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Saucke MC, Jacobson N, McKinney G, Neuman HB. Role of the Surgeon in De-Escalating Emotion During a Breast Cancer Surgery Consultation: A Qualitative Study of Patients' Experiences in Alliance A231701CD. Ann Surg Oncol 2024:10.1245/s10434-024-16156-1. [PMID: 39320397 DOI: 10.1245/s10434-024-16156-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 08/23/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Patient engagement in decision making can improve satisfaction with care. Studies demonstrate that patients' emotional states can be significant barriers to engaging in shared decision making. OBJECTIVE We sought to examine how emotion associated with a breast cancer diagnosis impacts patient experiences during the surgical consultation, and explore opportunities for surgeons to mitigate the impact of emotion. METHODS We conducted 30 semi-structured interviews with patients who participated in the decision aid arm of Alliance A231701CD, had low engagement, and experienced barriers to engagement. We used qualitative content analysis to analyze the interview data and organize it into overarching themes. RESULTS Participants recalled strong emotions with their diagnosis, describing it as devastating and shocking. Although several participants said that their emotional reaction to the diagnosis lessened over time, others expressed still feeling very anxious. Participants described ways in which their surgeon helped to de-escalate their emotional state, beginning with the establishment of rapport and continuing through treatment planning. Participants valued surgeons who they perceived to be personable and compassionate, treated them as an individual, provided reassuring and matter-of-fact information about their cancer, and efficiently communicated plans for next steps. CONCLUSIONS Patients with breast cancer are often emotionally overwhelmed during their surgical consults, which impedes their ability to listen and participate in decision making. However, surgeon behaviors can help de-escalate emotions. Addressing emotion is critical to support patients in reaching a decision for breast cancer surgery and is likely to improve patient satisfaction with the decision process. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov identifier: NCT03766009.
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Affiliation(s)
- Megan C Saucke
- Wisconsin Surgical Outcomes Research Program, University of Wisconsin, Madison, WI, USA
| | - Nora Jacobson
- University of Wisconsin Institute for Clinical and Translational Research, Madison, WI, USA
| | - Grace McKinney
- Wisconsin Surgical Outcomes Research Program, University of Wisconsin, Madison, WI, USA
| | - Heather B Neuman
- Wisconsin Surgical Outcomes Research Program, University of Wisconsin, Madison, WI, USA.
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
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2
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Chiu HC, Lin CY, Kuo YL, Hou WL, Shu BC. Resilience among women with breast cancer surviving longer than five years: The relationship with illness perception and body image. Eur J Oncol Nurs 2023; 62:102254. [PMID: 36621263 DOI: 10.1016/j.ejon.2022.102254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aimed to investigate the correlations and identify the relationships between the resilience, perception of illness and body image of women with breast cancer in the 5-year-or-above survivorship. METHODS We used convenient sampling to recruit from an outpatient department 106 women with breast cancer. The inclusion criteria were participants aged >20 years currently in a stable condition and were able to understand the Chinese language. Those women with mental health illness were excluded. All participants completed questionnaires on the following: demographic information, revision of illness perception (IPQ-R), body image scale (BIS), Eysenck personality questionnaire (EPQ), and resilience scale (RS). We conducted the structural equation modeling (SEM) to explore the factor structure. RESULTS SEM results showed a good fit to the data (comparative fit index = 0.97, Tucker-Lewis index = 0.94). Findings F indicated the existence of significant relationships between resilience and either illness perception or body image. Personality had a direct association with illness perception (β = 0.73, P < 0.05). Body image had an indirect effect on the relationship between resilience and illness perception (coefficient = -2.52; 95% bootstrapping CI = -31.36, -0.62). CONCLUSIONS Results indicated that illness perception is a crucial predictor for better resilience as mediated through body image. To provide adequate information to women with breast cancer can improve their perception of breast cancer more positively. Hence, their body image and their way of coping with survival life turn better.
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Affiliation(s)
- Hsing-Chan Chiu
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Nursing, Tainan Municipal Hospital, Show Chwan Health Care System, Tainan, Taiwan
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yao-Lung Kuo
- Department of Surgery, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan; Breast Medical Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wen-Li Hou
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Bih-Ching Shu
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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3
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Peng F, Li H, Zhang J, Li X, Zhang H, Li Y. Effects of different psychological interventions on quality of life and remission rate in patients with acute leukemia receiving chemotherapy: A randomized controlled trial. Front Psychol 2023; 14:1045031. [PMID: 36874817 PMCID: PMC9978370 DOI: 10.3389/fpsyg.2023.1045031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Aims This study aimed to examine and compare different psychological intervention effects on the quality of life (QoL) and remission rates of patients with acute leukemia receiving chemotherapy. Methods A total of 180 participants were randomly divided into a cognitive intervention group, a progressive muscle relaxation (PMR) group, a cognitive intervention plus PMR group, and a usual care control group. QoL via the Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 and remission rate were assessed at baseline and immediate post-intervention. A Generalized Linear Mixed Model was used for statistical analysis. Cost-effectiveness analysis with the value of the Incremental Cost-effectiveness Ratio was conducted to realize the economic evaluation of psychological interventions. Results The total score of QoL and its most dimensions were significantly improved for participants in the intervention groups compared with the control group. The cognitive intervention plus PMR intervention was the most effective concerning QoL with cost-effectiveness. No significant improvements were indicated in participants' remission rates among the groups. Conclusion The cognitive intervention plus PMR intervention is the most effective in improving QoL with cost-effectiveness among patients with acute leukemia receiving chemotherapy. More rigorous randomized controlled trials with multiple follow-up points are suggested to clarify the psychological interventions on remission rates in this population.
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Affiliation(s)
- Fang Peng
- Changsha Social Work College, Changsha, China
| | - Huiyuan Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jingping Zhang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiaoyun Li
- Second Xiangya Hospital of Central South University, Changsha, China
| | - Haimiao Zhang
- The School of Nursing and Rehabilitation, Xi'an Medical University, Xi'an, China
| | - Yifei Li
- Xiangya School of Nursing, Central South University, Changsha, China
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4
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Honari S, Soltani D, Mirimoghaddam MM, Kheiri N, Rouhbakhsh Zahmatkesh MR, Saghebdoust S. Post-Traumatic Stress Disorder and Post-Traumatic Growth in Patients with Breast Cancer: A Retrospective Cross-Sectional Study in a Developing Country. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00654-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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5
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Hutchens J, Frawley J, Sullivan EA. Quality of life and mental health of women who had cardiac disease in pregnancy and postpartum. BMC Pregnancy Childbirth 2022; 22:797. [PMID: 36307772 PMCID: PMC9617394 DOI: 10.1186/s12884-022-05123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/25/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Cardiac disease is a leading cause of maternal morbidity and mortality yet there is limited research on women’s experiences and quality of life (QoL) outcomes. The aim of this study is to explore the general and health-related QoL (HRQoL) and mental health outcomes for women who have experienced cardiac disease in pregnancy and the first 12 months postpartum (CDPP). Methods This exploratory descriptive study recruited 43 women with acquired, genetic and congenital CDPP. Patient reported outcomes measures (PROMs) used were: WHOQoL-Bref, a Kansas City Cardiac Questionnaire (KCCQ), the Depression, Anxiety and Stress Scales-21 (DASS-21), the Cardiac Anxiety Questionnaire (CAQ) plus newly developed questions. Results Women reported low health satisfaction (51.7/100), physical health (55.2/100) and low HRQoL (63.1/100). Women had clinically significant scores for depression (24%), anxiety (22%) and stress (19.5%) (DASS-21) and 44.5% scored at least moderate anxiety on the CAQ. Most women (83.7%) were advised to avoid pregnancy which 88.9% found “upsetting” to “devastating”; 10.0% were offered counselling. Most women were concerned about reduced longevity (88.1%), offspring developing a cardiac condition (73.8%), and the limitations on enjoyment of life (57.1%). Women missed medical appointments due to cost (25.03%) and difficulty arranging childcare (45.5%). Conclusion The majority of women reported inadequate information and counselling support, with women with CDPP having sustained impaired QoL and mental health outcomes. The new and modified questions relating to mothering and children reflected the primacy of mothering to women’s identity and needs. Supplementary information The online version contains supplementary material available at 10.1186/s12884-022-05123-x.
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Bach A, Knauer K, Graf J, Schäffeler N, Stengel A. Psychiatric comorbidities in cancer survivors across tumor subtypes: A systematic review. World J Psychiatry 2022; 12:623-635. [PMID: 35582337 PMCID: PMC9048448 DOI: 10.5498/wjp.v12.i4.623] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/20/2021] [Accepted: 03/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Psychiatric disorders are common but underdiagnosed in cancer survivors. Research suggests that tumor type has an effect on the prevalence of clinically relevant depression, anxiety, comorbid anxiety-depression and posttraumatic stress disorder (PTSD).
AIM To identify studies that examined the prevalence of clinically relevant levels of depression, anxiety, comorbid anxiety-depression and PTSD for patients with one or more tumor sites and compare those prevalences between cancer subtypes.
METHODS Four databases (PubMed, PsycInfo, PubPsych and the Cochrane Database) were searched and resulted in a total of 2387 articles to be screened. To be included, a study must have investigated cancer-free and posttreatment survivors using tools to assess clinically relevant levels of the listed psychiatric comorbidities. All articles were screened by two authors with a third author reviewing debated articles.
RESULTS Twenty-six studies on ten different tumor types fulfilled all inclusion criteria and were included in the review. The studies showed heterogeneity regarding the study characteristics, number of participants, time since diagnosis, and assessment tools. Generally, all four comorbidities show higher prevalences in cancer survivors than the general population. Brain tumor survivors were reported to have a relatively high prevalence of both depression and anxiety. Studies with melanoma survivors reported high prevalences of all four psychiatric comorbidities. Regarding comorbidities, a wide range in prevalence existed across the tumor types. Within one cancer site, the prevalence also varied considerably among the studies.
CONCLUSION Psychiatric comorbidities are more frequent in cancer survivors than in the general population, as reflected by the prevalence of depression, anxiety, comorbid anxiety-depression and PTSD across all tumor subtypes. Developing generalized screening tools that examine psychological distress in cancer survivors up to at least ten years after diagnosis could help to understand and address the psychological burden of cancer survivors.
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Affiliation(s)
- Anne Bach
- Section Psychooncology, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen 72076, Germany
| | - Klara Knauer
- Section Psychooncology, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen 72076, Germany
| | - Johanna Graf
- Section Psychooncology, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen 72076, Germany
| | - Norbert Schäffeler
- Section Psychooncology, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen 72076, Germany
| | - Andreas Stengel
- Section Psychooncology, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen 72076, Germany
- Germany & Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charite-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin 10117, Germany
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7
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Jung A, Crandell JL, Nielsen ME, Smith SK, Bryant AL, Mayer DK. Relationships among uncertainty, post-traumatic stress disorder symptoms, and quality of life in non-muscle-invasive bladder cancer survivors. Support Care Cancer 2022; 30:6175-6185. [PMID: 35437672 DOI: 10.1007/s00520-022-07034-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/03/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE The aim of this study was to examine relationships among uncertainty, PTSD symptoms (PTSS), and quality of life (QOL) in non-muscle-invasive bladder cancer (NMIBC) survivors. METHODS Eligible NMIBC survivors were identified through the North Carolina Central Cancer Registry, and 398 survivors participated in a mailed survey that measured survivor's outcomes (uncertainty, PTSS, and QOL). Structural equation modeling was used to examine the mediating effect of uncertainty and PTSS on the association between personal characteristics and QOL in NMIBC survivors. RESULTS NMIBC survivors experienced cancer-related uncertainty; higher uncertainty was associated with male, lower income, lack of cure, and lower cognition-ability. Uncertainty was significantly and negatively associated with QOL. In addition, PTSS completely mediated the effect of uncertainty on QOL, and higher PTSS had a strong association with poorer QOL. Additionally, comorbidities, cognition-general concerns, uncertainty, and PTSS had strong negative effects on QOL. CONCLUSION This study has identified modifiable psychosocial factors which affect QOL in NMIBC survivors. The study findings can be used in the development of interventions to improve QOL for NMIBC survivors.
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Affiliation(s)
- Ahrang Jung
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA.
| | - Jamie L Crandell
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew E Nielsen
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | - Ashley Leak Bryant
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Deborah K Mayer
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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8
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Marzo RR, Bhattacharya S, Aye SS, Tripathi S, Naing TW, Maung Soe M, Kyaw YW, A.L. Richard Packiam CD, Chai Ping Ping D, Binti Zolpakar PM, A.P. Selvakumar V, Binti Abdul Ali SR, Binti Hasrudin AF, Sutikno J. Study on the quality of life among cancer survivors attending a tertiary care cancer center in Malaysia. J Public Health Res 2022; 10:10.4081_jphr.2021.2919. [PMID: 35898930 PMCID: PMC9310245 DOI: 10.4081/jphr.2021.2919] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Cancer is a major public health problem across the globe. According to the
Malaysian National Cancer Registry Report (MNCR), between 2007 and 2011,
there has been a greater increase in the number of reported cancer cases
among females (99.3 per 100,000 people) than males (86.9 cases per 100,000
people). Nearly 15 million new cancer cases were projected by 2020. We
conducted this study to assess the quality of life (QoL) among cancer
patients. Design and Methods This was a cross-sectional study conducted in the oncology department of
Malaysian hospitals from October to November 2019. The study population
comprised Malaysians in the age range of18 to 100 years diagnosed with
cancer, irrespective of their treatment status, cancer type and prognosis. A
pre-tested structured questionnaire was used in seventy cancer patients'
using a convenient sampling method. Data were collected using a
questionnaire survey after obtaining permission from the hospital
administrators. Data were entered in MS Excel and analysis was done using
the SPSS-version 23. Participants' socio-demographic characteristics were
described using descriptive statistics. Results are presented using graphs,
tables, mean, percentages, standard deviation, frequency, and significance.
Analysis of variance (ANOVA) test was performed to find out the association
between socio-demographic variables and overall QoL scores of the
patients. Results Of the seventycancer patients, 29 (41.43%) were males and 41 (58.57%) were
females. The most affected socio-demographic factors were marital status and
occupation (employment). It was found that there were 55 (78.57%) married
patients and 49 (70%) employed patients. QoL of most of the patients was
influenced by the education level and treatment. It was found that 35 (50%)
of them had low QoL scores. It was observed that QoL among the study
participants was significantly (p<0.05) associated with their level of
education and the level of treatment. Conclusions There is a need to develop measures for community education, involvement of
family physicians for the treatment of cancer and to increase awareness to
improve the QoL among cancer patients. The focus should be on the
development of strategies empowering patients to seek treatment and gain
control over their illness with the collaboration with primary care
physicians.
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Abuhadra N, Stecklein S, Sharma P, Moulder S. Early-stage Triple-negative Breast Cancer: Time to Optimize Personalized Strategies. Oncologist 2022; 27:30-39. [PMID: 35305094 PMCID: PMC8842325 DOI: 10.1093/oncolo/oyab003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 11/16/2021] [Indexed: 11/15/2022] Open
Abstract
Triple-negative breast cancer (TNBC) accounts for approximately 15%-20% of breast cancers diagnosed worldwide, which amounts to almost 200 000 cases each year. Although historically TNBC is considered difficult to treat with a poor prognosis, there is emerging evidence showing excellent response rates in a subset of TNBC patients. Attempts to de-escalate chemotherapy in hormone-receptor-positive (HR+) and HER2-neu amplified breast cancer subtypes have been successful. At present, robust strategies to personalize therapy in early-stage TNBC do not exist, and despite excellent response rates in a subset of patients, all patients are exposed to the same several cycles of cytotoxic chemotherapy. Personalizing therapy in TNBC represents a challenge due to the scarcity of treatment options outside of cytotoxic chemotherapy and limited predictive and prognostic biomarkers to tailor treatment. Recent developments in understanding TNBC biology have sparked interest in exploring treatment optimization and personalization with the goal of achieving excellent response rates and long-term clinical outcomes, while simultaneously reducing physical, psychological, and financial toxicities for select patients. Here, we provide an update on the current evidence to support future studies examining de-escalating chemotherapy in patients with low-risk TNBC and adjuvant intensification strategies to improve outcomes for patients who are at high risk for systemic failure despite current standard-of-care treatments.
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Affiliation(s)
- Nour Abuhadra
- Breast Medicine Service, Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shane Stecklein
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Priyanka Sharma
- Division of Medical Oncology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Stacy Moulder
- Eli Lilly and Company. Lilly Corporate Center, Indianapolis, IN, USA
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10
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Abdelhadi OA, Pollock BH, Joseph JG, Keegan THM. Psychological distress and associated additional medical expenditures in adolescent and young adult cancer survivors. Cancer 2022; 128:1523-1531. [PMID: 35001391 DOI: 10.1002/cncr.34064] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/19/2021] [Accepted: 11/13/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adolescent and young adult (AYA) cancer survivors experience psychological distress often because of cancer and its treatment. However, no prior studies have evaluated the additional medical expenditures and health care utilization associated with psychological distress in AYA cancer survivors. METHODS AYA cancer survivors and a comparison matched group of adults with no history of cancer were identified from 2011-2016 Medical Expenditure Panel Survey data. Medical expenditures and health care utilization were evaluated with multivariable regression models. RESULTS AYA cancer survivors were more likely to have psychological distress (11.5% of 1757) than adults with no history of cancer (5.8% of 5227). The prevalence of psychological distress was found to be high many years after the diagnosis, with 11.2% reporting distress ≥20 years after their cancer diagnosis. AYA cancer survivors with psychological distress were more likely to smoke and have chronic conditions and were less likely to exercise regularly in comparison with AYAs with no history of psychological distress. AYA cancer survivors with psychological distress had additional annual medical expenses ($4415; 95% CI, $993-$9690), office visits (2.80; 95% CI, 0.23-6.15), and use of prescription medications/medication renewals (11.58; 95% CI, 5.70-19.47) in comparison with AYA cancer survivors without psychological distress. Additional annual medical expenses of psychological distress were $2600 higher in AYA cancer survivors than adults without a history of cancer ($1802; 95% CI, $440-$3791). CONCLUSIONS These results highlight the substantial economic burden associated with psychological distress in AYA cancer survivors. This research could inform survivorship care plans and interventions addressing the psychological needs of AYA cancer survivors.
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Affiliation(s)
- Ola A Abdelhadi
- Graduate Group of Epidemiology, University of California Davis, Davis, California
| | - Brad H Pollock
- Graduate Group of Epidemiology, University of California Davis, Davis, California.,Department of Public Health Sciences, University of California Davis, Sacramento, California
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California
| | - Theresa H M Keegan
- Graduate Group of Epidemiology, University of California Davis, Davis, California.,Department of Public Health Sciences, University of California Davis, Sacramento, California.,Center for Oncology Hematology Outcomes Research and Training and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, California
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11
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Housman B, Flores R, Lee DS. Narrative review of anxiety and depression in patients with esophageal cancer: underappreciated and undertreated. J Thorac Dis 2021; 13:3160-3170. [PMID: 34164206 PMCID: PMC8182527 DOI: 10.21037/jtd-20-3529] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Depression and anxiety are emotional disorders that commonly affect patients with esophageal cancer. As a result of its high morbidity, mortality, and complication rates, this population is at particularly high risk for developing or exacerbating affective disorders; even when compared to patients with other forms of cancer. Many of the medical conditions and social behaviors that predispose patients to this disease are also independently associated with affective disorders, and likely compound their effects. Unfortunately, in the existing literature, there is wide variability in study design and diagnostic criteria. There is no standard method of evaluation, many studies are limited to written surveys, and widespread mental health screening is not included as a part of routine care. As a result, the prevalence of these illnesses remains elusive. Additionally, psychiatric and psychosocial illness can affect compliance with surveillance and treatment, and gaps in knowledge may ultimately influence patient outcomes and survival. This review will discuss the existing literature on depression and anxiety in patients with esophageal cancer. It will highlight current methods of psychological evaluation, the prevalence of affective disorders in this population, and their effects on treatment, compliance, and outcomes. It will also discuss possible screening tools, treatments and interventions for these comorbid illnesses that may improve oncologic outcomes as well as quality of life.
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Affiliation(s)
- Brian Housman
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Dong-Seok Lee
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
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12
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Jung A, Crandell JL, Nielsen ME, Mayer DK, Smith SK. Post-traumatic stress disorder symptoms in non-muscle-invasive bladder cancer survivors: A population-based study. Urol Oncol 2020; 39:237.e7-237.e14. [PMID: 33308978 DOI: 10.1016/j.urolonc.2020.11.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/22/2020] [Accepted: 11/21/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This cross-sectional study examined the prevalence of post-traumatic stress disorder (PTSD) and identified the predictive factors associated with PTSD symptoms in a population of non-muscle-invasive bladder cancer (NMIBC) survivors. METHODS A random sample of 2,000 NMIBC survivors, identified through the North Carolina Central Cancer Registry, were sent postal mail survey. PTSD symptoms were measured using the PTSD Checklist for DSM-5 (PCL-5). Descriptive statistics and hierarchical multiple linear regression were used to examine the prevalence of PTSD and to identify the factors associated with PTSD. RESULTS A total of 376 participants were included in the analysis. The average PCL-5 score was 7.1 (standard deviation [SD] = 10.9, range: 0-66), where higher scores represent higher levels of PTSD symptoms. The prevalence of the provisional PTSD diagnosis was 5.3% or 6.9% (after adjusting for nonresponse). In addition, 28.7% of participants met criteria for at least one PTSD symptom cluster. After controlling for other variables, participants who were younger, had active disease or unsure of status, had more comorbidities, had lower social support, and had higher cognitive concerns reported significantly higher PTSD symptoms. CONCLUSION More than one-fourth of NMIBC survivors had PTSD symptoms. Thus, healthcare providers should assess PTSD symptoms and provide supportive care for NMIBC survivors in the survivorship phase of care.
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Affiliation(s)
- Ahrang Jung
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Jamie L Crandell
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Matthew E Nielsen
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC; School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Deborah K Mayer
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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13
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Eli B, Zhou Y, Liang Y, Fu L, Zheng H, Liu Z. A profile analysis of post-traumatic stress disorder and depressive symptoms among Chinese Shidu parents. Eur J Psychotraumatol 2020; 11:1766770. [PMID: 33029310 PMCID: PMC7472999 DOI: 10.1080/20008198.2020.1766770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/21/2020] [Accepted: 05/01/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Due to the one-child policy implemented in China, most families have only one child. When parents experience the death of their only child, these parents receive the label 'Shidu parents'. Shidu is a major public health issue in China. However, the patterns of post-traumatic stress disorder (PTSD) and depressive symptoms that are present in this population remain unclear. OBJECTIVE This study aims to identify profiles of PTSD and depressive symptoms among Shidu parents and to explore the predictors of profile membership. METHODS A total of 363 participants (M age = 61.5 years, SD = 7.5) were asked to complete questionnaires assessing PTSD, depressive symptoms, perceived social support, and demographic information. Latent profile analyses and multivariate logistic regressions were used. RESULTS Three distinct profiles were identified: low (39.4%), moderate (32.8%), and high symptoms (27.8%). Parents who were younger and perceived lower levels of support from family and significant others were more likely to experience higher levels of PTSD and depressive symptoms. CONCLUSIONS These results indicate that the severity of PTSD and depressive symptoms tightly cohere, providing evidence for the co-occurrence of PTSD and depressive symptoms after bereavement. The findings provide valuable information for the development of tailored professional interventions for bereaved parents.
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Affiliation(s)
- Buzohre Eli
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yueyue Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yiming Liang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Lin Fu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Hao Zheng
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Higher Distress in Patients with Breast Cancer Is Associated with Declining Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2636. [PMID: 32309083 PMCID: PMC7159969 DOI: 10.1097/gox.0000000000002636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/09/2019] [Indexed: 11/13/2022]
Abstract
Background: Distress among newly diagnosed patients with breast cancer is common and may have an impact on their surgical decision-making. The revised Edmonton Symptom Assessment System (ESAS-r) is a validated instrument that provides an estimate of patients’ total distress, and no previous study has related preoperative scores to the choice to have breast reconstruction. Methods: Women with breast cancer treated at the Princess Margaret Cancer Centre in 2014 were reviewed, and patient and tumor characteristics were collected from local databases. Breast reconstruction status was obtained from patients’ electronic medical records until April 2017. A multivariable logistic regression model assessed for an independent association between preoperative ESAS-r total distress scores and patients’ decision to have breast reconstruction. Results: A total of 312 patients were analyzed. ESAS-r values had an overall median score of 10.0 and ranged from 0 to 69 (interquartile range, 17). Of these patients, 82 chose to undergo breast reconstruction surgery (26.8%). Multivariable logistic regression analysis showed that higher ESAS-r scores were associated with patients forgoing breast reconstruction surgery (lumpectomy-alone group: odds ratio estimate, 1.034 [1.004–1.064], P = 0.025; mastectomy-alone group: odds ratio estimate, 1.031 [1.004–1.059], P = 0.023). Conclusions: This study of patients with breast cancer found that higher distress scores as measured by the ESAS-r were associated with reduced breast reconstruction. Distress in patients with breast cancer is important to address, as it is often treatable, and its resolution may unmask a desire for breast reconstruction, which has known benefits psychosocially.
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Long-term distress in older patients with cancer: a longitudinal cohort study. BJGP Open 2019; 3:bjgpopen19X101658. [PMID: 31581109 PMCID: PMC6970590 DOI: 10.3399/bjgpopen19x101658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/29/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Receiving a cancer diagnosis can be a major life event which causes distress even years after primary treatment. AIM To examine the prevalence of distress in older patients with cancer (OPCs) up until 5 years post-diagnosis, and identify predictors present at time of diagnosis. Results are compared with reference groups of middle-aged patients with cancer (MPCs) and older patients without a cancer diagnosis (OPs). DESIGN & SETTING OPCs, MPCs, and OPs participated in a longitudinal cohort study in Belgium and the Netherlands by filling in questionnaires at designated time points from 2010-2019. METHOD Data from 541 patients were analysed using multivariable logistic regression analyses. RESULTS At baseline, 40% of OPCs, 37% of MPCs, and 17% of OPs reported distress. After 5 years, 35% of OPCs, 23% of MPCs, and 25% of OPs reported distress. No significant predictors for long-term distress in OPCs and OPs were found. For MPCs, it was found that baseline distress (odds ratio [OR] 2.94; 95% confidence intervals [CI] = 1.40 to 6.19) and baseline fatigue (OR 4.71; 95% CI = 1.81 to 12.31) predicted long-term distress. CONCLUSION Distress is an important problem for people with cancer, with peaks at different moments after diagnosis. Feelings of distress are present shortly after diagnosis but they decrease quickly for the majority of patients. In the long term, however, OPCs in particular appear to be most at risk for distress. This warrants extra attention from primary healthcare professionals, such as GPs who are often patients' first medical contact point. More research into risk factors occurring later in an illness trajectory might shed more light on predictors for development of long-term distress.
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Zhou X, Gao M, Wang W, Wu X. Patterns of posttraumatic stress disorder symptoms among cancer patients: A latent profile analysis. J Psychosom Res 2019; 125:109788. [PMID: 31421322 DOI: 10.1016/j.jpsychores.2019.109788] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE It has been documented that posttraumatic stress disorder symptoms (PTSS) in traumatized individuals have naturally heterogeneous characteristics; studies have recently begun to assess the specific heterogeneous patterns of PTSS. However, most of them used the DSM-IV criteria for PTSS and focused on victims following combat, interpersonal violence, and natural disasters, with no studies focusing on cancer patients. To extend the existing literature and fill the gaps in previous studies, this study aims to examine the specific patterns of PTSS and their predictors. METHOD One hundred and ninety-one cancer patients were selected to complete self-reported questionnaires; the data analysis involved latent profile analysis and multinomial logistic regression. RESULTS Three patterns of PTSS were found: the non-symptom group (n = 29, 15.3%), the hyperarousal symptoms group (n = 84, 44.2%), and the severe PTSS group (n = 77, 40.5%). In addition, a longer elapsed time since diagnosis was related to fewer hyperarousal symptoms [OR (95%CI) = 0.98 (0.95-1.00)] and severe PTSS [OR (95%CI) = 0.98 (0.95-1.00)]; a greater fear of cancer recurrence was related to more hyperarousal symptoms [OR (95%CI) = 1.09 (1.00-1.19)] and severe PTSS [OR (95%CI) = 1.32 (1.18-1.47)]; and individuals with higher household incomes [OR (95%CI) = 1.65 (0.96-2.84)] and female patients [OR (95%CI) = 0.37 (0.16-0.87)] had more severe PTSS. CONCLUSIONS Cancer patients exhibited heterogeneous PTSS patterns.
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Affiliation(s)
- Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310028, China
| | - Mengqi Gao
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Wenchao Wang
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Xinchun Wu
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing 100875, China.
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17
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Lucas AG, Chang EC, Morris LE, Angoff HD, Chang OD, Duong AH, Li M, Hirsch JK. Relationship between Hope and Quality of Life in Primary Care Patients: Vitality as a Mechanism. SOCIAL WORK 2019; 64:233-241. [PMID: 31190068 DOI: 10.1093/sw/swz014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 07/05/2018] [Accepted: 07/31/2018] [Indexed: 06/09/2023]
Abstract
The present study examined the role of vitality as a mediator of the association between dispositional hope and quality of life (QoL) (namely, physical health, psychological health, social relationships, and environment) in a sample of 101 adult primary care patients. Vitality was found to fully mediate the relationship between hope and physical health, social relationships, and environment. In addition, vitality was found to partially mediate the association between hope and psychological health. The present findings are consistent with a model in which vitality represents an important mechanism through which hope affects QoL in adults. Accordingly, these findings point to the importance of fostering both hope and vitality in efforts to promote positive QoL in adults.
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Affiliation(s)
| | - Edward C Chang
- Department of Psychology, University of Michigan, Ann Arbor
| | - Lily E Morris
- Department of Psychology, University of Michigan, Ann Arbor
| | | | - Olivia D Chang
- Department of Psychology, University of Michigan, Ann Arbor
| | - Ashley H Duong
- Department of Psychology, University of Michigan, Ann Arbor
| | | | - Jameson K Hirsch
- Department of Psychology, East Tennessee State University, Johnson City
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Carreira H, Williams R, Müller M, Harewood R, Stanway S, Bhaskaran K. Associations Between Breast Cancer Survivorship and Adverse Mental Health Outcomes: A Systematic Review. J Natl Cancer Inst 2018; 110:1311-1327. [PMID: 30403799 PMCID: PMC6292797 DOI: 10.1093/jnci/djy177] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/08/2018] [Accepted: 08/31/2018] [Indexed: 01/02/2023] Open
Abstract
Background We aimed to systematically review the evidence on adverse mental health outcomes in breast cancer survivors (≥1 year) compared with women with no history of cancer. Methods Studies were identified by searching MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Social Sciences Citation Index, and through backward citation tracking. Two researchers selected the studies, extracted data, and assessed the risk of bias. Results Sixty studies were included. Of 38 studies of depression, 33 observed more depression in breast cancer survivors; this was statistically significant in 19 studies overall, including six of seven where depression was ascertained clinically, three of four studies of antidepressants, and 13 of 31 that quantified depressive symptoms. Of 21 studies of anxiety, 17 observed more anxiety in breast cancer survivors, statistically significant in 11 studies overall, including two of four with clinical/prescription-based outcomes, and in eight of 17 of anxiety symptoms. Breast cancer survivors also had statistically significantly increased symptoms/frequency of neurocognitive dysfunction (18 of 24 studies), sexual dysfunctions (5 of 6 studies), sleep disturbance (5 of 5 studies), stress-related disorders/PTSD (2 of 3 studies), suicide (2 of 2 studies), somatisation (2 of 2 studies), and bipolar and obsessive-compulsive disorders (1 of 1 study each). Studies were heterogeneous in terms of participants' characteristics, time since diagnosis, ascertainment of outcomes, and measures reported. Approximately one-half of the studies were at high risk of selection bias and confounding by socio-economic status. Conclusions There is compelling evidence of an increased risk of anxiety, depression and suicide, and neurocognitive and sexual dysfunctions in breast cancer survivors compared with women with no prior cancer. This information can be used to support evidence-based prevention and management strategies. Further population-based and longitudinal research would help to better characterize these associations.
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Affiliation(s)
- Helena Carreira
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachael Williams
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Rhea Harewood
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Susannah Stanway
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Krishnan Bhaskaran
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Choi J, Lee M, Ki M, Lee JY, Song YJ, Kim M, Lee S, Park S, Lim J. Risk factors for feelings of sadness and suicide attempts among cancer survivors in South Korea: findings from nationwide cross-sectional study (KNHANES IV-VI). BMJ Open 2017; 7:e016130. [PMID: 29247081 PMCID: PMC5735398 DOI: 10.1136/bmjopen-2017-016130] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION As the number of cancer survivors is rapidly increasing with the increased incidence of the disease and improved survival of patients, the prevalence of, and risk factors for, mental health problems and suicidality among cancer survivors should be examined. METHODS AND ANALYSIS Using data obtained from the Korean National Health and Nutrition Examination Survey (2007-2013), we examined 1285 and 33 772 participants who had been and never been diagnosed with cancer, respectively. We investigated the risks of feelings of sadness and suicide attempts among cancer survivors and general population and examined differences in the risks of cancer survivors among subgroups according to cancer-related characteristics. RESULTS The median age of survivors at the time of the survey and at diagnosis was 63 and 54 years, respectively. After adjusting for sex, level of education, household income, occupation, marital status, cancer type, current status of treatment, age at diagnosis and years since diagnosis, the risk of suicide attempts was significantly higher in participants diagnosed with cancer before 45 years of age compared with those diagnosed at 45-64 years (adjusted OR=3.81, 95% CI 1.07 to 13.60, P=0.039), and the higher risk of suicide attempts with borderline significance was found in those for whom more than 10 years had passed since diagnosis compared with those for whom the diagnosis was made only 2-10 years ago (adjusted OR=3.38, 95% CI 0.98 to 11.70, P=0.055). However, feelings of sadness were not significantly associated with any cancer-related characteristic. CONCLUSION Our results reveal an increased risk of suicide attempts among cancer survivors diagnosed early in life and in those for whom more than 10 years has passed since the diagnosis, suggesting the need for intensive monitoring and support for mental health problems and suicidal risks in this population.
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Affiliation(s)
- Jeewoong Choi
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, The Republic of Korea
| | - Mijo Lee
- Department of Radiation Oncology, Eulji University College of Medicine, Daejeon, The Republic of Korea
| | - Myung Ki
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Ju-Yeong Lee
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, The Republic of Korea
| | - Yeong-Jun Song
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, The Republic of Korea
| | - Miram Kim
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, The Republic of Korea
| | - Sunyoung Lee
- Department of Radiation Oncology, Sun Medical Cancer Center, Daejeon, The Republic of Korea
| | - Soonjoo Park
- Department of Nursing, Eulji University College of Medicine, Daejeon, The Republic of Korea
| | - Jiseun Lim
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, The Republic of Korea
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Dougall AL, Swanson J, Kyutoku Y, Belani CP, Baum A. Posttraumatic Symptoms, Quality of Life, and Survival among Lung Cancer Patients. ACTA ACUST UNITED AC 2017; 22. [PMID: 28966544 DOI: 10.1111/jabr.12065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE This longitudinal study characterized psychological adjustment in a sample of lung cancer patients by examining the occurrence of posttraumatic stress and growth and their relationships with mental and physical health quality of life and survival over time. METHODS Two waves of consecutive cohort samples, totaling 115 participants diagnosed with lung cancer, were identified from outpatient oncology clinics. Of these, 93 consented and completed the first of three assessments, and 57 completed the study. Prevalence of posttraumatic stress symptoms (PTSD Checklist) and posttraumatic growth (Posttraumatic Growth Inventory) were assessed and used to predict physical and mental health components of quality of life (Short Form 36) and survival. RESULTS Patients reported both negative and positive psychological sequelae, with prevalence of estimated PTSD ranging from 5-16% at each assessment as determined by symptom and cut-off methods. Posttraumatic stress and growth were positively related, but were differentially associated with outcomes. More posttraumatic stress predicted lower mental health quality of life, whereas more posttraumatic growth predicted better physical health quality of life and longer survival. These relationships persisted after accounting for disease variables and attrition due to death or illness. CONCLUSIONS These findings highlight the importance of using longitudinal designs to identify relationships between stress and resilience factors in predicting outcomes.
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Affiliation(s)
| | - Jeffrey Swanson
- Department of Psychology, The University of Texas at Arlington, Arlington, TX
| | - Yasushi Kyutoku
- Research and Development Initiative, Chuo University, Bunkyo-ku, Tokyo, Japan
| | - Chandra P Belani
- Penn State Cancer Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Andrew Baum
- Department of Psychology, The University of Texas at Arlington, Arlington, TX. Andrew Baum is now deceased
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Feldman DB. Stepwise Psychosocial Palliative Care: A New Approach to the Treatment of Posttraumatic Stress Disorder at the End of Life. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2017; 13:113-133. [PMID: 28753122 DOI: 10.1080/15524256.2017.1346543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although evidence-based therapies for Posttraumatic Stress Disorder (PTSD) exist for physically healthy populations, these often do not adequately address PTSD in dying patients. Particularly because these interventions require 8-16 weekly sessions, and the median stay in U.S. hospices is 17.5 days (National Hospice and Palliative Care Organization [NHPCO], 2015 ), there is a potentially serious timing mismatch. Moreover, these treatments may temporarily increase trauma symptoms (Nishith, Resick, & Griffin, 2002 ), resulting in some patients dying in greater distress than had they not received care. The Stepwise Psychosocial Palliative Care (SPPC) model presented in this article compensates for these difficulties by embracing a palliative care approach to PTSD. Although it utilizes techniques drawn from existing PTSD interventions, these are re-ordered and utilized in a time-responsive, patient-centered manner that takes into account prognosis, fatigue, and logistical concerns. The SPPC approach is further considered with respect to existing social work palliative care competencies (Gwyther et al., 2005 ) and a case study is used to demonstrate its application.
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Affiliation(s)
- David B Feldman
- a Department of Counseling Psychology , Santa Clara University , Santa Clara , California , USA
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Robins HI, Johnson L, LoConte N, Brandt K. Cancer-related cognitive impairment and its relation to PTSD. Breast 2017; 34:134. [PMID: 28285890 DOI: 10.1016/j.breast.2017.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/03/2017] [Indexed: 10/20/2022] Open
Affiliation(s)
- H Ian Robins
- University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.
| | - Laddie Johnson
- University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Noelle LoConte
- University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
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23
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de Lima MM, Tobias-Machado M. Suicide in patients with genitourinary malignancies. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28134462 DOI: 10.1111/ecc.12635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 09/20/2016] [Accepted: 11/20/2016] [Indexed: 12/21/2022]
Abstract
Genitourinary cancers are significant causes of morbidity and mortality around the world. The present review summarises the current literature on suicide and its risk factors among patients with genitourinary cancers. The review was based on relevant articles published in MEDLINE, ProQuest, PsycINFO, Science Direct and Scopus databases. Patients with prostate cancer represented the most important risk group for suicide, among patients with urogenital cancers. Other risk factors are male gender, older age, white race, advanced disease, living alone and co-existing psychological comorbidities. Findings from the review call for a greater caregiver awareness on psychosocial morbidity and suicidality among genitourinary cancer patients pre- and post-treatment and their early identification, adoption of risk-reduction strategies and prompt referral for expert mental health care.
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Affiliation(s)
- M M de Lima
- Department of Urology, Coronel Mota Hospital, Roraima, Brazil
| | - M Tobias-Machado
- Section of Urologic Oncology, Department of Urology, ABC Medical School, São Paulo, UK
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Menon SB, Jayan C. An assessment of the mental health of mastectomized women in South India. PSYCHOLOGY, COMMUNITY & HEALTH 2016. [DOI: 10.5964/pch.v5i3.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aim The present study is aimed at understanding the psychiatric morbidity among mastectomized women and in identifying differences in depression, anxiety, psychological impact and well-being based on psychiatric diagnosis. Method One hundred and sixty breast cancer patients who had undergone mastectomy and were on either on adjuvant therapies or on waiting list were interviewed. The Mini-International Neuropsychiatric Interview (M.I.N.I.) - Plus, Hospital Anxiety and Depression Scale, the Impact of Event Scale and the Psychological General Well-Being Schedule were used. Results Around 68% of patients did not meet psychiatric diagnosis, while the remaining 32% patients were found to have psychiatric morbidity. Of these, 15% diagnosed with adjustment disorders, 13% patients with a major depressive disorder, while 4% patients with anxiety disorders. A significant difference in anxiety, depression, psychological impact and well-being was found among mastectomized women who were grouped on the basis of their psychiatric diagnosis. Conclusion Psychiatric morbidity is evident in patients. This study reinforces the need for identifying psychiatric disorders among women who are undergoing mastectomy, in order to provide adequate psychological treatment.
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Ogle JP, Ullstrup K. Breast Cancer as an Embodied Life Event: A Synthesis of Research and Theory and Directions for Intervention and Future Work. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/105413730601400302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With the present work, we reviewed literature exploring breast cancer and body image and invoked this synthesis as a platform from which to develop (a) theoretical applications for understanding the embodied experience of breast cancer, (b) implications for counseling interventions, and (c) recommendations for continued research. Of particular relevance to our analyses was theory related to the social construction of the female body and also theories related to meaning-making, illness, and loss. Based upon our synthesis, we suggest a counseling approach in which professionals treating breast cancer patients listen for and attend to breast cancer patients' attributions of meaning and consider the varied influences that may contribute to those meanings. Additionally, we propose that researchers invoke qualitative approaches and social constructionist/meaning-making perspectives to build understanding about the ways in which a woman's social roles, embodied history, world views, and other contextual factors shape her embodied experience of breast cancer.
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Yang H, Brand JS, Fang F, Chiesa F, Johansson ALV, Hall P, Czene K. Time-dependent risk of depression, anxiety, and stress-related disorders in patients with invasive and in situ breast cancer. Int J Cancer 2016; 140:841-852. [PMID: 27859142 DOI: 10.1002/ijc.30514] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/25/2016] [Indexed: 11/07/2022]
Abstract
Despite concerns about the mental health of breast cancer patients, little is known regarding the temporal risk pattern and risk factors of common mental disorders among these patients. We estimated standardized incidence ratios (SIRs) of depression, anxiety and stress-related disorders in a Swedish nationwide cohort of 40,849 women with invasive and 4,402 women with in situ breast cancer (2001-2010, median follow-up = 4.5 years). The impact of patient, tumor and treatment characteristics was analyzed using flexible parametric survival models in a regional cohort of 7,940 invasive breast cancer patients (2001-2013, median follow-up = 7.5 years). Women with invasive breast cancer showed increased rates of depression, anxiety and stress-related disorders [overall SIR (95% CI) = 1.57 (1.46-1.69), 1.55 (1.43-1.68) and 1.77 (1.60-1.95), respectively]. SIRs were highest shortly after diagnosis, but remained increased up to 5 years. Younger age at diagnosis, comorbidity, higher-grade disease, lymph node involvement and chemotherapy were independently associated with the risk of depression and anxiety in invasive cancer patients, with chemotherapy and higher-grade disease conferring short-term risk only, while comorbidities were mainly associated with late-onset events. No clinical risk factors were identified for stress-related disorders except for a greater risk associated with younger age. Patients with in situ cancer only showed an increased incidence of stress-related disorders during the first 6 months after diagnosis [SIR (95% CI) = 2.76 (1.31-5.79)]. The time-dependent risk profile of invasive cancer patients may guide health care professionals for timely and targeted psycho-oncologic interventions.
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Affiliation(s)
- Haomin Yang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Judith S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Flaminia Chiesa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Collie K, Bottorff JL, Long BC. A Narrative View of Art Therapy and Art Making by Women with Breast Cancer. J Health Psychol 2016; 11:761-75. [PMID: 16908471 DOI: 10.1177/1359105306066632] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Art therapy (with an art therapist) and art making (without an art therapist) show promise as avenues for psychosocial support for women with breast cancer. The purpose of this study was to gain an in-depth understanding of how 17 women with breast cancer in Canada and the USA used art therapy and their own art making to address their psychosocial needs, focusing particularly on meaning making. Narrative analysis of interviews yielded four storylines: Art and Art Therapy as a Haven; Getting a Clearer View; Clearing the Way Emotionally; and Enhancing and Enlivening the Self. The storylines show existence being affirmed, confirmed and proclaimed through visual artistic expression and meaning making being achieved through physical acts of making.
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Affiliation(s)
- Kate Collie
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA.
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Abstract
Purpose: Incorporating holistic health perspectives, this study compared and examined relationships among meaning in life, spirituality, perceived stress, and psychological distress in breast cancer survivors (BCS) and healthy women. Methods: Standardized self-report measures were completed once by all participants (N = 78). Findings: Group comparison revealed statistically significant variances across the measures. Covariate analysis identified BCS without children had less meaningful lives and greater stress and distress than BCS with children and participants without cancer. Significant correlations (p > .001) between meaning in life and spirituality (r = .43), stress (r = -.39), and distress (r = -.41) were also identified. Conclusion: Personal factors (i.e., being a parent) may be especially important in BCS. Also, psychological and spiritual variables are highly correlated, suggesting the use of an integrated term psycho-spiritual functioning. Implications: Holistic nursing interventions can facilitate self-awareness, interpersonal connection, and living a meaningful life, particularly in vulnerable patients such as BCS without children.
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Affiliation(s)
- Susan Bauer-Wu
- Phyllis F. Cantor Center for Research in Nursing and Patient Care, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA.
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Şengün İnan F, Üstün B. Experiences of Turkish survivors of breast cancer: Neuman systems model perspective. Jpn J Nurs Sci 2016; 13:466-477. [DOI: 10.1111/jjns.12129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 11/30/2015] [Accepted: 01/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Figen Şengün İnan
- Department of Psychiatric Nursing; Dokuz Eylül University; Izmir Turkey
| | - Besti Üstün
- Nursing Department; Üsküdar University; Istanbul Turkey
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Voigt V, Neufeld F, Kaste J, Bühner M, Sckopke P, Wuerstlein R, Hellerhoff K, Sztrókay-Gaul A, Braun M, von Koch FE, Silva-Zürcher E, Hasmüller S, Bauerfeind I, Debus G, Herschbach P, Mahner S, Harbeck N, Hermelink K. Clinically assessed posttraumatic stress in patients with breast cancer during the first year after diagnosis in the prospective, longitudinal, controlled COGNICARES study. Psychooncology 2016; 26:74-80. [PMID: 26898732 DOI: 10.1002/pon.4102] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE There is ongoing debate whether cancer qualifies as traumatic stressor. We investigated prevalence and course of posttraumatic stress in patients with early breast cancer (BC) during their first year after diagnosis and determined effects of mastectomy and chemotherapy. METHODS Patients with stage 0-III BC aged ≤65 years were evaluated with the Structured Clinical Interview for DSM-IV modules for acute and posttraumatic stress disorder (ASD and PTSD, respectively) before treatment, after chemotherapy, and 1 year after diagnosis. Matched controls were assessed at matched intervals. Effects of time, mastectomy, and chemotherapy on BC-related PTSD symptom severity were tested with linear mixed model analysis. RESULTS Stress disorder (ASD or PTSD) related to BC was diagnosed in 6 (3.6%) of 166 patients before treatment and in 3 patients (2.0%) 1 year later. The rate of patients who experienced PTSD symptoms related to BC decreased from 82.5 to 57.3% (p < 0.001), and the mean of BC-related PTSD symptoms diminished from 3.1 to 1.7 (p < 0.001). Only university education significantly predicted the course of BC-related PTSD symptom severity (p = 0.009). In 60 controls, no diagnosis of stress disorder, a rate of 18% women experiencing PTSD symptoms, and a mean of 0.4 PTSD symptoms (p vs. patients <0.001) were found. CONCLUSIONS Most newly diagnosed patients with BC experience PTSD symptoms, whereas full diagnoses of DSM-IV stress disorder are rare. Symptoms diminish somewhat within 1 year furthered by university education but independently from mastectomy and chemotherapy. Throughout the year after diagnosis, having BC entails markedly increased PTSD symptom burden. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Varinka Voigt
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Franziska Neufeld
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Judith Kaste
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Markus Bühner
- Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany
| | - Philipp Sckopke
- Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany
| | - Rachel Wuerstlein
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Karin Hellerhoff
- Institute for Clinical Radiology, CCCLMU University Hospital of Munich, Munich, Germany
| | - Anikó Sztrókay-Gaul
- Institute for Clinical Radiology, CCCLMU University Hospital of Munich, Munich, Germany
| | - Michael Braun
- Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany
| | - Franz Edler von Koch
- Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany
| | - Eliane Silva-Zürcher
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Stephan Hasmüller
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany.,Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany
| | - Ingo Bauerfeind
- Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany
| | - Gerlinde Debus
- Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany
| | - Peter Herschbach
- Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany
| | - Sven Mahner
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Kerstin Hermelink
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
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Thekdi SM, Milbury K, Spelman A, Wei Q, Wood C, Matin SF, Tannir N, Jonasch E, Pisters L, Cohen L. Posttraumatic stress and depressive symptoms in renal cell carcinoma: association with quality of life and utility of single-item distress screening. Psychooncology 2015; 24:1477-84. [PMID: 25690556 PMCID: PMC4539280 DOI: 10.1002/pon.3758] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 12/18/2014] [Accepted: 12/23/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the prevalence of posttraumatic stress symptoms (PTSS) in patients with renal cell carcinoma (RCC), the associations and co-occurrence between PTSS, depressive, and other cancer-related symptoms and the ability of a single-item distress question to identify patients with PTSS. METHODS Patients with stage I-IV RCC completed assessments of depressive symptoms (Center for Epidemiologic Studies Depression Scale), PTSS (Impact of Event Scale), cancer-related symptoms (MD Anderson Symptom Inventory), fatigue (Brief Fatigue Inventory), and sleep disturbance (Pittsburgh Sleep Quality Index). We used the distress item on the MD Anderson Symptom Inventory as a distress screener and general linear model analyses to test study hypotheses. RESULTS Of the 287 patients (29% stage IV; 42% female; mean age = 58 years), 46% (n = 131) reported psychiatric symptoms with 15% (n = 44) reporting comorbid clinical levels of depressive symptoms and PTSS, 24% (n = 70) PTSS alone, and 6% (n = 17) depressive symptoms alone. Controlling for age, gender, and stage, patients with comorbid depressive symptoms and PTSS reported more cancer-related symptoms (p < 0.0001), fatigue (p < 0.0001), and sleep disturbance (p = 0.0003) than those with PTSS alone and more cancer-related symptoms (p = 0.002) and fatigue (p = 0.09) than those with depressive symptoms alone. Sensitivity analyses revealed that 26.9% of negative cases on the distress item fell within the clinical range of the Impact of Event Scale and 9.3% of negative cases met caseness on the Center for Epidemiologic Studies Depression Scale. CONCLUSIONS Posttraumatic stress symptoms occurred both independently and comorbid with depressive symptoms in patients with RCC. PTSS were correlated with overall cancer symptom burden. Single-item distress screening was less sensitive in detecting PTSS than depressive symptoms. Therefore, additional screening strategies are required in the clinical setting.
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Affiliation(s)
- Seema Malhotra Thekdi
- Department of Psychiatry, The University of Texas MD Anderson Cancer Center, Houston, Texas, US
| | - Kathrin Milbury
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, US
| | - Amy Spelman
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, US
| | - Qi Wei
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, US
| | - Christopher Wood
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Surena F. Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nizar Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric Jonasch
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Louis Pisters
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lorenzo Cohen
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, US
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Pérez S, Conchado A, Andreu Y, Galdón MJ, Cardeña E, Ibáñez E, Durá E. Acute stress trajectories 1 year after a breast cancer diagnosis. Support Care Cancer 2015; 24:1671-8. [DOI: 10.1007/s00520-015-2960-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/14/2015] [Indexed: 11/27/2022]
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Jassim GA, Whitford DL, Hickey A, Carter B. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev 2015:CD008729. [PMID: 26017383 DOI: 10.1002/14651858.cd008729.pub2] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. OBJECTIVES To assess the effects of psychological interventions on psychological morbidities, quality of life and survival among women with non-metastatic breast cancer. SEARCH METHODS We searched the following databases up to 16 May 2013: the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL and PsycINFO; and reference lists of articles. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) search portal and ClinicalTrials.gov for ongoing trials in addition to handsearching. SELECTION CRITERIA Randomised controlled trials that assessed the effectiveness of psychological interventions for non-metastatic breast cancer in women. DATA COLLECTION AND ANALYSIS Two review authors independently appraised and extracted data from eligible trials. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcome. MAIN RESULTS Twenty-eight randomised controlled trials comprising 3940 participants were included. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. A wide range of interventions were evaluated, with 24 trials investigating a cognitive behavioural therapy and four trials investigating psychotherapy compared to control. Pooled standardised mean differences (SMD) from baseline indicated less depression (SMD -1.01, 95% confidence interval (CI) -1.83 to -0.18; P = 0.02; 7 studies, 637 participants, I(2) = 95%, low quality evidence), anxiety (SMD -0.48, 95% CI -0.76 to -0.21; P = 0.0006; 8 studies, 776 participants, I(2) = 64%, low quality evidence) and mood disturbance (SMD -0.28, 95% CI -0.43 to -0.13; P = 0.0003; 8 studies, 1536 participants, I(2) = 47%, moderate quality evidence) for the cognitive behavioural therapy group than the control group. For quality of life, only an individually-delivered cognitive behavioural intervention showed significantly better quality of life than the control with an SMD of 0.65 (95% CI 0.07 to 1.23; P = 0.03; 3 studies, 141 participants, I(2) = 41%, very low quality evidence). Pooled data from two group-delivered studies showed a non-significant overall survival benefit favouring cognitive behavioural therapy compared to control (pooled hazard ratio (HR) 0.76, 95% CI 0.25 to 2.32; P = 0.63; 530 participants, I(2) = 84%, low quality evidence). Four studies compared psychotherapy to control with one to two studies reporting on each outcome. The four studies were assessed as high risk of bias and provided limited evidence of the efficacy of psychotherapy. Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS A psychological intervention, namely cognitive behavioural therapy, produced favourable effects on some psychological outcomes, in particular anxiety, depression and mood disturbance. However, the evidence for survival improvement is still lacking. These findings are open to criticism because of the notable heterogeneity across the included studies and the shortcomings of the included studies.
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Affiliation(s)
- Ghufran A Jassim
- Department of Family & Community Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Adliya, Bahrain
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Zhou Q, Jackson-Cook C, Lyon D, Perera R, Archer KJ. Identifying molecular features associated with psychoneurological symptoms in women with breast cancer using multivariate mixed models. Cancer Inform 2015; 14:139-45. [PMID: 25983548 PMCID: PMC4426955 DOI: 10.4137/cin.s17276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/15/2015] [Accepted: 02/17/2015] [Indexed: 12/29/2022] Open
Abstract
Breast cancer (BC) is the second most common cancer among women. Research shows many women with BC experience anxiety, depression, and stress (ADS). Epigenetics has recently emerged as a potential mechanism for the development of depression.1 Although there are growing numbers of research studies indicating that epigenetic changes are associated with ADS, there is currently no evidence that this association is present in women with BC. The goal of this study was to identify high-throughput methylation sites (CpG sites) that are associated with three psychoneurological symptoms (ADS) in women with BC. Traditionally, univariate models have been used to examine the relationship between methylation sites and each psychoneurological symptom; nevertheless, ADS can be treated as a cluster of related symptoms and included together in a multivariate linear model. Hence, an overarching goal of this study is to compare and contrast univariate and multivariate models when identifying methylation sites associated with ADS in women with BC. When fitting separate linear regression models for each ADS scale, 3 among 285,173 CpG sites tested were significantly associated with depression. Two significant CpG sites are located on their respective genes FAM101A and FOXJ1, and the third site cannot be mapped to any known gene at this time. In contrast, the multivariate models identified 8,535 ADS-related CpG sites. In conclusion, when analyzing correlated psychoneurological symptom outcomes, multivariate models are more powerful and thus are recommended.
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Affiliation(s)
- Qing Zhou
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Debra Lyon
- College of Nursing, University of Florida, Gainesville, FL, USA
| | - Robert Perera
- Departments of Biostatistics & Social and Behavioral Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Kellie J Archer
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
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Abbey G, Thompson SBN, Hickish T, Heathcote D. A meta-analysis of prevalence rates and moderating factors for cancer-related post-traumatic stress disorder. Psychooncology 2015; 24:371-81. [PMID: 25146298 PMCID: PMC4409098 DOI: 10.1002/pon.3654] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 07/23/2014] [Accepted: 07/25/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Systematic reviews highlight a broad range of cancer-related post-traumatic stress disorder (CR-PTSD) prevalence estimates in cancer survivors. This meta-analysis was conducted to provide a prevalence estimate of significant CR-PTSD symptoms and full diagnoses to facilitate the psychological aftercare of cancer survivors. METHODS A systematic literature search was conducted for studies using samples of cancer survivors by using validated clinical interviews and questionnaires to assess the prevalence of CR-PTSD (k = 25, n = 4189). Prevalence estimates were calculated for each assessment method using random-effects meta-analysis. Mixed-effects meta-regression and categorical analyses were used to investigate study-level moderator effects. RESULTS Studies using the PTSD Checklist-Civilian Version yielded lower event rates using cut-off [7.3%, 95% confidence intervals (CI) = 4.5-11.7, k = 10] than symptom cluster (11.2%, 95% CI = 8.7-14.4, k = 9). Studies using the Structured Clinical Interview for Diagnostic and Statistical Manual, Fourth Edition (SCID), yielded low rates for lifetime (15.3%, 95% CI = 9.1-25, k = 5) and current CR-PTSD (5.1%, 95% CI = 2.8-8.9, k = 9). Between-study heterogeneity was substantial (I(2) = 54-87%). Studies with advanced-stage samples yielded significantly higher rates with PTSD Checklist-Civilian Version cluster scoring (p = 0.05), and when assessing current CR-PTSD on the SCID (p = 0.05). The effect of mean age on current PTSD prevalence met significance on the SCID (p = 0.05). SCID lifetime prevalence rates decreased with time post-treatment (R(2) = 0.56, p < 0.05). DISCUSSION The cancer experience is sufficiently traumatic to induce PTSD in a minority of cancer survivors. Post-hoc analyses suggest that those who are younger, are diagnosed with more advanced disease and recently completed treatment may be at greater risk of PTSD. More research is needed to investigate vulnerability factors for PTSD in cancer survivors. © 2014 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.
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Affiliation(s)
- Gareth Abbey
- Faculty of Science & Technology, Psychology Research Centre, Bournemouth UniversityTalbot Campus, Poole, UK
| | - Simon B N Thompson
- Faculty of Science & Technology, Psychology Research Centre, Bournemouth UniversityTalbot Campus, Poole, UK
| | - Tamas Hickish
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation TrustBournemouth, Dorset, UK
- School of Healthcare Sciences, Psychology Research Centre, Bournemouth UniversityTalbot Campus, Poole, UK
| | - David Heathcote
- Faculty of Science & Technology, Psychology Research Centre, Bournemouth UniversityTalbot Campus, Poole, UK
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Lee SJ, Park JH, Park BY, Kim SY, Lee IH, Kim JH, Koh DH, Kim CH, Park JH, Sohn MS. Depression and suicide ideas of cancer patients and influencing factors in South Korea. Asian Pac J Cancer Prev 2015; 15:2945-50. [PMID: 24815429 DOI: 10.7314/apjcp.2014.15.7.2945] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study compared risk factors for depression and suicidal ideas among cancer patients for comparison with the general population, and identified influencing factors. MATERIALS AND METHODS We analyzed data from 2,472 cancer patients in the National Cancer Center and nine Regional Cancer Centers and frequency-matched data for age and sex from 2,349 members of the general population who completed the National Health and Nutrition Examination Survey in 2008. Logistic regression analysis was used to identify factors affecting depression and suicidal ideas. RESULTS Cancer patients were not likely to have more depression (OR=0.96, 95%CI=0.79-1.18) and were less likely to have suicidal ideas (OR=0.64, 95%CI=0.53-0.79) compared to the general population. Female sex, more stress, and lower quality of life were influencing factors. The additional risk factors for suicidal ideas among cancer patients included income (OR=0.62, 95%CI=0.43-0.91), smoking (OR=1.63, 95% CI=1.06-2.50), recurrence (OR=1.50, 95%CI=1.15-1.95), and chemotherapy (OR=1.66, 95%CI=1.26-2.19). CONCLUSIONS No differences appeared in depression rates between cancer patients and the general population, and cancer patients were less likely to have suicidal ideas. However, cancer patients were likely to have more risk factors than the general population, and those classified as being at high risk of suicide should receive distress management and social economic support, from early in the treatment process.
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Affiliation(s)
- Su Jin Lee
- National Cancer Center in Korea, E-mail :
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Postoperative pain and subsequent PTSD-related symptoms in patients undergoing lung resection for suspected cancer. J Thorac Oncol 2014; 9:362-9. [PMID: 24496000 DOI: 10.1097/jto.0000000000000084] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Because lung cancer resection is at the crossroad between cancer and high-risk surgery, we hypothesized that the patients undergoing lung resection for cancer are exposed to develop a post-traumatic stress disorder (PTSD) syndrome-related symptoms. METHODS Forty-seven adult patients were included in the study. Patients were eligible for inclusion if they underwent lung resection for suspected cancer, if they were able to speak and read French, and if they agreed to be reached for a telephone interview. We assessed before, immediately after, and 3 months after surgery the presence of symptoms of anxiety and depression (Hospital Anxiety and Depression Scale) and PTSD-related symptoms (impact of events scale revised [IES-R]). At the 3-month assessment, an IES-R score > 22 was used as criteria for predicting the patients at risk of PTSD-related symptoms. RESULTS We identified an IES-R score higher than 22 in 24 participants (51%). Patients with a preoperatory Hospital Anxiety and Depression Scale(anxiety) score more than 7 (T0) and a maximal visual analogic scale score more than 40 during the first 24 hours after surgery were more likely to develop PTSD-related symptoms at 3-months with odd ratios at 4.61 [1.20-17.73] (p = 0.03) and 1.34 [1.05-1.75] (p = 0.02). CONCLUSION The prevalence of PTSD-related symptoms after lung cancer resection is high, showing that lung cancer patients undergoing surgical resection are at high risk of postprocedure burden. The presence of preoperative symptoms of anxiety and acute procedural pain during the early postoperative period are strong predictors for developing PTSD-related symptoms after lung cancer surgery.
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Hu LY, Ku FC, Wang YP, Shen CC, Hu YW, Yeh CM, Chen PM, Chiang HL, Lu T, Chen TJ, Teng CJ, Liu CJ. Anxiety and depressive disorders among patients with esophageal cancer in Taiwan: a nationwide population-based study. Support Care Cancer 2014; 23:733-40. [PMID: 25179690 DOI: 10.1007/s00520-014-2403-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/11/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND The comorbidity of depression with anxiety disorders is associated with poorer treatment outcomes, worse quality of life, poorer adherence to treatment, and greater suicide risk in cancer patients. OBJECTIVE To assess the risk of comorbid anxiety and depressive disorders after the diagnosis of esophageal cancer compared with a matched cohort by using the Taiwan National Health Insurance Research Database (NHIRD). METHODS We conducted a retrospective study of 28,454 patients (14,227 patients with esophageal cancer and 14,227 matched patients) who were selected from the NHIRD. Patients were observed for a maximum of 12 years to determine the incidence of new-onset anxiety and depressive disorders for which antidepressants had been prescribed. A Cox regression analysis was performed to identify the risk factors associated with anxiety and depressive disorders in esophageal cancer patients. RESULTS The cumulative incidence of anxiety and depressive disorders in the esophageal cancer patients was significantly higher than that in the matched cohort (P < .001). The adjusted hazard ratio (HR) was 2.24 (95 % confidence interval, CI = 1.95-2.56, P < .001) in the esophageal cancer cohort compared with the matched cohort. Independent risk factors for developing anxiety and depressive disorders among the patients with esophageal cancer included cirrhosis, cerebrovascular disease, and surgical treatment. CONCLUSION Esophageal cancer may be a prominent risk factor for anxiety and depressive disorders. Based on our data, we suggest that attention should be focused on esophageal cancer patients with comorbid cirrhosis and cerebrovascular disease and those who have received surgical interventions.
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Affiliation(s)
- Li-Yu Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Nicholls W, Hulbert-Williams N, Bramwell R. The role of relationship attachment in psychological adjustment to cancer in patients and caregivers: a systematic review of the literature. Psychooncology 2014; 23:1083-95. [DOI: 10.1002/pon.3664] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 08/01/2014] [Accepted: 08/11/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Wendy Nicholls
- Department of Psychology; University of Wolverhampton; Wolverhampton UK
| | | | - Ros Bramwell
- Department of Psychology; University of Chester; Chester UK
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Dubruille S, Libert Y, Merckaert I, Reynaert C, Vandenbossche S, Roos M, Bron D, Razavi D. The prevalence and implications of elderly inpatients' desire for a formal psychological help at the start of cancer treatment. Psychooncology 2014; 24:294-301. [DOI: 10.1002/pon.3636] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 07/04/2014] [Accepted: 07/06/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Stéphanie Dubruille
- Faculté des Sciences Psychologiques et de l'Éducation; Université Libre de Bruxelles; Brussels Belgium
- Service de Médecine Psychosomatique, Cliniques Universitaires de Mont-Godinne; Université Catholique de Louvain; Louvain-la-Neuve Belgium
| | - Yves Libert
- Faculté des Sciences Psychologiques et de l'Éducation; Université Libre de Bruxelles; Brussels Belgium
- Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Isabelle Merckaert
- Faculté des Sciences Psychologiques et de l'Éducation; Université Libre de Bruxelles; Brussels Belgium
- Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Christine Reynaert
- Service de Médecine Psychosomatique, Cliniques Universitaires de Mont-Godinne; Université Catholique de Louvain; Louvain-la-Neuve Belgium
| | | | - Myriam Roos
- Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Dominique Bron
- Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Darius Razavi
- Faculté des Sciences Psychologiques et de l'Éducation; Université Libre de Bruxelles; Brussels Belgium
- Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
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Kenyon M, Mayer DK, Owens AK. Late and Long‐Term Effects of Breast Cancer Treatment and Surveillance Management for the General Practitioner. J Obstet Gynecol Neonatal Nurs 2014; 43:382-98. [DOI: 10.1111/1552-6909.12300] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Wachen JS, Patidar SM, Mulligan EA, Naik AD, Moye J. Cancer-related PTSD symptoms in a veteran sample: association with age, combat PTSD, and quality of life. Psychooncology 2014; 23:921-7. [PMID: 24519893 DOI: 10.1002/pon.3494] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 01/03/2014] [Accepted: 01/10/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The diagnosis and treatment of cancer is a potentially traumatic experience that may evoke posttraumatic stress symptoms (PTSS) among survivors. This paper describes the rates of endorsement of cancer-related PTSS along with the relationship of demographic, cancer, and combat variables on PTSS and quality of life. METHODS Veterans (N = 166) with head and neck, esophageal, gastric, or colorectal cancers were recruited through tumor registries at two regional Veterans Administration Medical Centers. Standardized scales were used to assess self-report of PTSS, combat, and quality of life. RESULTS Most participants (86%) reported experiencing at least some cancer-related PTSS; 10% scored above a clinical cutoff for probable PTSD. In linear regressions, younger age and current combat PTSS were associated with cancer-related PTSS, whereas disease and treatment characteristics were not; in turn, cancer-related PTSS were negatively associated with physical and social quality of life. CONCLUSIONS Individual characteristics and psychosocial factors may play a larger role than disease-related variables in determining how an individual responds to the stress of cancer diagnosis and treatment. Given the rates of reported cancer-related PTSS in this sample, and other non-veteran samples, clinicians should consider screening these following diagnosis and treatment, particularly in younger adults and those with previous trauma histories.
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Mulligan EA, Wachen JS, Naik AD, Gosian J, Moye J. Cancer as a Criterion A Traumatic Stressor for Veterans: Prevalence and Correlates. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2014; 6:S73-S81. [PMID: 25741406 DOI: 10.1037/a0033721] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The diagnosis of cancer is an uncontrollable stressor posing the threat of death and disfigurement, often followed by repeated exposure to aversive reminders in the form of noxious treatments, persisting side effects, reengagement at times of surveillance, and the threat of recurrence. The phenomenon of cancer as a traumatic stressor is explored in this study, with a focus on the prevalence and correlates of posttraumatic stress disorder (PTSD) Criterion A in a sample of 170 mostly male adults who received health care at VA Medical Centers in Boston or Houston. Participants were interviewed 6 months after diagnosis with head and neck, gastro-esophageal, or colorectal cancers. Approximately half-42.9% to 65.9% depending on cut-score used-perceived cancer to be a traumatic stressor involving actual/threatened death or injury or threat to physical integrity as well as fear, helplessness, or horror. Younger veterans and those with current combat PTSD symptoms were more likely to perceive cancer as a traumatic stressor, as were those who perceived their prognosis as uncertain; 12% had PTSD symptoms above a PCLC cut score of 50, which is similar to incidence rates of PTSD associated with other traumatic stressors. Cancer, therefore, appears to be a serious and for some, traumatic stressor, suggesting the importance of screening for cancer related PTSD in cancer survivors, particularly those most at risk.
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Affiliation(s)
| | | | - Aanand D Naik
- Health Services Research and Development, Michael E. DeBakey VAMC, Houston, Texas, and Baylor College of Medicine
| | | | - Jennifer Moye
- VA Boston Health Care System, Boston, Massachusetts and Harvard Medical School
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In the shadow of terror: posttraumatic stress and psychiatric co-morbidity following bombing in Iraq: the role of shattered world assumptions and altered self-capacities. J Psychiatr Res 2013. [PMID: 23186645 DOI: 10.1016/j.jpsychires.2012.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Whilst research has looked at posttraumatic stress disorder (PTSD) and psychiatric co-morbidity among civilians exposed to bombing, there is a lack of longitudinal data on the development of these outcomes and the psychological factors associated with them, particularly among Iraqi civilians. This study aimed to: investigate 1) the trajectory of PTSD and psychiatric co-morbidity following bombing among civilians in Iraq and 2) the link between shattered world assumptions, altered self-capacities and identified health outcomes. One hundred and eighty (F = 90, M = 90) Iraqi civilians exposed to first time bombing were recruited approximately one month (time 1) after the bombing and five months (time 2) after the baseline assessment. A control group data (178, F = 91, M = 87) from people who were not exposed to bombing was also collected. They completed the Posttraumatic Stress Diagnostic Scale, the General Health Questionnaire-28, the World Assumptions Questionnaire and the Inventory of Altered Self-Capacities. The results showed that there was a significant decline in the proportion of people meeting the screening criteria for PTSD and psychiatric co-morbidity symptoms over time. For the cross-sectional analysis, controlling for demographic variables, regression analysis showed that severity of the bombing (β = .16), controllability of events (β = -.21), safety and vulnerability (β=.31) and affect dysregulation (β = .37) significantly predicted PTSD time 1. Controllability of events (β = -.20) and affect dysregulation (β = .37) also predicted psychiatric co-morbidity at time 1. For the prospective analysis, controlling for PTSD and psychiatric co-morbidity at time 1, none of these dimensions predicted PTSD and psychiatric co-morbidity at time 2. Findings are discussed in terms of individual resilience. It can be concluded that following bombing, civilians developed PTSD and psychiatric co-morbidity which declined over time. Civilians' perceptions of their ability to control events in the world and regulate their affect had a short term impact on the severity of these symptoms.
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Kang DH, Park NJ, McArdle T. Cancer-specific stress and mood disturbance: implications for symptom perception, quality of life, and immune response in women shortly after diagnosis of breast cancer. ISRN NURSING 2012; 2012:608039. [PMID: 23316388 PMCID: PMC3539323 DOI: 10.5402/2012/608039] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 11/28/2012] [Indexed: 11/26/2022]
Abstract
Purpose. To determine the levels of cancer-specific stress and mood disturbance in women shortly after diagnosis of breast cancer and to assess their associations with symptom perception, quality of life, and immune response. Design. Descriptive and correlational. Sample and Setting. One hundred women with newly diagnosed breast cancer were recruited from interdisciplinary breast clinics. Methods. Baseline data were collected using standardized questionnaires and established bioassay prior to the initiation of cancer adjuvant therapy. Blood samples were collected about the same time of day. Results. High cancer-specific stress was significantly correlated with high mood disturbance, which, in turn, was correlated with high symptom perception, poor quality of life, and an immune profile indicating high neutrophils and low lymphocytes. Conclusions. High cancer-specific stress and related mood disturbance show extensive negative relationships with multiple behavioral, clinical, and biological factors. Implications for Nursing. Routine screening for cancer-related stress and mood disturbance should be incorporated into nursing practice for all patients diagnosed with cancer. Given broad negative associations with other biobehavioral factors, early identification of patients at risk and provision and evaluation of stress and mood management programs may have a beneficial effect on subsequent health outcomes over time.
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Affiliation(s)
- Duck-Hee Kang
- University of Texas School of Nursing at Houston, 6901 Bertner Avenue, CNR No. 536, Houston, TX 77030, USA
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Gold JI, Douglas MK, Thomas ML, Elliott JE, Rao SM, Miaskowski C. The relationship between posttraumatic stress disorder, mood states, functional status, and quality of life in oncology outpatients. J Pain Symptom Manage 2012; 44:520-31. [PMID: 22743157 DOI: 10.1016/j.jpainsymman.2011.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 10/20/2011] [Accepted: 10/27/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT Oncology patients are at risk for developing posttraumatic stress disorder (PTSD) and other comorbid mood states, which are associated with decreases in functional status and quality of life (QOL). However, few studies have investigated the relationship between PTSD, other mood states, functional status, and QOL in oncology outpatients. OBJECTIVES This study had four aims: 1) determine the percentages of patients with PTSD and partial PTSD; 2) evaluate for differences in demographic and clinical characteristics among patients with PTSD, partial PTSD, and no PTSD; 3) evaluate for differences in mood states, functional status, and QOL among the three PTSD groups; and 4) evaluate whether demographic and disease characteristics were predictors of PTSD. METHODS As part of a larger clinical trial that evaluated the effects of a cognitive-behavioral intervention on cancer pain management, 289 adult oncology patients (M(age)=61.3, SD=11.6) completed self-report measures that assessed PTSD, other mood states, functional status, and QOL. RESULTS Forty-five percent of the sample met the diagnostic criteria for PTSD (n=78) and partial PTSD (n=53) and were younger than those with no PTSD. Patients with PTSD had a significantly lower Karnofsky Performance Status, shorter time since diagnosis, higher ratings of mood disturbance, lower ratings of functional status, and lower QOL than patients with no PTSD. A lower Karnofsky Performance Status, fewer months since diagnosis, and presence of bone metastases predicted a higher likelihood of being classified as having PTSD. CONCLUSION Early identification and interventions may mediate the onset of psychological distress and improve health outcomes.
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Affiliation(s)
- Jeffrey I Gold
- Keck School of Medicine, University of Southern California, and Pain Management and Palliative Care Program, Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, CA 90027, USA.
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Philip EJ, Merluzzi TV, Zhang Z, Heitzmann CA. Depression and cancer survivorship: importance of coping self-efficacy in post-treatment survivors. Psychooncology 2012; 22:987-94. [PMID: 22573371 DOI: 10.1002/pon.3088] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 03/26/2012] [Accepted: 03/28/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND An estimated 30% of cancer patients are expected to experience clinically significant psychological distress during the treatment phase of their disease. Despite significant attention being directed to the mental health needs of individuals undergoing and completing treatment, there is less known about the mental health needs of survivors and the role of potential protective factors in survivorship, such as coping self-efficacy and social support. METHOD One hundred and twenty-four post-treatment cancer survivors (mean age = 62.23 years, women = 70%, average 9.3 years post-treatment) were asked to complete measures of physical symptoms, coping self-efficacy, social support, and depression as part of a national convenience sample of cancer patients and survivors. RESULTS About 20% of participants possessed scores on the Center for Epidemiologic Studies-Depressed Mood Scale indicative of clinically relevant depression. Coping self-efficacy was not only a significant predictor of depression (43% Variance Accounted For); it also partially mediated the relationship between symptoms and depression. Social support accounted for limited variance and was not a significant predictor of depression in a model containing both social support and coping self-efficacy as predictors. CONCLUSION A substantial minority of post-treatment survivors reported depression symptomatology. Coping self-efficacy may be an important component of patients' adjustment and possible target for intervention. These results highlight the ongoing mental health and support needs of cancer survivors.
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Affiliation(s)
- Errol J Philip
- Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA.
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Posttraumatic stress disorder at the end of life: extant research and proposed psychosocial treatment approach. Palliat Support Care 2012; 9:407-18. [PMID: 22104417 DOI: 10.1017/s1478951511000435] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
According to some estimates, 84% of people experience a traumatic event during their lives (Vrana & Lauterbach, 1994), and 15% to 24% then develop posttraumatic stress disorder (PTSD). Many carry with them lasting effects of trauma as they age and enter the last phase of life. PTSD manifests in unique ways at the end of life, possibly disrupting factors associated with a positive dying process, including social support, medical communication, life review, and acceptance of death. Terminally ill people with PTSD may suffer more emotional distress, lower quality of life, and poorer medical prognosis than those without PTSD. Unfortunately, healthcare providers may not be trained to address this issue. This article reviews the literature concerning how PTSD may affect the end of life and proposes an intervention model based on a palliative care philosophy.
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Fischer MJ, Krol-Warmerdam EMM, Ranke GMC, Zegers MHW, Aeijelts Averink R, Scholten AN, Kaptein AA, Nortier HWR. Routine Monitoring of Quality of Life for Patients with Breast Cancer: An Acceptability and Field Test. J Psychosoc Oncol 2012; 30:239-59. [DOI: 10.1080/07347332.2011.644398] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lally RM, Underhill ML. Transition to Breast Cancer Survivorship: A Longitudinal Qualitative Follow-Up Study of Two-Year Survivors. J Psychosoc Oncol 2012; 30:97-127. [DOI: 10.1080/07347332.2011.633983] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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