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Cockle S, Ogden J. The expectations of cancer treatment questionnaire and the experiences of cancer treatment questionnaire: Development and validation. COGENT PSYCHOLOGY 2023. [DOI: 10.1080/23311908.2023.2180871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Affiliation(s)
- Sam Cockle
- School of Psychology, University of Surrey, Guildford, UK
| | - Jane Ogden
- School of Psychology, University of Surrey, Guildford, UK
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Baliga MS, Lasrado S, Krishna A, George T, Madathil LP, D’souza RF, Palatty PL. Social, Ethical and Treatment Related Problems Faced by Healthcare Workers in the Care of Head and Neck Cancer Patients: A Narrative Review from the Bioethics Consortium from India. Indian J Otolaryngol Head Neck Surg 2023:1-11. [PMID: 37362104 PMCID: PMC10206566 DOI: 10.1007/s12070-023-03738-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/26/2023] [Indexed: 06/28/2023] Open
Abstract
Head and neck cancer (HNC) presents a variety of ethical difficulties for an oncologist involved in screening, diagnosis, treatment, and rehabilitation that are challenging to address, especially for those professionals/people who are not trained in medical ethics. The bioethics department has spent the last ten years compiling information and rating the seriousness of numerous niche ethical concerns and their effects on healthcare professionals practising in India. Based on these findings, the current analysis makes an effort to outline the different challenges faced by oncologists when screening, diagnosing, treating, and rehabilitating people affected with HNC, particularly in a traditional nation like India. According to the authors, this is the first overview to address these issues from an Indian viewpoint, and it represents a small effort to document a crucial but unaddressed component of cancer treatment. It is hoped that these endeavours would aid in educating upcoming healthcare professionals on how to effectively handle the difficulties.
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Affiliation(s)
- Manjeshwar Shrinath Baliga
- Bioethics Education and Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka 575002 India
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala 682041 India
- Member, International Chair in Bioethics, University of Porto Portugal (Formerly UNESCO Chair in Bioethics, University of Haifa) Directorate of The Asia Pacific Division and Education Department, Cleeland Street, Melbourne, Australia
| | - Savita Lasrado
- Department of Otorhinolaryngology, Father Muller Medical College, Kankanady, Mangalore, 575002 India
| | - Abhishek Krishna
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, Karnataka 570001 India
| | - Thomas George
- Internal Medicine, Coney Island Hospital, 2601 Ocean Pkwy, Brooklyn, NY 11235 USA
| | - Lal P. Madathil
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala 682041 India
| | - Russell Franco D’souza
- Member, International Chair in Bioethics, University of Porto Portugal (Formerly UNESCO Chair in Bioethics, University of Haifa) Directorate of The Asia Pacific Division and Education Department, Cleeland Street, Melbourne, Australia
- Chair Department of Education, International Chair in Bioethics, University of Porto Portugal (Formerly UNESCO Chair in Bioethics, University of Haifa); Directorate of The Asia Pacific Division and Education Department, Cleeland Street, Melbourne, Australia
| | - Princy Louis Palatty
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala 682041 India
- Department of Pharmacology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala 682041 India
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Ihrig A, Richter J, Bugaj TJ, Friederich HC, Maatouk I. Between hope and reality: How oncology physicians and information providers of a cancer information service manage patients' expectations for and experiences with immunotherapies. PATIENT EDUCATION AND COUNSELING 2023; 109:107622. [PMID: 36641334 DOI: 10.1016/j.pec.2023.107622] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/31/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Immune checkpoint inhibitors have established themselves as a further therapeutic pillar in the treatment of various types of cancer. This can create challenges and possible misunderstandings for patients. The aim of this study was to assess the experiences of physicians and information providers in their interactions with patients about immunotherapy. METHODS The study design was exploratory with qualitative research methodology. We performed focus groups with 8 oncology physicians and 9 information providers of a cancer information service. RESULTS In the coding process, five focal points could be identified: (1) image of immunotherapy, (2) presentation of immunotherapy in the media, (3) hope, (4) creation of an information base, and (5) lessons learned and future directions. Physicians and information providers report that immunotherapy has a very positive image among patients. This seems to be due to the presentation of immunotherapy in the media and the positive associations of people with terms such as the immune system and the body's own defense. CONCLUSIONS In contrast to chemotherapy, patients are at risk of underestimating the early symptoms of serious side effects of immunotherapy. From the point of view of physicians, the exaggerated expectations of patients regarding the possibilities of immunotherapy are often not met. The challenge for practitioners is to consider patients' expectations to provide balanced information and recommendations. PRACTICAL IMPLICATIONS Communication skills training and up-to-date information tools should improve physician-patient communication.
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Affiliation(s)
- Andreas Ihrig
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany.
| | - Jenniffer Richter
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Till Johannes Bugaj
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Imad Maatouk
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany; Section of Psychosomatic Medicine, Psychotherapy and Psychooncology, Department of Internal Medicine II, University Hospital Wuerzburg, Wuerzburg, Germany
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Peipert JD, Shaunfield S, Kaiser K, Moreno PI, Fox RS, Kircher S, Mohindra N, Ip E, Zhao F, Wagner L, Cella D. How do patients interpret and respond to a single-item global indicator of cancer treatment tolerability? Support Care Cancer 2022; 31:37. [PMID: 36525100 PMCID: PMC10356672 DOI: 10.1007/s00520-022-07484-7] [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: 05/02/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is increasing interest in patient-reported measures of cancer treatment tolerability. A global measure of bother, the FACT GP5 item ("I am bothered by side effects of treatment") is potentially useful for regulatory, research, and clinical use. To understand this item's appropriateness for capturing treatment tolerability, we conducted cognitive interviews on this item with 3 samples of cancer patients. METHODS Patients with ovarian cancer (Study 1: N = 21; on treatment), lymphoma (Study 2: N = 14; on treatment), and colorectal or lung cancer (Study 3: N = 16; treatment naïve) were interviewed about GP5's understandability and relevance to their treatment side effects. What patients think about when answering GP5 was also assessed. In all studies, the interview included both structured and open-ended questions. Qualitative data were coded to extract themes and responses to structured questions were tallied. RESULTS Most patients on treatment (Studies 1 and 2) reported that the GP5 item wording is appropriate (88%) and its meaning is clear (97%). They were very confident or confident in their response (97%) and stated that GP5 was relevant to their cancer experience (97%). When answering GP5, patients considered their treatment and specific side effects. A large proportion (40%) of the treatment-naïve (Study 3) patients reported that GP5 was not relevant to their cancer treatment, and the largest proportion responded to GP5 thinking of negative side effect expectancies. CONCLUSION This study provides assurance that GP5 is a useful indicator of treatment tolerability, and is meaningful to people with cancer, especially once they have started treatment.
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Affiliation(s)
- John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, IL, 60611, Chicago, USA.
| | - Sara Shaunfield
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, IL, 60611, Chicago, USA
| | - Karen Kaiser
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, IL, 60611, Chicago, USA
| | - Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rina S Fox
- University of Arizona College of Nursing, Tucson, AZ, USA
- University of Arizona Cancer Center, Tucson, AZ, USA
| | - Sheetal Kircher
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, IL, Chicago, USA
| | - Nisha Mohindra
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, IL, Chicago, USA
| | - Edward Ip
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Fengmin Zhao
- ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Lynne Wagner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, IL, 60611, Chicago, USA
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Michnevich T, Pan Y, Hendi A, Oechsle K, Stein A, Nestoriuc Y. Preventing adverse events of chemotherapy for gastrointestinal cancer by educating patients about the nocebo effect: a randomized-controlled trial. BMC Cancer 2022; 22:1008. [PMID: 36138381 PMCID: PMC9502603 DOI: 10.1186/s12885-022-10089-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Adverse events of chemotherapy may be caused by pharmacodynamics or psychological factors such as negative expectations, which constitute nocebo effects. In a randomized controlled trial, we examined whether educating patients about the nocebo effect is efficacious in reducing the intensity of self-reported adverse events. Methods In this proof-of-concept study, N = 100 outpatients (mean age: 60.2 years, 65% male, 54% UICC tumour stage IV) starting first-line, de novo chemotherapy for gastrointestinal cancers were randomized 1:1 to a nocebo education (n = 49) or an attention control group (n = 51). Our primary outcome was patient-rated intensity of four chemotherapy-specific and three non-specific adverse events (rated on 11-point Likert scales) at 10-days and 12-weeks after the first course of chemotherapy. Secondary outcomes included perceived control of adverse events and tendency to misattribute symptoms. Results General linear models indicated that intensity of adverse events differed at 12-weeks after the first course of chemotherapy (mean difference: 4.04, 95% CI [0.72, 7.36], p = .02, d = 0.48), with lower levels in the nocebo education group. This was attributable to less non-specific adverse events (mean difference: 0.39, 95% CI [0.04, 0.73], p = .03, d = 0.44) and a trend towards less specific adverse events in the nocebo education group (mean difference: 0.36, 95% CI [− 0.02, 0.74], p = .07, d = 0.37). We found no difference in adverse events at 10-days follow-up, perceived control of adverse events, or tendency to misattribute non-specific symptoms to the chemotherapy. Conclusions This study provides first proof-of-concept evidence for the efficacy of a brief information session in preventing adverse events of chemotherapy. However, results regarding patient-reported outcomes cannot rule out response biases. Informing patients about the nocebo effect may be an innovative and clinically feasible intervention for reducing the burden of adverse events. Trial registration Retrospectively registered on March 27, 2018 to the German Clinical Trial Register (ID: DRKS00009501). Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10089-2.
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Affiliation(s)
- T Michnevich
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Berlin, Germany. .,Present address: Charité - University Medicine Berlin, Berlin, Germany.
| | - Y Pan
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Hendi
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Oncology, Asklepios Clinic Barmbek, Hamburg, Germany
| | - K Oechsle
- Center of Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Stein
- Center of Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Y Nestoriuc
- Department of Clinical Psychology, Helmut Schmidt University, University of the Federal Armed Forces Hamburg, Hamburg, Germany.,Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Barth J, Muff S, Kern A, Zieger A, Keiser S, Zoller M, Rosemann T, Brinkhaus B, Held L, Witt CM. Effect of Briefing on Acupuncture Treatment Outcome Expectations, Pain, and Adverse Side Effects Among Patients With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2121418. [PMID: 34505889 PMCID: PMC8433606 DOI: 10.1001/jamanetworkopen.2021.21418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE In observational studies, patients' treatment outcome expectations have been associated with better outcomes (ie, a placebo response), whereas concerns about adverse side effects have been associated with an in increase in the negative effects of treatments (ie, a nocebo response). Some randomized trials have suggested that communication from clinicians could affect the treatment outcomes by changing patients' expectations. OBJECTIVE To investigate whether treatment outcome expectations and reported adverse side effects could be affected by different briefing contents before a minimal acupuncture treatment in patients with chronic low back pain (CLBP). DESIGN, SETTING, AND PARTICIPANTS This randomized single-blinded clinical trial was conducted among patients with CLBP at 1 outpatient clinic in Switzerland who had a pain intensity of at least 4 on a numeric rating scale from 0 to 10. Different recruitment channels were used to enroll patients. Data were collected from May 2016 to December 2017 and were analyzed from June to November 2018. INTERVENTIONS Patients were randomized to receive either a regular expectation briefing or a high expectation briefing (effectiveness) and either a regular adverse side effect briefing or an intense adverse side effect briefing (adverse side effect) in a 2 × 2 factorial design. The intervention (briefing sessions and written materials) was standardized and delivered before the acupuncture treatment, with additional booster informative emails provided during the 4-week, 8-session acupuncture course. MAIN OUTCOMES AND MEASURES The primary end point was the patients' expectations regarding the effectiveness of the acupuncture treatment (Expectation for Treatment Scale [ETS]) after the briefing and the subsequent pain intensity (numeric rating scale). The primary end point for the adverse side effect briefing was the adverse side effect score at the end of the acupuncture treatment, derived from session-by-session assessments of adverse side effects. RESULTS A total of 152 patients with CLBP (mean [SD] age, 39.54 [12.52] years; 100 [65.8%] women) were included. The estimated group difference (regular vs high) for the ETS was -0.16 (95% CI -0.81 to 0.50, P = .64), indicating no evidence for a difference between intervention groups. There was also no evidence for a difference in pain intensity at the end of the acupuncture treatment between the groups with different expectation briefings. The adverse side effects score in the group with the intense adverse side effect briefing were estimated to be 1.31 times higher (95% CI, 0.94 to 1.82; P = .11) than after a regular adverse side effect briefing, but the finding was not statistically significant. CONCLUSIONS AND RELEVANCE In this study, suggestions regarding treatment benefits (placebo) and adverse side effects (nocebo) did not affect treatment expectations or adverse side effects. Information regarding adverse side effects might require more research to understand nocebo responses. TRIAL REGISTRATION German Clinical Trials Register Identifier: DRKS00010191.
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Affiliation(s)
- Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stefanie Muff
- Department of Biostatistics at the Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Alexandra Kern
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Anja Zieger
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stefanie Keiser
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Marco Zoller
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University Hospital Zurich, Zurich, Switzerland
| | - Benno Brinkhaus
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Leonhard Held
- Department of Biostatistics at the Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Claudia M. Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
- Center for Integrative Medicine, University of Maryland, School of Medicine, Baltimore
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Devlin EJ, Whitford HS, Peoples AR, Morrow GR, Katragadda S, Giguere JK, Naqvi B, Roscoe J. Psychological predictors of chemotherapy-induced nausea in women with breast cancer: Expectancies and perceived susceptibility. Eur J Cancer Care (Engl) 2021; 30:e13488. [PMID: 34323340 PMCID: PMC9022467 DOI: 10.1111/ecc.13488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 01/21/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
Objective Chemotherapy‐induced nausea is challenging to predict and treat. Research indicates that pretreatment psychological variables including patients' perceptions of their susceptibility to nausea, expectancies of treatment‐related nausea and nausea history (i.e., motion sickness, morning sickness and baseline levels of nausea) may aid in predicting nausea severity during chemotherapy. However, this research is dated and limited in quantity. We investigated whether psychological variables could improve prediction of nausea severity to inform interventions targeting chemotherapy‐induced nausea. Methods In this secondary analysis, a subgroup of women receiving chemotherapy (for the first time) for breast cancer completed pretreatment measures: perceived nausea susceptibility, nausea expectancies, nausea history and baseline nausea. They rated subsequent nausea severity across 4‐days, during treatment and posttreatment in a self‐report diary. Structural Equation Modelling was used to explore associations. Results Across the women (N = 481), perceived nausea susceptibility predicted subsequent nausea severity (β = 0.16), but nausea expectancies did not (β = 0.05). Nausea history variables demonstrated small‐moderate associations with perceived susceptibility (β = 0.21–0.32) and negligible‐small associations with nausea expectancies (β = 0.07–0.14). Conclusion Perceived nausea susceptibility appears to capture patients' nausea history, to a degree, and is related to nausea severity during treatment. This is an important variable to include in pretreatment prediction of patients at risk of severe nausea.
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Affiliation(s)
- Elise J Devlin
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Hayley S Whitford
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anita R Peoples
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA.,Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Gary R Morrow
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Sreedhar Katragadda
- Southeast Clinical Oncology Research Consortium, Winston Salem, North Carolina, USA
| | - Jeffrey K Giguere
- NCORP of the Carolinas (Greenville Health System), Greenville, South Carolina, USA
| | - Bilal Naqvi
- Wisconsin NCI Community Oncology Research Program, Marshfield, Wisconsin, USA
| | - Joseph Roscoe
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
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Colagiuri B, Park J, Barnes K, Sharpe L, Boakes RA, Colloca L, Livesey EJ. Pre-Exposure, But Not Overshadowing, Inhibits Nocebo Hyperalgesia. THE JOURNAL OF PAIN 2021; 22:864-877. [PMID: 33636369 DOI: 10.1016/j.jpain.2021.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/24/2020] [Accepted: 02/11/2021] [Indexed: 12/19/2022]
Abstract
Nocebo hyperalgesia is a pervasive problem that significantly adds to the burden of pain. Conditioning is a key mechanism of nocebo hyperalgesia and recent evidence indicates that, once established, nocebo hyperalgesia is resistant to extinction. This means that preventive strategies are critical. We therefore tested whether two novel strategies - overshadowing (Experiment 1) and pre-exposure (Experiment 2) - could inhibit conditioned nocebo hyperalgesia. Overshadowing involves introducing additional cues during conditioning that should compete with and overshadow learning about the target nocebo cue. Pre-exposure involves pre-exposing the target nocebo cue in the absence of pain, which should diminish its ability to become associated with pain later. In both studies, healthy volunteers (N = 141) received exposure to a series of electrocutaneous pain stimuli with and without a sham electrode 'activated', which they were led to believe was a genuine hyperalgesic treatment. Nocebo conditioning was achieved by pairing sham activation with high pain prior to testing at equivalent pain intensity. In both studies, standard nocebo conditioning led to clear nocebo hyperalgesia relative to natural history controls. In Experiment 1, there was no evidence that overshadowing attenuated nocebo hyperalgesia. Importantly, however, Experiment 2 found that pre-exposure successfully attenuated nocebo hyperalgesia with post hoc analysis suggesting that this effect was dose-dependent. These findings provide novel evidence that pre-exposure, but not overshadowing, could be a cheap and effective way for mitigating the substantial harm caused by conditioned nocebo hyperalgesia in clinical settings. PERSPECTIVE: Nocebo hyperalgesia causes substantial patient burden with few preventive options available. Our study found novel evidence that pre-exposing treatment cues without pain, but not overshadowing them with other cues, has the capacity to inhibit conditioned nocebo hyperalgesia. Pre-exposure may therefore be an effective preventive strategy to combat nocebo hyperalgesia.
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Affiliation(s)
- B Colagiuri
- School of Psychology, University of Sydney, NSW, Australia.
| | - J Park
- School of Psychology, University of Sydney, NSW, Australia
| | - K Barnes
- School of Psychology, University of Sydney, NSW, Australia
| | - L Sharpe
- School of Psychology, University of Sydney, NSW, Australia
| | - R A Boakes
- School of Psychology, University of Sydney, NSW, Australia
| | - L Colloca
- School of Nursing, University of Maryland Baltimore, Maryland, USA
| | - E J Livesey
- School of Psychology, University of Sydney, NSW, Australia
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Cockle S, Ogden J. Patients' expectations of cancer treatment and their perceived link to subsequent experiences: A qualitative study. Br J Health Psychol 2021; 27:267-282. [PMID: 34173698 DOI: 10.1111/bjhp.12544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 05/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Whilst much research has addressed patients' expectations and experiences of cancer treatment, little research has explored the association between these factors. The current qualitative study aimed to explore patients' beliefs about the relationship between their expectations of cancer treatment and their subsequent experiences. DESIGN Qualitative semi-structured interviews were conducted with sixteen individuals who had received cancer treatment. RESULTS Data were analysed using thematic analysis and illustrated that cancer treatment was experienced as a challenge that could be understood in terms of two themes: 'investing in treatment' reflecting trust in treatment and health care professionals and a sense that treatment was a necessary evil and 'encountering tensions or disconnects' illustrating the mismatch between expectations and experiences with patient reporting feeling unprepared, pleasantly surprised or shock. Transcending these themes was the notion of 'searching for stability and certainty' in terms of a desire for normality and a shift in focus between treatment process and outcome. Overall, disconnects were apparent between participants' expectations and experiences. However, due to their trust in treatment, participants were able to shift their focus between the treatment itself and future outcomes, to regain a sense of certainty. CONCLUSION Patients describe a complex relationship between expectations and experiences and are able to shift their focus between process and outcome to cope with the challenges they face.
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Affiliation(s)
- Sam Cockle
- School of Psychology, University of Surrey, Guildford, UK
| | - Jane Ogden
- School of Psychology, University of Surrey, Guildford, UK
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10
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Nam GH, Choi Y, Kim GB, Kim S, Kim SA, Kim IS. Emerging Prospects of Exosomes for Cancer Treatment: From Conventional Therapy to Immunotherapy. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e2002440. [PMID: 33015883 DOI: 10.1002/adma.202002440] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/29/2020] [Indexed: 05/05/2023]
Abstract
Exosomes are a class of extracellular vesicles of around 100 nm in diameter that are secreted by most cells and contain various bioactive molecules reflecting their cellular origin and mediate intercellular communication. Studies of these exosomal features in tumor pathogenesis have led to the development of therapeutic and diagnostic approaches using exosomes for cancer therapy. Exosomes have many advantages for conveying therapeutic agents such as small interfering RNAs, microRNAs, membrane-associated proteins, and chemotherapeutic compounds; thus, they are considered a prime candidate as a delivery tool for cancer treatment. Since exosomes also provide an optimal microenvironment for the effective function of immunomodulatory factors, exosomes harboring bioactive molecules have been bioengineered as cancer immunotherapies that can effectively activate each stage of the cancer immunity cycle to successfully elicit cancer-specific immunity. This review discusses the advantages of exosomes for treating cancer and the challenges that must be overcome for their successful clinical development.
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Affiliation(s)
- Gi-Hoon Nam
- Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul, 02792, Republic of Korea
| | - Yoonjeong Choi
- Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul, 02792, Republic of Korea
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Gi Beom Kim
- Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul, 02792, Republic of Korea
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Seohyun Kim
- Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul, 02792, Republic of Korea
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Seong A Kim
- Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul, 02792, Republic of Korea
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - In-San Kim
- Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul, 02792, Republic of Korea
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
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Ihrig A, Richter J, Grüllich C, Apostolidis L, Horak P, Villalobos M, Grapp M, Friederich HC, Maatouk I. Patient expectations are better for immunotherapy than traditional chemotherapy for cancer. J Cancer Res Clin Oncol 2020; 146:3189-3198. [PMID: 32813113 PMCID: PMC7679331 DOI: 10.1007/s00432-020-03336-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/23/2020] [Indexed: 12/12/2022]
Abstract
Purpose The main aim of the study was to explore the expectations and knowledge of advanced-stage cancer patients about immunotherapy. Methods This mixed methods study included 53 cancer patients on immune checkpoint inhibitors (ICIs), 55 cancer patients undergoing chemotherapy (CT), and 53 non-cancer patients. Participants’ expectations about ICIs and CT were compared. Additional qualitative data were derived from semi-structured interviews. Results Among patients who did not receive ICIs, 63 (58%) had never heard of ICIs and 94 (87%) had large gaps in their knowledge of ICIs. Among ICI patients, 33 (62%) simply described ICIs without errors. ICI perception was positive, regardless of whether respondents received or had heard of ICIs, which became particularly evident when compared to CT. ICIs were rated as more promising, and all adverse effects were expected to be significantly lower than those of CT. Knowledge about ICIs was also limited in the interviewed ICI patients. Some patients reported adverse effects of ICIs that were mostly mild and well-tolerated or easily treated. Conclusions The lack of understanding of ICIs should be improved by activities to increase the knowledge of ICI patients and the general population. In contrast to CT, ICIs invoked fewer negative associations with efficacy and toxicity. Therefore, attention should be paid to risk awareness when educating patients. (Clinical trial registration number: DRKS00011868) Trial Registration: German clinical trials register, www.germanctr.de, number DRKS00011868.
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Affiliation(s)
- Andreas Ihrig
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital Heidelberg, Heidelberg, Germany
| | - Jenniffer Richter
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital Heidelberg, Heidelberg, Germany
| | - Carsten Grüllich
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Leonidas Apostolidis
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Horak
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias Villalobos
- Department of Thoracic Oncology, University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstr. 1, 69126, Heidelberg, Germany
| | - Miriam Grapp
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital Heidelberg, Heidelberg, Germany
| | - Imad Maatouk
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital Heidelberg, Heidelberg, Germany.
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12
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Smith LE, Webster RK, Rubin GJ. A systematic review of factors associated with side-effect expectations from medical interventions. Health Expect 2020; 23:731-758. [PMID: 32282119 PMCID: PMC7495066 DOI: 10.1111/hex.13059] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Fear of side-effects can result in non-adherence to medical interventions, such as medication and chemotherapy. Side-effect expectations have been identified as strong predictors of later perception of side-effects. However, research investigating predictors of side-effect expectations is disparate. OBJECTIVE To identify factors associated with side-effect expectations. SEARCH STRATEGY We systematically searched Embase, Ovid MEDLINE, Global Health, PsycARTICLES, PsycINFO, Web of Science and Scopus. INCLUSION CRITERIA Studies were included if they investigated associations between any predictive factor and expectations of side-effects from any medical intervention. DATA EXTRACTION AND SYNTHESIS We extracted information about participant characteristics, medication, rates of side-effects expected and predictors of side-effect expectations. Data were narratively synthesized. MAIN RESULTS We identified sixty-four citations, reporting on seventy-two studies. Predictors fell into five categories: personal characteristics, clinical characteristics, psychological traits and state, presentation format of information, and information sources used. Using verbal risk descriptors (eg 'common') compared to numerical descriptors (eg percentages), having lower quality of life or well-being, and currently experiencing symptoms were associated with increased side-effect expectations. DISCUSSION AND CONCLUSIONS Decreasing unrealistic side-effect expectations may lead to decreased experience of side-effects and increased adherence to medical interventions. Widespread communications about medical interventions should describe the incidence of side-effects numerically. Evidence suggests that clinicians should take particular care with patients with lower quality of life, who are currently experiencing symptoms and who have previously experienced symptoms from treatment. Further research should investigate different clinical populations and aim to quantify the impact of the media and social media on side-effect expectations.
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Affiliation(s)
- Louise E Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - G James Rubin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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13
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'Measuring up': A comparison of two response expectancy assessment formats completed by men treated with radiotherapy for prostate cancer. J Psychosom Res 2020; 132:109979. [PMID: 32146249 DOI: 10.1016/j.jpsychores.2020.109979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Response expectancies of cancer treatment toxicities are often, but not always, associated with subsequent experiences. A recent meta-analysis indicated that response expectancies, measured using different assessment formats, reveal different effect sizes, potentially explaining mixed outcomes. Utilizing a clinical sample, we compared 5-point assessments and visual analogue scales, as measures of response expectancies for the incidence and severity of subsequent toxicities. METHODS Four weeks pre-radiotherapy, 45 men with prostate cancer rated their response expectancies of the same 18 toxicities on 5-point assessments and visual analogue scales, presented in random order. Descriptors anchored each end of visual analogue scales and every point of 5-point assessments was labelled, including an 'unsure' midpoint. Toxicities were subsequently assessed 2-weeks into radiotherapy on 100-point visual analogue scales. RESULTS Across all toxicities, 17.5-62.8% of patients selected 'unsure' on 5-point assessments. No response expectancies were reported on 5-point assessments for 'blood in stools' or 'rectal urgency' yet 54.8%-64.3% of patients indicated response expectancies for these toxicities on visual analogue scales. Visual analogue scales and 5-point scales demonstrated small-to-moderate associations (r = 0.30-0.58) as measures of response expectancy incidence, but mostly large associations when visual analogue scales captured severity (r = 0.43-0.76). Response expectancies measured with visual analogue scales predicted more toxicities to a moderate degree or greater (68.8%) than 5-point assessments (37.5%). CONCLUSION This novel investigation demonstrated an 'unsure' midpoint is often selected, potentially reducing the sensitivity of 5-point assessments. Based on their associations, and outcomes, these assessment formats should be considered independent in response expectancy research of cancer treatment toxicities.
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14
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Schmitz J, Müller M, Stork J, Eichler I, Zöllner C, Flor H, Klinger R. Positive Treatment Expectancies Reduce Clinical Pain and Perceived Limitations in Movement Ability Despite Increased Experimental Pain: A Randomized Controlled Trial on Sham Opioid Infusion in Patients with Chronic Back Pain. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:203-214. [PMID: 31302644 DOI: 10.1159/000501385] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/09/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Increasing evidence for the efficacy of analgesic placebo effects in laboratory studies with healthy persons raises the question whether placebos could be used to improve the treatment of pain patients. Expectancies play a central role in shaping analgesic placebo but also nocebo effects. OBJECTIVES We investigated to what extent a sham opioid infusion (saline solution) produces sustained clinically relevant placebo and nocebo effects in chronic back pain patients. METHODS Fifty-nine patients received the sham opioid infusion applied via a large drain dressing and were compared to 14 control patients without intervention (natural history, NH) while experimental pain stimuli were applied. All subjects were told that the infusion would decrease pain although in rare cases pain increase would be possible (induction of expectancy). In addition, conditioning was introduced where the participants either experienced a decrease in experimental pain (n = 17; placebo conditioning), an increase (n = 21; nocebo conditioning), or no change (n = 21, no conditioning). RESULTS Compared to the NH group, all infusion groups showed positive treatment expectancies and significantly (p < 0.001) reduced clinical back pain (primary outcome) and pain-related disability (secondary outcome, assessed by self-reported functional capacity and perceived impairment of mobility). Even the nocebo conditioned group experiencing increased experimental pain developed positive treatment expectancies followed by reduced pain experience. Positive treatment expectancies and relief in clinical back pain were significantly positively correlated (r = 0.72, p < 0.01). CONCLUSIONS These findings suggest that it may be beneficial to explicitly shape and integrate treatment expectancies into clinical pain management.
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Affiliation(s)
- Julia Schmitz
- Division of Pain Medicine and Pain Psychology, Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maike Müller
- Department of Anesthesiology, University Hospital of Würzburg, Würzburg, Germany
| | - Jan Stork
- Division of Pain Medicine and Pain Psychology, Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Iris Eichler
- Division of Pain Medicine and Pain Psychology, Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Zöllner
- Division of Pain Medicine and Pain Psychology, Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Regine Klinger
- Division of Pain Medicine and Pain Psychology, Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
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15
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Rottman BM, Wyatt G, Crane TE, Sikorskii A. Expectancy and Utilisation of Reflexology among Women with Advanced Breast Cancer. Appl Psychol Health Well Being 2020; 12:493-512. [PMID: 32022470 DOI: 10.1111/aphw.12194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Little is understood about patient expectations and use of complementary therapies (CT) during cancer treatment. A secondary analysis of an 11-week reflexology trial among women with breast cancer was conducted. We examined factors that predicted women's expectations about reflexology for symptom relief, factors that predicted utilisation of reflexology, and whether by the end of the trial they believed that reflexology had helped with symptom management. METHODS Women (N = 256) were interviewed at baseline and week 11. Friend or family caregivers in the reflexology group were trained to deliver standardised sessions to patients at least once a week for 4 weeks. Baseline and week-11 reflexology expectations were analysed using general linear models. Reflexology utilisation was analysed with generalised linear mixed effects models. RESULTS Patients who expected benefits from reflexology ("higher expectancy") at baseline were younger, had lower anxiety, higher education, higher spirituality, and greater CT use. Worsening symptoms over time were associated with greater utilisation of reflexology, but only when baseline expectancy was low. At week 11, expectancy was higher for those with greater symptom improvement. CONCLUSIONS Assessing patterns of patient factors, expectancy, and change in symptoms can help determine who is likely to use reflexology, and when.
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Affiliation(s)
| | - Gwen Wyatt
- Michigan State University College of Nursing, East Lansing, MI, USA
| | - Tracy E Crane
- University of Arizona College of Nursing, Tucson, AZ, USA
| | - Alla Sikorskii
- Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
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16
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Abstract
The role of psychological mechanisms in the treatment process cannot be underestimated, the well-known placebo effect unquestionably being a factor in treatment. However, there is also a dark side to the impact of mental processes on health/illness as exemplified by the nocebo effect. This phenomenon includes the emergence or exacerbation of negative symptoms associated with the therapy, but arising as a result of the patient's expectations, rather than being an actual complication of treatment. The exact biological mechanisms of this process are not known, but cholecystokinergic and dopaminergic systems, changes in the HPA axis, and the endogenous secretion of opioids are thought to be involved. The nocebo effect can affect a significant proportion of people undergoing treatment, including cancer patients, leading in some cases to the cessation of potentially effective therapy, because of adverse effects that are not actually part of the biological effect of treatment. In extreme cases, as a result of suggestions and expectations, a paradoxical effect, biologically opposite to the mechanism of the action of the drug, may occur. In addition, the nocebo effect may significantly interfere with the results of clinical trials, being the cause of a significant proportion of complications reported. Knowledge of the phenomenon is thus necessary in order to facilitate its minimalization and thus improve the quality of life of patients and the effectiveness of treatment.
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17
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Foufi V, Timakum T, Gaudet-Blavignac C, Lovis C, Song M. Mining of Textual Health Information from Reddit: Analysis of Chronic Diseases With Extracted Entities and Their Relations. J Med Internet Res 2019; 21:e12876. [PMID: 31199327 PMCID: PMC6595941 DOI: 10.2196/12876] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/06/2019] [Accepted: 05/21/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Social media platforms constitute a rich data source for natural language processing tasks such as named entity recognition, relation extraction, and sentiment analysis. In particular, social media platforms about health provide a different insight into patient's experiences with diseases and treatment than those found in the scientific literature. OBJECTIVE This paper aimed to report a study of entities related to chronic diseases and their relation in user-generated text posts. The major focus of our research is the study of biomedical entities found in health social media platforms and their relations and the way people suffering from chronic diseases express themselves. METHODS We collected a corpus of 17,624 text posts from disease-specific subreddits of the social news and discussion website Reddit. For entity and relation extraction from this corpus, we employed the PKDE4J tool developed by Song et al (2015). PKDE4J is a text mining system that integrates dictionary-based entity extraction and rule-based relation extraction in a highly flexible and extensible framework. RESULTS Using PKDE4J, we extracted 2 types of entities and relations: biomedical entities and relations and subject-predicate-object entity relations. In total, 82,138 entities and 30,341 relation pairs were extracted from the Reddit dataset. The most highly mentioned entities were those related to oncological disease (2884 occurrences of cancer) and asthma (2180 occurrences). The relation pair anatomy-disease was the most frequent (5550 occurrences), the highest frequent entities in this pair being cancer and lymph. The manual validation of the extracted entities showed a very good performance of the system at the entity extraction task (3682/5151, 71.48% extracted entities were correctly labeled). CONCLUSIONS This study showed that people are eager to share their personal experience with chronic diseases on social media platforms despite possible privacy and security issues. The results reported in this paper are promising and demonstrate the need for more in-depth studies on the way patients with chronic diseases express themselves on social media platforms.
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Affiliation(s)
- Vasiliki Foufi
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Tatsawan Timakum
- Department of Library and Information Science, Yonsei University, Seoul, Republic of Korea
| | - Christophe Gaudet-Blavignac
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Min Song
- Department of Library and Information Science, Yonsei University, Seoul, Republic of Korea
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18
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Devlin EJ, Whitford HS, Denson LA. The impact of valence framing on response expectancies of side effects and subsequent experiences: a randomised controlled trial. Psychol Health 2019; 34:1358-1377. [PMID: 31132015 DOI: 10.1080/08870446.2019.1609677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: Pre-treatment side effect expectancies often influence subsequent experiences; however, expectancy-based reduction strategies are lacking. We explored whether framing information about adverse responses (in positive or negative formats) altered expectancies and experiences of a cold pressor task. We further investigated associations between expectancies and experiences, to inform potential interventions. Design: Healthy volunteers (N = 134), randomised to receive positively- or negatively-framed pre-cold pressor task information, self-rated 12 expectancies for cold pressor experiences, emotional state and coping style. Main Outcome Measures: Self-reports of the same 12-experiences (recorded during and after the experiment) were assessed. Results: Framing had minimal impact on expectancies and experiences; however, discomfort threshold (p = .08, d = 0.22) showed a trend in the expected direction. Hierarchical regressions revealed expectancies uniquely, significantly predicted 6-23% of the variance for 11 subsequent experiences. Following a popular charity event (Ice Bucket Challenge), all participants showed higher 'discomfort thresholds' (p = .001, d = 0.59), and those in the negative frame reported more overall 'discomfort' (p = .01, d = 0.60) than participants in the positive condition. Conclusion: Expectancies uniquely influenced subsequent cold pressor experiences. Framing had minimal impact in this 'analogue' medical setting, only influencing 'discomfort threshold'. 'Discomfort threshold' and overall 'discomfort' were also impacted by a social media challenge, highlighting a potential area for intervention.
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Affiliation(s)
- Elise J Devlin
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide , Adelaide , SA , Australia
| | - Hayley S Whitford
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide , Adelaide , SA , Australia.,University of South Australia Cancer Research Institute , Adelaide , SA , Australia
| | - Linley A Denson
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide , Adelaide , SA , Australia
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19
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Meissner K, Talsky N, Olliges E, Jacob C, Stötzer OJ, Salat C, Braun M, Flondor R. Individual Factors Contributing to Nausea in First-Time Chemotherapy Patients: A Prospective Cohort Study. Front Pharmacol 2019; 10:410. [PMID: 31133847 PMCID: PMC6524707 DOI: 10.3389/fphar.2019.00410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/01/2019] [Indexed: 12/13/2022] Open
Abstract
Objective The expectation of developing side effects can enhance the likelihood to develop them – a phenomenon referred to as nocebo effect. Whether nocebo effects can be reduced by lowering negative expectancies, is not clear. The aim of this prospective study was to learn more about the factors contributing to nausea expectancy and their potential role in actual occurrence of nausea in patients undergoing chemotherapy for the first time in their life. Methods Patients scheduled for moderately emetogenic chemotherapeutic regimens filled in questionnaires to assess state anxiety and quality of life and to rate the expectancy of nausea as a side effect of chemotherapy. Patient diaries were used to monitor the severity of post-chemotherapy nausea in the 4 days following chemotherapy administration. Bivariate analyses complemented by multiple regression analyses were performed to identify the relationship between nausea expectation and nausea occurrence. Results 121 female patients (mean age 53 years) with completed questionnaires were included in the analyses. The majority of the patients had a diagnosis of breast cancer (86%). The two main sources for nausea expectancy were positive history of nausea in other situations and state anxiety. Patients with high expectancy levels (first quartile) experienced greater nausea than those with lower expectancy levels. Bivariate analyses revealed a weak but non-significant association between nausea expectation and post-chemotherapy nausea. When controlling for age, type of cancer, history of nausea, state and trait anxiety, and global quality of life, positive history of nausea (OR = 2.592; 95% CI, 1.0 to 6.67; p < 0.05), younger age (OR = 0.95; 95% CI, 0.92 to 0.99; p < 0.05), and a lower quality of life (OR = 0.97; 95% CI, 0.94 to 1.0; p < 0.05), but not nausea expectancy (OR = 1.014; 95% CI, 0.51 to 2.02; p = 0.969), predicted the occurrence of post-chemotherapy nausea. Conclusion In this female cohort, younger patients with lower initial quality of life and a positive history of nausea were at higher risk to develop nausea after first time chemotherapy. These patients may benefit from psychological co-interventions that aim to enhance quality of life.
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Affiliation(s)
- Karin Meissner
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Nicola Talsky
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Elisabeth Olliges
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Carmen Jacob
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany.,Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Oliver J Stötzer
- Haematology and Oncology, Outpatient Cancer Care Center, Munich, Germany
| | - Christoph Salat
- Haematology and Oncology, Outpatient Cancer Care Center, Munich, Germany
| | - Michael Braun
- Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany
| | - Raluca Flondor
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
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20
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Devlin EJ, Whitford HS, Denson LA, Potter AE. "Just As I Expected": A Longitudinal Cohort Study of the Impact of Response Expectancies on Side Effect Experiences During Radiotherapy for Prostate Cancer. J Pain Symptom Manage 2019; 57:273-281.e4. [PMID: 30447387 DOI: 10.1016/j.jpainsymman.2018.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Previous research has indicated that pretreatment response expectancies of side effects often predict subsequent toxicity severity. However, this has been largely based on female patients undergoing chemotherapy. OBJECTIVES We tested whether this association also occurred in a novel cohort, men with prostate cancer undergoing radiotherapy. We investigated these associations throughout treatment (before and after side effects were medically predicted to occur), controlling known and novel variables. METHODS Homogenous male patients scheduled for radiotherapy (N = 35, mean age 71 years) completed baseline (pretreatment) measures; response expectancies of 18 treatment-related side effects; questions about baseline health and hormonal treatment, emotional state, and coping style. Response expectancies of the side effects were again measured two weeks into treatment. The severity of the same 18 toxicities was assessed two and seven weeks into treatment. RESULTS Hierarchical multiple linear regressions revealed baseline response expectancies significantly and independently predicted six of 18 toxicities two weeks into radiotherapy, contributing 12%-30% of explained variance (β = 0.39-0.59). Response expectancies assessed two weeks into treatment significantly and uniquely predicted seven of 17 experienced toxicities at seven weeks, explaining 17%-50% of variance (β = 0.49-0.91). Sexual toxicity response expectancies revealed the strongest associations with experience throughout treatment (β = 0.46-0.91), with "inability to reach orgasm" showing the largest effect. CONCLUSION In this older male sample, response expectancies of side effects predicted experiences throughout treatment, including the period before toxicities were medically expected. Response expectancies of sexual side effects were robust, independent predictors of subsequent toxicities across treatment, especially issues with orgasm, warranting focus in practice and future research.
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Affiliation(s)
- Elise J Devlin
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Hayley S Whitford
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia; University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Linley A Denson
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew E Potter
- GenesisCare Radiation Oncology South Australia, Adelaide, South Australia, Australia
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21
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Pan Y, Kinitz T, Stapic M, Nestoriuc Y. Minimizing Drug Adverse Events by Informing About the Nocebo Effect-An Experimental Study. Front Psychiatry 2019; 10:504. [PMID: 31427995 PMCID: PMC6690228 DOI: 10.3389/fpsyt.2019.00504] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/26/2019] [Indexed: 12/16/2022] Open
Abstract
Relevance: Informing patients about potential adverse events as part of the informed consent may facilitate the development of nocebo-driven drug adverse events (nocebo side effects). Objective: To investigate whether informing about the nocebo effect using a short information sheet can reduce nocebo side effects. Methods: A total of N = 44 participants with weekly headaches for at least 6 months were recruited using the cover story of a clinical trial for a headache medicine. In reality, all participants took a placebo pill and were randomized to the nocebo information group or the standard leaflet group. Participants were instructed to read the bogus medication leaflet entailing side effects information shortly before pill intake. The nocebo group additionally received an explanation about the nocebo effect as part of the leaflet. Questionnaires were completed at baseline, 2 min, and 4 days after the pill intake. We conducted general linear models with bootstrap sampling. Baseline symptoms were included as a covariate. Results: Most participants (70.5%) reported nocebo side effects at 2 min. Participants who received the nocebo information (n = 24) reported less nocebo symptoms than the control group (n = 20) (estimated difference: 3.3, BCa 95% CI [1.14; 5.15], p = 0.01, Cohen's d = 0.59). Baseline symptoms, perceived sensitivity to medicine, and side effect expectations each moderated the group effect (estimated difference in slope: 0.47, BCa 95% CI [0.19; 0.73], p = 0.001, d = 0.75; 1.07 [0.27; 1.61], p = 0.006, d = 0.73; 1.57 [0.38; 2.76], p = 0.02, d = 0.58). No group differences were found at 4-day follow-up. After revealing the actual aim of the study, 86% of the participants evaluated the nocebo information to be helpful in general. Conclusions: Results provide the first evidence that informing about the nocebo effect can reduce nocebo side effects.
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Affiliation(s)
- Yiqi Pan
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Timm Kinitz
- Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Marin Stapic
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yvonne Nestoriuc
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces Hamburg, Hamburg, Germany
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22
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Quidde J, Pan Y, Salm M, Hendi A, Nilsson S, Oechsle K, Stein A, Nestoriuc Y. Preventing adverse events of chemotherapy by educating patients about the nocebo effect (RENNO study) - study protocol of a randomized controlled trial with gastrointestinal cancer patients. BMC Cancer 2018; 18:916. [PMID: 30249191 PMCID: PMC6154808 DOI: 10.1186/s12885-018-4814-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/12/2018] [Indexed: 01/19/2023] Open
Abstract
Background Patients undergoing chemotherapy are highly burdened by side effects. These may be caused by the pharmacodynamics of the drug or be driven by psychological factors such as negative expectations or pre-conditioning, which reflect nocebo effects. As such, negative pre-treatment expectations or prior experiences might exacerbate the burden of chemotherapy side effects. Educating patients about this nocebo effect has been put forward as a potential strategy to optimize patients’ pre-treatment expectations. In this study, we evaluate whether a briefing about the nocebo effect is efficacious in reducing side effects. Methods In this exploratory study, a total number of n = 100 outpatients with newly diagnosed gastrointestinal cancers are randomized 1:1 to an information session about the nocebo effect (nocebo-education) or an attention control group (ACG) with matching interaction time. Assessments take place before the intervention (T1 pre), post-intervention (T1 post), and 10 days (T2) and 12 weeks (T3) after the initial chemotherapy. The primary outcomes are the patient-rated number and intensity of side effects at 10-days and at 12-weeks follow-up. Secondary outcomes include coping with side effects, tendency to misattribute symptoms, compliance intention, attitude towards the chemotherapy, co-medication to treat side effects and the clinician-rated severity of toxicity. Further analyses are conducted to investigate whether a potential beneficial effect is mediated by a change of expectations before and after the intervention. Discussion Informing patients about the nocebo effect might be an innovative and feasible intervention to reduce the burden of side effects and strengthen patients’ perceived control over adverse symptoms. Trial registration The trial is registered at the German Clinical Trials Register (ID: DRKS00009501; retrospectively registered on March 27, 2018). The first patient was enrolled on September 29, 2015.
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Affiliation(s)
- Julia Quidde
- Department of Oncology, Haematology, Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Yiqi Pan
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Melanie Salm
- Clinical Psychology and Psychotherapy, University of Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany
| | - Armin Hendi
- Department of Oncology, Haematology, Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Sven Nilsson
- Department of Oncology, Haematology, Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Haematology, Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Alexander Stein
- University Cancer Center Hamburg, Hubertus Wald Tumorzentrum, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Yvonne Nestoriuc
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Fletcher C, Wilson C, Hutchinson AD, Grunfeld EA. The relationship between anticipated response and subsequent experience of cancer treatment-related side effects: A meta-analysis comparing effects before and after treatment exposure. Cancer Treat Rev 2018; 68:86-93. [DOI: 10.1016/j.ctrv.2018.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
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Pan Y, Heisig SR, von Blanckenburg P, Albert US, Hadji P, Rief W, Nestoriuc Y. Facilitating adherence to endocrine therapy in breast cancer: stability and predictive power of treatment expectations in a 2-year prospective study. Breast Cancer Res Treat 2018; 168:667-677. [PMID: 29330625 PMCID: PMC5842254 DOI: 10.1007/s10549-017-4637-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/23/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE To identify modifiable factors predictive of long-term adherence to adjuvant endocrine therapy (AET). METHODS As part of a 2-year cohort study in primary care (n = 116), we investigated whether initial treatment expectations predict adherence at 24 months after controlling for demographic, medical, and psychosocial variables. Treatment expectations were measured as necessity-concern beliefs, expected side-effect severity, and expected coping with side effects. Their stability over time and differences of trajectories between the adherent and nonadherent group were examined. RESULTS Nonadherence at 24 months was 14.7% (n = 17). Side-effect severity at 3 months [OR 0.25, 95% CI (0.08, 0.81), p = 0.02] and necessity-concern beliefs [OR 2.03, 95% CI (1.11, 3.72), p = 0.02] were the sole predictors of adherence. Necessity-concern beliefs remained stable over 2 years, whereas expected side-effect severity (p = 0.01, η p2 = 0.07) and expected coping with side effects became less optimistic over time (p < 0.001, η p2 = 0.19), the latter particularly among nonadherers (p < 0.01, η p2 = 0.10). CONCLUSIONS Patients' initial necessity-concern beliefs about the AET and early severity of side effects affect long-term adherence. Expecting poor management of side effects may also facilitate nonadherence. We suggest that discussing benefits, addressing concerns of AET, and providing side-effect coping strategies could constitute a feasible and promising option to improve adherence in clinical practice.
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Affiliation(s)
- Yiqi Pan
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
- Schön Klinik Hamburg Eilbek, University Clinic for Psychosomatic Medicine and Psychotherapy, Dehnhaide 120, 20081, Hamburg, Germany.
| | - Sarah R Heisig
- Clinical Psychology and Psychotherapy, University of Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Ute-Susann Albert
- AWMF-Institute for Medical Knowledge Management, Philipps-University of Marburg, Karl-von-Frisch-Str. 1, 35043, Marburg, Germany
| | - Peyman Hadji
- Department of Gynecology and Obstetrics, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Yvonne Nestoriuc
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
- Schön Klinik Hamburg Eilbek, University Clinic for Psychosomatic Medicine and Psychotherapy, Dehnhaide 120, 20081, Hamburg, Germany
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Maguire R, Hanly P, Drummond FJ, Gavin A, Sharp L. Expecting the worst? The relationship between retrospective and prospective appraisals of illness on quality of life in prostate cancer survivors. Psychooncology 2018; 27:1237-1243. [DOI: 10.1002/pon.4660] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/09/2018] [Accepted: 01/23/2018] [Indexed: 01/27/2023]
Affiliation(s)
| | - Paul Hanly
- National College of Ireland; Dublin Ireland
| | | | | | - Linda Sharp
- Newcastle University; Newcastle upon Tyne UK
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Shi ZX, Li HY, Yang XD, Gao H, Li DG, Yang WH, Yao F, Yan LX. Yi-qi-yang-yin-tang increases the sensitivity of KG1a leukemia stem cells to daunorubicin by promoting cell cycle progression and regulating the expression of PTEN, TOPOII and mTOR. Oncol Lett 2017; 14:6441-6448. [PMID: 29163680 PMCID: PMC5686439 DOI: 10.3892/ol.2017.7067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 07/14/2017] [Indexed: 11/29/2022] Open
Abstract
The present study aimed to investigate the effects of serum containing a combination of yi-qi-yang-yin-tang (YQYYT) and daunorubicin (DNR) on multidrug resistance in KG1a leukemia stem cells (LSCs). The effects of YQYYT and DNR on proliferation, cell cycle progression and the expression of phosphatase and tensin homolog (PTEN), topoisomerase II (Topo II) and mechanistic target of rapamycin (mTOR) in KG1a cells were investigated in vitro using cell counting kit-8 assay, flow cytometry, reverse transcription-quantitative polymerase chain reaction and western blotting, respectively. It was revealed that YQYYT-containing serum did not affect proliferation of KG1a cells compared with the blank group. Furthermore, there were no significant differences on the inhibition of proliferation among different groups at various concentrations of YQYYT. Treatment with YQYYT-containing serum (volume, 20 and 40 µl) and DNR was able to significantly inhibit the proliferation of KG1a cells compared with the blank group. The inhibition rate in the treatment group with YQYYT-containing serum (40 µl) and DNR for 48 h (72.5%) was higher compared with treatment for 24 h (60.4%, P<0.01). Treatment with YQYYT-containing serum was able to promote G0 phase of KG1a cells into cell cycle in a dose- and time-dependent manner, and significantly upregulated the mRNA expression of PTEN and Topo II, but did not affect mTOR expression compared with the blank group. Treatment with serum containing YQYYT alone did not directly affect the proliferation of KG1a cells, but when the cells were treated with a combination of YQYYT-containing serum and DNR, the proliferation of KG1a cells was significantly inhibited in a dose- and time-dependent manner. Furthermore, treatment with YQYYT-containing serum was able to promote cell cycle progression of KG1a cells in the G0 phase and upregulate the expression of the negative regulatory genes PTEN and Topo II. These results indicated the potential of YQYYT to reverse multidrug resistance in LSCs.
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Affiliation(s)
- Zhe-Xin Shi
- Department of Hematology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, P.R. China
| | - Hong-Yu Li
- Tianjin University of Traditional Chinese Medicine, Tianjin 300193, P.R. China
| | - Xiang-Dong Yang
- Department of Hematology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, P.R. China
| | - Hong Gao
- Department of Hematology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, P.R. China
| | - De-Guan Li
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Academy of Medical Science and Peking Union Medical College, Tianjin 300192, P.R. China
| | - Wen-Hua Yang
- Department of Hematology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, P.R. China
| | - Fang Yao
- Department of Hematology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, P.R. China
| | - Li-Xiang Yan
- Department of Hematology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, P.R. China
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Smith SG, Sestak I, Howell A, Forbes J, Cuzick J. Participant-Reported Symptoms and Their Effect on Long-Term Adherence in the International Breast Cancer Intervention Study I (IBIS I). J Clin Oncol 2017; 35:2666-2673. [PMID: 28661758 PMCID: PMC5549455 DOI: 10.1200/jco.2016.71.7439] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose To assess the role of participant-reported symptoms on long-term adherence to preventive therapy in the United Kingdom sample of the International Breast Cancer Intervention Study (IBIS-I). IBIS-I was a randomized controlled trial that investigated the effectiveness of tamoxifen in reducing the risk of breast cancer among women at increased risk of the disease. Participants and Methods Women were randomly assigned to tamoxifen versus placebo (20 mg/day; n = 4,279). After 456 exclusions, 3,823 women were included in this analysis. Adherence (< 4.5 years or ≥ 4.5 years) was calculated using data from six monthly clinical visits. Analyses were adjusted for age, Tyrer-Cuzick risk, smoking, use of hormone replacement therapy, menopausal status, baseline menopausal symptoms, and treatment. Results Overall, 69.7% of women were adherent for at least 4.5 years (tamoxifen: 65.2% v placebo: 74.0%; P < .001). Differences in adherence between treatment arms were observed from 12 months onward (all P < .01) and were largest at 54 months. Dropout rates were highest in the first 12 to 18 months and decreased thereafter. Women reporting nausea/vomiting were less likely to be adherent in both the tamoxifen (odds ratio [OR], 0.57; 95% CI, 0.37 to 0.86; P = .007) and placebo (OR, 0.58; 95% CI, 0.37 to 0.93; P = .023) arms. Headaches were associated with adherence only in the placebo arm (OR, 0.62; 95% CI, 0.42 to 0.91; P = .016), whereas gynecologic symptoms were significant only in the tamoxifen arm (OR, 0.77; 95% CI, 0.62 to 0.97; P = .024). Effect sizes for each symptom on adherence were not significantly different between the treatment groups ( P > .05). In both treatment arms, we observed significant trends for lower adherence with increasing severity for all symptoms ( P < .01) except headaches ( P = .054). Conclusion In the IBIS-I trial, experiencing predefined symptoms in the first 6 months reduced long-term adherence. Effects were similar between treatment arms, suggesting that women were attributing age-related symptoms to preventive therapy. Interventions were required to support symptom management.
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Affiliation(s)
- Samuel George Smith
- Samuel George Smith, Leeds Institute of Health Science, University of Leeds, Leeds; Samuel George Smith, Ivana Sestak, and Jack Cuzick, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Anthony Howell, Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom; and John Forbes, Calvary Mater Newcastle Hospital, Newcastle, Australia
| | - Ivana Sestak
- Samuel George Smith, Leeds Institute of Health Science, University of Leeds, Leeds; Samuel George Smith, Ivana Sestak, and Jack Cuzick, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Anthony Howell, Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom; and John Forbes, Calvary Mater Newcastle Hospital, Newcastle, Australia
| | - Anthony Howell
- Samuel George Smith, Leeds Institute of Health Science, University of Leeds, Leeds; Samuel George Smith, Ivana Sestak, and Jack Cuzick, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Anthony Howell, Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom; and John Forbes, Calvary Mater Newcastle Hospital, Newcastle, Australia
| | - John Forbes
- Samuel George Smith, Leeds Institute of Health Science, University of Leeds, Leeds; Samuel George Smith, Ivana Sestak, and Jack Cuzick, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Anthony Howell, Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom; and John Forbes, Calvary Mater Newcastle Hospital, Newcastle, Australia
| | - Jack Cuzick
- Samuel George Smith, Leeds Institute of Health Science, University of Leeds, Leeds; Samuel George Smith, Ivana Sestak, and Jack Cuzick, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Anthony Howell, Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom; and John Forbes, Calvary Mater Newcastle Hospital, Newcastle, Australia
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Mosher CE, Ott MA, Hanna N, Jalal SI, Champion VL. Development of a Symptom Management Intervention: Qualitative Feedback From Advanced Lung Cancer Patients and Their Family Caregivers. Cancer Nurs 2017; 40:66-75. [PMID: 26925990 PMCID: PMC5001932 DOI: 10.1097/ncc.0000000000000350] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about cancer patient and family caregiver preferences for the content and format of nonpharmacologic interventions. Revising interventions based on patient and caregiver feedback before implementation may improve intervention feasibility and acceptability, especially in the context of advanced-stage cancer. OBJECTIVES The aim of the study was to obtain feedback from patients with advanced-stage, symptomatic lung cancer and their family caregivers on the content and format of a nonpharmacologic symptom management intervention under development. The intervention blended evidence-based cognitive-behavioral and emotion-focused strategies to reduce physical and psychological symptoms. METHODS Semistructured qualitative interviews were conducted with 21 patients with advanced-stage, symptomatic lung cancer and caregivers. Participants reviewed handouts regarding intervention components and provided feedback. RESULTS Patients and caregivers desired intervention components that addressed the patient's high symptom burden such as education regarding treatment adverse effects and the provision of various coping tools. Offering interventions with a brief or flexible length and delivering them via telephone were other suggestions for enhancing intervention acceptability. Participants also preferred an equal focus on patient and caregiver concerns and a more positive intervention framework. CONCLUSIONS Intervention preferences of patients with advanced-stage lung cancer and caregivers underscore the severity of the disease and treatment process and the need to adapt interventions to patients with high symptom burden. These preferences may be incorporated into future intervention trials to improve participant recruitment and retention. IMPLICATIONS FOR PRACTICE Nurses can modify interventions to meet the needs of patients with advanced-stage, symptomatic lung cancer and caregivers. For example, flexibility regarding intervention content and length may accommodate those with significant symptoms.
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Affiliation(s)
- Catherine E Mosher
- Author Affiliations: Department of Psychology, Indiana University-Purdue University Indianapolis (Dr Mosher); and Departments of Pediatrics (Dr Ott) and Medicine (Drs Hanna and Jalal), School of Medicine, and School of Nursing (Dr Champion), Indiana University, Indianapolis
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Devlin EJ, Denson LA, Whitford HS. Cancer Treatment Side Effects: A Meta-analysis of the Relationship Between Response Expectancies and Experience. J Pain Symptom Manage 2017; 54:245-258.e2. [PMID: 28533160 DOI: 10.1016/j.jpainsymman.2017.03.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/22/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Although previous research has, overall, suggested a moderate relationship between response expectancies (REs) and cancer treatment-related side effects, empirical results have been mixed. OBJECTIVES We aimed to further explore these relationships, hypothesizing that REs would predict subsequent toxicities with the inclusion of more recent studies, across a broader range of side effects, while incorporating the impact of potential moderators including patients' experience with treatment and measurement methods. We further investigated the impact of REs across individual toxicities. METHODS A systematic search and analysis were conducted across four databases (PsychInfo, PubMed, CINAHL, and Embase) and reference lists, from 1985 to February 2016. This provided 27 eligible studies with 4474 participants, through which the main analysis, moderator analyses, and individual side-effect analyses were explored. RESULTS REs were moderately related to side effects overall (r = 0.26), and effect sizes were significantly influenced by sample diagnostic homogeneity, whereas differences between type and timing of measurement showed trends. Of the 16 toxicities examined, 15 demonstrated significant relationships between REs and side-effect experience, with hair loss (r = 0.48) the strongest. No clear difference emerged between objective and subjective side effects; however, significant differences across individual toxicities were revealed. CONCLUSION Findings support a relationship between REs and a wide range of subsequent side effects, yet differences between individual RE-toxicity associations emerged. These findings provide direction for the measurement of side effects and REs and support REs as potential targets for intervention during the informed consent process.
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Affiliation(s)
- Elise J Devlin
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Linley A Denson
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Hayley S Whitford
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia; Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
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Abstract
Accumulating evidence suggests an association between patient pretreatment expectations and numerous health outcomes. However, it remains unclear if and how expectations relate to outcomes after treatments in multidisciplinary pain programs. The present study aims at investigating the predictive association between expectations and clinical outcomes in a large database of chronic pain patients. In this observational cohort study, participants were 2272 patients treated in one of 3 university-affiliated multidisciplinary pain treatment centers. All patients received personalized care, including medical, psychological, and/or physical interventions. Patient expectations regarding pain relief and improvements in quality of life and functioning were measured before the first visit to the pain centers and served as predictor variables. Changes in pain intensity, depressive symptoms, pain interference, and tendency to catastrophize, as well as satisfaction with pain treatment and global impressions of change at 6-month follow-up, were considered as treatment outcomes. Structural equation modeling analyses showed significant positive relationships between expectations and most clinical outcomes, and this association was largely mediated by patients' global impressions of change. Similar patterns of relationships between variables were also observed in various subgroups of patients based on sex, age, pain duration, and pain classification. Such results emphasize the relevance of patient expectations as a determinant of outcomes in multimodal pain treatment programs. Furthermore, the results suggest that superior clinical outcomes are observed in individuals who expect high positive outcomes as a result of treatment.
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Coteţ CD, David D. The truth about predictions and emotions: Two meta-analyses of their relationship. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2015.12.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Orom H, Biddle C, Underwood W, Nelson CJ, Homish DL. What Is a "Good" Treatment Decision? Decisional Control, Knowledge, Treatment Decision Making, and Quality of Life in Men with Clinically Localized Prostate Cancer. Med Decis Making 2016; 36:714-25. [PMID: 26957566 DOI: 10.1177/0272989x16635633] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/02/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We explored whether active patient involvement in decision making and greater patient knowledge are associated with better treatment decision-making experiences and better quality of life (QOL) among men with clinically localized prostate cancer. Localized prostate cancer treatment decision making is an advantageous model for studying patient treatment decision-making dynamics because there are multiple treatment options and a lack of empirical evidence to recommend one over the other; consequently, it is recommended that patients be fully involved in making the decision. METHODS Men with newly diagnosed clinically localized prostate cancer (N = 1529) completed measures of decisional control, prostate cancer knowledge, and decision-making experiences (decisional conflict and decision-making satisfaction and difficulty) shortly after they made their treatment decision. Prostate cancer-specific QOL was assessed at 6 months after treatment. RESULTS More active involvement in decision making and greater knowledge were associated with lower decisional conflict and higher decision-making satisfaction but greater decision-making difficulty. An interaction between decisional control and knowledge revealed that greater knowledge was only associated with greater difficulty for men actively involved in making the decision (67% of sample). Greater knowledge, but not decisional control, predicted better QOL 6 months after treatment. CONCLUSIONS Although men who are actively involved in decision making and more knowledgeable may make more informed decisions, they could benefit from decisional support (e.g., decision-making aids, emotional support from providers, strategies for reducing emotional distress) to make the process easier. Men who were more knowledgeable about prostate cancer and treatment side effects at the time that they made their treatment decision may have appraised their QOL as higher because they had realistic expectations about side effects.
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Affiliation(s)
- Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA (HO, CB, DLH)
| | - Caitlin Biddle
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA (HO, CB, DLH)
| | - Willie Underwood
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA (WU)
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA (CJN)
| | - D Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA (HO, CB, DLH)
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Faasse K, Grey A, Horne R, Petrie KJ. High perceived sensitivity to medicines is associated with higher medical care utilisation, increased symptom reporting and greater information-seeking about medication. Pharmacoepidemiol Drug Saf 2015; 24:592-9. [DOI: 10.1002/pds.3751] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 12/11/2014] [Accepted: 12/13/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Kate Faasse
- Department of Psychological Medicine and Department of Medicine; The University of Auckland; Auckland New Zealand
- UCL School of Pharmacy; London UK
| | - Andrew Grey
- Department of Psychological Medicine and Department of Medicine; The University of Auckland; Auckland New Zealand
- UCL School of Pharmacy; London UK
| | - Rob Horne
- Department of Psychological Medicine and Department of Medicine; The University of Auckland; Auckland New Zealand
- UCL School of Pharmacy; London UK
| | - Keith J. Petrie
- Department of Psychological Medicine and Department of Medicine; The University of Auckland; Auckland New Zealand
- UCL School of Pharmacy; London UK
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Prady SL, Burch J, Vanderbloemen L, Crouch S, MacPherson H. Measuring expectations of benefit from treatment in acupuncture trials: A systematic review. Complement Ther Med 2015; 23:185-99. [DOI: 10.1016/j.ctim.2015.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 12/15/2014] [Accepted: 01/07/2015] [Indexed: 01/15/2023] Open
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von Blanckenburg P, Schuricht F, Heisig SR, Shedden-Mora MC, Rehahn-Sommer S, Albert US, Rief W, Nestoriuc Y. Psychologische Optimierung von Erwartungen zur Prävention von Nocebo-Nebenwirkungen bei Brustkrebs - 2 Fallberichte. VERHALTENSTHERAPIE 2015. [DOI: 10.1159/000377711] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Neukirch N, Colagiuri B. The placebo effect, sleep difficulty, and side effects: a balanced placebo model. J Behav Med 2014; 38:273-83. [PMID: 25119580 DOI: 10.1007/s10865-014-9590-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 08/01/2014] [Indexed: 11/28/2022]
Abstract
Medical treatment is usually accompanied by a warning about potential side effects. While constituting an important component of informed consent, these warnings may themselves contribute to side effects via the placebo effect. We tested this possibility using a 2 × 2 between-subjects design. Under the guise of a trial of a new hypnotic, 91 undergraduates experiencing difficulty sleeping were allocated to receive a warning about a target side effect (either increase or decrease in appetite, counterbalanced) or no warning and then to receive placebo treatment or no treatment for one week. Placebo treatment led to significantly better sleep on almost all self-reported outcomes, suggesting a placebo effect for reported sleep difficulty. Actigraphy recordings were unaffected by treatment. There was a clear effect of the warning in that placebo treated participants who were warned about side effects were much more likely to report the target side effect than those not warned about side effects. Implications for clinical practice are discussed.
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Affiliation(s)
- Nadine Neukirch
- School of Psychology, University of New South Wales, Sydney, Australia
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Chlebowski RT, Kim J, Haque R. Adherence to endocrine therapy in breast cancer adjuvant and prevention settings. Cancer Prev Res (Phila) 2014; 7:378-87. [PMID: 24441675 DOI: 10.1158/1940-6207.capr-13-0389] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adherence to oral endocrine therapy in adjuvant breast cancer settings is a substantial clinical problem. To provide current perspective on adherence to oral endocrine therapies, a comprehensive literature review was conducted. In adjuvant trials, endocrine therapy adherence is relatively high with greater adherence for aromatase inhibitors compared with tamoxifen. In contrast, adherence to adjuvant therapy in clinical practice is relatively poor, with only about 50% of women successfully completing 5-year therapy. Importantly, good adherence (>80% use) has been associated with lower recurrence risk. Endocrine therapy adherence in primary breast cancer prevention trials parallels that seen in adjuvant trials. Factors associated with nonadherence include low recurrence risk perception, side effects, age extremes, medication cost, suboptimal patient-physician communication, and lack of social support. Few prospective studies have evaluated interventions designed to improve adherence. Interventions currently proposed reflect inferences from clinical trial procedures in which clinical contacts are commonly greater than in usual practice settings. In conclusion, for optimal breast cancer outcome, adherence to endocrine therapy must improve. Although general recommendations likely to improve adherence can be made based on clinical trial results and preliminary prospective trial findings, research specifically targeting this issue is needed to establish effective intervention strategies.
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Affiliation(s)
- Rowan T Chlebowski
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, 1124 W. Carson Street, Bldg. J3, Torrance, CA 90502.
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von Blanckenburg P, Schuricht F, Albert US, Rief W, Nestoriuc Y. Optimizing expectations to prevent side effects and enhance quality of life in breast cancer patients undergoing endocrine therapy: study protocol of a randomized controlled trial. BMC Cancer 2013; 13:426. [PMID: 24047450 PMCID: PMC3848828 DOI: 10.1186/1471-2407-13-426] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 09/12/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Adjuvant endocrine therapy can improve disease-free survival and time before recurrence in breast cancer patients. However, it is associated with considerable side effects that negatively affect patients' quality of life and cause non-adherence. The recently demonstrated effect of individual expectations on side-effect development (nocebo effect) suggests that psychological factors play a role in the prevention of side effects. The aim of this study is to evaluate cognitive-behavioral side-effect prevention training (SEPT) for breast cancer patients. This article describes the study protocol and applied research methods. METHODS/DESIGN In a randomized controlled trial, 184 female breast cancer patients are assigned to receive either SEPT, standard medical care or a manualized supportive therapy at the start of adjuvant endocrine treatment. SEPT consists of three sessions of cognitive-behavioral training including psychoeducation to provide a realistic view of endocrine therapy, imagination-training to integrate positive aspects of medication into daily life, and side-effect management to enhance expectations about coping ability. Side effects three months after the start of endocrine therapy serve as primary outcomes. Secondary outcomes include quality of life, coping ability and patients' medication adherence. Patients' expectations (i.e., expectations about side effects, coping ability, treatment and illness) are analyzed as mediators. DISCUSSION The optimization of expectations might be a potential pathway in health care to improve patients' quality of life during long-term medication intake. The results will provide implications for a possible integration of evidence-based prevention training into clinical practice. TRIAL REGISTRATION ClinicalTrials.gov, (NCT01741883).
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Rodríguez M. Individual differences in chemotherapy-induced anticipatory nausea. Front Psychol 2013; 4:502. [PMID: 23950751 PMCID: PMC3738859 DOI: 10.3389/fpsyg.2013.00502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 07/17/2013] [Indexed: 12/05/2022] Open
Abstract
Anticipatory Nausea (AN) is a severe side effect of chemotherapy that can lead cancer patients to discontinue their treatment. This kind of nausea is usually elicited by the re-exposure of the patients to the clinical context they need to attend to be treated. There has been considerable agreement that AN represents a paradigmatic example of Pavlovian conditioning, and within this framework, several behavioral interventions have been proposed in order to prevent this phenomenon. However, some studies have questioned the validity of the Pavlovian approach, suggesting that CS-US associations are neither necessary nor sufficient for AN to occur. The data and the alternative theories behind such criticisms are discussed. Additionally, it is suggested that animal models of AN could be enriched by taking into account rats' individual differences.
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Affiliation(s)
- Marcial Rodríguez
- Laboratory of Comparative Psychology, Department of Experimental Psychology, Faculty of Education and Humanities, University of Granada Ceuta, Spain
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Anton R, David D. Response expectancy versus response hope in predicting birth-related emotional distress and pain. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2012; 48:954-63. [PMID: 23121203 DOI: 10.1080/00207594.2012.720376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Response expectancies and response hopes have been shown to be two distinct constructs with important implications for nonvolitional outcomes. More specifically, studies show that response expectancies: (1) are sufficient to cause nonvolitional outcomes, (2) are not mediated by other psychological variables, and (3) are self-confirming while seemingly automatic. A new programmatic research line has differentiated between people's response expectancies and their response hopes regarding nonvolitional outcomes and showed that even if response hope and response expectancy are separate constructs, they are not unrelated. These concepts have not yet been studied in pregnant women. Moreover, determining the causal factors that best explain the variance of emotional distress and pain in pregnancy is of great importance. Thus, the aim of this study was to investigate the interrelations between response expectancy and response hope in pregnant women with respect to (1) emotional distress prior to giving birth and (2) pain during giving birth. Additionally, self-reported labor hours were analyzed as a secondary outcome. Results show that response expectancy for pain directly predicts pain, and that the discrepancy between response hopes and response expectancies is a strong predictor of investigated outcomes. Thus, our results support the idea that preventive psychological interventions for pregnant women should emphasize adjusting response expectancies and response hopes regarding the pain and emotional distress associated with giving birth. We believe that the results have both theoretical and practical implications and the topic deserves further investigation.
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Affiliation(s)
- Raluca Anton
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
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Ferriolli E, Skipworth RJE, Hendry P, Scott A, Stensteth J, Dahele M, Wall L, Greig C, Fallon M, Strasser F, Preston T, Fearon KCH. Physical activity monitoring: a responsive and meaningful patient-centered outcome for surgery, chemotherapy, or radiotherapy? J Pain Symptom Manage 2012; 43:1025-35. [PMID: 22269181 DOI: 10.1016/j.jpainsymman.2011.06.013] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 06/25/2011] [Accepted: 06/28/2011] [Indexed: 11/26/2022]
Abstract
CONTEXT In surgical and clinical oncology, there is a growing need for patient-centered outcomes that are responsive, meaningful, and fit for purpose. OBJECTIVES The aim of this study was to validate physical activity (PA) monitoring as a responsive outcome measure at different stages of disease and treatment, by verifying correlations between PA, performance score, and quality of life (QoL). METHODS Daily life PA of 162 cancer patients, monitored by a device that records time sitting/lying, time standing, time walking, number of steps taken, and walking cadence, was compared with 20 healthy volunteers. In a subgroup of patients, functional status and QoL were assessed using the World Health Organization/Eastern Cooperative Oncology Group and the Karnofsky Performance Status scores and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) questionnaire. RESULTS The PA of patients with resectable gastrointestinal cancer did not differ significantly from controls. In contrast, patients with advanced cancer took 45% fewer steps and spent an extra 2.8 hours/day lying/sitting (P=0.001). Patients undergoing neoadjuvant chemotherapy and surgery (5-6 weeks after operation) experienced a similar reduction in PA. There were significant correlations between PA and the physical and role domains as well as fatigue subscale of the EORTC QLQ-C30 scale. CONCLUSION Objective PA scores correlate significantly with disease stage, functional status, and QoL of patients with cancer. Therefore, activity monitoring can make meaningful objective estimates of patient function in response to cancer and its treatment and may provide surrogate outcomes of QoL.
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Affiliation(s)
- Eduardo Ferriolli
- Clinical and Surgical Sciences, University of Edinburgh, Royal Infirmary Edinburgh, Edinburgh, Scotland, UK.
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Whitford HS, Olver IN. When expectations predict experience: the influence of psychological factors on chemotherapy toxicities. J Pain Symptom Manage 2012; 43:1036-50. [PMID: 22651947 DOI: 10.1016/j.jpainsymman.2011.06.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 06/20/2011] [Accepted: 06/28/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT Patients with cancer undergoing similar treatments experience variable severity and frequency of side effects not adequately explained by pharmacological mechanisms, suggesting psychological influence. OBJECTIVES First, this study aimed to further examine the relationship between patients' expectations of multiple chemotherapy-related toxicities and experiences. Second, this study aimed to explore the impact of anxiety and cancer coping styles to aid in informing interventions to lessen such expectations. METHODS A total of 59 eligible, consenting patients with cancer rated their expectations of 20 chemotherapy toxicities on 100-point linear analogue self-assessment indicators before treatment and completed the Spielberger State Anxiety Inventory and the Mental Adjustment to Cancer scale. Patients then rated their experience of side effects after one chemotherapy session. RESULTS Regressions controlling primary treating nurse influence and patient performance status showed toxicity experience was significantly predicted by patient expectations of mood changes, bleeding, skin itchiness, hair loss, feeling tired, and sleep disturbance (β=0.30-0.55). Anxiety was significantly related to expectations of nervousness and mood changes; the coping style Fighting Spirit showed no significant associations, whereas conversely, Anxious Preoccupation showed some degree of association with all 20 toxicities (r=0.11-0.34). CONCLUSION Findings support the growing contention that patient expectations influence experience, negatively impacting quality of life. As it is unethical to withhold treatment information, research into screening for at-risk patients and offering brief interventions to minimize Anxious Preoccupation could be one way to reduce overall side effect burden, perhaps in the case of many medical interventions.
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Mora MS, Nestoriuc Y, Rief W. Lessons learned from placebo groups in antidepressant trials. Philos Trans R Soc Lond B Biol Sci 2011; 366:1879-88. [PMID: 21576145 DOI: 10.1098/rstb.2010.0394] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This comprehensive review provides an overview about placebo and nocebo phenomena in antidepressant trials. Improvements in the placebo groups may partly be explained through methodological issues such as natural course of depression and regression to the mean, but also fundamentally reflect investigators' and participants' expectations. A meta-analysis by our group of 96 randomized placebo-controlled trials showed large placebo responses to antidepressant medication. Moderator analyses revealed substantially larger placebo responses in observer ratings compared with self-report. Effect sizes in observer ratings showed strong increase with publication year while this effect was not found for patients' self-ratings. This reflects the strong influence of investigators' expectations. The analysis of 'nocebo effects', e.g. adverse effects in placebo groups of antidepressant trials also confirms the impact of expectations: nocebo symptoms reflected the typical side-effect patterns expected in the drug group, with higher symptoms rates in the placebo groups of tricyclic antidepressant trials compared with placebo groups of trials testing selective serotonin reuptake inhibitors. While the placebo response seems to be similar for women and men, gender differences were found for nocebo rates. In the conclusion, we discuss potential implications for clinical trial designs and argue for interventions aimed at optimizing positive expectations of treatment benefit while minimizing the impact of adverse effects.
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Affiliation(s)
- Meike Shedden Mora
- Department of Clinical Psychology, Philipps University of Marburg, Marburg, Germany.
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Sohl SJ, Schnur JB, Sucala M, David D, Winkel G, Montgomery GH. Distress and emotional well-being in breast cancer patients prior to radiotherapy: an expectancy-based model. Psychol Health 2011; 27:347-61. [PMID: 21678183 PMCID: PMC3299868 DOI: 10.1080/08870446.2011.569714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Understanding precursors to distress and emotional well-being (EWB) experienced in anticipation of radiotherapy would facilitate the ability to intervene with this emotional upset (i.e. higher distress, lower EWB). Thus, this study tested an expectancy-based model for explaining emotional upset in breast cancer patients prior to radiotherapy. Women affected by breast cancer (N = 106) were recruited and participants completed questionnaires prior to commencing radiotherapy. Structural equation modelling was used to test a cross-sectional model, which assessed the ability of dispositional optimism (Life Orientation Test-Revised - two factors), response expectancies (Visual Analog Scale items), medical (type of surgery, cancer stage and chemotherapy history) and demographic (age, race, ethnicity, education and marital status) variables to predict both EWB (Functional Assessment of Chronic Illness Therapy - Emotional Well-being Subscale) and distress (Profile of Mood States - short version). The model represented a good fit to the data accounting for 65% of the variance in EWB and 69% in distress. Significant predictors of emotional upset were pessimism, response expectancies, Latina ethnicity, cancer stage and having had a mastectomy. These variables explained a large portion of emotional upset experienced prior to radiotherapy for breast cancer and are important to consider when aiming to reduce distress and improve EWB in this context.
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Affiliation(s)
- Stephanie J Sohl
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Abstract
Hypnotic suggestibility has been described as a powerful predictor of outcomes associated with hypnotic interventions. However, there have been no systematic approaches to quantifying this effect across the literature. This meta-analysis evaluates the magnitude of the effect of hypnotic suggestibility on hypnotic outcomes in clinical settings. PsycINFO and PubMed were searched from their inception through July 2009. Thirty-four effects from 10 studies and 283 participants are reported. Results revealed a statistically significant overall effect size in the small to medium range (r = .24; 95% Confidence Interval = -0.28 to 0.75), indicating that greater hypnotic suggestibility led to greater effects of hypnosis interventions. Hypnotic suggestibility accounted for 6% of the variance in outcomes. Smaller sample size studies, use of the SHCS, and pediatric samples tended to result in larger effect sizes. The authors question the usefulness of assessing hypnotic suggestibility in clinical contexts.
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Affiliation(s)
- Guy H Montgomery
- Department of Oncological Sciences, Box 1130, Mount Sinai School of Medicine, 1425 Madison Avenue, New York, NY 10029-6574, USA.
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48
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.1851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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49
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Montgomery GH, Schnur JB, Erblich J, Diefenbach MA, Bovbjerg DH. Presurgery psychological factors predict pain, nausea, and fatigue one week after breast cancer surgery. J Pain Symptom Manage 2010; 39:1043-52. [PMID: 20538186 PMCID: PMC2918882 DOI: 10.1016/j.jpainsymman.2009.11.318] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 11/10/2009] [Accepted: 11/10/2009] [Indexed: 11/27/2022]
Abstract
Before scheduled surgery, breast cancer surgical patients frequently experience high levels of distress and expect a variety of postsurgery symptoms. Previous literature has supported the view that presurgery distress and response expectancies are predictive of postsurgery outcomes. However, the contributions of distress and response expectancies to postsurgical side effect outcomes have rarely been examined together within the same study. Furthermore, studies on the effects of response expectancies in the surgical setting have typically focused on the immediate postsurgical setting rather than the longer-term setting. The purpose of the present study was to test the contribution of presurgery distress and response expectancies to common postsurgery side effects (pain, nausea, and fatigue). Female patients (n=101) undergoing breast cancer surgery were recruited to a prospective study. Results indicated that presurgery distress uniquely contributed to patients' postsurgery pain severity (P<0.05) and fatigue (P<0.003) one week after surgery. Response expectancies uniquely contributed to pain severity (P<0.001), nausea (P<0.012), and fatigue (P<0.010) one week after surgery. Sobel tests indicated that response expectancies partially mediated the effects of distress on pain severity (P<0.03) and fatigue (P<0.03). Response expectancies also mediated the effects of age on pain severity, nausea, and fatigue. Results highlight the contribution of presurgery psychological factors to postsurgery side effects, the importance of including both emotional and cognitive factors within studies as predictors of postsurgery side effects, and suggest presurgical clinical targets for improving patients' postoperative experiences of side effects.
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Affiliation(s)
- Guy H Montgomery
- Mount Sinai School of Medicine, New York, New York 10029-6574, USA.
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50
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Schnur JB, Montgomery GH. A systematic review of therapeutic alliance, group cohesion, empathy, and goal consensus/collaboration in psychotherapeutic interventions in cancer: Uncommon factors? Clin Psychol Rev 2010; 30:238-47. [PMID: 20006414 PMCID: PMC2830397 DOI: 10.1016/j.cpr.2009.11.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 11/17/2009] [Indexed: 12/14/2022]
Abstract
The effects of four empirically supported therapeutic relationship factors (therapeutic alliance, empathy, goal consensus/collaboration, and group cohesion) on the outcome of psychotherapeutic interventions conducted with individuals living with cancer were systematically reviewed. PubMed, PsycINFO, and CINAHL were searched from their inception through November 13, 2008. Studies of psychotherapeutic interventions targeted to individuals living with cancer, which also empirically assessed the association between any of these therapeutic relationship factors and psychotherapy outcome were included in the review (8 of 742 papers initially reviewed). Information on study methodology and results were abstracted independently by the authors using a standardized form. Results indicated that therapist-rated rapport and group cohesion were significantly related to positive psychotherapeutic outcomes. No studies examined empathy. The literature on collaboration was mixed, but showed some support for increased collaboration being related to positive therapeutic outcomes. Overall the current literature on the role of therapeutic relationship factors in the context of individuals living with cancer is scant, and much more research is needed to determine the overall contribution of these four relationship elements to the outcomes of psychotherapeutic interventions for individuals living with cancer. Results of such studies could have important clinical and research implications.
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Affiliation(s)
- Julie B Schnur
- Mount Sinai School of Medicine, Department of Oncological Sciences, 1425 Madison Avenue, Box 1130, New York, NY 10029-6574, USA.
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