Age and depression in patients with metastatic cancer: the protective effects of attachment security and spiritual wellbeing

Cognitive-behavioral and mindfulness-based interventions for distress in patients with advanced cancer: A meta-analysis

OBJECTIVE

Various psychosocial interventions have been developed to reduce distress and improve quality of life (QoL) in patients with advanced cancer, many of which are traditional cognitive-behavioral interventions (CBIs) or mindfulness-based interventions (MBIs). The aims of this meta-analysis were to determine and compare the overall effects of traditional CBIs and MBIs on distress and QoL in this population and to explore potential moderators of intervention efficacy.

METHODS

A systematic search was conducted in CINAHL, Embase, PsycINFO, PubMed, and Web of Science. Randomized controlled trials (RCTs) comparing CBIs or MBIs to controls on distress and QoL outcomes were eligible for inclusion. Random effects meta-analyses using standardized baseline to post-intervention mean differences were calculated using Hedges's g. Meta-regressions were used to compare intervention effects and examine potential moderators.

RESULTS

Across 37 RCTs (21 CBIs, 14 MBIs, 2 combination therapies), there was a small decrease in distress (Hedges's g = 0.21) and a minimal improvement in QoL (Hedges's g = 0.15). Traditional CBIs and MBIs did not differ in effect sizes. Heterogeneity was significant across distress effect sizes but not across QoL effects. Interventions delivered to individuals (vs. dyads/group) had larger effects on QoL. No moderators of intervention effects on distress were found.

CONCLUSIONS

Findings suggest traditional CBIs and MBIs produce small reductions in distress compared to controls in patients with advanced cancer, although effects on QoL appear minimal. Given limitations in the number of studies and their quality, rigorous trials are needed to directly compare the impact of traditional CBIs and MBIs in this population.

[Old age and attachment theory, a systematic review of attachment typology, continuity, prevalence and association with psychological and health variables in older adults]

The aim of this paper is to review the research on attachment theory during old age in the last 10 years, in order to obtain: a) the prevalence of different types of attachment, b) the assessment of attachment methods, c) the relationship established between attachment and other psychosocial and health variables in the aging process. A systematic search of PsycINFO, PsycArticles, WOS, and Scopus identified 17 studies, in which attachment had been assessed in a population of 7118 older adults. The results of this research present a clear evolution and some differences, with respect to the previous systematic 2010 review. Regarding the prevalence of the different types of attachment, it is confirmed that secure attachment and avoidant attachment are more abundant in old age than in adulthood or youth people. There is no consensus on the instruments used for the evaluation, and results are presented that associate insecure attachment with depression, life satisfaction, physical illness and loneliness. The attachment construct appears as an explanatory and mediating variable, directly involved in the psychology and psychopathology of old age.

Evaluation of Managing Cancer and Living Meaningfully (CALM) in people with advanced non-small cell lung cancer treated with immunotherapies or targeted therapies: protocol for a single-arm, mixed-methods pilot study

INTRODUCTION

People with advanced non-small cell lung cancer (NSCLC) treated with immunotherapies (IT) or targeted therapies (TT) may have improved outcomes in a subset of people who respond, raising unique psychological concerns requiring specific attention. These include the need for people with prolonged survival to reframe their life plans and tolerate uncertainty related to treatment duration and prognosis. A brief intervention for people with advanced cancer, Managing Cancer and Living Meaningfully (CALM), could help people treated with IT or TT address these concerns. However, CALM has not been specifically evaluated in this population. This study aims to evaluate the acceptability and feasibility of CALM in people with advanced NSCLC treated with IT or TT and obtain preliminary evidence regarding its effectiveness in this population.

METHODS AND ANALYSIS

Twenty people with advanced NSCLC treated with IT or TT will be recruited from Peter MacCallum Cancer Centre, Melbourne, Australia. Participants will complete three to six sessions of CALM delivered over 3-6 months. A prospective, single-arm, mixed-methods pilot study will be conducted. Participants will complete outcome measures at baseline, post-intervention, 3 months and 6 months, including Patient Health Questionnaire, Death and Dying Distress Scale, Functional Assessment of Cancer Therapy General and Clinician Evaluation Questionnaire. The acceptability of CALM will be assessed using patient experiences surveys and qualitative interviews. Feasibility will be assessed by analysis of recruitment rates, treatment adherence and intervention delivery time.

ETHICS AND DISSEMINATION

Ethics approval has been granted by the Peter MacCallum Cancer Centre Human Research Ethics Committee (HREC/82047/PMCC). Participants with cancer will complete a signed consent form prior to participation, and carers and therapists will complete verbal consent. Results will be made available to funders, broader clinicians and researchers through conference presentations and publications. If CALM is found to be acceptable in this cohort, this will inform a potential phase 3 trial.

Social Wellbeing in Cancer Survivorship: A Cross-Sectional Analysis of Self-Reported Relationship Closeness and Ambivalence from a Community Sample

Improvements in early screening and treatment have contributed to the growth of the number of cancer survivors. Understanding and mitigating the adverse psychosocial, functional, and economic outcomes they experience is critical. Social wellbeing refers to the quality of the relationship with partners/spouses, children, or significant others. Close relationships contribute to quality of life and self-management; however, limited literature exists about social wellbeing during survivorship. This study examined positive and negative self-reported changes in a community sample of 505 cancer survivors. Fourteen items assessed changes in communication, closeness with partner/children, stability of the relationship, and caregiving burden. An exploratory factor analysis was conducted using a robust weighted least square procedure. Differences by sociodemographic and clinical characteristics were investigated. Respondents were mostly male, non-Hispanic white, and ≥4 years since diagnosis. Two factors, labeled Relationship Closeness and Ambivalence, emerged from the analysis. Women, younger survivors, individuals from minority groups, and those with lower income experienced greater negative changes in social wellbeing. Variations by treatment status, time since diagnosis, and institution were also reported. This contribution identifies groups of cancer survivors experiencing affected social wellbeing. Results emphasize the need to develop interventions sustaining the quality of interpersonal relationships to promote long-term outcomes.

An Interaction Effect of Life-Threatening Experience, Self-Efficacy, and Financial Resources on Quality of Life Among Chinese Middle-Aged and Older Women

The current study explores the interaction effect of adversities and self-efficacy at baseline on quality of life (QoL) at follow-up among middle-aged and older Chinese women. 531 women were interviewed in 2008 and 226 of them were re-interviewed a year later using Quality of Life Ladder (QoLL), General Self-Efficacy Scale (GSE), List of Threatening Experiences (LTE), Somatic Complaint Scale, and self-rated health. Respondents' mean age at baseline was 55.7 (SD = 4.7, range: 50-78). Over a year's time, respondents had a decline in quality of life and self-rated health (p < .001), experienced more life-threatening events (p < .05) and somatic complaints. The hierarchical multiple regression model, employed in the study, identifies three predictors of future quality of life after adding the interaction term 'Previous LTE × Previous GSE × Previous household income' - previous quality of life (β = .492, p < .001), previous LTE (β = -.292, p < .001), and the interaction term (β = .221, p < .05). This model explains 34.1% of the variance of future quality of life (Adjusted R² = .341, p < .001). The findings suggests that respondents' good self-appraisal of coping resources could moderate the impact of adversities on their future quality of life. Interventions for promoting positive psychological growth among middle-aged and older adults should cover four domains, i.e. event-related factors, environmental factors, personal factors, and cognitive and coping responses. Traditional Chinese wisdom emphasizes the importance of understanding the bad ('Yin'-the shady side) and the good ('Yang'-the sunny side) aspect of life events. Future research may explore the Yin Yang perspective on life-threatening experiences and its applications in cross-cultural quality of life studies in the era of globalization.

Psychological Adaptive Mechanism Maturity, Age, and Depression Symptoms in Advanced-Stage Cancer Patients

Background: Previously, we reported that the maturity of Psychological Adaptive Mechanism (PAM; alternatively, ego defense mechanism) endorsement, but not depression symptom severity, predicted 5-year survival rates in adult cancer patients and that study controlled for age as a significant variable. In this investigation, we hypothesized that greater PAM maturity would correlate significantly with age and with fewer depression symptoms in a larger sample.

Methods: In this cross-section study, adult cancer outpatients (N=293) completed the Defense Style Questionnaire (DSQ), the Beck Depression Inventory (BDI), and provided additional clinical data. Spearman’s correlation and multiple regression modeling provided statistical tests of the study hypotheses.

Results: Contrary to our hypothesis, DSQ PAM maturity endorsement did not correlate significantly with increasing age. Greater PAM maturity ratio on the DSQ (p<0.0001) and current antidepressant use (p<0.05), however, both provided inverse associations with total BDI symptom frequency (p<0.01). Age was inversely associated with BDI mood (p<0.0001) and somatic scores (p<0.04). Items that worsened BDI symptom frequency included self-reported mood-altering anti-cancer medications and any psychiatric history. Cancer stage, time since diagnosis, and chemotherapy treatment did not correlate with DSQ or BDI scores. Multiple regression analysis found that the correlated items accounted for 17.2% of the variance in mood symptoms and 4.9% in somatic symptoms. Specifically, adaptive maturity and age associated with fewer depression symptoms, while cancer medications affecting mood, and a previous psychiatric history each predicted higher frequency of depression scores.

Conclusion: The results suggest that PAM maturity likely predicts fewer depression symptoms while younger age associates with more depression symptoms in this clinical sample. Centrally, acting cancer medications, such as glucocorticoids, and any history of psychiatric disorder correlated with increased depression symptom frequencies. In this cross-section study, antidepressant medications indicated higher frequencies of depressive symptoms, likely reflecting their use in persons previously diagnosed with depression. Further research should target factors that improve PAM maturity as a potential treatment target, especially in younger age groups.

Existential Suffering in Palliative Care: An Existential Positive Psychology Perspective

The COVID-19 pandemic has exposed the inadequacies of the current healthcare system and needs a paradigm change to one that is holistic and community based, illustrated by the healing wheel. The present paper proposes that existential positive psychology (PP 2.0) represents a promising approach to meet the rising needs in palliative care. This framework has a twofold emphasis on (a) how to transcend and transform suffering as the foundation for wellbeing and (b) how to cultivate our spiritual and existential capabilities to achieve personal growth and flourishing. We propose that these objectives can be achieved simultaneously through dialectical palliative counselling, as illustrated by Wong's integrative meaning therapy and the Conceptual Model of CALM Therapy in palliative care. We then outline the treatment objectives and the intervention strategies of IMT in providing palliative counselling for palliative care and hospice patients. Based on our review of recent literature, as well as our own research and practice, we discover that existential suffering in general and at the last stage of life in particular is indeed the foundation for healing and wellbeing as hypothesized by PP 2.0. We can also conclude that best palliative care is holistic-in addition to cultivating the inner spiritual resources of patients, it needs to be supported by the family, staff, and community, as symbolized by the healing wheel.

Medical Assistance in Dying in patients with advanced cancer and their caregivers: a mixed methods longitudinal study protocol

BACKGROUND

The legal criteria for medical assistance in dying (MAiD) for adults with a grievous and irremediable medical condition were established in Canada in 2016. There has been concern that potentially reversible states of depression or demoralization may contribute to the desire for death (DD) and requests for MAiD. However, little is known about the emergence of the DD in patients, its impact on caregivers, and to what extent supportive care interventions affect the DD and requests for MAiD. The present observational study is designed to determine the prevalence, predictors, and experience of the DD, requests for MAiD and MAiD completion in patients with advanced or metastatic cancer and the impact of these outcomes on their primary caregivers.

METHODS

A cohort of patients with advanced or metastatic solid tumour cancers and their primary caregivers will be recruited from a large tertiary cancer centre in Toronto, Ontario, Canada, to a longitudinal, mixed methods study. Participants will be assessed at baseline for diagnostic information, sociodemographic characteristics, medical history, quality of life, physical and psychological distress, attitudes about the DD and MAiD, communication with physicians, advance care planning, and use of psychosocial and palliative care interventions. Measures will subsequently be completed every six months and at the time of MAiD requests. Quantitative assessments will be supplemented by qualitative interviews in a subset of participants, selected using quota sampling methods.

DISCUSSION

This study has the potential to add importantly to our understanding of the prevalence and determinants of the DD, MAiD requests and completions in patients with advanced or metastatic cancer and of the experience of both patients and caregivers in this circumstance. The findings from this study may also assist healthcare providers in their conversations about MAiD and the DD with patients and caregivers, inform healthcare providers to ensure appropriate access to MAiD, and guide modifications being considered to broaden MAiD legislation and policy.

The impact of attachment security on death preparation in advanced cancer: The role of couple communication

OBJECTIVE

Attachment security protects psychological well-being in patients with advanced cancer, but its effect on death preparation in this population has not been demonstrated. We examined the relationship of attachment security to death preparation in advanced cancer and tested whether couple communication mediates this relationship and whether gender and age moderate this mediating effect, using longitudinal data from a psychotherapy trial.

METHODS

Patients with advanced cancer who lived with a partner (N_baseline = 289) completed measures of attachment security (attachment avoidance, attachment anxiety), couple communication, and death preparation (preparation for end of life, life completion) and attendant health involvement (relationship with healthcare provider). A moderated mediation model was evaluated at each time period (baseline, 3 months, and 6 months).

RESULTS

Couple communication mediated the relationship of attachment security to preparation for end of life and life completion (b's = -.06 to -.10). Anxiety × Gender effects on baseline couple communication (P's = .016) indicated that women with greater attachment anxiety reported worse communication than their male counterparts. Couple-communication × Gender × Age effects on baseline preparation for end of life (P = .007-.020) suggested that women showed better preparation with better couple communication. Younger patients reported less preparation than older patients, especially with poorer communication, but their preparation increased with better communication, especially in younger men.

CONCLUSIONS

Attachment security supports death preparation in advanced cancer partly through better couple communication. Couple-based psychotherapeutic interventions, especially for younger individuals and women with attachment anxiety, may facilitate constructive conversations and death preparation.

Understanding the Relationship Between Spiritual Well-Being and Depression in Chronic Pain Patients: The Mediating Role of Pain Catastrophizing

BACKGROUND

It is well established that there is an association between chronic pain and depression.

AIMS

The present study aimed to identify whether pain catastrophizing and spiritual well-being may influence depression in chronic pain patients when other variables are controlled for (sociodemographic characteristics and pain intensity). Furthermore, it investigated possible mechanisms by which spiritual well-being can influence depression in these patients.

DESIGN

The present study employed a cross-sectional design.

SETTINGS AND PARTICIPANTS

This study was performed with a convenience sample of 300 consecutive patients with different types of chronic pain (defined as recurrent or persistent pain over >3 months), referred to clinics affiliated with Shiraz university of Medical Sciences between March and October 2017.

METHODS

Patients completed validated self-report questionnaires: Spiritual Well-being Questionnaire, Patient Health Questionnaire, Pain Catastrophizing Scale, and Numeric Rating Scale.

RESULTS

Hierarchical multiple regression analysis indicated that a significant portion of the variance in depression scores can be explained by catastrophizing and spiritual well-being. In Multiple Mediation Procedure, pain catastrophizing could negatively mediate the relationship between spiritual well-being and depression when controlling for sociodemographic characteristics and pain intensity.

CONCLUSIONS

The findings add some evidence to further support the influence of spiritual well-being on depression levels through diminished pain catastrophizing. The present results could help clinicians to determine which variables should be emphasized for a successful treatment of depression in pain patients. Clinical interventions that increase meaningfulness and purpose in life may allow patients with chronic pain to overcome the maladaptive cognitions associated with pain, thereby reducing depressive symptoms.

Distress and Supportive Care Needs of Ethnically Diverse Older Adults With Advanced or Recurrent Cancer

OBJECTIVES

To assess the prevalence of supportive care needs (SCNs) and distress and to describe relationships among these and patient characteristics for ethnically diverse older adults with advanced or recurrent cancer.

SAMPLE & SETTING

Cross-sectional survey in five outpatient oncology clinics in an urban academic medical center involving 100 participants receiving cancer care in an economically challenged community.

METHODS & VARIABLES

The supportive care framework for cancer care guided this study, and participants completed the SCN Survey Short Form 34 and the Distress Thermometer. Study variables are cancer diagnosis, gender, helping to raise children, number of comorbid diseases, race or ethnicity, treatment status, and zip code.

RESULTS

Clinically meaningful distress was found in about a third of patients. Distress was not affected by race or ethnicity. Many ethnically diverse older patients with advanced or recurrent cancer report distress and SCNs; those with high distress are more likely to report multiple SCNs.

IMPLICATIONS FOR NURSING

Nursing assessment of patient SCNs and distress is integral to establishing individualized patient-centered care plans and to delivering optimal care.

Identifying factors of psychological distress on the experience of pain and symptom management among cancer patients

Background

Epidemiological evidence suggests the impact psychological distress has on symptomatic outcomes (pain) among cancer patients. While studies have examined distress across various medical illnesses, few have examined the relationship of psychological distress and pain among patients diagnosed with cancer. This study aimed to examine the impact psychological distress-related symptoms has on pain frequency, presence of pain, and pain-related distress among oncology patients.

Methods

Data were collected from a sample of White and Black adults (N = 232) receiving outpatient services from a comprehensive cancer center. Participants were surveyed on questions assessing psychological distress (i.e., worry, feeling sad, difficulty sleeping), and health (pain presence, pain frequency, comorbidities, physical functioning), behavioral (pain-related distress), and demographic characteristics.

Results

Patients reporting functional limitations were more likely to report pain. Specifically, those reporting difficulty sleeping and feeling irritable were similarly likely to report pain. Data further showed age and feeling irritable as significant indicators of pain-related distress, with younger adults reporting more distress.

Conclusions

It must be recognized that psychological distress and experiences of pain frequency are contingent upon a myriad of factors that are not exclusive, but rather coexisting determinants of health. Further assessment of identified predictors such as age, race, socioeconomic status, and other physical and behavioral indicators are necessary, thus allowing for an expansive understanding of the daily challenges and concerns of individuals diagnosed with cancer, while providing the resources for clinicians, researchers, and policy makers to better meet the needs of this patient population.

Correlates of self-rated attachment in patients with cancer and their caregivers: a systematic review and meta-analysis

BACKGROUND

This study aimed to evaluate the association between an anxious/avoidant attachment style and psychosocial variables in patients with cancer and their caregivers.

METHODS

PsycINFO, PubMed, Google Scholar, and SCOPUS were searched for empirical studies published in peer-reviewed journals between 1994 and 2015, and unpublished data from one cohort were added. Meta-analyses synthesized results from studies investigating the correlates of attachment styles, measured with validated scales, among patients with cancer or their caregivers.

RESULTS

Thirteen studies (k = 13) were included in the quantitative synthesis (including unpublished data from one cohort). Anxious attachment was associated with depression (r = 0.29, CI 0.19-0.38, I(2)  = 76%), anxiety (r = 0.34, CI 0.13-0.52, I(2)  = 69%), and social support (r = -0.39, CI -0.55-0.21, I(2)  = 87%). Avoidant attachment was associated with depressive symptoms (r = 0.20, CI 0.15-0.25, I(2)  = 16%), anxiety (r = 0.13, CI 0.01-0.24, I(2)  = 4%), and social support (r = -0.28, CI -0.42-0.14, I(2)  = 75%).

CONCLUSIONS

Patients with cancer and their caregivers showing high levels of insecure attachment are at risk of experiencing higher levels of depressive symptoms, anxiety, and poor social support. Findings suggest that clinicians' awareness of attachment styles may serve as important clinical insight to improve treatment outcomes. Large-scale studies and longitudinal studies are required to investigate distinct longitudinal pathways in cancer-related distress across different attachment styles Copyright © 2016 John Wiley & Sons, Ltd.

Rehabilitation of women with gynaecological cancer: the association between adult attachment, post-traumatic stress disorder and depression

OBJECTIVE

We hypothesised that being diagnosed with gynaecological cancer influences adult attachment and occurrence of depression and post-traumatic stress disorder (PTSD). The main aim of the study was to assess changes in the attachment dimensions, PTSD and depression from baseline to 5-month post-treatment. Further, we evaluated the association between attachment avoidance/anxiety dimensions and PTSD/depression among women newly diagnosed with ovarian, endometrial, or cervical cancer.

METHODS

Consecutive Danish-speaking women aged 20 to 75 years and treated surgically for primary gynaecological cancer were eligible. All patients were offered a rehabilitation programme consisting of two face-to-face sessions and two phone calls carried out by a nurse. Patients were asked to complete the Revised Adult Attachment Scale, the Harvard Trauma Questionnaire and the Major Depression Inventory at baseline and at 5-month follow-up. In all, 151 women consent to participate in the sessions where 51 fulfilled Revised Adult Attachment Scale questionnaire and contribute with socio-demographic data.

RESULTS

We found significant positive changes within the attachment anxiety dimension among women with ovarian cancer, a significant reduction of PTSD among endometrial cancer patients and insignificant changes in depression among all cancer types. The attachment anxiety dimension significantly increased the odds for PTSD and depression.

CONCLUSIONS

Depression and PTSD were prevalent among ovarian and cervical cancer patients. The adjustment of rehabilitation according to patients' attachment anxiety dimension contains possibilities for indirect impact on PTSD and depression symptoms. Copyright © 2015 John Wiley & Sons, Ltd.

Depressive symptoms in the last days of life of patients with cancer: a nationwide retrospective mortality study

OBJECTIVES

Depressive symptoms are common in patients with cancer and tend to increase as death approaches. The study aims were to examine the prevalence of depressive symptoms in patients with cancer in their final 24 h, and their association with other symptoms, sociodemographic and care characteristics.

METHODS

A stratified sample of deaths was drawn by Statistics Netherlands. Questionnaires on patient and care characteristics were sent to the physicians (N=6860) who signed the death certificates (response rate 77.8%). Adult patients with cancer with non-sudden death were included (n=1363). Symptoms during the final 24 h of life were assessed on a 1-5 scale and categorised as 1=no, 2-3=mild/moderate and 4-5=severe/very severe.

RESULTS

Depressive symptoms were registered in 37.6% of the patients. Patients aged 80 years or more had a reduced risk of having mild/moderate depressive symptoms compared with those aged 17-65 years (OR 0.70; 95% CI 0.50 to 0.99). Elderly care physicians were more likely to assess patients with severe/very severe depressive symptoms than patients with no depressive symptoms (OR 4.18; 95% CI 1.48 to 11.76). Involvement of pain specialists/palliative care consultants and psychiatrists/psychologists was associated with more ratings of severe/very severe depressive symptoms. Fatigue and confusion were significantly associated with mild/moderate depressive symptoms and anxiety with severe/very severe symptoms.

CONCLUSIONS

More than one-third of the patients were categorised with depressive symptoms during the last 24 h of life. We recommend greater awareness of depression earlier in the disease trajectory to improve care.

How are patient populations characterized in studies investigating depression in advanced cancer? Results from a systematic literature review

CONTEXT

Prevalence rates of depression in patients with advanced cancer vary considerably. This may be because of heterogeneous samples and use of different assessment methods. Adequate sample descriptions and consistent use of measures are needed to be able to generalize research findings and apply them to clinical practice.

OBJECTIVES

Our objective was twofold: First, to investigate which clinically important variables were used to describe the samples in studies of depression in patients with advanced cancer; and second, to examine the methods used for assessing and classifying depression in these studies.

METHODS

PubMed, PsycINFO, Embase, and CINAHL were searched combining search term groups representing "depression," "palliative care," and "advanced cancer" covering 2007-2011. Titles and abstracts were screened, and relevant full-text articles were evaluated independently by two authors. Information on 32 predefined variables on cancer disease, treatment, sociodemographics, depression-related factors, and assessment methods was extracted from the articles.

RESULTS

After removing duplicates, 916 citations were screened of which 59 articles were retained. Age, gender, and stage of the cancer disease were the most frequently reported variables. Depression-related variables were rarely reported, for example, antidepressant use (17%) and previous depressive episodes (12%). Only 25% of the studies assessed and classified depression according to a validated diagnostic system.

CONCLUSION

Current practice for describing sample characteristics and assessing depression varies greatly between studies. A more standardized practice is recommended to enhance the generalizability and utility of findings. Stakeholders are encouraged to work toward a common standard for sample descriptions.

The Protective Effects of Religiosity on Depression: A 2-Year Prospective Study

PURPOSE OF THE STUDY

Approximately 20% of older adults are diagnosed with depression in the United States. Extant research suggests that engagement in religious activity, or religiosity, may serve as a protective factor against depression. This prospective study examines whether religiosity protects against depression and/or aids in recovery.

DESIGN AND METHODS

Study data are drawn from the 2006 and 2008 waves of the Health and Retirement Study. The sample consists of 1,992 depressed and 5,740 nondepressed older adults (mean age = 68.12 years), at baseline (2006), for an overall sample size of 7,732. Logistic regressions analyzed the relationship between organizational (service attendance), nonorganizational (private prayer), and intrinsic measures of religiosity and depression onset (in the baseline nondepressed group) and depression recovery (in the baseline depressed group) at follow-up (2008), controlling for other baseline factors.

RESULTS

Religiosity was found to both protect against and help individuals recover from depression. Individuals not depressed at baseline remained nondepressed 2 years later if they frequently attended religious services, whereas those depressed at baseline were less likely to be depressed at follow-up if they more frequently engaged in private prayer.

IMPLICATIONS

Findings suggest that both organizational and nonorganizational forms of religiosity affect depression outcomes in different circumstances (i.e., onset and recovery, respectively). Important strategies to prevent and relieve depression among older adults may include improving access and transportation to places of worship among those interested in attending services and facilitating discussions about religious activities and beliefs with clinicians.

Sexual activity and body image: examining gender variability and the influence of psychological distress in cancer patients

Psychosocial factors impacting on the overall quality of life for cancer patients may differ between men and women. This study examined the influence that psychological distress, clinical, and social variables have on sexual activity and body image in adult oncology patients. Symptom data was collected from the Memorial Symptom Assessment Scale (MSAS). Analysis indicated women and patients with reported functional limitations were more likely to be less satisfied with how they looked. The final model showed that younger adults, Caucasians, those who were married and patients with some functional limitations were more likely to have problems with sexual interest/activity. Gender was not a significant predictor of having problems with sexual interest/activity. These results can be used by clinicians to identify patients who may be at an increased risk for negative body image and problems in sexual functioning. Further research regarding gender differences in cancer-related psychological symptoms is needed to assist healthcare professionals in providing comprehensive care while alleviating unresolved and interrelated health and psychosocial symptoms.

Receiving palliative treatment moderates the effect of age and gender on demoralization in patients with cancer

Background

Existential distress is an important factor affecting psychological well-being in cancer patients. We studied occurrence and predictors of demoralization, a syndrome of existential distress, in particular the interaction of age, gender, and curative vs. palliative treatment phase.

Methods

A cross-sectional sample of N = 750 patients with different tumor sites was recruited from in- and outpatient treatment facilities. Patients completed the following self-report questionnaires: Demoralization Scale, Patient Health Questionnaire-9, Illness-Specific Social Support Scale Short Version-8, and physical problems list of the NCCN Distress Thermometer. Moderated multiple regression analyses were conducted.

Results

We found high demoralization in 15% and moderate demoralization in 8% of the sample. Curative vs. palliative treatment phase moderated the impact of age and gender on demoralization (three-way interaction: b = 1.30, P = .02): the effect of age on demoralization was negative for women receiving palliative treatment (b = −.26, P = .02) and positive for men receiving palliative treatment (b = .25, P = .03). Effects of age and gender were not significant among patients receiving curative treatment. Female gender was associated with higher demoralization among younger patients receiving palliative treatment only. Analyses were controlled for significant effects of the number of physical problems (b = 6.10, P<.001) and social support (b = −3.17, P<.001).

Conclusions

Existential distress in terms of demoralization is a relevant problem within the spectrum of cancer-related distress. It is associated with a complex interaction of demographic and medical patient characteristics; existential challenges related to palliative treatment may exacerbate the impact of age- and gender-related vulnerability factors on demoralization. Psychosocial interventions should acknowledge this interaction in order to address the individual nature of existential distress in subgroups of cancer patients.

The role of chaplains within oncology interdisciplinary teams

PURPOSE OF REVIEW

The role of chaplains/spiritual care professionals and the importance of addressing spiritual needs within interdisciplinary oncology teams are in need of systematic review and critical appraisal. This review focuses on four key areas: basic concepts of spirituality within the healthcare domain; the relevance of spirituality within cancer care; the role of spiritual care within interdisciplinary cancer teams; and the current status of spiritual care professionals in interdisciplinary cancer teams.

RECENT FINDINGS

Addressing cancer patient's spiritual issues is recognized as a component of comprehensive cancer care. Spirituality has a positive effect on subjective and emotional aspects of cancer patient's health, including quality of life, wellbeing and distress. Failing to address cancer patients spiritual needs impacts patient wellbeing, satisfaction with care, perceived quality of care and is associated with higher healthcare costs. Although a variety of disciplines address spiritual issues, spiritual care professionals are recognized by patients, clinicians, researchers and within best practice guidelines of national health councils as specialists within this domain.

SUMMARY

Spiritual care professionals are increasingly recognized as integral members of interdisciplinary oncology teams. However, the full integration of spiritual care professionals within the standard practice of oncology interdisciplinary teams is lacking, as spiritual care services continue to be treated as ancillary services within cancer care organizations.