RESULTS Participants (N = 4 groups, 23 survivors, enrollment response rate = 58%) included survivors of seven common cancer types who were on average 12 months post-treatment. Attendance was high (M = 6.1 sessions), and 96% of survivors completed all surveys. Sustained increases in relaxation skills practice 3+ days/week were reported (baseline = 16%, post-intervention = 76%, +3 months = 71%). Most sessions (87%) were rated as highly or very highly acceptable. Moderate-to-large (d = 0.87) improvements in FOR severity were observed post-intervention (p < .01) and across assessments (p < .01), with similar changes observed in other patient-reported outcomes. Exit interviews revealed behavioral, cognitive, emotional, and existential benefits. CONCLUSIONS The targeted mind-body resiliency intervention shows promising acceptability, feasibility, and favorable changes in FOR and coping skills practice. Further adaptation and testing in a randomized trial are warranted. ClinicalTrials.govRegistration Number: NCT03695406.
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Affiliation(s)
- Daniel L Hall
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States of America.
| | - Elyse R Park
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States of America
| | - Tina Cheung
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States of America
| | - Roger B Davis
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States of America; Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Gloria Y Yeh
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States of America
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Lebel S, Mutsaers B, Tomei C, Leclair CS, Jones G, Petricone-Westwood D, Rutkowski N, Ta V, Trudel G, Laflamme SZ, Lavigne AA, Dinkel A. Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates. PLoS One 2020; 15:e0234124. [PMID: 32716932 PMCID: PMC7384626 DOI: 10.1371/journal.pone.0234124] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with chronic diseases commonly report fears of illness or symptoms recurring or worsening. These fears have been addressed from an illness-specific perspective (e.g., fear of cancer recurrence), a generic illness perspective (e.g., fear of progression), and a psychiatric perspective (DSM-5 illness anxiety disorder and somatic symptom disorder). The broader concept of health anxiety (HA) can also be applied to patients with a chronic disease. This review was conducted to investigate the conceptual, theoretical, measurement-overlap, and differences between these distinct perspectives. We also aimed to summarize prevalence, course, and correlates of these fears in different chronic illnesses. METHODS We used PsycINFO, PubMED, CINAHL, Web of Science, SCOPUS, and PSYNDEX to conduct a systematic review of studies pertaining to these fears in chronic illness published from January 1996 to October 2017. A total of 401 articles were retained. RESULTS There were commonalities across different conceptualizations and diseases: a high prevalence of clinical levels of fears (>20%), a stable course over time, and a deleterious impact on quality of life. Reviewed studies used definitions, models, and measures that were illness-specific, with only a minority employing a psychiatric perspective, limiting cross-disease generalizability. There appears to be some applicability of DSM-5 disorders to the experience of fear of illness/symptoms in patients with a chronic illness. While conceptualizing HA on a continuum ranging from mild and transient to severe may be appropriate, there is a lack of agreement about when the level of fear becomes 'excessive.' The definitions, models, and measures of HA across chronic illnesses involve affective, cognitive, behavioral, and perceptual features. CONCLUSIONS The concept of HA may offer a unifying conceptual perspective on the fears of illness/symptoms worsening or returning commonly experienced by those with chronic disease.
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Affiliation(s)
- Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Christina Tomei
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Georden Jones
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Nicole Rutkowski
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Viviane Ta
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Geneviève Trudel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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20
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Muldbücker P, Steinmann D, Christiansen H, de Zwaan M, Zimmermann T. Are women more afraid than men? Fear of recurrence in couples with cancer - predictors and sex-role-specific differences. J Psychosoc Oncol 2020; 39:89-104. [PMID: 32589114 DOI: 10.1080/07347332.2020.1762823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Although fear of cancer recurrence (FoR) is one of the major concerns in cancer patients and their partners with approximately 49% reporting moderate to high FoR, few studies investigated predictors and sex-role-specific differences. The aim of the current study was to investigate FoR in couples with different types of cancer and to gain a deeper understanding of sex and role-specific differences and predictors of FoR in patients and partners. DESIGN Cross-sectional study in Germany. Sample: N = 188 couples with prostate (PC; n=52), laryngeal (LC; n=21) or breast cancer (BC; n=115) participated. All PC and LC patients were males, all BC patients were females. METHODS Fear of recurrence, depression, and relationship satisfaction were measured with validated questionnaires (Fear of Progression Questionnaire, Patient Health Questionnaire, Hospital Anxiety and Depression Scale, Quality of Marriage Index) in couples with PC, LC, or BC. FINDINGS Results indicated sex-role-specific differences. For women, FoR was higher for patients (M = 35.76) than for caregivers (M = 27.11). For males, spouses of women with BC (M = 30.1) showed higher FoR than male PC or LC patients (M = 24.9). Moreover, in couples there was a correlation between the FoR of one and the other (PC: r = .51, BC: r = .31, LC: r = .41). Depression was as a significant predictor, with a positive relationship to FoR. Moreover, in men with PC and LC besides depression, age emerged as significant predictor with a negative relationship to FoR. The Actor-Partner-Interdependence-Model showed for couples with PC or LC significant actor effects, both for patients and partners. Moreover, a significant partner effect emerged for patients' depression on partners' FoR. For couples with BC only significant actor effects occurred. CONCLUSIONS FoR remains a major concern for both cancer patients and their partners. Implications for Psychosocial Providers or Policy: FoR should be considered both in cancer patients and their spouses. In addition, sex and role effects should be taken into account in treatment of FoR.
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Affiliation(s)
- Pia Muldbücker
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Diana Steinmann
- Department of Radiation Therapy and Special Oncology, Hannover Medical School, Hannover, Germany
| | - Hans Christiansen
- Department of Radiation Therapy and Special Oncology, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Tanja Zimmermann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
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Fond G, Baumstarck K, Auquier P, Fernandes S, Pauly V, Bernard C, Orleans V, Llorca PM, Lançon C, Salas S, Boyer L. Recurrent major depressive disorder's impact on end-of-life care of cancer: A nationwide study. J Affect Disord 2020; 263:326-335. [PMID: 31969262 DOI: 10.1016/j.jad.2019.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We still don't know if recurrent major depressive disorder (RMDD) may impact the quality of the end-of-life (EOL) cancer care in France. To tackle this knowledge gap, we explored EOL care in RMDD subjects who died from cancer compared to subjects without psychiatric disorder in a 4-year nationwide cohort study. DESIGN Nationwide cohort study. SETTING National hospital database, France. PARTICIPANTS All patients aged ≥15 years who died from cancer in hospital: 4070 RMDD subjects and 222,477 controls, 2013-2016, France. MAIN OUTCOME MEASURES Palliative care in the last 31 days of life and high-intensity EOL care including chemotherapy in the last 14 days of life, artificial nutrition, tracheal intubation, mechanical ventilation, gastrostomy, cardiopulmonary resuscitation, dialysis, transfusion, surgery, endoscopy, imaging, intensive care unit and emergency department admission in the last 31 days of life. Multivariate generalized mixed models with log-normal distribution was used to compare RMDD subjects and controls. RESULTS Compared to the controls, the RMDD subjects died 3 years younger, had more comorbidities, more thoracic cancers, less metastases and longer time from cancer diagnosis to death. After matching and adjustment, subjects with RMDD were found to receive more palliative care and less high-intensity EOL care, had fewer iterative admissions to acute care unit, and died less often in the intensive care unit and emergency department. CONCLUSIONS RMDD subjects were more likely to receive palliative care associated with less high-intensity EOL care. Yet the interpretation may be discussed, resulting from either patients'/families' wishes or difficulties for providers in offering personalized care to RMDD.
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Affiliation(s)
- Guillaume Fond
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France; Department of Medical Information, APHM, Marseille, France; Department of Epidemiology and Health Economics, APHM, Marseille, France.
| | - Karine Baumstarck
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Pascal Auquier
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France; Department of Epidemiology and Health Economics, APHM, Marseille, France
| | - Sara Fernandes
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Vanessa Pauly
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France; Department of Medical Information, APHM, Marseille, France
| | - Cecile Bernard
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | | | | | - Christophe Lançon
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France; Department of Psychiatry, APHM, Marseille, France
| | | | - Laurent Boyer
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France; Department of Medical Information, APHM, Marseille, France; Department of Epidemiology and Health Economics, APHM, Marseille, France
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McCormick AD, Schumacher KR, Zamberlan M, Uzark K, Yu S, Lowery R, Rottach N, Cousino MK. Generalized and specific anxiety in adolescents following heart transplant. Pediatr Transplant 2020; 24:e13647. [PMID: 31885147 DOI: 10.1111/petr.13647] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/26/2019] [Accepted: 12/09/2019] [Indexed: 12/18/2022]
Abstract
Mental health concerns are associated with worse outcomes after adult heart transplant. Illness-specific anxiety is associated with worsened psychological well-being after other solid organ transplants but has never been characterized after pediatric heart transplant. This single-center cross-sectional study aimed to evaluate illness-specific and generalized anxiety after heart transplantation in adolescents. A novel 12-item PHTF, GAD-7, and the PedsQL were administered. Univariate associations of demographics, clinical features, and medication adherence as measured by immunosuppression standard deviation with the PHTF and GAD-7 scores were evaluated. Internal consistency and validity of the PHTF were examined. In total, 30 patients participated. The most common illness-specific fears were retransplantation, rejection, and more generally post-transplant complications. The PHTF had good internal consistency (Cronbach α = .88). Construct validity was demonstrated between PHTF and GAD-7 (r = .62) and PedsQL (r = -.54 to -.62). 23% endorsed moderate to severe generalized anxiety symptoms. More severe symptoms were associated with older age at survey (P = .03), older age at listing (P = .01) and having post-transplant complications (P = .004). Patients with moderate or severe symptoms were more likely to report late immunosuppression doses (P = .004). Illness-specific and generalized anxiety may be prevalent after pediatric heart transplant. Screening for anxiety in adolescents post-transplant may identify those at risk for adverse outcomes including non-adherence. The PHTF is a brief, valid, and reliable instrument identifying illness-specific anxiety in this population.
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Affiliation(s)
| | - Kurt R Schumacher
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan.,University of Michigan Transplant Center, Ann Arbor, Michigan
| | - Mary Zamberlan
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan
| | - Karen Uzark
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan
| | - Sunkyung Yu
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan
| | - Ray Lowery
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan
| | - Nichole Rottach
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan
| | - Melissa K Cousino
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan.,University of Michigan Transplant Center, Ann Arbor, Michigan
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23
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Luberto CM, Hall DL, Chad-Friedman E, Park ER. Theoretical Rationale and Case Illustration of Mindfulness-Based Cognitive Therapy for Fear of Cancer Recurrence. J Clin Psychol Med Settings 2019; 26:449-460. [PMID: 30756278 PMCID: PMC6689451 DOI: 10.1007/s10880-019-09610-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Fear of cancer recurrence (FCR) is a common problem among cancer survivors and evidence-based interventions grounded in theoretical models are needed. Mindfulness-Based Cognitive Therapy (MBCT) is an evidence-based intervention for reducing health anxiety that could be useful to apply to FCR. However, there has only been one study of MBCT for FCR to date, and the theoretical rationale and practical application of MBCT for FCR has not been described. The purpose of this paper is to offer an evidence-based rationale for MBCT to treat FCR based on a health anxiety model; describe the process of adapting MBCT to target FCR; and present a case study of the adapted protocol for treating FCR in a young adult breast cancer survivor to illustrate its delivery, feasibility, acceptability, and associated changes in outcomes. Clinical implications and directions for future research are discussed.
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Affiliation(s)
- Christina M Luberto
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Benson-Henry Institute for Mind Body Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge St, 15th floor, Boston, MA, 02114, USA.
| | - Daniel L Hall
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Benson-Henry Institute for Mind Body Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Outcomes Research, Massachusetts General Hospital, Boston, MA, USA
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge St, 15th floor, Boston, MA, 02114, USA
| | - Emma Chad-Friedman
- Benson-Henry Institute for Mind Body Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elyse R Park
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Benson-Henry Institute for Mind Body Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Outcomes Research, Massachusetts General Hospital, Boston, MA, USA
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge St, 15th floor, Boston, MA, 02114, USA
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24
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Mutsaers B, Butow P, Dinkel A, Humphris G, Maheu C, Ozakinci G, Prins J, Sharpe L, Smith AB, Thewes B, Lebel S. Identifying the key characteristics of clinical fear of cancer recurrence: An international Delphi study. Psychooncology 2019; 29:430-436. [PMID: 31713279 DOI: 10.1002/pon.5283] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/29/2019] [Accepted: 11/03/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Without an agreed-upon set of characteristics that differentiate clinical from nonclinical levels of fear of cancer recurrence (FCR), it is difficult to ensure that FCR severity is appropriately measured, and that those in need of intervention are identified. The objective of this study was to establish expert consensus on the defining features of clinical FCR. METHOD A three-round Delphi was used to reach consensus on the defining features of clinical FCR. Sixty-five experts in FCR (researchers, psychologists, physicians, nurses, and allied health professionals) were recruited to suggest and rate potential features of clinical FCR. Participants who indicated they could communicate diagnoses within their clinical role were also asked to consider the application of established DSM-5 and proposed ICD-11 diagnostic criteria (Health Anxiety, Illness Anxiety Disorder, Somatic Symptom Disorder) to clinical FCR. RESULTS Participants' ratings suggested that the following four features are key characteristics of clinical FCR: (a) high levels of preoccupation; (b) high levels of worry; (c) that are persistent; and (d) hypervigilance to bodily symptoms. Of participants whose professional role allowed them to diagnose mental disorders, 84% indicated it would be helpful to diagnose clinical FCR, but the use of established diagnostic criteria related to health anxiety or somatic-related disorders to clinical FCR was not supported. This suggests that participants consider clinical FCR as a presentation that is specific to cancer survivors. CONCLUSION Clinical FCR was conceptualized as a multidimensional construct. Further research is needed to empirically validate the proposed defining features.
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Affiliation(s)
| | - Phyllis Butow
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gerald Humphris
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | | | - Gozde Ozakinci
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | | | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Allan Ben Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Belinda Thewes
- School of Psychology, The University of Sydney, Sydney, Australia
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25
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Zhang Y, Tan X, Li W, Wang H, Sun H, Liu T, Zhang J, Zhang B, Yang Y. Self-Perceived Pain in Chinese Patients With Cancer. Front Psychol 2019; 10:1994. [PMID: 31555179 PMCID: PMC6724506 DOI: 10.3389/fpsyg.2019.01994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/14/2019] [Indexed: 11/13/2022] Open
Abstract
Background Pain is one of the most burdensome and prevalent symptoms cancer patient report and it has severe negative impact on patient's quality of life. The aim of this study is to estimate the prevalence of pain and to test the association between demographic, clinical, psychological factors, and self-assessed pain in Chinese cancer population. Methods A total of 553 cancer patients were recruited in this cross-sectional study. Patient's basic demographic data was collected by a study-designed information sheet, and patient's pain, sleep disturbance and psychological distress were assessed by several validated measurements (MPQ-SF, AIS, FoP-Q-SF, PHQ-9, and GAD-7). Descriptive statistics and hierarchical multiple regression analyses were performed. Results Of the 553 patients, 411 (74.32%) patients reported that they experience some degree of pain. Fear of progression, anxiety, insomnia, and depressive symptoms were significantly associated with different subscales and the overall pain score in bivariate correlation matrix. Insomnia, depressive symptoms, and fear of cancer progression were significant independent factors of cancer pain on multivariate analyses. Conclusion Psychological factors play a great role in the relationship between objective pathophysiology and patient's subjective experience of pain. It is important to evaluate each individual in detail with respect to psychological distress and pain severity when planning treatment and rehabilitation.
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Affiliation(s)
- Yongfu Zhang
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Xiaomin Tan
- Department of Educational Administration, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wengao Li
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hongmei Wang
- Department of Radiotherapy, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hengwen Sun
- Department of Radiation, Cancer Center of Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ting Liu
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jingying Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuan Yang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
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26
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Mirosevic S, Thewes B, van Herpen C, Kaanders J, Merkx T, Humphris G, Baatenburg de Jong RJ, Langendijk JA, Leemans CR, Terhaard CHJ, Verdonck-de Leeuw IM, Takes R, Prins J. Prevalence and clinical and psychological correlates of high fear of cancer recurrence in patients newly diagnosed with head and neck cancer. Head Neck 2019; 41:3187-3200. [PMID: 31173429 PMCID: PMC6771492 DOI: 10.1002/hed.25812] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/02/2019] [Accepted: 05/13/2019] [Indexed: 01/04/2023] Open
Abstract
Background Patients with head and neck cancer (HNC) are vulnerable to fear of cancer recurrence (FCR) and psychiatric morbidity. We investigated the prevalence of high FCR and demographic, clinical, psychological, and psychiatric factors associated with high FCR prior to the start of the treatment. Methods In a cross‐sectional substudy of the large ongoing prospective NET‐QUBIC study questionnaires and psychiatric interviews of 216 patients newly diagnosed with HNC were analyzed. Results High FCR was observed in 52.8% of patients and among those 21.1% also had a lifetime history of selected anxiety or major depressive disorder. FCR was not related to any clinical characteristics; however, younger age, higher anxiety symptoms, introversion, greater needs for support regarding sexuality, and being an exsmoker were significantly associated with higher FCR. Conclusion Factors associated with high FCR provide us with a better conceptual understanding of FCR in patients newly diagnosed with HNC.
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Affiliation(s)
- Spela Mirosevic
- Department of Family Medicine, Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - Belinda Thewes
- Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Carla van Herpen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Johannes Kaanders
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Thijs Merkx
- Department Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gerry Humphris
- School of Medicine, University of St. Andrews, St. Andrews, Scotland, UK
| | - Robert J Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery, Erasmus Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Chris H J Terhaard
- Department of Radiotherapy, University Medical Center, Utrecht, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.,Department of Clinical Psychology, Vrije Universiteit Amsterdam, The Netherlands
| | - Robert Takes
- Department of Head and Neck Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Judith Prins
- Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
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- Project Kubus, Vumc, Afdeling KNO, Amsterdam, The Netherlands
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27
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Secinti E, Tometich DB, Johns SA, Mosher CE. The relationship between acceptance of cancer and distress: A meta-analytic review. Clin Psychol Rev 2019; 71:27-38. [PMID: 31078056 DOI: 10.1016/j.cpr.2019.05.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 04/23/2019] [Accepted: 05/01/2019] [Indexed: 12/15/2022]
Abstract
Acceptance of cancer has long been recognized as playing a critical role in psychological adjustment to the illness, but its associations with distress outcomes have not been quantitatively reviewed. Informed by coping theory and third wave conceptualizations of acceptance, we first propose an integrated model of acceptance of cancer. Then we examine the strength of the relationships between acceptance of cancer and general and cancer-specific distress in cancer patients and potential moderators of these relationships. CINAHL, Embase, MEDLINE, PsycINFO, PsycARTICLES, and Web of Science databases were searched. Random-effects meta-analyses were conducted on 78 records (N = 15,448). Small-to-moderate, negative, and significant relationships were found between acceptance of cancer and general distress (r = -0.31; 95% CI: -0.36 to -0.26, k = 75); cancer-specific distress (r = -0.18; 95% CI: -0.21 to -0.14, k = 13); depressive symptoms (r = -0.25; 95% CI: -0.31 to -0.19, k = 41); and anxiety symptoms (r = -0.22; 95% CI: -0.30 to -0.15, k = 29). Age, marital status, and stage of cancer were identified as significant moderators. Findings suggest that acceptance of cancer may be important to target in interventions to reduce general and cancer-specific distress in cancer patients. Future research should focus on developing multifaceted measures of acceptance and identifying theory-based psychological and social processes that lead to greater acceptance.
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Affiliation(s)
- Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN 46202, USA.
| | - Danielle B Tometich
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN 46202, USA
| | - Shelley A Johns
- Center for Health Services Research, Regenstrief Institute, 1101 West 10th Street, Indianapolis, IN 46202, USA; Department of Medicine, Indiana University School of Medicine, 545 Barnhill Drive, Indianapolis, IN 46202, USA; Fairbanks Center for Medical Ethics, Indiana University Health Methodist Hospital, 1800 North Capital Avenue, Noyes E649, Indianapolis, IN 46202, USA
| | - Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN 46202, USA
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28
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van de Wal M, Servaes P, Berry R, Thewes B, Prins J. Cognitive Behavior Therapy for Fear of Cancer Recurrence: A Case Study. J Clin Psychol Med Settings 2018; 25:390-407. [PMID: 29468568 PMCID: PMC6209054 DOI: 10.1007/s10880-018-9545-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This case study describes the course and content of cognitive behavior therapy (CBT) for clinical fear of cancer recurrence (FCR) in a breast cancer survivor. The CBT for clinical FCR consisted of seven face-to-face therapy sessions and one telephone session. The primary treatment goal was to reduce FCR severity by modifying cognitive processes and dysfunctional behavior. Assessments of FCR and quality of life were completed by the breast cancer survivor pre-therapy, post-therapy, and at 6 and 12 months of post-therapy. In each treatment session, perceived control over FCR was assessed. A clinical nurse specialist participated in evaluation interviews. The patient's perceived control over FCR increased during the therapy, and FCR severity declined to a non-clinical level. This improvement was still evident at the 6- and 12-month follow-up assessments and was supported by results for secondary and exploratory outcomes measures. FCR offers a great challenge for health care professionals due to the lack of effective treatment options. This case study shows how clinical FCR can be addressed with CBT and can contribute to the improvement of care for cancer survivors.
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Affiliation(s)
- Marieke van de Wal
- Department of Medical Psychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
- Department of Medical Psychology, Maxima Medical Center, Eindhoven/Veldhoven, The Netherlands.
| | - Petra Servaes
- Department of Medical Psychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Rebecca Berry
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Belinda Thewes
- Department of Medical Psychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Judith Prins
- Department of Medical Psychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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29
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Yang Y, Sun H, Liu T, Zhang J, Wang H, Liang W, Chen Y, Zhang B. Factors associated with fear of progression in chinese cancer patients: sociodemographic, clinical and psychological variables. J Psychosom Res 2018; 114:18-24. [PMID: 30314574 DOI: 10.1016/j.jpsychores.2018.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Fear of progression (FoP) is a widespread problem among cancer patients and is considered to be one of the most distressing psychological consequences of cancer. The aim of this study was to investigate the association of sociodemographic, clinical, and psychological variables to FoP in Chinese cancer patients. METHODS In this cross-sectional study, six hundred and thirty-six cancer patients were recruited. All participants were asked to complete a personal information sheet, the Chinese version of Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder Questionnaire (GAD-7). Descriptive statistics and hierarchical multiple regression was conducted to analyze the data. RESULTS Hierarchical multiple regression revealed that childhood severe illness experience (P = .011), stress (P < .001), anxiety (P < .001), depressive symptom (P < .001) and personality (P = .042) were independently predictive of higher FoP. The final regression model explained up to 40.0% (adjusted R square: 38.8%) of the observed variance. CONCLUSION There are a number of factors that increase the likelihood of the development of FoP. The findings underline the necessity to provide effective psychological intervention for patients with high FoP in the future.
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Affiliation(s)
- Yuan Yang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China
| | - Hengwen Sun
- Department of Radiotherapy, Cancer Centre, Guangdong General Hospital, Guangzhou, Guangdong 510080, China
| | - Ting Liu
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China
| | - Jingying Zhang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China
| | - Hongmei Wang
- Department of Radiotherapy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China
| | - Weijiang Liang
- Department of Oncology, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China
| | - Yu Chen
- Nursing School, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Bin Zhang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China.
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30
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Hall DL, Luberto CM, Philpotts LL, Song R, Park ER, Yeh GY. Mind-body interventions for fear of cancer recurrence: A systematic review and meta-analysis. Psychooncology 2018; 27:2546-2558. [PMID: 29744965 PMCID: PMC6488231 DOI: 10.1002/pon.4757] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/21/2018] [Accepted: 04/19/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is a common existential concern and source of distress among adults with a cancer history. Multiple randomized controlled trials (RCTs) have examined mind-body approaches to mitigating FCR. We summarized characteristics of these trials and calculated their pooled effects on decreasing FCR. METHODS Six electronic databases were systematically searched from inception to May 2017, using a strategy that included multiple terms for RCTs, cancer, mind-body medicine, and FCR. Data extraction and reporting followed Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled effect sizes on self-report measures of FCR were computed by using random-effects models. RESULTS Nineteen RCTs (pooled N = 2806) were included. Most studies (53%) were published since 2015 and targeted a single cancer type (84%; mostly breast). Intervention sessions (median = 6, mode = 4) tended to last 120 minutes and occur across 1.5 months. Delivery was predominantly in-person (63%) to either groups (42%) or individuals (42%). Most interventions incorporated multiple mind-body components (53%), commonly cognitive-behavioral skills (58%), or meditative practices (53%). Small-to-medium pooled effect sizes were observed postintervention (Hedges' g = -0.36, 95% CI = -0.49, -0.23, P < .001) and at follow-up assessments (median = 8 months, P < .001). Potential modifiers (control group design, group/individual delivery, use of cognitive-behavioral or mindfulness skills, number of mind-body components, cancer treatment status, and number of sessions) did not reach statistical significance. CONCLUSIONS Mind-body interventions are efficacious for reducing FCR, with small-to-medium effect sizes that persist after intervention delivery ends. Recommendations include testing effects among survivors of various cancers and exploring the optimal integration of mind-body practices for managing fundamental uncertainties and fears during cancer survivorship.
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Affiliation(s)
- Daniel L. Hall
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Rhayun Song
- College of Nursing, Chungnam National University, South Korea
| | - Elyse R. Park
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA
| | - Gloria Y. Yeh
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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31
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Vehling S, Kissane DW. Existential distress in cancer: Alleviating suffering from fundamental loss and change. Psychooncology 2018; 27:2525-2530. [DOI: 10.1002/pon.4872] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/26/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Sigrun Vehling
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - David W. Kissane
- University of Notre Dame; Sydney Australia
- Cunningham Centre; St Vincent's Hospital; Sydney Australia
- Szalmuk Family Psycho-Oncology Research Unit; Cabrini Health and Monash Partner's Comprehensive Cancer Centre; Melbourne Australia
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32
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Lee KT, Lin JJ, Shi HY. Anxiety and depression are associated with long-term outcomes of hepatocellular carcinoma: A nationwide study of a cohort from Taiwan. World J Biol Psychiatry 2018; 19:431-439. [PMID: 28000517 DOI: 10.1080/15622975.2016.1273548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES A natural experimental design was coupled with propensity score matching to assess the risks of anxiety and depression and to assess the longitudinal effects of anxiety and depression on healthcare utilisation and mortality in hepatocellular carcinoma (HCC) patients. METHODS This nationwide population-based cohort study retrospectively analysed 7304 patients treated for HCC during 1996-2010. Generalised estimating equations were used to estimate differences-in-differences models for examining the effects of anxiety and depression disorders. RESULTS Independent risk factors for anxiety and depression in the HCC patients were female gender (hazard ratio (HR) 1.45; P < 0.001), Charlson co-morbidity index score (HR 1.12; P = 0.005), and liver cirrhosis (HR 1.35; P = 0.004). Anxiety and depression (differences-in-differences value) had a significant (P < 0.001) positive net effect on number of physician visits. Furthermore, the mean overall survival time was 83.4 months (SD 5.4 months) in the anxiety/depression group and 65.4 months (SD 4.8 months) in the non-disorder group. Additionally, the overall survival rate was significantly higher in the anxiety/depression group compared to the non-disorder group during the study period (P = 0.003). CONCLUSIONS Anxiety disorders and depression disorders are associated with a significantly increased overall survival rate in HCC patients. However, further studies are needed to investigate this association.
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Affiliation(s)
- King-Teh Lee
- a Department of Healthcare Administration and Medical Informatics , Kaohsiung Medical University , Kaohsiung , Taiwan.,b Division of Hepatobiliary Surgery, Department of Surgery , Kaohsiung Medical University Hospital , Kaohsiung , Taiwan
| | - Jin-Jia Lin
- c Department of Psychiatry , Chi-Mei Medical Center , Tainan , Taiwan.,d Department of Psychiatry , Chi-Mei Hospital , Liouying , Tainan , Taiwan.,e Department of Psychiatry, School of Medicine, College of Medicine , Taipei Medical University , Taipei , Taiwan
| | - Hon-Yi Shi
- a Department of Healthcare Administration and Medical Informatics , Kaohsiung Medical University , Kaohsiung , Taiwan
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33
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Initial validation of the Danish version of the Fear of Cancer Recurrence Inventory (FCRI) in colorectal cancer patients. J Cancer Surviv 2018; 12:723-732. [DOI: 10.1007/s11764-018-0709-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/04/2018] [Indexed: 01/03/2023]
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34
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Wang JY, Chen JD, Huang CC, Liu CS, Chung TF, Hsieh MH, Wang CW. Investigation of time-dependent risk of mental disorders after infertility diagnosis, through survival analysis and data mining: a nationwide cohort study. EUR J CONTRACEP REPR 2018; 23:218-226. [PMID: 29848102 DOI: 10.1080/13625187.2018.1450972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Infertile patients are vulnerable to mental disorders. However, a time-dependent model predicting the onset of mental disorders specific to infertile patients is lacking. This study examined the risk factors for the development of mental disorders in infertile patients and measured the duration until the occurrence of mental disorders after a diagnosis of infertility. METHODS A total of 13,317 infertile patients in the 2002-2013 Taiwan National Health Insurance Research Database were observed. The 11 independent variables included in the hypothesised model, together with the dates of infertility and mental disorder diagnoses, were analysed using Cox proportional hazards. Data-mining methods using C5.0 and Apriori supplemented the statistical analyses. RESULTS The total prevalence rate of mental disorders among infertile patients in Taiwan was 12.41%, including anxiety (4.66%), depression (1.81%) and other mental disorders (5.94%). The average time interval for onset of mental illness identified using survival analysis was 1.67 years. Income, occupation, treatment method, co-morbidity, region and hospital level and ownership were significant predictors of development of mental illness (all p < .05). CONCLUSIONS The four categories of factors associated with time-dependent onset were demographics, health, health care provider and geographical characteristics. Certain patient characteristics may predict a higher likelihood of onset of a specific mental disorder. Clinical practitioners may use the findings to identify high-risk patients and make timely health interventions.
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Affiliation(s)
- Jong-Yi Wang
- a Department of Health Services Administration , China Medical University , Taichung , Taiwan, ROC
| | - Jen-De Chen
- b Department of Sports , National Changhua University of Education , Changhua , Taiwan, ROC
| | - Chun-Chi Huang
- c Department of Community Medicine and Health , Taichung Hospital, Ministry of Health and Welfare , Taichung , Taiwan, ROC
| | - Chiu-Shong Liu
- d Department of Family Medicine , China Medical University Hospital , Taichung , Taiwan, ROC.,e Department of Medicine , China Medical University , Taichung , Taiwan, ROC
| | - Tsai-Fang Chung
- f Department of Medical Secretary, Ministry of Health and Welfare , Taipei , Taiwan, ROC
| | - Ming-Hong Hsieh
- g Department of Psychiatry , Chung Shan Medical University Hospital , Taichung , Taiwan, ROC.,h School of Medicine , Chung Shan Medical University , Taichung , Taiwan, ROC
| | - Chia-Woei Wang
- i Department of Obstetrics and Gynaecology , Taipei Medical University Hospital , Taipei , Taiwan, ROC.,j Graduate Institute of Clinical Medicine , Taipei Medical University , Taipei , Taiwan, ROC
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Bussmann S, Vaganian L, Kusch M, Labouvie H, Gerlach AL, Cwik JC. Angst und Emotionsregulation bei Krebspatienten. PSYCHOTHERAPEUT 2018. [DOI: 10.1007/s00278-018-0283-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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36
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Existential distress and meaning-focused interventions in cancer survivorship. Curr Opin Support Palliat Care 2018; 12:46-51. [DOI: 10.1097/spc.0000000000000324] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Fear of progression (or fear of recurrence) is an appropriate, adequate response to the real threat of cancer. However, elevated levels of fear of progression can become dysfunctional, affecting well-being, quality of life, and social functioning. Research has shown that fear of progression is one of the most frequent distress symptoms of patients with cancer. As a clear consensus concerning clinically relevant states of fear of progression is still lacking, it is difficult to provide a valid estimate of the rate of cancer patients who clearly suffer from fear of progression. Current evidence suggests that probably 50% of cancer survivors experience moderate to severe fear of progression. Furthermore, many patients express unmet needs in dealing with the fear of cancer spreading. These results underscore the need to provide effective psychological treatments for clinical states of fear of progression. Some psychosocial interventions for treating fear of progression have been developed. Our own, targeted intervention study showed that clinical fear of progression can be effectively treated with brief group therapy.
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Daigre C, Grau-López L, Rodríguez-Cintas L, Ros-Cucurull E, Sorribes-Puertas M, Esculies O, Bones-Rocha K, Roncero C. The role of dual diagnosis in health-related quality of life among treatment-seeking patients in Spain. Qual Life Res 2017; 26:3201-3209. [PMID: 28786018 DOI: 10.1007/s11136-017-1668-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE The comorbidity of any substance use disorder and another mental disorder is defined as dual diagnosis. Dual diagnosis is very common and clinical and therapeutic consequences have been described. This cross-sectional study aimed to analyse health-related quality of life (HRQoL) according to clinical characteristics and psychiatric comorbidities in patients with substance dependence. METHODS A total of 1276 substance-dependent patients seeking treatment were recruited. HRQoL was evaluated by the Short-Form 36 (SF-36) questionnaire. The SCID-I, SCID-II and Conners' adult ADHD diagnostic interview were used to evaluate dual diagnosis. A visual analogue scale was used to measure craving. Bivariate and multivariate analyses were performed, and correction for multiple tests was conducted. RESULTS Substance-dependent patients had impaired quality of life, especially in the mental component. SF-36 physical and mental component scores were 47.7 ± 10.9 and 36.1 ± 14.1, respectively. Furthermore, 65% of the patients had dual diagnosis, 51% had an Axis I DSM-IV-TR mental disorder and 35% had some personality disorder. Impaired physical quality of life was independently associated with medical condition, age, being female, depressive disorder and anxiety disorder. Depression disorder, any personality disorder, active consumption last month, Attention deficit hyperactivity disorder, anxiety disorder, suicide attempt were independently associated with worse mental quality of life. CONCLUSION These findings emphasize the significance of dual diagnosis in the impairment of HRQoL in substance-dependent patients, particularly with regard to mental component. In addicted patients with low scores on SF-36, psychiatric comorbidity should be evaluated and treated in an integrated approach.
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Affiliation(s)
- Constanza Daigre
- Addiction and Dual Diagnosis Unit, Psychiatry Deparment, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Agencia de Salud Pública de Barcelona, CIBERSAM, Barcelona, Spain.
| | - Lara Grau-López
- Addiction and Dual Diagnosis Unit, Psychiatry Deparment, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Agencia de Salud Pública de Barcelona, CIBERSAM, Barcelona, Spain
| | - Laia Rodríguez-Cintas
- Addiction and Dual Diagnosis Unit, Psychiatry Deparment, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Agencia de Salud Pública de Barcelona, CIBERSAM, Barcelona, Spain
| | - Elena Ros-Cucurull
- Addiction and Dual Diagnosis Unit, Psychiatry Deparment, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Agencia de Salud Pública de Barcelona, CIBERSAM, Barcelona, Spain
| | - Marta Sorribes-Puertas
- Addiction and Dual Diagnosis Unit, Psychiatry Deparment, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Agencia de Salud Pública de Barcelona, CIBERSAM, Barcelona, Spain
| | | | - Katia Bones-Rocha
- Faculty of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carlos Roncero
- Addiction and Dual Diagnosis Unit, Psychiatry Deparment, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Agencia de Salud Pública de Barcelona, CIBERSAM, Barcelona, Spain
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Wang JY, Hsieh MH, Lin PC, Liu CS, Chen JD. Parallel contagion phenomenon of concordant mental disorders among married couples: a nationwide cohort study. J Epidemiol Community Health 2017; 71:640-647. [PMID: 28219896 PMCID: PMC5485751 DOI: 10.1136/jech-2016-208283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/12/2016] [Accepted: 02/05/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aggregation of mental disorders in couples, as reported by prior research, indicates the effect of familial environments and warrants attention. However, the concordant categories of mental disorders in couples remain unclear. This study investigated spousal concordance for the category of mental disorders among couples throughout Taiwan by using factors associated with such disorders. METHODS 5643 couples in the 2002-2013 Taiwan National Health Insurance Research Database were analysed and compared with propensity-matched 5643 non-couples. Twelve independent variables, including spouse and shared characteristics, and the category of mental disorders were analysed, mainly by using multinomial logistic regression. RESULTS The determined prevalence rates for concordant categories of mental disorder were 0.19% for affective disorders, 6.96% for anxiety disorders, and 3.15% of other mental disorders. Multinomial logistic regression results revealed that two spouses were significantly more likely to be diagnosed with the same category of the aforementioned mental disorders (ORs=2.914, 1.776 and 1.727, respectively). Other associated factors included gender, age, occupation, comorbidity and region. The odds of concordances were significantly higher in couples than in non-couples. CONCLUSIONS A category of mental disorder in one spouse is a determinant of that in the other spouse. This study extended the emotional contagion theory to the phenomenon of parallel contagion to reflect the three concordances, suggesting a direction of family-based mental health intervention, particularly prevention for the same category of mental disorders in couples. Policymakers should strengthen the coping strategies of the caring spouse and external support system to psychiatrically vulnerable families.
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Affiliation(s)
- Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Ming-Hong Hsieh
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Pei-Ching Lin
- Tele-Healthcare Center, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Chiu-Shong Liu
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of Medicine, China Medical University, Taichung, Taiwan
| | - Jen-De Chen
- Department of Sports, National Changhua University of Education, Changhua, Taiwan
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Kuba K, Esser P, Scherwath A, Schirmer L, Schulz-Kindermann F, Dinkel A, Balck F, Koch U, Kröger N, Götze H, Mehnert A. Cancer-and-treatment-specific distress and its impact on posttraumatic stress in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Psychooncology 2016; 26:1164-1171. [PMID: 27718504 DOI: 10.1002/pon.4295] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 08/30/2016] [Accepted: 10/06/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND In this prospective multicenter study, we investigated cancer-and-treatment-specific distress (CTXD) and its impact on symptoms of posttraumatic stress disorder (PTSD) in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). METHODS Patients were consulted before (T0, N = 239), 3 (T1, N = 150), and 12 months (T2, N = 102) after HSCT. Medical (eg, diagnosis and pretreatment) and demographic information, CTXD and PTSD (PCL-C) were assessed. RESULTS Random intercept models revealed that the sum score of CTXD was highest pre-HSCT (T0), decreased by T1 (γ = -.18, 95% CI [-.26/-.09]), and by T2 (γ = -.10, 95% CI [-.20/-.00]). Uncertainty, family strain, and health burden were rated most distressing during HSCT. Uncertainty and family strain decreased from T0 to T1 (γ = -.30, 95% CI [-.42/-.17]; γ = -.10, 95% CI [-.20/-.00]) and health burden from T1 to T2 (γ = -.21, 95% CI [-.36/.05]). Women were more likely to report uncertainty (γ = .38, 95% CI [.19/.58]), family strain (γ = .38, 95% CI [.19/.58]), and concerns regarding appearance and sexuality (γ = .31, 95% CI [.14/.47]) than men. Uncertainty (γ = .18, 95% CI [.12/.24]), appearance and sexuality (γ = .09, 95% CI [.01/.16]), and health burden (γ = .21, 95% CI [.14/.27]) emerged as predictors of PTSD symptomatology across the 3 assessment points. CONCLUSIONS Our data provide first evidence regarding the course of 6 dimensions of CTXD during HSCT and their impact on PTSD symptomatology. Specifically, results emphasize the major burden of uncertainty pre-HSCT and the impact of uncertainty and concerns regarding appearance and sexuality on PTSD symptomatology.
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Affiliation(s)
- Katharina Kuba
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Peter Esser
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Angela Scherwath
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Schirmer
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Schulz-Kindermann
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Friedrich Balck
- Department of Medical Psychology and Medical Sociology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Uwe Koch
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heide Götze
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.,Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Manne SL, Myers-Virtue S, Kissane D, Ozga ML, Kashy DA, Rubin SC, Rosenblum NG, Heckman CJ. Group-based trajectory modeling of fear of disease recurrence among women recently diagnosed with gynecological cancers. Psychooncology 2016; 26:1799-1809. [PMID: 27421919 DOI: 10.1002/pon.4223] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/21/2016] [Accepted: 07/10/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Fear of cancer recurrence is an important clinical phenomenon and is associated with decrements in life domains. The study goals were to characterize patterns of global fear of recurrence (FOR) and 4 domains of fear (health, role, womanhood, and death worry) over time in women who were diagnosed with gynecological cancer and to identify demographic, medical, and psychological predictors of FOR. METHOD One hundred eighteen women participating in the usual care arm of a randomized trial completed the Concerns about Recurrence scale as well as measures of depressive symptoms, cancer-specific distress, coping, coping efficacy, and social network responses at 4 time points. The majority of the sample was diagnosed with stage 3 ovarian cancer. RESULTS Group-based trajectory modeling identified subgroups of women with high-stable (49.1%), high-decreasing (25.3%), and low-stable (25.5%) trajectories for global FOR. For role worries, 3 similar group trajectories were identified. For health worries, modeling identified subgroups with high-decreasing (19.1%) and low-increasing (80.9%) trajectories. For womanhood worries, modeling identified subgroups with high-increasing (15.7%) and low-decreasing (84.2%) trajectories. Young age, metastatic cancer, depression, cancer distress, holding back, and lower coping efficacy were associated with the high-stable global FOR and at least 1 domain of FOR. CONCLUSION Almost half of the women recently diagnosed with gynecological cancer evidence persistently elevated FOR over the 6-month period postdiagnosis. Psychological interventions to reduce FOR may be more effective if they focus on teaching patients coping skills, as well as greater comfort expressing cancer-specific concerns to others.
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Affiliation(s)
- Sharon L Manne
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Shannon Myers-Virtue
- Temple University Maurice H. Kornberg School of Dentistry, Philadelphia, Pennsylvania, USA
| | - David Kissane
- Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Monash University, Clayton, Victoria, Australia
| | - Melissa L Ozga
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Lebel S, Ozakinci G, Humphris G, Thewes B, Prins J, Dinkel A, Butow P. Current state and future prospects of research on fear of cancer recurrence. Psychooncology 2016; 26:424-427. [DOI: 10.1002/pon.4103] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 01/25/2016] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - Belinda Thewes
- Radboud University Medical Centre; Nijmegen The Netherlands
| | - Judith Prins
- Radboud University Medical Centre; Nijmegen The Netherlands
| | | | - Phyllis Butow
- University of Sydney; Sydney New South Wales Australia
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Fidika A, Herle M, Herschbach P, Goldbeck L. Fear of disease progression questionnaire for parents: Psychometric properties based on a sample of caregivers of children and adolescents with cystic fibrosis. J Psychosom Res 2015; 79:49-54. [PMID: 25799454 DOI: 10.1016/j.jpsychores.2015.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/20/2015] [Accepted: 02/21/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Parents caring for a child with a chronic somatic condition are at risk of increased distress and impaired quality of life. Fear of disease progression (FoP) is known to be an important source of distress in patients and their partners, and may be of relevance for parents as well. Existing measures are not applicable to parents. This study describes the adaptation of the FoP questionnaire for parental caregivers and investigated its psychometric properties. METHODS Sixteen items appropriate for parents were derived from existing measures and from interviews with clinical experts in family-oriented psychosocial care. Factor structure, internal consistency, validity and sensitivity to change were analyzed in a clinical sample of 162 caregivers (M(age)=42.07 years, SD=6.0 years, 87.8% female) of a child with cystic fibrosis. RESULTS The exploratory factor analysis reveal ed a two-factor structure, which was not supported by confirmatory analysis. Cronbach's α was examined for total score (.91) and significant positive correlations of the total score with anxiety (HADS: r=.70) and depression (CES-D: r=.60, BDI-II: r=.59), and a significant negative correlations with quality of life (r=-.66) could be demonstrated. A significant decrease in FoP was found (d=1.11) in a group of highly distressed caregivers undergoing web-based cognitive behavioral intervention. CONCLUSIONS The FoP questionnaire is a reliable and valid instrument for parents of children with CF. Further studies in larger samples are needed to clarify dimensionality and validity among parents of children with other chronic conditions.
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Affiliation(s)
- Astrid Fidika
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm Medical Centre, Ulm, Germany.
| | - Marion Herle
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm Medical Centre, Ulm, Germany
| | - Peter Herschbach
- Roman-Herzog-Comprehensive Cancer Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Lutz Goldbeck
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm Medical Centre, Ulm, Germany
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Dunn LB, Langford DJ, Paul SM, Berman MB, Shumay DM, Kober K, Merriman JD, West C, Neuhaus JM, Miaskowski C. Trajectories of fear of recurrence in women with breast cancer. Support Care Cancer 2015; 23:2033-43. [PMID: 25524004 PMCID: PMC5469210 DOI: 10.1007/s00520-014-2513-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Although fear of recurrence (FCR) is common among cancer survivors, it remains unclear what factors predict initial levels (e.g., prior to surgery) or changes in FCR in the post-treatment period. Among women treated for breast cancer, this study evaluated the effects of demographic, clinical, symptom, and psychosocial adjustment characteristics on the initial (preoperative) levels of FCR and trajectories of FCR over 6 months following surgery. METHODS Prior to and for 6 months following breast cancer surgery, 396 women were assessed for demographic and clinical (disease and treatment) characteristics, symptoms, psychological adjustment characteristics, and quality of life (QOL). FCR was assessed using a four-item subscale from the QOL instrument. Hierarchical linear modeling was used to examine changes in FCR scores and to identify predictors of inter-individual differences in preoperative FCR levels and trajectories over 6 months. RESULTS From before surgery to 6 months post-operatively, women with breast cancer showed a high degree of inter-individual variability in FCR. Preoperatively, women who lived with someone, experienced greater changes in spiritual life, had higher state anxiety, had more difficulty coping, or experienced more distress due to diagnosis or distress to family members reported higher FCR scores. Patients who reported better overall physical health and higher FCR scores at enrollment demonstrated a steeper decrease in FCR scores over time. CONCLUSIONS These findings highlight inter-individual heterogeneity in initial levels and changes in FCR over time among women undergoing breast cancer surgery. Further work is needed to identify and provide interventions for women experiencing FCR during and after breast cancer treatment.
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Affiliation(s)
- Laura B Dunn
- School of Medicine, University of California, San Francisco, CA, USA,
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