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Bai M. Psychological Response to the Diagnosis of Advanced Cancer: A Systematic Review. Ann Behav Med 2021; 56:125-136. [PMID: 34473821 DOI: 10.1093/abm/kaab068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite major efforts to address psychological distress and quality of life (QOL) in people with cancer, only none to small intervention effect has been observed. There is reason to question whether psychosocial needs of patients have already been met under the usual oncology care. PURPOSE The purpose of this systematic review was to examine changes in depression, anxiety and QOL during the existential plight in advanced cancer. METHODS A literature search was performed in the PubMed and APA PsycINFO databases from year 1976 up to May 31, 2021. Longitudinal observational or experimental research targeting depression, anxiety or QOL in advanced cancer (stage III or IV), with baseline time since cancer diagnosis within 100 days, follow-up within 16 weeks post-baseline were eligible. Quality rating was based on the GRADE guidelines. RESULTS Overall QOL did not reveal clinically relevant changes for the majority of studies as evaluated by effect size and raw score changes (median effect size 0.01, interquartile range -0.10-0.15). Nonetheless, modest to moderate improvement was found for depression (median effect size 0.28, interquartile range 0.03-0.38) and anxiety (median effect size 0.57, interquartile range 0.32-0.79). CONCLUSION Transient distress symptoms and temporarily reduced functioning in the oncology setting may be considered normal, whereas impaired overall QOL needs to be addressed. Developing innovative interventions that enhance QOL for patients newly diagnosed with advanced cancer without interfering with patients' natural adaptation process is imperative.
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Affiliation(s)
- Mei Bai
- University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205
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van Nuenen FM, Donofrio SM, Tuinman MA, van de Wiel HBM, Hoekstra-Weebers JEHM. Effects on patient-reported outcomes of "Screening of Distress and Referral Need" implemented in Dutch oncology practice. Support Care Cancer 2020; 28:3391-3398. [PMID: 31781949 PMCID: PMC7256091 DOI: 10.1007/s00520-019-05140-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/17/2019] [Indexed: 11/12/2022]
Abstract
PURPOSE This study investigated the effect of the "Screening for Distress and Referral Need" (SDRN) process (completing a screening instrument; patient-caregiver discussion about the patient's responses, regardless of distress level, and possible referral to specialized care), implemented in Dutch oncology practice on patient-reported outcomes (PROs). METHODS A non-randomized time-sequential study was conducted to compare two cohorts. Cohort 1 respondents (C1) were recruited before and cohort 2 respondents (C2) after SDRN implementation in nine Dutch hospitals. Participants completed the EORTC-QLQ-C30, HADS, Patient Satisfaction Questionnaire-III, and the Distress Thermometer and Problem List (DT&PL). Descriptive analyses and univariate tests were conducted. RESULTS C2 respondents (N = 422, response = 54%) had significantly lower mean scores on the practical (t = 2.3; p = 0.02), social (t = 2.3; p = 0.03), and emotional PL domains (t = 2.9; p = 0.004) compared with C1 (N = 518, response = 53%). No significant differences were found on quality of life, anxiety, depression, satisfaction with care, distress level, the spiritual and physical PL domains, or on referral wish. CONCLUSIONS After implementation of SDRN, patients report significantly fewer psychosocial (practical, social, and emotional) problems on the DT/PL but responses on the other patient-reported outcomes were comparable. These results add to the mixed evidence on the beneficial effect of distress screening. More and better focused research is needed.
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Affiliation(s)
- Floor M van Nuenen
- Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stacey M Donofrio
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Psychology, University of Groningen, Groningen, The Netherlands
| | - Marrit A Tuinman
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harry B M van de Wiel
- Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Josette E H M Hoekstra-Weebers
- Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
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Fradgley EA, Boltong A, O'Brien L, Boyes AW, Lane K, Beattie A, Clinton-McHarg T, Jacobsen PB, Doran C, Barker D, Roach D, Taylor J, Paul CL. Implementing Systematic Screening and Structured Care for Distressed Callers Using Cancer Council's Telephone Services: Protocol for a Randomized Stepped-Wedge Trial. JMIR Res Protoc 2019; 8:e12473. [PMID: 31099341 PMCID: PMC6542249 DOI: 10.2196/12473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/10/2019] [Accepted: 03/29/2019] [Indexed: 11/18/2022] Open
Abstract
Background Structured distress management, comprised a 2-stage screening and referral model, can direct supportive care resources toward individuals who are most likely to benefit. This structured approach has yet to be trialed in Australian community-based services such as Cancer Council New South Wales (NSW) and Victoria Cancer Information and Support (CIS) 13 11 20 lines who care for a large community of cancer patients and caregivers. Objective The aim of this study was to evaluate the effectiveness of structured screening and referral in (1) increasing the proportion of distressed CIS callers who accept supportive care referrals and (2) reducing distress levels at 6-month follow-up. Methods In this stepped-wedge trial, Cancer Council NSW and Victoria CIS consultants are randomized to deliver structured care during inbound 13 11 20 calls in accordance with 3 intervention periods. Eligible callers are patients or caregivers who score 4 or more on the Distress Thermometer; NSW or Victorian residents; aged 18 years or older; and English proficient. Study data are collected via computer-assisted telephone interviews (CATIs) at 3- and 6-month follow-up and CIS record audit. CATIs include demographic and service use items and the General Health Questionnaire (GHQ-28) to assess distress. An economic analysis of the structured care model will be completed. Results The structured care model was developed by guideline review and identification of service characteristics to guide mapping decisions; place-card methodology; and clinical vignettes with think-aloud methodology to confirm referral appropriateness. The model includes an additional screening tool (Patient Health Questionnaire-4) and a referral model with 16-20 CIS services. Descriptive statistics will be used to assess referral uptake rates. Differences between GHQ-28 scores for structured and usual care callers will be tested using a generalized linear mixed model with fixed effects for intervention and each time period. The trial will recruit 1512 callers. The sample size will provide the study with approximately 80% power to detect a difference of 0.3 SD in the mean score of the GHQ-28 at an alpha level of .05 and assuming an intra-cluster correlation of .04. A random sample of recorded calls will be reviewed to assess intervention fidelity and contamination. To date, 1835 distressed callers have been invited to participate with 60.71% (1114/1835) enrolled in the study. A total of 692 participants have completed 6-month CATIs. Recruitment is anticipated to end in late 2019. Conclusions This trial is among the first to rigorously test the outcomes of a community-based structured approach to distress management. The model is evidence-informed, practice-ready, and trialed in a real-world setting. The study outcomes will advance the understanding of distress management internationally for both patients and caregivers. Trial Registration Australian New Zealand Clinical Trial Registry ACTRN12617000352303; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372105&isReview=true (Archived by WebCite on http://www.webcitation.org/78AW0Ba09) International Registered Report Identifier (IRRID) DERR1-10.2196/12473
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Affiliation(s)
- Elizabeth A Fradgley
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Anna Boltong
- Strategy and Support, Cancer Council Victoria, Melbourne, Australia
| | | | - Allison W Boyes
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, Callaghan, Australia
| | - Katherine Lane
- Cancer Information and Support Services, Cancer Council Victoria, Melbourne, Australia
| | - Annette Beattie
- Cancer Information and Support Services, Cancer Council NSW, Woolloomooloo, Australia
| | - Tara Clinton-McHarg
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Psychology, University of Newcastle, Callaghan, Australia
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, United States
| | - Christopher Doran
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, University of Central Queensland, Brisbane, Australia
| | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Della Roach
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Jo Taylor
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Christine L Paul
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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