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Patierno C, Fava GA, Carrozzino D. Illness Denial in Medical Disorders: A Systematic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:211-226. [PMID: 37429268 DOI: 10.1159/000531260] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/23/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Illness denial pertains to medical patients who do not acknowledge the presence or severity of their disease or the need of treatment. OBJECTIVE This systematic review was performed to clarify the clinical role and manifestations of illness denial, its impact on health attitudes and behavior, as well as on short- and long-term outcomes in patients with medical disorders. METHODS The systematic search according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines was conducted on PubMed, Scopus, and Web of Science. RESULTS The initial search yielded a total of 14,098 articles; 176 studies met the criteria for inclusion. Illness denial appeared to be a relatively common condition affecting a wide spectrum of health attitudes and behavior. In some cases, it may help a person cope with various stages of illness and treatment. In other situations, it may determine delay in seeking treatment, impaired adherence, and reduced self-management, leading to adverse outcomes. The Diagnostic Criteria for Psychosomatic Research (DCPR) were found to set a useful severity threshold for the condition. An important clinical distinction can also be made based on the DCPR for illness denial, which require the assessment of whether the patient has been provided with an adequate appraisal of the medical situation. CONCLUSIONS This systematic review indicates that patients with medical disorders experience and express illness denial in many forms and with varying degrees of severity. The findings suggest the need for a multidimensional assessment and provide challenging insights into the management of medical disorders.
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Affiliation(s)
- Chiara Patierno
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Danilo Carrozzino
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
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2
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Dogan E, Ozcelik H. Determine the Symptom Intensities, Performance and Hopelessness Levels of Advanced Lung Cancer Patients for the Palliative Care Approach. Am J Hosp Palliat Care 2022; 39:1325-1332. [PMID: 35234052 PMCID: PMC9527446 DOI: 10.1177/10499091211073528] [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] [Indexed: 11/15/2022] Open
Abstract
This research was conducted descriptively to determine the symptom intensities, performance and hopelessness levels of advanced lung cancer patients for the palliative care approach. The research sample consisted of 130 patients with advanced lung cancer, who were selected from 600 lung cancer populations in thoracic surgery and intensive care, outpatient chemotherapy, oncology in a university hospital in Turkey. Ethics Committee permission and the patients' written consent was obtained. Study data were collected face to face between January 2020 and July 2020 using the Edmonton Symptom Assessment System, Karnofsky Performance and Beck Hopelessness Scale. The mean age of the patients was 62.68 ± 8.867, 72.3% were males, and 89.2% were not currently working. The most common symptom in the patients was found to be fatigue 5.46 ± 2.12, worsening in general health and well-being 5.69 ± 1.87, loss of appetite 5.40 ± 2.59, and total symptom score 47.17 ± 19.03. Feelings and expectations about the future 1.40 ± 1.66, loss of motivation 3.43 ± 2.41, hope 2.05 ± 1.75, and total score of hopelessness 7.41 ± 6.01. There was a positive correlation between the patients' hopelessness level and their symptom burden, and a negative correlation was found with Karnofsky performance (P < .05). A significant difference was found between the patients' age, months since diagnosis, gender, education and employment status, stage of the disease, presence of metastases and analgesic use, and hopelessness scores (P < .05). It was determined that the symptom burden of patients with advanced lung cancer increased and as their Karnofsky performance decreased, their hopelessness level further increased. Hopelessness scores are affected by the socio-demographic and disease variables of the patients.
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Affiliation(s)
- Esra Dogan
- Nigde Bor State Hospital Orthopedic Service, 598724Nigde Omer Halisdemir University Zubeyde Hanim School of Health, Nigde, Turkey
| | - Hanife Ozcelik
- Department of Internal Medicine, 52989Nigde Omer Halisdemir University, Nigde, Turkey
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3
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Chu HY, Chan HS, Chen MF. Effects of Horticultural Activities on Attitudes toward Aging, Sense of Hope and Hand-Eye Coordination in Older Adults in Residential Care Facilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6555. [PMID: 34207071 PMCID: PMC8296344 DOI: 10.3390/ijerph18126555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 11/24/2022]
Abstract
This study investigated the effects of an 8-week horticultural activity intervention on attitudes toward aging, sense of hope, and hand-eye coordination in 88 older adults in residential care facilities. In the experimental group, the mean score for "attitudes toward aging" increased from 3.81 before the intervention to 4.74 points after the intervention (standard deviation SD = 0.24 and 0.27, respectively), and the control group dropped from 3.75 to 3.70 (standard deviations, respectively SD = 0.27 and 0.28). The mean score for "sense of hope" increased from 3.28 before the intervention to 3.81 points after the intervention (SD = 0.49 and 0.26, respectively). In contrast to the control group, the mean score gradually declined from 3.26 to 3.16 points (standard deviation SD = 0.54 and 0.48, respectively). In the test of hand-eye coordination, the time required to complete the cup stacking test significantly decreased from 33.56 to 25.38 s in the experimental group but did not significantly change in the control group. Generalized estimating equation analysis revealed a significant interaction between group and time (p < 0.001). The data trends revealed significant differences in outcomes between the experimental group and the control group. At 3 months after the end of the study, the effect size in the experimental group remained higher than that in the control group.
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Affiliation(s)
- Hui-Ying Chu
- Department of Living Services Industry, Tainan University of Technology, No. 529, Zhongzheng Rd., Yongkang District, Tainan City 71002, Taiwan
| | - Hui-Shan Chan
- Department of Applied Cosmetology, National Tainan Junior College of Nursing, 78 Sec. 2, Minzu Rd., Tainan City 70043, Taiwan;
| | - Mei-Fang Chen
- Department of Nursing, National Tainan Junior College of Nursing, 78 Sec. 2, Minzu Rd., Tainan City 70043, Taiwan;
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Scheau C, Draghici C, Ilie MA, Lupu M, Solomon I, Tampa M, Georgescu SR, Caruntu A, Constantin C, Neagu M, Caruntu C. Neuroendocrine Factors in Melanoma Pathogenesis. Cancers (Basel) 2021; 13:cancers13092277. [PMID: 34068618 PMCID: PMC8126040 DOI: 10.3390/cancers13092277] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Melanoma is a very aggressive and fatal malignant tumor. While curable if diagnosed in its early stages, advanced melanoma, despite the complex therapeutic approaches, is associated with one of the highest mortality rates. Hence, more and more studies have focused on mechanisms that may contribute to melanoma development and progression. Various studies suggest a role played by neuroendocrine factors which can act directly on tumor cells, modulating their proliferation and metastasis capability, or indirectly through immune or inflammatory processes that impact disease progression. However, there are still multiple areas to explore and numerous unknown features to uncover. A detailed exploration of the mechanisms by which neuroendocrine factors can influence the clinical course of the disease could open up new areas of biomedical research and may lead to the development of new therapeutic approaches in melanoma. Abstract Melanoma is one of the most aggressive skin cancers with a sharp rise in incidence in the last decades, especially in young people. Recognized as a significant public health issue, melanoma is studied with increasing interest as new discoveries in molecular signaling and receptor modulation unlock innovative treatment options. Stress exposure is recognized as an important component in the immune-inflammatory interplay that can alter the progression of melanoma by regulating the release of neuroendocrine factors. Various neurotransmitters, such as catecholamines, glutamate, serotonin, or cannabinoids have also been assessed in experimental studies for their involvement in the biology of melanoma. Alpha-MSH and other neurohormones, as well as neuropeptides including substance P, CGRP, enkephalin, beta-endorphin, and even cellular and molecular agents (mast cells and nitric oxide, respectively), have all been implicated as potential factors in the development, growth, invasion, and dissemination of melanoma in a variety of in vitro and in vivo studies. In this review, we provide an overview of current evidence regarding the intricate effects of neuroendocrine factors in melanoma, including data reported in recent clinical trials, exploring the mechanisms involved, signaling pathways, and the recorded range of effects.
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Affiliation(s)
- Cristian Scheau
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (C.C.)
| | - Carmen Draghici
- Dermatology Research Laboratory, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.D.); (M.A.I.); (M.L.); (I.S.)
| | - Mihaela Adriana Ilie
- Dermatology Research Laboratory, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.D.); (M.A.I.); (M.L.); (I.S.)
| | - Mihai Lupu
- Dermatology Research Laboratory, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.D.); (M.A.I.); (M.L.); (I.S.)
| | - Iulia Solomon
- Dermatology Research Laboratory, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.D.); (M.A.I.); (M.L.); (I.S.)
| | - Mircea Tampa
- Department of Dermatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.T.); (S.R.G.)
| | - Simona Roxana Georgescu
- Department of Dermatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.T.); (S.R.G.)
| | - Ana Caruntu
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania
- Correspondence:
| | - Carolina Constantin
- Immunology Department, Victor Babes National Institute of Pathology, 050096 Bucharest, Romania; (C.C.); (M.N.)
- Department of Pathology, Colentina University Hospital, 020125 Bucharest, Romania
| | - Monica Neagu
- Immunology Department, Victor Babes National Institute of Pathology, 050096 Bucharest, Romania; (C.C.); (M.N.)
- Department of Pathology, Colentina University Hospital, 020125 Bucharest, Romania
- Faculty of Biology, University of Bucharest, 076201 Bucharest, Romania
| | - Constantin Caruntu
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (C.C.)
- Department of Dermatology, “Prof. N. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
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5
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Abstract
Objectives: Hope/hopelessness is an important determinant of health and death, and is a modifiable risk factor for older adults. The present review aimed to evaluate the effectiveness of interventions on hope among older populations. Methods: PsychINFO and PubMed were systematically searched. Publications reporting on interventions delivered to older adults that included quantitative data on hope/hopelessness were systematically reviewed. Results: Thirty-six studies were included, most with hope/hopelessness as a secondary outcome. Interventions based on CBT alone or combined with antidepressants significantly decreased hopelessness in depressed older adults. Psychological interventions based on life review effectively improved hope/hopelessness in a range of samples, including depressed, bereaving, or medically ill older adults. Little to no support was found for exercise programs for healthy older adults, educational interventions for medically ill individuals, or Dignity Therapy for palliative care patients. Conclusions: Hope/hopelessness in older adults can be improved using psychological interventions based on CBT and life review. Controlled trials with hope/hopelessness as a primary objective are needed to more clearly demonstrate effectiveness. Clinical implications: Cognitive-behavioral interventions can improve hopelessness in depressed older adults. Life-review based interventions can positively impact hope in a range of older populations. Dignity Therapy, physical exercise, and educational programs may not effectively improve hope/hopelessness in older adults.
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Affiliation(s)
- Silvia C Hernandez
- Department of Psychological Sciences, Case Western Reserve University , Cleveland, Ohio, USA
| | - James C Overholser
- Department of Psychological Sciences, Case Western Reserve University , Cleveland, Ohio, USA
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Padrnos L, Scherber R, Geyer H, Langlais BT, Dueck AC, Kosiorek HE, Senyak Z, Clark M, Boxer M, Cotter M, Harrison C, Stonnington C, Geda Y, Mesa R. Depressive symptoms and myeloproliferative neoplasms: Understanding the confounding factor in a complex condition. Cancer Med 2020; 9:8301-8309. [PMID: 32976697 PMCID: PMC7666736 DOI: 10.1002/cam4.3380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/17/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022] Open
Abstract
Background Philadelphia chromosome negative myeloproliferative neoplasms (MPNs), including essential thrombocythemia, polycythemia vera, and myelofibrosis, have severe function‐limiting symptom burden that is experienced by the majority of patients. Previous studies have suggested that depression may be present in over a quarter of MPN patients, but to date no studies have evaluated the relationship between depression and other variables such as symptoms. Methods A 70‐item internet based survey regarding fatigue and mood symptoms was developed by a multidisciplinary team of MPN investigators, patients and patient advocates including Patient Health Questionnaire and the Myeloproliferative Neoplasm Symptom Assessment Form was completed by over 1300 patients with MPN diagnosis. Results There were 309 respondents (23%) with PHQ‐2 scores ≥ 3. In this analysis, we found worse systemic symptom burden in individuals reporting depressive symptoms. Conclusion This analysis suggests the importance of depression in contributing to as well as confounding symptomatology in MPN patients, and suggests that this critical variable should also be addressed by clinicians and researchers alike when comprehensively assessing symptom burden etiologies.
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Affiliation(s)
- Leslie Padrnos
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - Robyn Scherber
- Department of Hematology and Oncology, UT Health San Antonio MD Anderson Cancer Center, San Antonio, Portland, Texas, Oregon, USA
| | - Holly Geyer
- Division of Hospital Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Amylou C Dueck
- Division of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Zhenya Senyak
- MPN Forum, MPN Research Foundation, Chicago, IL, USA
| | - Matthew Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Mary Cotter
- MPN Forum, MPN Research Foundation, Chicago, IL, USA
| | - Claire Harrison
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,MPN Voice, London, United Kingdom
| | | | - Yonas Geda
- Department of Psychiatry and Psychology, Mayo Clinic, Scottsdale, AZ, USA.,Center for Bioelectronics and Biosensors, Arizona State University, Tempe, AZ, USA
| | - Ruben Mesa
- Department of Hematology and Oncology, UT Health San Antonio MD Anderson Cancer Center, San Antonio, Portland, Texas, Oregon, USA
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7
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Rymarczyk K, Turbacz A, Strus W, Cieciuch J. Type C Personality: Conceptual Refinement and Preliminary Operationalization. Front Psychol 2020; 11:552740. [PMID: 33041918 PMCID: PMC7525034 DOI: 10.3389/fpsyg.2020.552740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/20/2020] [Indexed: 12/24/2022] Open
Abstract
In this paper, we have presented our proposal for reconceptualization and operationalization of Type C (cancer-prone) personality. Based on theoretical analyses, taking into account both the literature on Type C and models of personality structure, we have proposed a two-facet structure of Type C, comprising Submissiveness (the interpersonal aspect) and Restricted Affectivity (the intrapersonal aspect). The study devoted to the validation of the measure of Type C involved 232 participants aged 18-70 (M = 29.35, SD = 8.93; 54% male). We used (a) our proposed measure of Type C personality and (b) the Circumplex of Personality Metatraits Questionnaire (CPM-Q-SF; Strus and Cieciuch, 2017), assessing personality metatraits. The measure of Type C proved to have acceptable internal consistency (Cronbach's alpha was 0.85 for Submissiveness and 0.78 for Restricted Affectivity). The measurement model in confirmatory factor analysis with two latent variables proved to be well-fitted to the data. We have also confirmed the hypothesis concerning the location of the two facets of Type C personality close to each other in the theoretically predicted area between the Delta-Plus/Self-Restraint and Beta-Minus/Passiveness metatraits (in the Circumplex of Personality Metatraits). The clinical value of the theoretically refined Type C can be tested in the next step in research on patients with cancer.
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Affiliation(s)
- Karolina Rymarczyk
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
| | - Anna Turbacz
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
| | - Włodzimierz Strus
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
| | - Jan Cieciuch
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
- URPP Social Networks University of Zurich, Zurich, Switzerland
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8
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Chernyshov PV, Lallas A, Tomas-Aragones L, Arenbergerova M, Samimi M, Manolache L, Svensson A, Marron SE, Sampogna F, Spillekom-vanKoulil S, Bewley A, Forsea AM, Jemec GB, Szepietowski JC, Augustin M, Finlay AY. Quality of life measurement in skin cancer patients: literature review and position paper of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes, Melanoma and Non-Melanoma Skin Cancer. J Eur Acad Dermatol Venereol 2019; 33:816-827. [PMID: 30963614 DOI: 10.1111/jdv.15487] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
The European Academy of Dermatology and Venereology (EADV) Task Forces (TFs) on Quality of Life (QoL) and Patient Oriented Outcomes, Melanoma and Non-Melanoma Skin Cancer (NMSC) present a review of the literature and position statement on health-related (HR) QoL assessment in skin cancer patients. A literature search was carried out to identify publications since 1980 that included information about the impact of SC on QoL. Generic, dermatology-specific, cancer-specific, SC-specific, facial SC-specific, NMSC-specific, basal cell carcinoma-specific and melanoma-specific QoL questionnaires have been used to assess HRQoL in SC patients. HRQoL was assessed in the context of creation and validation of the HRQoL instruments, clinical trials, comparison of QoL in SC and other cancers, other diseases or controls, HRQoL assessment after treatment, comorbidities, behaviour modification, predictors of QoL and survival, supportive care needs, coping strategies and fear of cancer recurrence. The most widely used instruments for HRQoL assessment in SC patients are the European Organisation for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30), the Functional Assessment of Cancer Therapy-Melanoma (FACT-M), Skin Cancer Index (SCI), Short Form 36 Item Health Survey (SF-36) and the Dermatology Life Quality Index (DLQI). The TFs recommend the use of the cancer-specific EORTC QLQ-C30, especially in late stages of disease, and the melanoma-specific FACT-M and SC-specific SCI questionnaires. These instruments have been well validated and used in several studies. Other HRQoL instruments, also with good basic validation, are not currently recommended because the experience of their use is too limited. Dermatology-specific HRQoL instruments can be used to assess the impact of skin-related problems in SC. The TFs encourage further studies to validate HRQoL instruments for use in different stages of SC, in order to allow more detailed practical recommendations on HRQoL assessment in SC.
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Affiliation(s)
- P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - M Arenbergerova
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - M Samimi
- Dermatology Department, University of Tours, Tours, France
| | - L Manolache
- Dermatology, Dali Medical, Bucharest, Romania
| | - A Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - S E Marron
- Department of Dermatology, Royo Villanova Hospital, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - F Sampogna
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS FLMM, Rome, Italy
| | - S Spillekom-vanKoulil
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Bewley
- Whipps Cross University Hospital, London, UK.,The Royal London Hospital, London, UK
| | - A M Forsea
- Department of Oncologic Dermatology and Allergology, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Y Finlay
- Department of Dermatology and Wound Healing, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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9
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Lehto US, Ojanen M, Väkevä A, Dyba T, Aromaa A, Kellokumpu-Lehtinen P. Early quality-of-life and psychological predictors of disease-free time and survival in localized prostate cancer. Qual Life Res 2019; 28:677-686. [PMID: 30511254 PMCID: PMC6394517 DOI: 10.1007/s11136-018-2069-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE The constructs evaluated in investigating association between psychosocial factors and cancer survival has varied between studies, and factors related to quality of life (QOL) have shown contradictory results. We investigated the effect of socioeconomic and early QOL and psychological factors on disease-free time and survival in localized prostate cancer. METHODS A consecutive sample of patients with localized prostate cancer (T1-3, N0, M0) treated with external beam radiotherapy completed validated questionnaires on coping with cancer (the Ways of Coping Questionnaire WOC-CA), anger expression (the Anger Expression Scale), life events (the Life Experience Survey), and various aspects of QOL (the Rotterdam Symptom Checklist, the Depression Scale DEPS, the EORTC QLQ-C30, the LENT-SOMA outcome measure) approximately 4.5 months after diagnosis. Cox regression analyses were used to determine the predictors of the disease-free and overall survival times measured from the date of diagnosis to the date of a PSA-relapse and date of death. RESULTS After controlling for biological prognostic factors, age, and adjuvant hormonal therapies, moderate and high socioeconomic status and an increased level of pain predicted longer survival, whereas an increased level of prostate-area symptoms and fatigue and, especially, reports of no/few physical symptoms were predictors of a shorter survival time. A longer PSA-relapse-free time was predicted by Cognitive Avoidance/Denial coping, whereas problems in social functioning, hopelessness, and an excellent self-reported QOL predicted a shorter PSA-relapse-free time. CONCLUSIONS Higher socioeconomic status was prognostic for longer survival, as previously reported. Patients with a seemingly good QOL (few physical complaints, excellent self-reported QOL) had poorer prognoses. This association may due to the survival decreasing effect of emotional non-expression; patients with high emotional non-expression may over-report their wellbeing in simple measures, and thus actually be in need of extra attention and care.
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Affiliation(s)
- Ulla-Sisko Lehto
- Medical School, Oncology, University of Tampere, 33014, Tampere, Finland.
- Public Health Evaluation and Projection, National Institute for Health and Welfare THL, Mannerheimintie 166, P.O. Box 30, 00271, Helsinki, Finland.
- Department of Oncology, Tampere University Hospital, PL 2000, 33521, Tampere, Finland.
| | - Markku Ojanen
- Department of Psychology, University of Tampere, 33014, Tampere, Finland
| | - Anna Väkevä
- Medical School, Oncology, University of Tampere, 33014, Tampere, Finland
- Department of Oncology, Tampere University Hospital, PL 2000, 33521, Tampere, Finland
| | - Tadeusz Dyba
- Finnish Cancer Registry, Pieni Roobertinkatu 9, 00130, Helsinki, Finland
- Joint Research Centre (JRC), European Commission, Building 58A/006, Via Enrico Fermi 2749, TP 581, 21027, Ispra, Italy
| | - Arpo Aromaa
- Public Health Evaluation and Projection, National Institute for Health and Welfare THL, Mannerheimintie 166, P.O. Box 30, 00271, Helsinki, Finland
| | - Pirkko Kellokumpu-Lehtinen
- Medical School, Oncology, University of Tampere, 33014, Tampere, Finland
- Department of Oncology, Tampere University Hospital, PL 2000, 33521, Tampere, Finland
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10
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Udumyan R, Montgomery S, Fang F, Valdimarsdottir U, Fall K. Stress Resilience in Late Adolescence and Survival among Cancer Patients: A Swedish Register-Based Cohort Study. Cancer Epidemiol Biomarkers Prev 2018; 28:400-408. [PMID: 30333220 DOI: 10.1158/1055-9965.epi-18-0451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/28/2018] [Accepted: 10/10/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chronic stress has been suggested to play a role in cancer progression, but few studies have so far examined the potential influence of stress susceptibility. This national register-based cohort study utilizes a unique data source to investigate whether a stress resilience measure is associated with survival in cancer patients. METHODS The cohort includes 9,318 Swedish male cancer patients born during 1952 to 1956 who had their stress resilience evaluated at a semistructured interview with a psychologist during mandatory conscription examination in late adolescence. RESULTS Over a median of 3 years of follow-up from cancer diagnosis, a total of 2,541 patients died (2,322 from cancer). Overall, low (23%) compared with high (25%) stress resilience was associated with increased mortality (adjusted hazard ratio estimated by Cox regression 1.45; 95% confidence interval 1.28-1.65), particularly among men with carcinomas of the oropharynx (2.62, 1.24-5.56), upper respiratory tract (4.64, 1.05-20.41), and prostate (2.20, 1.04-4.62), as well as with Hodgkin lymphoma (3.52, 1.40-8.86). An association was evident for both cancer types associated with smoking (1.35, 1.10-1.66) and malignancies without an established smoking etiology (1.32, 1.12-1.56). The association between low stress resilience and mortality could partly be explained by tumor stage, marital status, and psychiatric comorbidity at cancer diagnosis. CONCLUSIONS We observed an association between low stress resilience and mortality among men diagnosed with cancer, particularly oropharyngeal cancer, upper respiratory tract cancers, prostate cancer, and Hodgkin lymphoma. IMPACT These results suggest that individual variation in stress resilience may influence survival among men with some cancer types.
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Affiliation(s)
- Ruzan Udumyan
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Unnur Valdimarsdottir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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11
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Zhu AQ, Kivork C, Vu L, Chivukula M, Buczek JP, Qiu WWQ, Mwamburi M. The association between hope and mortality in homebound elders. Int J Geriatr Psychiatry 2017; 32:e150-e156. [PMID: 28185311 PMCID: PMC5552440 DOI: 10.1002/gps.4676] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/11/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite high rates of mortality and depression, there is limited knowledge of how depressive symptoms, especially feeling of hopefulness, affect mortality in the homebound elderly. METHODS We conducted a secondary analysis of data from a community sample of 1034 adults, age 60 years and older. The Center for Epidemiologic Studies Depression Scale was used to evaluate the mood symptoms and feeling of hopefulness at baseline. The death data were collected within an 8-year follow-up period. Analysis of variance and Chi-square were used to compare the clinical conditions among the groups of individuals who feel hopeful always, sometimes, and rarely. Logistic regression was used to explore the association between the hopefulness about the future and mortality as an outcome. RESULTS In the 8-year follow-up period, frequency of feeling hopeful, but not other individual depressive symptoms, was associated with mortality rate. The mortality rate among those who always, sometimes, and rarely felt hopeful were 21.6%, 26.4%, and 35.7%, respectively (P = 0.002). Logistic regression also confirmed that individuals who rarely feel hopeful had higher odds of decease within the 8-year follow-up period than those who always felt hopeful (OR = 1.74, CI = 1.14-2.65) after adjusting for age and medical conditions. CONCLUSIONS Baseline hopefulness predicts mortality outcome among the homebound elderly in the community. Identifying individuals who are depressed with hopelessness in the elderly and providing early intervention may improve the mortality rate. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Andrea Q. Zhu
- Department of Public Health and Family Medicine, Tufts University, Medford, MA, USA,Brown University, Providence, RI, USA
| | - Christine Kivork
- Pharmacology, Boston University School of Medicine, Boston, MA, USA,Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Linh Vu
- Pharmacology, Boston University School of Medicine, Boston, MA, USA
| | - Meenakshi Chivukula
- Alzheimers Disease Center, Boston University School of Medicine, Boston, MA, USA
| | | | - Wendy Wei Qiao Qiu
- Departments of Psychiatry, Boston University School of Medicine, Boston, MA, USA,Pharmacology, Boston University School of Medicine, Boston, MA, USA,Alzheimers Disease Center, Boston University School of Medicine, Boston, MA, USA
| | - Mkaya Mwamburi
- Department of Public Health and Family Medicine, Tufts University, Medford, MA, USA
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12
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The role of depression and personality traits in patients with melanoma: a South-European study. Melanoma Res 2017; 27:625-631. [DOI: 10.1097/cmr.0000000000000380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Eslami B, Kovacs AH, Moons P, Abbasi K, Jackson JL. Hopelessness among adults with congenital heart disease: Cause for despair or hope? Int J Cardiol 2017; 230:64-69. [DOI: 10.1016/j.ijcard.2016.12.090] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/18/2016] [Accepted: 12/16/2016] [Indexed: 11/25/2022]
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14
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Comparison of quality of life among long-term melanoma survivors and non-melanoma controls: a cross-sectional study. Qual Life Res 2017; 26:1761-1766. [PMID: 28243994 DOI: 10.1007/s11136-017-1532-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE Little is known about specific concerns facing long-term melanoma survivors. The goal of this study was to compare quality of life (QOL) and mental health between long-term melanoma survivors and population controls. METHODS Participants from a previously conducted case-control study of risk factors for melanoma were recruited for a cross-sectional survey. Generic QOL and emotional health were measured using the SF-36 and Hospital Anxiety and Depression Scale questionnaires. A total of 724 melanoma survivors and 660 controls participated. Most melanoma survivors had stage I disease (85.6%); mean time from diagnosis was 9.6 ± 1.0 years. Comparisons of QOL measures between melanoma survivors and controls were conducted using regression models, adjusting for potential confounders. RESULTS Melanoma survivors, compared to controls, reported statistically significant but only slightly higher physical functioning and bodily pain QOL subscale scores than controls and otherwise similar QOL as measured by the remaining six SF-36 subscale scores. Prevalence of anxiety (18.1% vs. 19.3%, adjusted OR = 1.00 (0.74, 1.36); p = 1.00) and depression (7.2% vs. 9.8%, adjusted OR = 0.74 (0.48, 1.16); p = 1.00) were similar between melanoma survivors and controls. CONCLUSION Long-term early stage melanoma survivors report similar general QOL and mental health compared to population controls. Further research is needed to identify concerns more specific to melanoma.
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Pereira MG, Ponte M, Ferreira G, Machado JC. Quality of life in patients with skin tumors: the mediator role of body image and social support. Psychooncology 2016; 26:815-821. [DOI: 10.1002/pon.4236] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 07/24/2016] [Accepted: 07/26/2016] [Indexed: 11/11/2022]
Affiliation(s)
| | - Mafalda Ponte
- School of Psychology; University of Minho; Braga Portugal
| | | | - José C. Machado
- Institute of Social Sciences; University of Minho; Braga Portugal
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16
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Pereira MG, Baia V, Machado JC. Coping and quality of life in patients with skin tumors in the follow-up stage: The mediating role of body image and psychological morbidity. J Psychosoc Oncol 2016; 34:400-12. [DOI: 10.1080/07347332.2016.1196807] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Sawamoto R, Nagano J, Kajiwara E, Sonoda J, Hiramoto T, Sudo N. Inhibition of emotional needs and emotional wellbeing predict disease progression of chronic hepatitis C patients: an 8-year prospective study. Biopsychosoc Med 2016; 10:24. [PMID: 27478498 PMCID: PMC4966853 DOI: 10.1186/s13030-016-0075-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 07/22/2016] [Indexed: 01/16/2023] Open
Abstract
Background The role of psycosocial factors in the disease progression of chronic hepatitis C (CHC) patients remains unclear. The aim of the present study was to prospectively evaluate the prognostic value of behavioral patterns and the quality of life (QOL) of patients with CHC. Methods Two hundred and forty Japanese CHC patients (mean age 62.4 years) were assessed for behavioral patterns (Stress Inventory), QOL (Functional Assessment of Chronic Illness Therapy-Spiritual), and known prognostic factors at baseline then followed for a maximum of 8 years for disease progression, defined as either the first diagnosis of hepatocellular carcinoma (HCC) or hepatitis-related death. Results Forty-nine events occurred during the study period (46 newly diagnosed HCC cases, three hepatitis-related deaths). In a Cox proportional hazard model including known prognostic factors and treatment-related factors as time-dependent variables, behavioral patterns associated with inhibition of emotional needs (hazard ratio (HR): 1.35; 95 % confidence interval (CI): 1.02–1.77; p = 0.036) and QOL, representing emotional wellbeing (HR 0.60; 95 % CI 0.37–0.98; p = 0.041), were each associated with the risk of disease progression. Conclusion Psychosocial factors such as behavioral patterns relevant to the inhibition of emotional needs and emotional wellbeing independently affect the clinical course of patients with CHC. Electronic supplementary material The online version of this article (doi:10.1186/s13030-016-0075-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ryoko Sawamoto
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku Fukuoka, 812-8582 Japan
| | - Jun Nagano
- Institute of Health Science, Kyushu University, Fukuoka, Japan
| | | | - Junko Sonoda
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku Fukuoka, 812-8582 Japan
| | - Tetsuya Hiramoto
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku Fukuoka, 812-8582 Japan
| | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku Fukuoka, 812-8582 Japan
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18
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Colucci R, Moretti S. The role of stress and beta-adrenergic system in melanoma: current knowledge and possible therapeutic options. J Cancer Res Clin Oncol 2015; 142:1021-9. [PMID: 26597413 DOI: 10.1007/s00432-015-2078-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 11/13/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of the present review was to discuss recent findings on the role of beta-adrenergic system in melanoma, in order to provide information on the biological responses elicited by its activation and its potential application for melanoma treatment. METHODS A literature search was performed, and evidences regarding the involvement of stress and beta-adrenergic system in cancer and melanoma were found and discussed. RESULTS Our search pointed out that beta-adrenergic system is a key regulator of important biological processes involved in the onset and progression of some solid tumors. In the last decade, functional beta-adrenoceptors have been also identified on melanoma cells, as well as on their microenvironment cells. Similarly to other common cancers too, the activation of such adrenoceptors by catecholamines, usually released under stress conditions, has been found to trigger pro-tumorigenic pathways contributing to cell proliferation and motility, immune system regulation, apoptosis, epithelial-mesenchymal transition, invasion and neoangiogenesis. CONCLUSIONS The biological evidences we found clarify and sustain the clinical evidences reporting the involvement of chronic stress in melanoma onset and progression. In such scenario, it is conceivable that a therapeutic approach targeting beta-adrenergic system could constitute a novel and promising strategy for melanoma treatment.
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Affiliation(s)
- Roberta Colucci
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Ospedale Piero Palagi, Viale Michelangelo 41, 50125, Florence, Italy.
| | - Silvia Moretti
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Ospedale Piero Palagi, Viale Michelangelo 41, 50125, Florence, Italy
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19
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Gheihman G, Zimmermann C, Deckert A, Fitzgerald P, Mischitelle A, Rydall A, Schimmer A, Gagliese L, Lo C, Rodin G. Depression and hopelessness in patients with acute leukemia: the psychological impact of an acute and life-threatening disorder. Psychooncology 2015; 25:979-89. [PMID: 26383625 DOI: 10.1002/pon.3940] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 06/01/2015] [Accepted: 07/15/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Acute leukemia (AL) is a life-threatening cancer associated with substantial morbidity and mortality, particularly in older adults. Given that there has been little research on the psychological impact of such malignancies with acute onset, we assessed the prevalence and correlates of depression and hopelessness in patients with AL. METHODS Three hundred forty-one participants were recruited within 1 month of diagnosis or relapse and completed the Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS), Memorial Symptom Assessment Scale, and other psychosocial measures. Multivariate regression analyses identified correlates of depression and hopelessness. RESULTS 17.8% reported clinically significant depressive symptoms (BDI-II ≥ 15), 40.4% of which were in the moderate-severe range (BDI-II ≥ 20). 8.5% reported significant symptoms of hopelessness (BHS ≥ 8). Depression was associated with greater physical symptom burden (adjusted R(2) = 48.4%), while hopelessness was associated with older age and lower self-esteem (adjusted R(2) = 45.4%). Both were associated with poorer spiritual well-being. CONCLUSIONS Clinically significant depressive symptoms were common early in the course of AL and related to physical symptom burden. Hopelessness was less common and associated with older age and lower self-esteem. The results suggest that whereas depression in AL may be related to disease burden, the preservation of hope may be linked to individual resilience, life stage, and realistic prognosis.Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Galina Gheihman
- Faculty of Arts & Science, University of Toronto, Toronto, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Campbell Family Cancer Research Institute, Ontario Cancer Institute, University Health Network, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Amy Deckert
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Peter Fitzgerald
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ashley Mischitelle
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Anne Rydall
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Aaron Schimmer
- Campbell Family Cancer Research Institute, Ontario Cancer Institute, University Health Network, Toronto, Canada.,Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Lucia Gagliese
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Campbell Family Cancer Research Institute, Ontario Cancer Institute, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,School of Kinesiology and Health Science, York University, Toronto, Canada.,Department of Anesthesia, University of Toronto, Toronto, Canada.,Department of Anesthesia, University Health Network, Toronto, Canada
| | - Chris Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Campbell Family Cancer Research Institute, Ontario Cancer Institute, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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20
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Beesley VL, Smithers BM, Khosrotehrani K, Khatun M, O'Rourke P, Hughes MCB, Malt MK, Zonta MJ, Bayley GJ, Barbour AP, Brown LJ, D'Arcy J, Allan CP, Green AC. Supportive care needs, anxiety, depression and quality of life amongst newly diagnosed patients with localised invasive cutaneous melanoma in Queensland, Australia. Psychooncology 2014; 24:763-70. [DOI: 10.1002/pon.3718] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 08/12/2014] [Accepted: 10/07/2014] [Indexed: 01/21/2023]
Affiliation(s)
- Vanessa L. Beesley
- Gynaecological Cancers Group; QIMR Berghofer Medical Research Institute; Brisbane QLD Australia
| | - B. Mark Smithers
- Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital; The University of Queensland; Brisbane QLD Australia
| | - Kiarash Khosrotehrani
- Experimental Dermatology Group, Centre for Clinical Research; The University of Queensland; Brisbane QLD Australia
- Diamantina Institute; The University of Queensland; Brisbane QLD Australia
| | - Mohsina Khatun
- Statistics Unit; QIMR Berghofer Medical Research Institute; Brisbane QLD Australia
| | - Peter O'Rourke
- Statistics Unit; QIMR Berghofer Medical Research Institute; Brisbane QLD Australia
| | - Maria Celia B. Hughes
- Cancer and Population Studies group; QIMR Berghofer Medical Research Institute; Brisbane QLD Australia
| | - Maryrose K. Malt
- Cancer and Population Studies group; QIMR Berghofer Medical Research Institute; Brisbane QLD Australia
| | | | - Gerard J. Bayley
- Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital; The University of Queensland; Brisbane QLD Australia
- Phoenix Plastic Surgery Institute; Brisbane QLD Australia
| | - Andrew P. Barbour
- Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital; The University of Queensland; Brisbane QLD Australia
| | - Lee J. Brown
- Kawana Private Hospital; Sunshine Coast QLD Australia
| | | | - Christopher P. Allan
- Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital; The University of Queensland; Brisbane QLD Australia
- Mater Health Services; Brisbane QLD Australia
| | - Adèle C. Green
- Cancer and Population Studies group; QIMR Berghofer Medical Research Institute; Brisbane QLD Australia
- Institute of Inflammation and Repair, Manchester Academic Health Science Centre; University of Manchester; Manchester UK
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21
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Molassiotis A, Brunton L, Hodgetts J, Green AC, Beesley VL, Mulatero C, Newton-Bishop JA, Lorigan P. Prevalence and correlates of unmet supportive care needs in patients with resected invasive cutaneous melanoma. Ann Oncol 2014; 25:2052-2058. [PMID: 25081900 DOI: 10.1093/annonc/mdu366] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Knowledge about supportive care needs in patients with cutaneous invasive melanoma is scarce. We examined the unmet needs of melanoma patients treated with surgery and factors associated with these needs to assist health professionals identify areas needing clinical attention. PATIENTS AND METHODS Cross-sectional multisite survey of UK patients ascertained 3 months to 5 years after complete resection of stage I-III cutaneous melanoma. Participants completed the following validated questionnaires: Supportive Care Needs Survey (SCNS-SF34 with melanoma module), Hospital Anxiety and Depression Scale and 51-item Functional Assessment of Cancer Therapy-Melanoma quality-of-life scale. RESULTS A total of 472 participants were recruited [319 (67%) clinical stage I-II). Mean age was 60 years (standard deviation = 14) and 255 (54%) were female. One hundred and twenty-three (27%) participants reported at least one unmet need (mostly 'low' level). The most frequently reported unmet needs were fears of cancer returning (n = 138, 29%), uncertainty about the future (n = 119, 25%), lack of information about risk of recurrence (n = 112, 24%) and about possible outcomes if melanoma were to spread (n = 91, 20%). One hundred and thirty-eight (29%) participants reported anxiety and 51 (11%) depression at clinical or subclinical levels. Patients with nodal disease had a significantly higher level of unmet supportive care needs (P < 0.001) as did patients with anxiety or depression (P < 0.001). Key correlates of the total SCNS-SF34 score for unmet supportive care needs were younger age (odds ratio, OR = 2.23, P < 0.001) and leaving school early (OR = 4.85, P < 0.001), while better emotional (OR = 0.89, P < 0.001) and social well-being (OR = 0.91, P < 0.001) were linked with fewer unmet needs. Neither patients' sex nor tumour thickness was associated with unmet needs. CONCLUSIONS Around a quarter of melanoma patients may have unmet support needs in the mid to long term after primary treatment. In particular, patients who are younger, less educated, distressed or socially isolated could benefit from more support.
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Affiliation(s)
- A Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong; School of Nursing, Midwifery and Social Work, University of Manchester, Manchester.
| | - L Brunton
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester
| | - J Hodgetts
- Christie NHS Foundation Trust, Manchester
| | - A C Green
- Institute of Inflammation and Repair, University of Manchester, Manchester, UK; Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Brisbane
| | - V L Beesley
- Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - J A Newton-Bishop
- Institute of Cancer Studies and Pathology, University of Leeds, Leeds, UK
| | - P Lorigan
- Christie NHS Foundation Trust, Manchester
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22
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Mauer ME, Bottomley A, Coens C, Gotay C. Prognostic factor analysis of health-related quality of life data in cancer: a statistical methodological evaluation. Expert Rev Pharmacoecon Outcomes Res 2014; 8:179-96. [DOI: 10.1586/14737167.8.2.179] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Beyond psychiatric classification in oncology: Psychosocial dimensions in cancer and implications for care. PSYCHO-ONCOLOGIE 2013. [DOI: 10.1007/s11839-013-0436-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zickmund SL, Yang S, Mulvey EP, Bost JE, Shinkunas LA, LaBrecque DR. Predicting cancer mortality: Developing a new cancer care variable using mixed methods and the quasi-statistical approach. Health Serv Res 2013; 48:2208-23. [PMID: 24138682 DOI: 10.1111/1475-6773.12116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2013] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To demonstrate the value of using a variable derived from qualitative analysis in subsequent quantitative analyses. DATA SOURCES/STUDY SETTING Mixed methods data were combined with 10-year mortality outcomes. Participants with cancer were recruited from services at a large teaching hospital, and mortality data were from the Social Security Death Index. STUDY DESIGN An observational concurrent or convergent mixed methods design was used to collect demographics and structured ratings along with qualitative data from 909 cancer patients at baseline. DATA COLLECTION/EXTRACTION METHODS Coding rules for qualitative data were defined for open-ended responses from cancer participants speaking about their view of self, and a variable was numerically coded for each case. Mortality outcomes were matched to baseline data, including the view of self variable. PRINCIPAL FINDINGS Individuals with an improved view of self had a significantly lower mortality rate than those for whom it was worse or unchanged, even when adjusting for age, gender, and cancer stage. CONCLUSIONS Statistical analysis of qualitative data is feasible and can identify new predictors with health services' implications associated with cancer mortality. Future studies should consider the value of testing coded qualitative variables in relation with key health care outcomes.
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Affiliation(s)
- Susan L Zickmund
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Kasparian NA. Psychological Care for People with Melanoma: What, When, Why and How? Semin Oncol Nurs 2013; 29:214-22. [DOI: 10.1016/j.soncn.2013.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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26
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Brandberg Y, Johansson H, Aamdal S, Bastholt L, Hernberg M, Stierner U, von der Maase H, Hansson J. Role functioning before start of adjuvant treatment was an independent prognostic factor for survival and time to failure. A report from the Nordic adjuvant interferon trial for patients with high-risk melanoma. Acta Oncol 2013; 52:1086-93. [PMID: 23621752 DOI: 10.3109/0284186x.2013.789140] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the role of health-related quality of life (HRQoL) at randomization as independent prognostic factors for survival and time to failure, and to explore associations between HRQoL and treatment effects. MATERIAL AND METHODS In the Nordic adjuvant interferon trial, a randomized trial evaluating if adjuvant therapy with intermediate-dose IFN had the same beneficial effects on overall and disease-free survival in high-risk melanoma as high-dose IFN, 855 patients in Denmark, Finland, Norway, and Sweden were included. The EORTC QLQ-C30 questionnaire was used to assess HRQoL before randomization. RESULTS A total of 785 (92%) agreed to participate in the HRQoL-study and provided baseline HRQoL data. Prognostic variables included in the multivariate model were age, sex, performance status, tumor thickness, stage, and number of positive lymph nodes. Univariate analyses revealed an association between prolonged survival and age, stage/ number of metastatic lymph nodes and the HRQoL variable role functioning (p ≤ 0.01). After controlling for other prognostic factors, these variables remained independently statistically significant for survival. The univariate analyses of time to failure showed significant associations with the clinical variable stage/nodes and with the HRQoL variables physical functioning and role functioning. Adjusted multivariate analyses including the same clinical conditions as above showed statistically significant relationships between time to failure and global quality of life, physical functioning, role functioning, social functioning and fatigue (p ≤ 0.01). No interactions between HRQoL variables and treatment were found, with the exception for cognitive functioning. CONCLUSION Role functioning was found to be an independent prognostic factor for time to failure and survival in patients with high-risk melanoma. Thus, also in this early stage of melanoma, HRQoL variables might be useful as important prognostic factors for time to failure and overall survival.
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Affiliation(s)
- Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
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27
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Loquai C, Scheurich V, Syring N, Schmidtmann I, Rietz S, Werner A, Grabbe S, Beutel ME. Screening for distress in routine oncological care-a survey in 520 melanoma patients. PLoS One 2013; 8:e66800. [PMID: 23861748 PMCID: PMC3702515 DOI: 10.1371/journal.pone.0066800] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 05/13/2013] [Indexed: 11/19/2022] Open
Abstract
Introduction Despite the increasing incidence of melanoma little is known about patients' emotional distress associated with this disease. Supplemented by the problem list (PL), the distress thermometer (DT) is a recommended screening instrument to measure psychosocial distress in cancer patients. Our objective was to explore the acceptance and the feasibility of the DT and PL as a concise screening tool in an ambulatory setting for routine care and to elucidate determinants of distress in melanoma patients with regard to sociodemographic and clinical variables. Methods Consecutive melanoma outpatients were asked to complete the DT with the PL prior to their scheduled consultation. Demographic and clinical data were obtained from the patients' charts. Clinical data included melanoma stage, time since diagnosis, previous treatment, current treatment, and other cancer disease. Results Out of 734 patients recruited into the study, 520 patients (71%) completed both the DT and the PL. Forty-seven percent met the ≥5 cut-off score for distress. Younger and employed patients reported higher distress than older and retired patients. A cut-off score of ≥5 was closely associated with self-reported emotional sources of distress, with practical problems, especially at work, family problems (dealing with the partner), and physical problems like pain, appearance, getting around, and nausea. Apart from higher distress under current systemic treatment, no associations were found between distress and clinical data. Conclusion The DT together with the PL seems to be an economically reasonable screening tool to measure psychosocial distress in melanoma patients. In particular, younger melanoma patients who are currently employed are prone to experience distress at some point after diagnosis, but there appears to be almost no association between clinical data and the extent of distress. To characterize the impact of distress on disease outcome and quality of life in melanoma patients, further research is needed.
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Affiliation(s)
- Carmen Loquai
- Department of Dermatology, University of Mainz, Mainz, Rhineland Palatinate, Germany.
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Kasparian NA. Psychological stress and melanoma: are we meeting our patients' psychological needs? Clin Dermatol 2013; 31:41-6. [PMID: 23245972 DOI: 10.1016/j.clindermatol.2011.11.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Approximately 30% of all patients diagnosed with melanoma report levels of psychological distress indicative of the need for clinical intervention. Despite this, the psychological and emotional needs of patients frequently go undetected and unmet. This contribution aims to provide clinicians and researchers with a succinct update on our understanding of the psychosocial challenges faced by individuals with melanoma. There is now strong evidence that psychological interventions can improve psychosocial outcomes for patients with melanoma, including reductions in general mood disturbance, depression, and anxiety. Further prospective cohort studies are required for a better understanding of the impact of psychological stress on melanoma survival and recurrence, as well as the potential psycho-neuro-immunological mechanisms involved.
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Affiliation(s)
- Nadine Angele Kasparian
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales. Old CCIA Building, Level 0, Sydney Children's Hospital, High Street, Randwick, NSW 2031, Australia.
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Abstract
BACKGROUND Social relationship quantity and quality are associated with mortality, but it is unclear whether each relationship dimension is equally important for longevity and whether these associations are sensitive to baseline health status. METHODS This study examined the individual and joint associations of relationship quantity (measured using a social integration score) and quality (measured by perceived social support) with mortality in a representative US sample (n = 30,574). The study also evaluated whether these associations were consistent across individuals with and without diagnosed chronic illness and whether they were independent of socioeconomic status (SES; education, income, employment, and wealth). Baseline data were collected in 2001 and were linked to vital status records 5 years later (1836 deaths). RESULTS Both social integration and social support were individually related to mortality (hazard ratios [HRs] = 0.83 [95% confidence interval {CI} = 0.80-0.85] and HR = 0.94 [95% CI = 0.89-0.98], respectively). However, in multivariate models including demographic and SES variables, social integration (HR = 0.86, 95% CI = 0.83-0.89) but not social support (HR = 1.03, 95% CI = 0.98-1.08) was associated with mortality. The social integration association was linear and consistent across baseline health status and men and women. CONCLUSIONS Social integration but not social support was independently associated with mortality in the US sample. This association was consistent across baseline health status and not accounted for by SES.
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Which symptoms matter? Self-report and observer discrepancies in repressors and high-anxious women with metastatic breast cancer. J Behav Med 2012; 37:22-36. [PMID: 23085787 DOI: 10.1007/s10865-012-9461-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 10/05/2012] [Indexed: 01/10/2023]
Abstract
Clinicians working with cancer patients listen to them, observe their behavior, and monitor their physiology. How do we proceed when these indicators do not align? Under self-relevant stress, non-cancer repressors respond with high arousal but report low anxiety; the high-anxious report high anxiety but often have lower arousal. This study extends discrepancy research on repressors and the high-anxious to a metastatic breast cancer sample and examines physician rating of coping. Before and during a Trier Social Stress Test (TSST), we assessed affect, autonomic reactivity, and observers coded emotional expression from TSST videotapes. We compared non-extreme (N = 40), low-anxious (N = 16), high-anxious (N = 19), and repressors (N = 19). Despite reported low anxiety, repressors expressed significantly greater Tension or anxiety cues. Despite reported high anxiety, the high-anxious expressed significantly greater Hostile Affect rather than Tension. Physicians rated both groups as coping significantly better than others. Future research might productively study physician-patient interaction in these groups.
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31
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Lehto US, Ojanen M, Dyba T, Aromaa A, Kellokumpu-Lehtinen P. Impact of life events on survival of patients with localized melanoma. PSYCHOTHERAPY AND PSYCHOSOMATICS 2012; 81:191-3. [PMID: 22433748 DOI: 10.1159/000334486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 10/09/2011] [Indexed: 11/19/2022]
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32
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Health-Related Quality of Life in Patients with Melanoma: Overview of Instruments and Outcomes. Dermatol Clin 2012; 30:245-54, viii. [DOI: 10.1016/j.det.2011.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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33
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Saito-Nakaya K, Bidstrup PE, Nakaya N, Frederiksen K, Dalton SO, Uchitomi Y, Verkasalo P, Koskenvuo M, Pukkala E, Kaprio J, Johansen C. Stress and survival after cancer: A prospective study of a Finnish population-based cohort. Cancer Epidemiol 2012; 36:230-5. [DOI: 10.1016/j.canep.2011.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 04/14/2011] [Accepted: 04/27/2011] [Indexed: 11/28/2022]
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34
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Cormier JN, Askew RL. Assessment of patient-reported outcomes in patients with melanoma. Surg Oncol Clin N Am 2011; 20:201-13. [PMID: 21111967 DOI: 10.1016/j.soc.2010.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Assessment of patient-reported outcomes (PROs) provides important information to assist with clinical decision making. There has been significant progress in the field of PROs over the past 2 decades with the introduction of validated disease- and symptom-specific instruments. The Functional Assessment of Cancer Therapy-Melanoma (FACT-M) is a melanoma-specific module to accompany the FACT-General, which was validated to assess health-related quality of life for patients with all stages of melanoma. Melanoma-specific health state utilities also have been reported from a number of studies. Assessment of PROs should be incorporated into routine clinical practice to inform clinicians and researchers of the patient perspective for clinical decision making and to evaluate the effects of psychosocial and medical interventions.
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Affiliation(s)
- Janice N Cormier
- Department of Surgical Oncology, Unit 444, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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35
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Barbato MT, Bakos L, Bakos RM, Prieb R, Andrade CDD. Preditores de qualidade de vida em pacientes com melanoma cutâneo no serviço de dermatologia do Hospital de Clínicas de Porto Alegre. An Bras Dermatol 2011; 86:249-56. [DOI: 10.1590/s0365-05962011000200007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 05/04/2010] [Indexed: 01/02/2023] Open
Abstract
FUNDAMENTOS: Alguns sintomas presentes nos pacientes com melanoma estão diretamente relacionados à tensão psicológ ica, o que reforça a necessidade de avaliar a qualidade de vida em todas as fases da doença. OBJETIVOS: Avaliar a qualidade de vida dos pacientes diagnosticados com melanoma por meio do questionário Fact-G. MÉTODOS: Estudo descritivo transversal que incluiu todos os pacientes em seguimento no serviço de dermatologia do Hospital de Clínicas de Porto Alegre entre julho e dezembro de 2006. RESULTADOS: Sessenta pacientes foram incluídos. A idade média foi de 55,6 anos. O nível de escolaridade até primeiro grau foi correlacionado a escores mais baixos no Fact-G. Os pacientes com história familiar apresentaram maiores escores de QoL em três das quatro categorias avaliadas: bem-estar físico, emocional e funcional (P < 0,01). Pacientes casados mostraram melhor qualidade de vida (82,42) que os solteiros (70,28; P < 0,01). Os pacientes com metástase obtiveram uma menor pontuação no questionário no domínio bem-estar funcional. CONCLUSÕES: Os fatores relacionados ao tumor, assim como o sexo, a idade e a situação de emprego, não foram preditores de qualidade de vida. Pacientes com metástases apresentaram pior qualidade de vida no domínio bem-estar funcional. Pacientes casados têm mais conforto e apoio emocional para lidar com o diagnóstico do tumor. Os pacientes com história familiar de melanoma tiveram melhor qualidade de vida e os com baixa escolaridade, uma pior qualidade de vida.
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Affiliation(s)
| | - Lucio Bakos
- Universidade Federal do Rio Grande do Sul, Brasil
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36
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Airoldi M, Garzaro M, Raimondo L, Pecorari G, Giordano C, Varetto A, Caldera P, Torta R. Functional and psychological evaluation after flap reconstruction plus radiotherapy in oral cancer. Head Neck 2011; 33:458-68. [DOI: 10.1002/hed.21471] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
BACKGROUND The goal of the present study was to analyze associations between depression and mortality of cancer patients and to test whether these associations would vary by study characteristics. METHOD Meta-analysis was used for integrating the results of 105 samples derived from 76 prospective studies. RESULTS Depression diagnosis and higher levels of depressive symptoms predicted elevated mortality. This was true in studies that assessed depression before cancer diagnosis as well as in studies that assessed depression following cancer diagnosis. Associations between depression and mortality persisted after controlling for confounding medical variables. The depression-mortality association was weaker in studies that had longer intervals between assessments of depression and mortality, in younger samples and in studies that used the Beck Depression Inventory as compared with other depression scales. CONCLUSIONS Screening for depression should be routinely conducted in the cancer treatment setting. Referrals to mental health specialists should be considered. Research is needed on whether the treatment of depression could, beyond enhancing quality of life, extend survival of depressed cancer patients.
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Affiliation(s)
- M Pinquart
- Department of Psychology, Philipps University, Marburg, Germany.
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38
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Nissim R, Flora DB, Cribbie RA, Zimmermann C, Gagliese L, Rodin G. Factor structure of the Beck Hopelessness Scale in individuals with advanced cancer. Psychooncology 2010; 19:255-63. [PMID: 19274620 DOI: 10.1002/pon.1540] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although the Beck Hopelessness Scale is often used with the seriously ill, its factor structure has been given relatively little consideration in this context. METHODS The factor structure of this scale was examined in a sample of 406 ambulatory patients with advanced lung or gastrointestinal cancer, using a sequential exploratory-confirmatory factor analysis procedure. RESULTS A two-factor model was consistent with the data: The first factor reflected a negative outlook and was labeled 'negative expectations'; the second factor identified a sense of resignation and was labeled 'loss of motivation.' CONCLUSIONS Implications regarding scoring of the scale in this population are discussed, as are implications of the two-factor structure for our understanding of hopelessness in individuals with advanced cancer.
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Affiliation(s)
- Rinat Nissim
- Behavioural Sciences and Health Research Division, Toronto General Research Institute, University Health Network, Toronto, Canada.
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39
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Montazeri A. Quality of life data as prognostic indicators of survival in cancer patients: an overview of the literature from 1982 to 2008. Health Qual Life Outcomes 2009; 7:102. [PMID: 20030832 PMCID: PMC2805623 DOI: 10.1186/1477-7525-7-102] [Citation(s) in RCA: 372] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 12/23/2009] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Health-related quality of life and survival are two important outcome measures in cancer research and practice. The aim of this paper is to examine the relationship between quality of life data and survival time in cancer patients. METHODS A review was undertaken of all the full publications in the English language biomedical journals between 1982 and 2008. The search was limited to cancer, and included the combination of keywords 'quality of life', 'patient reported-outcomes' 'prognostic', 'predictor', 'predictive' and 'survival' that appeared in the titles of the publications. In addition, each study was examined to ensure that it used multivariate analysis. Purely psychological studies were excluded. A manual search was also performed to include additional papers of potential interest. RESULTS A total of 451 citations were identified in this rapid and systematic review of the literature. Of these, 104 citations on the relationship between quality of life and survival were found to be relevant and were further examined. The findings are summarized under different headings: heterogeneous samples of cancer patients, lung cancer, breast cancer, gastro-oesophageal cancers, colorectal cancer, head and neck cancer, melanoma and other cancers. With few exceptions, the findings showed that quality of life data or some aspects of quality of life measures were significant independent predictors of survival duration. Global quality of life, functioning domains and symptom scores - such as appetite loss, fatigue and pain - were the most important indicators, individually or in combination, for predicting survival times in cancer patients after adjusting for one or more demographic and known clinical prognostic factors. CONCLUSION This review provides evidence for a positive relationship between quality of life data or some quality of life measures and the survival duration of cancer patients. Pre-treatment (baseline) quality of life data appeared to provide the most reliable information for helping clinicians to establish prognostic criteria for treating their cancer patients. It is recommended that future studies should use valid instruments, apply sound methodological approaches and adequate multivariate statistical analyses adjusted for socio-demographic characteristics and known clinical prognostic factors with a satisfactory validation strategy. This strategy is likely to yield more accurate and specific quality of life-related prognostic variables for specific cancers.
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Affiliation(s)
- Ali Montazeri
- Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran.
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40
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Weiss SJ, Haber J, Horowitz JA, Stuart GW, Wolfe B. The inextricable nature of mental and physical health: implications for integrative care. J Am Psychiatr Nurses Assoc 2009; 15:371-82. [PMID: 21659251 DOI: 10.1177/1078390309352513] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is growing evidence that physical health problems are caused and exacerbated by psychological factors. Research indicates that psychological distress leads to physical disease through impairment of the neuroendocrine system and its interface with the body's immune response. However, the current health care delivery system splinters care into "psychiatric" and "physical" health silos. New approaches are needed to assure adequate professional knowledge of behavioral health at basic licensure, to increase the use of advanced practice psychiatric-mental health nurses in primary care settings, to identify and teach behavioral competencies for primary care providers, and to fund the design and evaluation of integrative models of care.
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41
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[Psycho-oncological aspects of malignant melanoma. A systematic review from 1990-2008]. DER HAUTARZT 2009; 60:727-33. [PMID: 19701615 DOI: 10.1007/s00105-009-1814-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND METHODS Despite the increasing prevalence of malignant melanoma, psychosocial aspects have found little attention. A systematic review was conducted in order to identify psycho-oncological articles on patients with malignant melanoma. RESULTS Out of a total of 31 studies, 12 examine quality of life in malignant melanoma patients and 6 studies monitor quality of life in the course of therapy. Most studies originate from English-speaking countries (USA, UK, AU); few German studies have been published. Methodological limitations of the studies include cross-sectional assessment, unreported return rate, small sample sizes and comparability (heterogeneous or non-standardized psychosocial measures). CONCLUSIONS In addition to the tumor stage, psychosocial characteristics (coping with disease, social support) have a substantial effect on quality of life. Results from psychotherapy trials with malignant melanoma patients are encouraging. Given the overall high survival rates of malignant melanoma, quality of life and needs for care of long-term survivors need to be assessed.
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42
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Nausheen B, Gidron Y, Peveler R, Moss-Morris R. Social support and cancer progression: a systematic review. J Psychosom Res 2009; 67:403-15. [PMID: 19837203 DOI: 10.1016/j.jpsychores.2008.12.012] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 12/22/2008] [Accepted: 12/23/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The variability in the conceptualization and categorization of social support has resulted in mixed findings regarding its role in cancer progression. This systematic review identifies and summarizes the evidence for the significance of two important indices of social support in progression of different cancers. METHOD We used systematic and replicable methods to search, select, and evaluate findings. RESULTS Thirty-one longitudinal prospective findings (in 26 papers) which were selected for inclusion categorized social support into structural and functional support. The types of cancer included in these studies fell into three major categories: breast cancer (16), other cancer (10), and mixed cancers (5). Results suggest that the evidence for the relationship between social support and cancer progression is sufficiently strong for breast cancer as shown by five out of seven methodologically sound studies but consistently unconvincing for other types of cancer or in studies which combined different types of cancer. Structural support indices were found to be more frequently associated with disease progression than the indices of functional support in breast cancer. Disease-related variables such as severity, treatment, nodal status, and site of metastasis were found to be significant predictors of cancer progression, and it is suggested that these variables must be considered when conducting studies on the role of psychosocial factors in cancer-related outcomes including progression. CONCLUSION Methodological limitations of the studies and counterintuitive findings are discussed, and further conclusive research, particularly randomized controlled trials of social support interventions, is warranted to support the findings of this systematic review.
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Affiliation(s)
- Bina Nausheen
- Mental Health Group, Division of Clinical Neurosciences, School of Medicine, University of Southampton, Royal South Hants Hospital, Brinton's Terrace, Southampton, UK.
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Cornish D, Holterhues C, van de Poll-Franse LV, Coebergh JW, Nijsten T. A systematic review of health-related quality of life in cutaneous melanoma. Ann Oncol 2009; 20 Suppl 6:vi51-8. [PMID: 19617298 PMCID: PMC2712593 DOI: 10.1093/annonc/mdp255] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Melanoma can be considered an emerging chronic disease that may considerably affect patients’ lives. The authors systematically reviewed the available literature on health-related quality of life (HRQOL) and melanoma. Of reviews and the selected studies, reference lists were hand-searched. The quality of the eligible studies was appraised based on 14 previously published criteria. Of the 158 abstracts, 44 articles were appraised, resulting in 13 selected studies written in English (published between 2001 and 2008). Most studies assessed patients from specialised centres with varying, but relatively advanced, disease stages. The most commonly used instruments were the SF-36 and EORTC QLQ-C30. Recently, a melanoma-specific HRQOL questionnaire [FACT-Melanoma (FACT-M)] was introduced for clinical trial purposes. It showed that approximately one-third of melanoma patients experienced considerable levels of distress, mostly at the time of diagnosis and following treatment. Systemic therapies affected HRQOL negatively in the short term, but to a lesser extent in the long term. Health status and patients’ psychological characteristics are associated with higher levels of HRQOL impairment. The authors found that the impact of melanoma on patients’ HRQOL is comparable to that of other cancers. Accurately assessing HRQOL impairment in melanoma patients is pivotal, as it may affect disease management, including therapy and additional counselling, future preventive behaviour and perhaps even prognosis.
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Affiliation(s)
- D Cornish
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients. Cancer 2009; 115:5349-61. [PMID: 19753617 DOI: 10.1002/cncr.24561] [Citation(s) in RCA: 638] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Jillian R Satin
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.
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Renz M, Koeberle D, Cerny T, Strasser F. Between Utter Despair and Essential Hope. J Clin Oncol 2009; 27:146-9. [PMID: 19047303 DOI: 10.1200/jco.2008.19.2203] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Monika Renz
- From the Sections of Psychooncology and Musictherapy, Oncological Palliative Medicine; and the Division of Oncology/Hematology, Department of Internal Medicine, Cantonal Hospital, St Gallen, Switzerland
| | - Dieter Koeberle
- From the Sections of Psychooncology and Musictherapy, Oncological Palliative Medicine; and the Division of Oncology/Hematology, Department of Internal Medicine, Cantonal Hospital, St Gallen, Switzerland
| | - Thomas Cerny
- From the Sections of Psychooncology and Musictherapy, Oncological Palliative Medicine; and the Division of Oncology/Hematology, Department of Internal Medicine, Cantonal Hospital, St Gallen, Switzerland
| | - Florian Strasser
- From the Sections of Psychooncology and Musictherapy, Oncological Palliative Medicine; and the Division of Oncology/Hematology, Department of Internal Medicine, Cantonal Hospital, St Gallen, Switzerland
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Depression and cancer: recent data on clinical issues, research challenges and treatment approaches. Curr Opin Oncol 2008; 20:353-9. [PMID: 18525327 DOI: 10.1097/cco.0b013e3282fc734b] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Clinical guidelines for depression screening, assessment and management in the oncologic field and palliative care are becoming paramount in routine cancer care. This psychiatric comorbidity has several impacts on quality of life, anticancer treatment compliance, hospital stay duration, health-care costs, morbidity and possibly mortality even if discordant reports exist. RECENT FINDINGS Recent development of brain imaging techniques (MRI, positron emission tomography), neurobiological and genetic tools allow new understanding of the pathophysiology process of depressive disorders in cancer populations besides the usual endocrinologic and psychoneuroimmunologic hypothesis. Broader indications besides depressive or anxiety disorders appear or must be investigated for the new generation of antidepressants (selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, noradrenergic specific serotonergic antidepressants) in oncology, such as hot flashes, neuropathic pain, fatigue, anorexia/cachexia. Psychosocial interventions seem to have a slight impact on well-being, quality of life and depressive symptomatology but not on survival. SUMMARY The present article reviews recent literature on depression and cancer and highlights practical assessment and detection of depression, biological and physiopathological correlates and its pharmacologic and psychosocial treatment. Implementation of these several techniques must be supported by ongoing research about the complex relation between depressive disorders and generally mental health and oncology.
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Noncancer life stresses in newly diagnosed cancer. Support Care Cancer 2008; 16:1231-41. [PMID: 18386077 DOI: 10.1007/s00520-008-0410-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 01/17/2008] [Indexed: 10/22/2022]
Abstract
GOALS OF WORK Noncancer life stresses affect psychosocial stress processes and have an impact on quality of life (QOL) of the patients. However, investigating life stresses in cancer is a recent development. We evaluated the life stresses of newly diagnosed melanoma, breast cancer, and prostate cancer patients in detail and investigated their impact on QOL outcomes after localized cancer diagnosis. MATERIALS AND METHODS Life change events from the previous year (negative events, positive events, total impact of events, impacts of the negative events, and impacts of loss events) and chronic ongoing life strains were measured with the Life Experience Survey and the Chronic Strains Survey in newly diagnosed patients 3 months after the diagnosis. Also, perceived symptoms and QOL were measured, and in melanoma and breast cancer, these were repeated up to 2 years later. RESULTS Noncancer life stress was common in newly diagnosed cancer patients: Both acute and chronic life stresses were experienced by four-fifths. Loss events (fateful negative events or social loss events) were reported by one-third. Many patients had a preceding chronic illness. Along with the cancer and treatment stresses, the noncancer life stresses predicted poorer QOL, particularly psychological and depressive symptoms. Different life stresses predicted slightly different domains of QOL, and depressive symptoms tended to be predicted by several kinds of life stresses. Baseline life stresses had impact also on later QOL in breast cancer. CONCLUSIONS Noncancer life stresses are common among newly diagnosed cancer patients and have impact on QOL, and thus they should be taken into account in cancer care. Screening for noncancer life stresses may offer means to enhance QOL outcomes in cancer.
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