Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies

Mediating role of accelerated aging in the association between depression and mortality risk: findings from NHANES

OBJECTIVE

To investigate the association between depression, accelerated biological aging, and mortality risk, and to assess whether accelerated aging mediates the relationship between major depression and mortality risk.

METHODS

A prospective cohort of 12,761 participants aged 20 years or older from the 2005-2010 cycle of the National Health and Nutrition Examination Survey (NHANES) was analyzed. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), with scores of ≥ 10 indicating major depression. Accelerated biological aging was measured using phenotypic age acceleration (PhenoAgeAccel). Multivariable linear regression models and subgroup analyses were used to examine the association between depression and accelerated aging, while weighted multivariable Cox proportional hazards regression models and subgroup analyses assessed the impact of major depression on mortality risk. Mediation analysis was performed to assess whether PhenoAgeAccel mediated the relationship between major depression and mortality outcomes.

RESULTS

Among the 12,761 adults, the weighted mean age was 46.6 years, with 48.8% being male, and 6.9% experiencing major depression. The results showed a positive association between major depression and PhenoAgeAccel (β: 0.61, 95% CI: 0.06-1.16). Over a median follow-up duration of 11.3 years (interquartile range: 9.9-13.1), major depression was associated with increased all-cause mortality (HR: 1.35, 95% CI: 1.13-1.62) and cardiovascular mortality (HR: 1.73, 95% CI: 1.18-2.54). However, the relationship with cancer mortality was not statistically significant after full adjustment for confounding factors. The mediation analysis further revealed that PhenoAgeAccel accounted for 10.32% and 5.12% of the associations between major depression and all-cause mortality, and cardiovascular mortality, respectively.

CONCLUSION

Depression is associated with accelerated aging and contributes to increased all-cause and cardiovascular mortality. Accelerated aging partially mediates the association between major depression and mortality risk. Our findings highlight the urgent need to incorporate mental health care into public health strategies to delay population aging and reduce mortality risk.

Factors associated with anxiety in colorectal cancer survivors: a scoping review

PURPOSE

Anxiety is one of the most common psychological issues among colorectal cancer (CRC) survivors. It can interact with physical symptoms, impacting cancer progression, survival, and quality of life. This scoping review aims to explore the factors associated with anxiety in patients with CRC and the instruments used to measure anxiety.

METHODS

Using Arksey and O'Malley's (2005) framework for the scoping review, studies investigating anxiety in CRC patients published in CINAHL, PubMed, PsycINFO, and Scopus between 2013 and 2024 were included.

RESULTS

We analyzed fifty-one studies for this review. The review identified several risk factors and consequences of anxiety in CRC patients. The risk factors were classified into six domains using Niedzwiedz et al.'s (2019) framework: individual characteristics, social/ contextual factors, prior psychological factors, psychological responses to diagnosis and treatment, characteristics of cancer, and treatment. The consequences of anxiety were classified into three categories: global health status/quality of life, functions, and symptoms/problems. The most frequently used tool was the Hospital Anxiety and Depression Scale, with International Classification of Diseases codes being the second most used.

CONCLUSIONS

This scoping review highlighted the intricate interaction between biological and psychosocial aspects in the lives of CRC survivors. It also identified unique factors associated with anxiety among these individuals. However, the review found some inconsistencies in the results related to anxiety-related factors, potentially due to differences in study populations, designs, measurement tools, and analysis methods.

IMPLICATIONS FOR CANCER SURVIVORS

This review underscores the potential for interventions targeting modifiable factors to prevent or reduce anxiety and enhance the quality of life for CRC survivors.

Clinical Variables Associated with Successful Treatment of Depression or Anxiety in Collaborative Care

Collaborative Care, an evidence-based model, has proven effective in treating depression and anxiety in healthcare settings. However, limited attention has been paid to exploring treatment outcome differences by clinical variables and diagnosis within this model. While previous research suggests that early and frequent contacts and swift treatment access lead to positive outcomes for depression and anxiety, these aspects have not been comprehensively examined in Collaborative Care. This study investigates the impact of clinical variables on treatment completion in patients primarily diagnosed with anxiety or depression who received collaborative care treatment as a treatment program. Analysis was completed as an observational study of patients (n =2018) with behavioral health diagnoses spanning from 2016 to 2023. Classification analysis offers insights into optimal practices for implementing Collaborative Care across diverse healthcare populations from pediatric to geriatric. Identifying clinical characteristics associated with successful treatment in Collaborative Care has far-reaching implications for model adoption and enhancing patient outcomes. Across all results, patients who received more clinical support and had shorter enrollment durations showed a strong association with successful treatment completion.

The mechanism of cancer-depression comorbidity

Cancer and depression are closely interrelated, particularly in patients with advanced cancer, who often present with comorbid anxiety and depression for various reasons. Recently, there has been a growing interest in the study of depression in cancer patients, with the aim of assessing the possible triggers, predictors, adverse events, and possible treatment options for depression in several common cancers. The objective of this narrative review is to synthesize the extant literature on the relationship between the occurrence and progression of depression in several common patient categories. The authors conducted a comprehensive review of 75 articles published in PubMed over the past five years. This review was further evaluated in the present paper. Ultimately, it was determined that depression is a prevalent and detrimental phenomenon among cancer patients, particularly those with advanced disease. Consequently, there is a pressing need to prioritize research and interventions aimed at improving the quality of life and psychosocial well-being of cancer patients, including those with advanced disease. The relationship between cancer and depression has been evolving dynamically in recent times. The current research findings indicate a strong association between cancer and depression. However, the direction of causality remains unclear. Focusing on depression in cancer patients may, therefore, be beneficial for these patients.

Tumor-infiltrating nerves functionally alter brain circuits and modulate behavior in a mouse model of head-and-neck cancer

Cancer patients often experience changes in mental health, prompting an exploration into whether nerves infiltrating tumors contribute to these alterations by impacting brain functions. Using a mouse model for head and neck cancer and neuronal tracing, we show that tumor-infiltrating nerves connect to distinct brain areas. The activation of this neuronal circuitry altered behaviors (decreased nest-building, increased latency to eat a cookie, and reduced wheel running). Tumor-infiltrating nociceptor neurons exhibited heightened calcium activity and brain regions receiving these neural projections showed elevated Fos as well as increased calcium responses compared to non-tumor-bearing counterparts. The genetic elimination of nociceptor neurons decreased brain Fos expression and mitigated the behavioral alterations induced by the presence of the tumor. While analgesic treatment restored nesting and cookie test behaviors, it did not fully restore voluntary wheel running indicating that pain is not the exclusive driver of such behavioral shifts. Unraveling the interaction between the tumor, infiltrating nerves, and the brain is pivotal to developing targeted interventions to alleviate the mental health burdens associated with cancer.

Chronic stress promotes non-small cell lung cancer (NSCLC) progression through circMBOAT2 upregulation mediated by CTCF

Circular RNA (circRNA) has been demonstrated to play a pivotal role in tumor development. This study aimed to investigate the regulatory mechanism of circMBOAT2 in non-small cell lung cancer (NSCLC) and its association with tumor growth induced by chronic stress. We constructed stably transfected A549 and H1299 cell lines with circMBOAT2 overexpression and knockdown. Colony formation, scratch healing, Transwell and CCK-8 assays were conducted to evaluate the effects of circMBOAT2 in the presence or absence of norepinephrine (NE) treatment on the proliferation, migration, and invasion of NSCLC cells, respectively. Additionally, A chronic unpredictable mild stress (CUMS)-induced depression with heterotopic transplantation LLC and injection of antisense oligonucleotides (ASOs) targeting circMBOAT2 mouse model was established to evaluate the effect of chronic stress on tumorigenesis via circMBOAT2. Moreover, we investigated the regulatory effect of CCCTC binding factor (CTCF) on circMBOAT2 expression through in vivo and in vitro silencing of CTCF. Our results revealed a significant upregulation of circMBOAT2 in NSCLC cell lines and tumor tissues. circMBOAT2 knockdown inhibited the proliferation, migration, and invasion of NSCLC cells, while NE treatment reversed the cell suppression effect caused by circMBOAT2 knockdown. Notably, CUMS promoted tumor growth, while silencing circMBOAT2 inhibited tumor growth in vivo. Furthermore, we identified CTCF as the upstream regulator of circMBOAT2, which exhibited upregulation in NSCLC cells and tissues. Knockdown of CTCF reversed the promotional effect of CUMS on circMBOAT2 expression and tumor growth. Our findings provide evidence that CTCF mediates chronic stress in promoting of NSCLC progression through circMBOAT2. circMBOAT2 may serve as a potential biomarker and therapeutic target for NSCLC as well as the treatment of comorbid depression in NSCLC patients.

Risk factors for cancer-related cognitive impairment among individuals with lung cancer: a systematic review and meta-analysis

OBJECTIVES

Cancer-related cognitive impairment (CRCI) exerts a negative impact on the quality of life in lung cancer survivors. Risk factors for CRCI in lung cancer patients remain unclear.This study aimed to identify risk factors for CRCI in lung cancer patients.

METHODS

A comprehensive literature search was conducted across PubMed, CINAHL, Web of Science, Wanfang, VIP Database, Embase, and China National Knowledge Infrastructure (CNKI) from their inception until March 10, 2024. Studies were screened, data extracted, and quality assessed using the Agency for Healthcare Research and Quality and Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.4, assessing risk factors through odds ratios (OR) with 95% confidence intervals (CIs).

RESULTS

The analysis was comprised of nine studies, including 1,305 patients. Seven studies were high quality, and two were moderate quality. Identified risk factors for CRCI in lung cancer patients included advanced age (OR = 3.51, 95%CI: 2.14-5.74, I2 = 0.0%), cranial irradiation (OR = 2.12, 95% CI: 1.39-3.22, I2 = 0.0%), anxiety (OR = 2.92, 95% CI: 1.65-5.25, I2 = 37%), and symptom cluster burden (OR = 4.85, 95% CI: 2.99-7.87, I2 = 0.0%). Physical activity (OR = 0.37, 95% CI; 0.23-0.58, I2 = 9.0%) was identified as a protective factor.

CONCLUSION

Advanced age, cranial irradiation, anxiety, and symptom cluster burden are significant risk factors for CRCI, while physical activity serves as a protective factor. These insights provide healthcare professionals with an evidence-based framework for managing CRCI in lung cancer patients.

Non-surgical nursing care for tumor patients: an overview of sedation, analgesia, and recent innovations

With the increasing prevalence of tumors, effective symptom management has emerged as a cornerstone of patient care. While surgical interventions remain pivotal, non-surgical nursing methods have gained prominence in providing relief from pain, discomfort, and other tumor-related symptoms. This review delves into the various non-surgical approaches employed, emphasizing tumor sedation and analgesia. We discuss the array of non-pharmacological and pharmacological strategies, shedding light on their indications, contraindications, and potential side effects. Furthermore, the importance of addressing individual differences in pain perception and the ethical considerations in symptom management are highlighted. We conclude by providing insights into the recent innovations in the field, emphasizing the need for personalized and comprehensive care to enhance patients' quality of life. Tumor sedation, Tumor analgesia, Non-surgical nursing care, Pain management, Non-pharmacological interventions, Palliative care, Recent innovations, Symptom management.

The association of psychological and trauma-related factors with biological and facial aging acceleration: evidence from the UK Biobank

BACKGROUND

Psychological and trauma-related factors are associated with many diseases and mortality. However, a comprehensive assessment of the association between psycho-trauma exposures and aging acceleration is currently lacking.

METHODS

Using data from 332,359 UK Biobank participants, we calculated biological aging acceleration, indexed by the presence of leukocyte telomere length (LTL) deviation (i.e., the difference between genetically determined and observed LTL > 0). The acceleration of facial aging (i.e., looking older than the chronological age) was assessed using a self-report question. Then, we estimated the associations of each psycho-trauma factor with biological and facial aging acceleration, using logistic regression models adjusted for multiple important covariates. Furthermore, restricted to 99,180 participants with complete psychological and trauma-related data, we identified clusters of individuals with distinct psycho-trauma patterns using the latent class analysis method and assessed their associations with aging acceleration using similar models.

RESULTS

We observed most of the studied psycho-trauma factors were associated with biological and facial aging acceleration. Compared to the "Absence of trauma and psychopathology" cluster, the "adverse childhood experiences (ACEs) with psychopathology" cluster showed strong associations with those aging measurements (odds ratio [OR] = 1.13 [1.05 - 1.23] for biological and 1.52 [1.18 - 1.95] for facial aging acceleration), while no such association was observed for the "ACEs without psychopathology" cluster (1.04 [0.99 - 1.09] and 1.02 [0.84 - 1.24].

CONCLUSIONS

Our study demonstrated significant associations of psycho-trauma factors with both biological and facial aging acceleration. The differential aging consequences observed among ACEs exposed individuals with and without psychopathology prompt interventions aimed to improve individuals' psychological resilience to prevent aging acceleration.

The effect of depression and anxiety on survival in patients with glioma: a systematic review and meta-analysis

PURPOSE

Depression and anxiety's impact on glioma patient survival lacks consensus. Understanding these effects can highlight the importance of identifying depression and anxiety in glioma patients, and inform future treatments. This systematic review and meta-analysis aims to clarify the impact of depression and anxiety on glioma patient survival.

METHODS

We conducted a systematic literature search of major databases, including PubMed, Embase, Web of Science Core Collection, Cochrane Library, and PsycINFO, from inception to June 2023, to identify relevant studies. Eligible studies were those that examined the association between depression, anxiety, or both, and survival outcomes in glioma patients. Data were extracted and analyzed using fixed-effects meta-analysis models to calculate pooled hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

A total of 15 studies met the inclusion criteria, encompassing a diverse range of glioma patients across different clinical settings and stages. The meta-analysis revealed a statistically significant association between depression and reduced overall survival in glioma patients, with a pooled HR of 1.65 (95% CI: 1.41-1.83, 11 studies). The preliminary univariate meta-regression results indicate no impact of individual study characteristics on the effect size. Likewise, anxiety was associated with worse overall survival, with a pooled HR of 1.65 (95% CI: 1.18-2.31, 5 studies).

CONCLUSIONS

This meta-analysis underscores the vital need to identify and treat depression and anxiety in glioma patients. Future research should explore the underlying mechanisms, aiding the creation of interventions enhancing both mental health and clinical outcomes for this vulnerable group.

Obesity, psychological well-being related measures, and risk of seven non-communicable diseases: evidence from longitudinal studies of UK and US older adults

BACKGROUND

We examined the role of psychological well-being related measures in explaining the associations between obesity and increased risk of non-communicable diseases (NCDs: hypertension, heart disease, stroke, diabetes, arthritis, cancer, and memory-related disease) in older adults.

METHODS

Data were from the English Longitudinal Study of Ageing (ELSA), UK (baseline: Wave 4-2008/2009; n = 8127) and the Health and Retirement Study (HRS), US (baseline: Waves 9 and 10-2008/2010; n = 12,477). Objective body mass index was used to define obesity. A range of psychological well-being related measures (e.g., depressive symptoms, life satisfaction) was available in ELSA (n = 7) and HRS (n = 15), and an index of overall psychological well-being was developed separately in each study. NCDs were from a self-reported doctor diagnosis and/or other assessments (e.g., biomarker data) in both studies; and in ELSA, NCDs from linked hospital admissions data were examined. Longitudinal associations between obesity status, psychological well-being measures, and NCDs were examined using Cox proportional hazard models (individual NCDs) and Poisson regression (a cumulative number of NCDs). Mediation by psychological well-being related measures was assessed using causal mediation analysis.

RESULTS

Obesity was consistently associated with an increased prospective risk of hypertension, heart disease, diabetes, arthritis, and a cumulative number of NCDs in both ELSA and HRS. Worse overall psychological well-being (index measure) and some individual psychological well-being related measures were associated with an increased prospective risk of heart disease, stroke, arthritis, memory-related disease, and a cumulative number of NCDs across studies. Findings from mediation analyses showed that neither the index of overall psychological well-being nor any individual psychological well-being related measures explained (mediated) why obesity increased the risk of developing NCDs in both studies.

CONCLUSION

Obesity and psychological well-being may independently and additively increase the risk of developing NCDs.

ElectroRetinoGraphy toward an exploration of the therapeutic potential of antidepressants in patients with major depressive disorder: A scoping review of the literature

Major Depressive Disorder (MDD) is characterized by at least one major depressive episode. It requires medical attention typically involving the prescription of antidepressants. Remission in MDD patients is often difficult to achieve because of the limited effectiveness of these drugs. Nowadays, numerous patients undergo various antidepressant treatments, with subjective changes in their personal experiences being regularly monitored. Therefore, it is essential to find clinical and objective tools that offer a more tailored approach to antidepressant selection. The neurochemistry of the retina being similar to the brain, one promising approach would be to use ElectroRetinoGraphy (ERG) measurements on MDD patients requiring antidepressant treatment. Thus, the aim of this scoping review is to highlight effects of different classes of antidepressants on retinal function evaluated by full-field ERG (ffERG), Pattern ERG (PERG) and multifocal ERG (mfERG) waveforms in MDD patients. These ERG measurements could serve as pivotal indicators in defining patient profiles, facilitating a more objective and personalized approach to therapeutic interventions, thereby advancing precision psychiatry.

COGNITIVE BEHAVIORAL THERAPY MAY ALLEVIATE ANXIETY AND DEPRESSIVE SYMPTOMS IN ADVANCED CANCER PATIENTS

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Tian L. Effects of cognitive behavioral therapy on anxiety and depressive symptoms in advanced cancer patients: A meta-analysis. Gen Hosp Psychiatry. 2024 Jan 20;87:20-32. doi:10.1016/j.genhosppsych.2024.01.006. Epub ahead of print. PMID: 38280276.

SOURCE OF FUNDING

This research was funded by the National College Students Innovation and Entrepreneurship Training Program (Grant No. 202310343044), and the Zhejiang University Student Science and Technology Innovation Activity Plan (Grant No. 2023R413038).

CONFLICT OF INTEREST

The authors have no actual or potential conflicts of interest.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis of data.

Association between depressive symptoms and second primary cancer in cancer survivors: Insights from a nationally representative study

OBJECTIVE

The purpose of this study was to investigate the association between depressive symptoms and second primary cancer (SPC) in U.S. cancer survivors.

METHODS

Cancer survivors from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study, and depressive symptoms were defined by the Patient Health Questionnaire 9 (PHQ-9). The association between depressive symptoms and SPC was assessed via multiple logistic regression, restricted cubic spline (RCS), sensitivity, and subgroup analyses.

RESULTS

This study involved 2315 participants representing >15 million noninstitutionalized U.S. residents. Multivariate logistic regression fully adjusted for confounders revealed that cancer survivors with a PHQ-9 score ≥ 10 had a greater risk of developing SPC than those with a PHQ-9 score of 0-4 ([OR] = 1.88, 95% [CI] = 1.20-2.89, p = 0.005). The RCS showed a linear positive correlation between the PHQ-9 score and SPC (p for overall = 0.017). The robustness of this association was subsequently confirmed via multiple interpolation of missing data and different cluster-level methods (namely weighted linear regression) as sensitivity analyses. Furthermore, subgroup analyses confirmed this correlation was stronger in participants with sleep duration <7 h (p for interaction = 0.036).

CONCLUSION

Moderate to severe depressive symptoms in cancer survivors were associated with an increased risk of developing SPC, especially at <7 h of sleep.

The links between symptom burden, illness perception, psychological resilience, social support, coping modes, and cancer-related worry in Chinese early-stage lung cancer patients after surgery: a cross-sectional study

OBJECTIVES

This study aims to investigate the links between the clinical, demographic, and psychosocial factors and cancer-related worry in patients with early-stage lung cancer after surgery.

METHODS

The study utilized a descriptive cross-sectional design. Questionnaires, including assessments of cancer-related worry, symptom burden, illness perception, psychological resilience, coping modes, social support and participant characteristics, were distributed to 302 individuals in early-stage lung cancer patients after surgery. The data collection period spanned from January and October 2023. Analytical procedures encompassed descriptive statistics, independent Wilcoxon Rank Sum test, Kruskal-Wallis- H- test, Spearman correlation analysis, and hierarchical multiple regression.

RESULTS

After surgery, 89.07% had cancer-related worries, with a median (interquartile range, IQR) CRW score of 380.00 (130.00, 720.00). The most frequently cited concern was the cancer itself (80.46%), while sexual issues were the least worrisome (44.37%). Regression analyses controlling for demographic variables showed that higher levels of cancer-related worry (CRW) were associated with increased symptom burden, illness perceptions, and acceptance-rejection coping modes, whereas they had lower levels of psychological resilience, social support and confrontation coping modes, and were more willing to obtain information about the disease from the Internet or applications. Among these factors, the greatest explanatory power in the regression was observed for symptom burden, illness perceptions, social support, and sources of illness information (from the Internet or applications), which collectively explained 52.00% of the variance.

CONCLUSIONS

Healthcare providers should be aware that worry is a common issue for early stage lung cancer survivors with a favorable prognosis. During post-operative recovery, physicians should identify patient concerns and address unmet needs to improve patients' emotional state and quality of life through psychological support and disease education.

The impact of alcohol consumption on the relationship between depression and chronic diarrhea: a cross-sectional study analysis on NHANES (2005-2010)

Background

Alcohol consumption, depression, and chronic diarrhea are all public health issues of concern, with irreversible consequences for individual health and significant economic burdens on health care systems. Previous studies have shown that depression increases the risk of developing chronic diarrhea, but few studies have explored whether alcohol consumption has an effect on the relationship between depression and chronic diarrhea.

Objective

To explore the effect of alcohol consumption on the relationship between depression and chronic diarrhea.

Methods

12,538 adults (≥20 years) in NHANES from 2005-2010 were analyzed. Participants were stratified according to drinking status, and differences between the risk of depression and chronic diarrhea among participants who drank alcohol or not were assessed using multiple regression analysis and likelihood ratio tests.

Results

In this cross sectional, after adding possible confounders, the prevalence of depression with chronic diarrhea was higher in the drinking population than in the non-drinking population (OR,2.34, 95%CI:1.84-2.98 and 1.26, 95%CI:0.85-1.86), with a likelihood ratio test of P=0.024.

Conclusion

Our findings suggest that there is a significant association between depression and chronic diarrhea and that alcohol consumption may increase the correlation between depression and chronic diarrhea. However, these findings require further prospective studies to provide more evidence.

Prevalence and risk factors for anxiety in patients with early- and middle-stage lung cancer: a cross-sectional study

Objective

Lung cancer is a leading cause of cancer-related morbidity and mortality worldwide, with patients frequently experiencing significant psychological distress, particularly anxiety. Despite the high prevalence of anxiety in patients with cancer, there is limited comprehensive research focusing on the specific factors influencing anxiety in patients with early- and middle-stage lung cancer within the context of Chinese medicine hospitals. Therefore, we aimed to investigate the epidemiology and factors influencing anxiety disorders in patients with early- and middle-stage primary bronchial lung cancer through a cross-sectional study.

Methods

A total of 340 patients with early and middle-stage lung cancer admitted to the outpatient ward of the oncology department at Guang'anmen Hospital from June 2023 to December 2023 were included in this study. Survey data, including the patients' general condition questionnaire, Generalized Anxiety Scale (GAD-7), Hospital Anxiety and Depression Scale (HADS), and Mental Toughness Scale (CD-RISC-10), were collected and recorded in a database using a two-person input format. Data analysis was performed using SPSS 27.0 software.

Results

Out of the 340 patients with early- and middle-stage lung cancer included in this study, 133 had anxiety, resulting in an overall anxiety detection rate of 39.12%. The chi-square test showed that statistically significant differences in religion, marital status, surgical treatment, tobacco use, and alcohol history between the anxious and non-anxious groups (p < 0.05). Moreover, statistically significant differences were observed in per capita annual family income, pathological type, VAS score, targeted therapy, treatment stage, and mental toughness level (p < 0.001). Other factors were not significantly correlated with anxiety onset. Multivariate logistic regression analysis showed that higher per capita family income and completed treatment independently acted as protective factors against anxiety onset in patients with early- and middle-stage lung cancer. Conversely, rare pathological types, increased pain severity, and lower levels of mental toughness were identified as independent risk factors for anxiety onset in these patients.

Conclusion

Anxiety was prevalent in patients with early- and middle-stage lung cancers. Rare pathological types, increased pain severity, and lower levels of mental toughness were independent risk factors for anxiety. Therefore, clinicians and psychologists should pay more attention to patients with rare types of tumors, actively manage their pain symptoms, and consider implementing mental resilience training to improve patients' mental toughness.

Foundations for a Personalized Psycho-Oncology: The State of the Art

Personalized psycho-oncology represents a major challenge for the holistic care of cancer patients. It focuses on individualized psychotherapeutic and psychiatric interventions to address specific psychological needs. This narrative review summarizes the current literature on personalized psycho-oncology and highlights the prevalence and impact of psychiatric/psychological disorders in cancer patients. Personalized approaches, including tailored interventions and interdisciplinary collaboration, have been shown to be effective in improving mental health and overall quality of life. The integration of inflammatory biomarkers into treatment plans is a promising but challenging way to alleviate mental health problems. In addition, there is a need for specific diagnostic tools and treatment guidelines that take into account the specific psychological impact of different types of cancer. Future research should aim to refine these personalized strategies, improve diagnostic accuracy, and evaluate the cost-effectiveness of these interventions to improve both the psychological well-being and treatment outcomes of cancer patients.

Exploring the L-shaped relationship between Atherogenic Index of Plasma and depression: Results from NHANES 2005-2018

BACKGROUND

The Atherogenic Index of Plasma (AIP) is a novel metric linked to several diseases. However, there is inadequate evidence to investigate the relationship between AIP and depression. Therefore, we aim to elucidate the non-linear association between AIP and depression.

METHODS

12,453 participants from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were included. The AIP was calculated as log10 (triglycerides/high-density lipoprotein cholesterol). The Patient Health Questionnaire (PHQ-9) was used to identify depression (PHQ-9 ≥ 10). Weighted multivariate logistic regression, restricted cubic splines (RCS) models, subgroup analysis, and interaction tests were employed to reveal the relationship between AIP and depression.

RESULTS

AIP was found to be significantly correlated with depression. In the fully adjusted model, elevated AIP levels were associated with higher odds of depression (odds ratio [OR] = 1.50; 95 % CI: 1.06-2.12). The RCS analysis indicated an L-shaped pattern in the relationship between depression and AIP, with inflection points at -0.289. Beyond this inflection point, individuals with elevated AIP levels were associated with higher odds of depression (OR = 2.25; 95 % CI: 1.49-3.39). Notably, the association was particularly pronounced among individuals with diabetes.

LIMITATION

This cross-sectional study is unable to establish causal relationships.

CONCLUSION

There was an L-shaped association between AIP and depression among US adults. AIP has the potential value as a biological marker for depression, and maintaining AIP values below a certain threshold may help in managing depression.

Effect of minocycline on changes in affective behaviors, cognitive function, and inflammation in breast cancer survivors undergoing chemotherapy: a pilot randomized controlled trial

PURPOSE

Minocycline suppresses chemotherapy-induced neuroinflammation in preclinical models, but its effects in cancer survivors are unknown. This study evaluated the longitudinal effects of minocycline on affective behaviors, cognitive functions, and inflammation in women with breast cancer (BC) undergoing chemotherapy.

METHODS

This is a pilot, double-blind, randomized controlled trial of oral minocycline (100 mg BID) versus placebo for chemotherapy-induced affective disorders in women initiating chemotherapy for stage I-III BC. Participants received minocycline or placebo up to one week before chemotherapy, continuing through cycle 4 (C4). Epidemiologic Studies Depression Scale (CES-D) and State-Trait Anxiety Inventory (STAI) were assessed at baseline, each cycle of chemotherapy (C1-C4), 2-3-week post-chemotherapy (end of chemotherapy), and 6-month post-chemotherapy (6 M) as the primary outcomes. Sub-group analysis of CES-D and STAI based on the severity of symptoms was also performed. Changes in self-reported cognition and serum inflammatory markers were also evaluated.

RESULTS

Fifty-seven women enrolled and 55 completed the study. Except for Interleukin-8 (p ≤ 0.03), changes in inflammatory markers, cognitive function, CES-D, and STAI were not significantly different between groups from baseline to any cycle or post-chemotherapy time point (all p > 0.05), adjusting for baseline scores. Increases in serum Interleukin-8 from baseline to C4 and 6 M were ameliorated by minocycline (p < 0.05). The sub-group symptomatic for depression (CES-D > = 16 at baseline) treated with minocycline had a greater reduction in CES-D score compared to placebo from baseline to 6 M (p = 0.01).

CONCLUSION

Despite attenuation of IL-8, minocycline did not alter self-reported affective symptoms or cognition in this cohort of BC survivors undergoing chemotherapy. The effect of minocycline on BC survivors symptomatic for depression before chemotherapy warrants further investigation.

Serious Health-Related Suffering Impairs Treatments and Survival in Older Patients With Cancer

CONTEXT

More than half of new cancer cases occurred in older adults. Older patients with cancer are particularly at risk of physical, psycho-existential or socio-familial suffering as defined by the concept of Serious Health-related Suffering (SHS).

OBJECTIVES

To assess the direct and indirect effects of physical, psycho-existential and socio-familial dimensions of suffering on cancer treatability, supportive care needs and 12-month mortality in older patients with cancer.

METHODS

We included patients with cancer aged 70 years and over from the Elderly Cancer Patients cohort (ELCAPA, Ile-de-France), referred for geriatric assessment between 2007 and 2019 before cancer treatment. Structural equation modelling examined the direct and indirect relationships between SHS dimensions (latent variables), patients' characteristics (age, sex, tumor location and metastatic status, comorbidity, period of care), and outcomes.

RESULTS

The analysis included 4,824 patients (mean age: 82.2 ± 4 years; women: 56%; main cancer sites: breast [22.3%], colorectal [15.2%], prostate [8.5%], and lung [6.8%]; metastatic cancer: 46%). Physical suffering had direct pejorative effects on cancer treatability, and mortality (standardized coefficient [SC] = 0.12 [P < 0.001], SC = 0.27 [P < 0.001], respectively). Psycho-existential and socio-familial sufferings had indirect pejorative effects on survival through decreased cancer treatability (SC = 0.08 [P < 0.001], SC = 0.03 [P < 0.001], respectively). Psycho-existential dimension had the main direct effect size on supportive care needs (SC = 0.35 [P < 0.001]) and was interrelated with physical suffering.

CONCLUSION

Physical suffering has direct pejorative effect on survival. All dimensions indirectly decrease survival due to poorer cancer treatability. Our findings support concomitant management of physical and psycho-existential suffering.

Assessment of psycho-oncology in the Middle East and North Africa region: a systematic review and meta-analysis

BACKGROUND

The Middle East and North Africa (MENA) region is expected to witness a significant increase in the burden of cancer. Contrary to Western literature, the burden of psycho-oncology is yet to be established within the MENA region. This study reviews all available evidence characterizing the psychological burden among patients with cancer across the MENA region.

METHODS

We systematically explored the PubMed/MEDLINE, Cochrane/CENTRAL, and Web of Science (WoS) databases for reports on the psychiatric burden among patients with cancer residing within the MENA region from January 2000 until January 2023. Raw proportion were extracted and analyzed using a random-effects model.

FINDINGS

Eighty-three studies comprised of 16 810 participants, representing 14 countries, met our inclusion criteria. Across the MENA region, the prevalence of depression, anxiety, and distress were 44% (95% CI, 39%-50%), 47% (95% CI, 40%-54%), and 43% (95% CI, 30%-56%), respectively. Prevalence of depression was significantly different across countries, with Palestine (73%; 95% CI, 42%-91%) reporting the highest rate while Morocco (23%; 95% CI, 7%-56%) reported the lowest. Similarly, anxiety significantly differed across MENA nations ranging from 64% (95% CI, 3%-99%) in Morocco to 28% (95% CI, 18%-42%) in Tunisia. Rates of depression and anxiety were significantly different across measurement tools but not between Arabic-speaking versus Persian/Farsi-speaking countries. Meta-regression models showed that neither publication year nor age affected the prevalence of both anxiety and depression (P = .374 and .091 for depression and P = .627, and .546 for anxiety, respectively).

INTERPRETATION

We report an abnormally high rate of psychiatric burden among patients with cancer in the MENA region. Thus, establishing appropriate psycho-oncologic interventions within the MENA region is of utmost importance.

Prospective trajectories of depression predict mortality in cancer patients

An ever-growing body of empirical evidence has demonstrated the relationship between depression and cancer. The objective of this study was to examine whether depression trajectories predict mortality risk above and beyond demographics and other general health-related factors. Participants (n = 2,345) were a part of the Health and Retirement Study. The sample consisted of patients who were assessed once before their cancer diagnosis and thrice after. Depressive symptoms and general health-related factors were based on self-reports. Mortality risk was determined based on whether the patient was alive or not at respective time points. Latent Growth Mixture Modeling was performed to map trajectories of depression, assess differences in trajectories based on demographics and general health-related factors, and predict mortality risk. Four trajectories of depression symptoms emerged: resilient (69.7%), emerging (13.5%), recovery (9.5%), and chronic (7.2%). Overall, females, fewer years of education, higher functional impairment at baseline, and high mortality risk characterized the emerging, recovery, and chronic trajectories. In comparison to the resilient trajectory, mortality risk was highest for the emerging trajectory and accounted for more than half of the deaths recorded for the participants in emerging trajectory. Mortality risk was also significantly elevated, although to a lesser degree, for the recovery and chronic trajectories. The data highlights clinically relevant information about the depression-cancer association that can have useful implications towards cancer treatment, recovery, and public health.

Trends analysis of cancer incidence, mortality, and survival for the elderly in the United States, 1975-2020

BACKGROUND

Cancer burden from the elderly has been rising largely due to the aging population. However, research on the long-term epidemiological trends in cancer of the elderly is lacking.

METHODS

Registry data of this population-based cross-sectional study were from the Surveillance, Epidemiology, and End Results (SEER) database. The study population aged 65 years or more, from geographically distinct regions. Joinpoint regression and JP Surv method were used to analyze cancer trends and survival.

RESULTS

Mortality rate during 1975-2020 decreased from 995.20 to 824.99 per 100,000 elderly persons, with an average annual decrease of 0.421% (95% CI, 0.378-0.464). While overall incidence increased with no significance. Prostate (29%) and breast (26%) cancer were the most common malignancies, respectively, in elderly males and females, and the mortality for both of the two (prostate 15%, breast 14%) ranked just behind lung and bronchus cancer, which had the highest mortality rates in males (29%) and females (23%). Many cancers showed adverse trends in the latest follow-up periods (the last period calculated by the Joinpoint method). For intrahepatic cholangiocarcinoma, incidence (male Annual Percentage Change [APC] = 7.4*; female APC = 6.7*) and mortality (male APC = 3.0*; female APC = 3.3*) increased relatively fast, and its survival was also terrible (3-year survival only 10%). Other cancers with recent increasing mortality included cancer of anus, anal canal and anorectum, retroperitoneum, pleura, peritoneum, etc. Most cancers had favorable trends of survival during the nearest follow-up period.

CONCLUSION

Against the background of overall improvement, many cancers showed adverse trends. Further research for the underlying mechanisms and targeted implements towards adverse trends is also urgent.

Enhancing the Cardiovascular Health Construct With a Psychological Health Metric for Predicting Mortality Risk

Background

The American Heart Association's Life's Essential 8 (LE8) Presidential Advisory deemed psychological health foundational for cardiovascular health (CVH) but did not include it as a CVH metric.

Objectives

The purpose of this study was to evaluate associations of a CVH construct enhanced with a ninth metric for psychological health based on readily administered depression screening with mortality risk in U.S. adults.

Methods

Participants were 21,183 adults (mean age: 48y, 51% female, 11% Black, 15% Hispanic, 65% White) from the 2011 to 2018 National Health and Nutrition Examination Survey. The LE8 algorithm was used to assess CVH. Two enhanced CVH constructs that include a ninth psychological health metric based on depression screening using the Patient Health Questionnaires (PHQ-2 and PHQ-9) were computed. Multivariable Cox proportional hazards models compared all-cause and cause-specific mortality risk across CVH score tertiles and a priori defined categories (high: 80-100, moderate: 50-79, low: 0-49) in the overall sample and by sex and race and ethnicity.

Results

There were 1,397 deaths (414 cardiovascular and 329 cancer deaths). High vs low CVH scores, enhanced with PHQ-2 and PHQ-9, were associated with 69% and 70% lower mortality risk, while a high vs low LE8 score was associated with 65% lower risk (p-trend<0.001). Higher LE8 and enhanced CVH scores predicted lower mortality risk in both sexes and in Black and White but not Hispanic adults and were also associated with lower cardiovascular and cancer mortality. Both enhanced CVH scores had excellent performance for predicting mortality, similar to the LE8 score (C-statistic = 0.843 vs 0.842, P < 0.001).

Conclusions

A CVH construct enhanced with psychological health strongly predicts mortality. Inclusion of psychological health as a ninth CVH metric, with depression screening as a feasible proxy in clinical and public health settings, should be considered.

Beyond standard treatment: A qualitative descriptive study of cancer patients' perceptions of hypnotherapy in cancer care

BACKGROUND AND PURPOSE

Cancer remains a leading cause of death in Australia. The number of new cancer cases diagnosed each year is expected to surpass 200,000 by 2033. This marks a significant increase from about 88,000 cases in 2000 to an estimated 165,000 cases in 2023. Despite advancements in treatment, emotional and psychological challenges in cancer care are often overlooked. This study focuses on hypnotherapy, a complementary therapy recognized for its efficacy for physical and emotional symptoms, yet underutilized in Australian cancer care. The research aims to explore patients' perceptions of hypnotherapy and identify barriers to its integration, contributing to the development of holistic, patient-centered cancer care models.

MATERIALS AND METHODS

A qualitative study employing semi-structured interviews was conducted with 14 adult cancer patients (breast, lung, and colorectal) undergoing active treatment, selected through convenience sampling. The interviews were carried out from May 2022 to August 2023, focusing on participants' experiences and attitudes toward hypnotherapy among other complementary and alternative medicine (CAM) therapies. Thematic analysis using Braun and Clarke's six-step framework was applied to the data.

RESULTS

Five themes were developed following analysis: 1) emotional roller coaster of cancer diagnosis, 2) participants' perspectives on hypnotherapy among other CAM modalities, 3) hypnotherapy as a psychological vs physiological support, 4) fringe benefits of hypnosis, and 5) the main hurdles: cost and lack of information. Participants expressed a diverse range of experiences and attitudes towards hypnotherapy and CAM, with a strong emphasis on the need for emotional support in cancer care. Although hypnotherapy was recognized for its potential to address both emotional and physical symptoms, its predominant use was for emotional well-being. Participants also highlighted the importance of attitudes and endorsements from healthcare providers in their decision-making process about CAM therapies.

CONCLUSION

The study findings emphasize the need for a more integrative and patient-centered approach in cancer care that includes hypnotherapy as a non-pharmacological intervention for physical and particularly emotional support. Healthcare providers should be aware of the potential value of hypnotherapy and consider patient preferences in their recommendations. In addition, addressing the identified barriers could improve the accessibility and integration of hypnotherapy into cancer care protocols in Australia.

Leisure-time physical activity is associated with depressive symptoms in cancer patients: Data from the NHANES 2007-2018

BACKGROUND

Cancer patients have a higher risk of depression and are associated with severe adverse prognosis. The relationship between leisure-time physical activity (LTPA) and depressive symptoms in cancer patients is currently unclear. Therefore, our study mainly explores the potential association between LTPA and the weekly cumulative time of LTPA with depressive symptoms in cancer patients.

METHODS

We included and analyzed 3368 cancer patients (aged >20 years) from the National Health and Nutrition Examination Survey (NHANES) of the United States from 1999 to 2018. The LTPA score was evaluated through a self-report questionnaire, while depressive symptoms were evaluated through the Health Questionnaire-9 (PHQ-9). Multiple logistic regression analysis was used to explore the relationship between LTPA duration and the occurrence of cancer-related depressiive symptoms. Linear correlation was studied using the restricted cubic spline method.

RESULTS

According to a fully adjusted multivariate logistic regression model with confounding variables, the odds ratio (OR) between LTPA and depressive symptoms in cancer patients in this study was 0.59 (95 % confidence interval = 0.39, 0.92; P = 0.02). When the LTPA level was ≥300 min/week, the incidence of depressive symptoms was reduced by 59 % (OR = 0.41, 95 % CI = 0.21, 0.83). In addition, the cubic spline method was used to obtain a linear negative correlation between LTPA duration and tumor depressive symptoms.

CONCLUSION

LTPA was negatively correlated with cancer-related depressive symptoms, and the cumulative time of LTPA/week was linearly correlated with depressive symptoms. The slope of the benefit curve changed significantly when the cumulative time of LTPA reached 600 min per week, suggesting that appropriately increasing LTPA had significant benefits on mental health of cancer patients.

A translational neuroscience perspective on loneliness: Narrative review focusing on social interaction, illness and oxytocin

This review addresses key findings on loneliness from the social, neurobiological and clinical fields. From a translational perspective, results from studies in humans and animals are included, with a focus on social interaction, mental and physical illness and the role of oxytocin in loneliness. In terms of social interactions, lonely individuals tend to exhibit a range of abnormal behaviors based on dysfunctional social cognitions that make it difficult for them to form meaningful relationships. Neurobiologically, a link has been established between loneliness and the hypothalamic peptide hormone oxytocin. Since social interactions and especially social touch regulate oxytocin signaling, lonely individuals may have an oxytocin imbalance, which in turn affects their health and well-being. Clinically, loneliness is a predictor of physical and mental illness and leads to increased morbidity and mortality. There is evidence that psychopathology is both a cause and a consequence of loneliness. The final section of this review summarizes the findings from social, neurobiological and clinical perspectives to present a new model of the complex construct of loneliness.

The effect of Tai Chi/Qigong on depression and anxiety symptoms in adults with Cancer: A systematic review and meta-regression

OBJECTIVE

We expand on prior systematic reviews of Tai chi/Qigong (TCQ) practice on depression or anxiety symptoms in adults with cancer to estimate the mean effect of TCQ on depression and anxiety in randomized controlled trials. Additionally, we perform moderator analysis to examine whether effects vary based on patient features, TCQ stimuli properties, or characteristics of research design.

METHODS

Guided by PRISMA guidelines, we located articles published before August 31, 2023 using a combination of electronic database search and a complementary manual search through reference lists of articles and published reviews. Two separate multilevel meta-analyses with random-effects model were employed to estimate the overall effect of TCQ on depression and anxiety respectively. Further, multilevel meta-regression analysis was utilized to examine moderating effects based on moderators derived from patient features, TCQ stimuli properties, or characteristics associated with research design. Meta-analyses were performed in R4.0.0 and certainty of evidence with GRADEpro software.

RESULTS

The TCQ intervention yielded a standardized mean effect size of 0.29 (95% CI, 0.18 to 0.40) for anxiety, indicating homogeneity among the included studies. Conversely, for depression, the standardized mean effect size was 0.35 (95% CI, 0.14 to 0.55), signifying heterogeneity: reductions were larger when the trial primary outcome, predominantly function-related outcomes, changed significantly between the TCQ and control group.

CONCLUSIONS

TCQ practice exhibits small-to-moderate efficacy in alleviating depression and anxiety symptoms among cancer patients and survivors. Moreover, patients with depressive symptoms for whom TCQ intervention coupled with improvements in function-related outcomes manifested greater antidepressant effect.

Effect of resistance exercise on physical fitness, quality of life, and fatigue in patients with cancer: a systematic review

Objective

The purpose of this study is to conduct a systematic review to assess the effects of different forms of resistance exercises (resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises) on physical fitness, quality of life (QOL), and fatigue of patients with cancer.

Methods

We conducted a systematic review using the Cochrane Handbook for Systematic Reviews of Interventions guidelines. We searched PubMed, Web of Science, and Scopus databases for the studies from the establishment of the database to September 2023, including randomized controlled trials and clinical trials that evaluated the effects of different resistance exercise on physical fitness, QOL, and fatigue in all patients with cancer. Two reviewers independently assessed the quality of all the included studies using the Cochrane Handbook for Systematic Reviews of Interventions and MINORS scale. We divided the intervention into three types: resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises.

Results

In total, 48 studies (3,843 participants) met the inclusion criteria. The three exercise intervention forms have significant effects on physical fitness and QOL, but the improvement effect on fatigue is not clear. A total of 34 studies reported significant and beneficial effects of resistance exercise on physical fitness across all types of cancer. There were 28 studies that reported significant or borderline improvement effects of resistance on QOL, and only 10 studies reported significant effects of resistance exercise interventions on fatigue improvement in patients with cancer.

Conclusions

Resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises all have a positive effect on improving fitness and QOL in patients with cancer. Resistance exercise has an advantage in improving muscle strength, while combined resistance exercise has an advantage in improving QOL; however, there are no consistent findings in improving fatigue, although low-intensity resistance exercise is effective.

Systematic review registration

www.inplasy.com, identifier INPLASY2023110034.

Investigation of the quality of life, mental status in patients with gynecological cancer and its influencing factors

BACKGROUND

Having a gynecological tumor or undergoing treatment can be a traumatic experience for women, as it affects their self-image and sexual relationships and can lead to psychological reactions. Psychological adjustment following cancer occurrence remains a key issue among the survivors.

AIM

To examine the current status of quality of life (QoL), anxiety, and depression in patients with gynecological cancer and to analyze the factors associated with it.

METHODS

Data for 160 patients with gynecological malignancies treated at Shanxi Bethune Hospital from June 2020 to June 2023 were collected and analyzed retrospectively. Patients' QoL was assessed using the European Organization for Research on Treatment of Cancer Quality of Life Questionnaire Core 30 and the Functional Assessment of Cancer Therapy-General Questionnaire. Their emotional status was evaluated using the Self-Rating Anxiety/Depression Scale. The associated factors of anxiety and depression were analyzed.

RESULTS

The overall QoL score of the patients 6 months after surgery was 76.39 ± 3.63 points. This included low levels of social and emotional function and severe fatigue and pain. The scores for physiological, functional, emotional, social, and family well-being exhibited an upward trend following surgery compared with those before surgery. One month after surgery, some patients experienced anxiety and depression, with an incidence of 18.75% and 18.13%, respectively. Logistic analysis revealed that good sleep was a protective factor against anxiety and depression in patients with gynecological tumors, whereas physical pain was a risk factor.

CONCLUSION

Patients with gynecological malignancies often experience anxiety and depression. By analyzing the factors that affect patients' QoL, effective nursing measures can be administered.

The relationship between psychological distress and cognitive failure among breast cancer survivors: a network analysis

Background

Psychological distress is highly prevalent and has a severe impact on the quality of life among breast cancer survivors. This type of distress is associated with cognitive failure. However, previous studies have focused solely on the total scale scores of these two concepts while ignoring the unique relationship between specific components. In the present study, we utilized network analysis to explore the relationship between psychological distress and cognitive failure in breast cancer survivors.

Methods

The network analysis approach was adopted to estimate the regularized partial correlation network in a cross-sectional sample of 409 breast cancer survivors. All participants were assessed using the Depression Anxiety Stress Scale and the Cognitive Failure Questionnaire. The Gaussian Graphical Model was employed to estimate the network, centrality indices, and edge weights, providing a description of the characteristics of the network.

Results

The results indicated that anxiety-stress and depression-stress were the strongest edges in the community of psychological distress. Distractibility-memory was the strongest edge in the community of cognitive failure. Distractibility and memory were the most central nodes, with the highest expected influence in the network. Depression and motor coordination acted as important bridge nodes with the highest bridge expected influence.

Conclusion

Distractibility and memory in cognitive failure played important roles in activating and maintaining the relationship network. Motor coordination was identified as the crucial pathway for the impact of cognitive failure on psychological distress. Interventions targeting these specific issues might be more effective in improving cognitive failure and reducing psychological distress among breast cancer survivors.

Psychological distress and health behaviours in people living with and beyond cancer: a cross-sectional study

This study aimed to examine whether psychological distress was cross-sectionally associated with meeting World Cancer Research Fund (WCRF) recommendations in people living with and beyond cancer. Participants were adults living with and beyond breast, prostate and colorectal cancer, participating in the baseline wave of the Advancing Survivorship after Cancer Outcomes Trial (ASCOT). Anxiety/depression was assessed using the EQ-5D-5L and dichotomised into any/no problems. WCRF recommendations were assessed via pedometers, 24-h dietary recalls, self-reported alcohol intake (AUDIT-C), and self-reported smoking status. Participants were categorised as meeting WCRF recommendations using the following cut-offs: average daily steps (≥ 10,000/day), average weekly aerobic steps (≥ 15,000/day), fruit and vegetables (≥ 400 g/day), fibre (≥ 30 g/day), red meat (< 500 g/week), processed meat (0 g/day), high calorie food (fat ≤ 33% of total daily energy intake and free sugar ≤ 5% of total daily energy intake), alcohol (≤ 14 units/week) and smoking (non-smoking). A composite health behaviour risk index (CHBRI) was calculated by summing the number of WCRF recommendations met (range: 0-9). Among 1348 participants (mean age = 64 years (SD = 11.4)), 41.5% reported anxiety/depression problems. The mean CHBRI score was 4.4 (SD = 1.4). Anxiety/depression problems were associated with lower odds of meeting WCRF recommendations for average daily steps (odds ratio (OR) = 0.73; 95% CI 0.55, 0.97), but not for any other health behaviour. Psychological distress is associated with lower adherence to WCRF recommendations for physical activity in people living with and beyond cancer. Physical activity may be a mechanism linking psychological distress and poorer outcomes among people living with and beyond cancer, and this should be explored in longitudinal studies.

Health Status in Heart Failure and Cancer: Analysis of the Medicare Health Outcomes Survey 2016-2020

BACKGROUND

People with heart failure (HF) and cancer experience impaired physical and mental health status. However, health-related quality of life (HRQOL) has not been directly compared between these conditions in a contemporary population of older people.

OBJECTIVES

The authors sought to compare HRQOL in people with HF vs those with lung, colorectal, breast, and prostate cancers.

METHODS

The authors performed a pooled analysis of Medicare Health Outcomes Survey data from 2016 to 2020 in participants ≥65 years of age with a self-reported history of HF or active treatment for lung, colon, breast, or prostate cancer. They used the Veterans RAND-12 physical component score (PCS) and mental component score (MCS), which range from 0-100 with a mean score of 50 (based on the U.S. general population) and an SD of 10. The authors used pairwise Student's t-tests to evaluate for differences in PCS and MCS between groups.

RESULTS

Among participants with HF (n = 71,025; 54% female, 16% Black), mean PCS was 29.5 and mean MCS 47.9. Mean PCS was lower in people with HF compared with lung (31.2; n = 4,165), colorectal (35.6; n = 4,270), breast (37.7; n = 14,542), and prostate (39.6; n = 17,670) cancer (all P < 0.001). Participants with HF had a significantly lower mean MCS than those with lung (31.2), colon (50.0), breast (52.0), and prostate (53.0) cancer (all P < 0.001).

CONCLUSIONS

People with HF experience worse HRQOL than those with cancer actively receiving treatment. The pervasiveness of low HRQOL in HF underscores the need to implement evidence-based interventions that target physical and mental health status and scale multidisciplinary clinics.

Parental Preconception Adversity and Offspring Mental Health in African Americans and Native Americans in the United States: A Systematic Review

This systematic review examines the impact of parental preconception adversity on offspring mental health among African Americans (AAs) and Native Americans (NAs), two populations that have experienced historical trauma and currently experience ethnic/racial mental health disparities in the United States. PsycINFO, PubMed, CINAHL, Scopus, and Web of Science were searched for studies that included at least two generations of AAs or NAs from the same family, measured parental preconception adversity and their offspring's mental health, and examined the association between these variables. Over 3,200 articles were screened, and 18 articles representing 13 unique studies were included in this review. Among the studies with samples that included AAs (n = 12, 92%), 10 (83%) reported a significant association between parental preconception adversity and adverse offspring mental health. The only study with a sample of NAs (n = 1, 8%) also reported a significant association between these variables. Although the literature suggests that parental preconception adversity is associated with offspring mental health among AAs and NAs, it must be interpreted in the context of the small number of studies on this topic and the less-than-ideal samples utilized-just one study included a sample of NAs and several studies (n = 6, 46%) used multi-ethnic/racial samples without testing for ethnic/racial disparities in their results. A more rigorous body of literature on this topic is needed as it may help explain an important factor underlying ethnic/racial mental health disparities, with important implications for interventions and policy.

The mediating role of health behaviors in the association between depression, anxiety and cancer incidence: an individual participant data meta-analysis

BACKGROUND

Although behavioral mechanisms in the association among depression, anxiety, and cancer are plausible, few studies have empirically studied mediation by health behaviors. We aimed to examine the mediating role of several health behaviors in the associations among depression, anxiety, and the incidence of various cancer types (overall, breast, prostate, lung, colorectal, smoking-related, and alcohol-related cancers).

METHODS

Two-stage individual participant data meta-analyses were performed based on 18 cohorts within the Psychosocial Factors and Cancer Incidence consortium that had a measure of depression or anxiety (N = 319 613, cancer incidence = 25 803). Health behaviors included smoking, physical inactivity, alcohol use, body mass index (BMI), sedentary behavior, and sleep duration and quality. In stage one, path-specific regression estimates were obtained in each cohort. In stage two, cohort-specific estimates were pooled using random-effects multivariate meta-analysis, and natural indirect effects (i.e. mediating effects) were calculated as hazard ratios (HRs).

RESULTS

Smoking (HRs range 1.04-1.10) and physical inactivity (HRs range 1.01-1.02) significantly mediated the associations among depression, anxiety, and lung cancer. Smoking was also a mediator for smoking-related cancers (HRs range 1.03-1.06). There was mediation by health behaviors, especially smoking, physical inactivity, alcohol use, and a higher BMI, in the associations among depression, anxiety, and overall cancer or other types of cancer, but effects were small (HRs generally below 1.01).

CONCLUSIONS

Smoking constitutes a mediating pathway linking depression and anxiety to lung cancer and smoking-related cancers. Our findings underline the importance of smoking cessation interventions for persons with depression or anxiety.

The dual roles of serotonin in antitumor immunity

Research has shown that a significant portion of cancer patients experience depressive symptoms, often accompanied by neuroendocrine hormone imbalances. Depression is frequently associated with decreased levels of serotonin with the alternate name 5-hydroxytryptamine (5-HT), leading to the common use of selective serotonin reuptake inhibitors (SSRIs) as antidepressants. However, the role of serotonin in tumor regulation remains unclear, with its expression levels displaying varied effects across different types of tumors. Tumor initiation and progression are closely intertwined with the immune function of the human body. Neuroimmunity, as an interdisciplinary subject, has played a unique role in the study of the relationship between psychosocial factors and tumors and their mechanisms in recent years. This article offers a comprehensive review of serotonin's regulatory roles in tumor onset and progression, as well as its impacts on immune cells in the tumor microenvironment. The aim is to stimulate further interdisciplinary research and discover novel targets for tumor treatment.

Nurse-Led Psychological Interventions For Depression In Adult Cancer Patients: A Systematic Review And Meta-Analysis of Randomized Controlled Trials

OBJECTIVES

Depression, frequently associated with cancer, significantly impacts health outcomes, necessitating effective treatments. This systematic review and meta-analysis aim to synthesize and critically evaluate the evidence from randomized controlled trials (RCTs) for the efficacy of nurse-led psychological interventions in managing depression among adult cancer patients. It focuses on the unique contribution of these interventions to improving depression management in oncology care, an underrepresented area in the existing literature.

METHODS

We conducted a comprehensive search in databases including Scopus, Medline, CINAHL, and PsycINFO, applying strict criteria to select RCTs assessing nurse-led psychological interventions for depression in cancer patients. We used the Cochrane Risk of Bias 2 tool to assess study quality.

RESULTS

Out of 425 screened abstracts, nine papers describing seven distinct interventions involving 1463 participants were selected. The overall effect size estimate of -0.75 (95% confidence interval: -1.23 to -0.27) indicates significant effectiveness of these interventions in reducing depression compared to treatment as usual. Additionally, the calculated prediction interval highlights the variability in effectiveness across different settings, suggesting that contextual factors play a crucial role in the success of these interventions.

CONCLUSION

The findings advocate for the integration of nurse-led psychological interventions into standard cancer care, highlighting their efficacy in improving depressive symptoms in adult cancer patients. These interventions show promise but require further refinement and research to optimize their effectiveness across diverse patient groups and healthcare settings. This review underscores the potential of nurse-led psychological interventions in enriching oncology care and addresses a critical gap in the existing body of research.

Depressive Symptoms, Socioeconomic Position, and Mortality in Older People Living With and Beyond Cancer

OBJECTIVE

Evidence shows that higher depressive symptoms are associated with mortality among people living with and beyond cancer (LWBC). However, prior studies have not accounted for a wider range of potential confounders, and no study has explored whether socioeconomic position (SEP) moderates the association. This study aimed to examine the association between depressive symptoms and mortality among people LWBC, and moderation by SEP.

METHODS

Participants from the English Longitudinal Study of Aging, diagnosed with cancer and with a measure of depressive symptoms within 4 years after their diagnosis, were included. Elevated depressive symptoms were indicated by a score of ≥3 on the eight-item Center for Epidemiologic Studies Depression Scale. Cox regression models examined associations with all-cause mortality. Competing risk regression examined associations with cancer mortality.

RESULTS

In 1352 people LWBC (mean age = 69.6 years), elevated depressive symptoms were associated with a 93% increased risk of all-cause mortality (95% confidence interval = 1.52-2.45) within the first 4 years of follow-up and a 48% increased risk within a 4- to 8-year follow-up (95% confidence interval = 1.02-2.13) after multivariable adjustment. Elevated depressive symptoms were associated with a 38% increased risk of cancer mortality, but not after excluding people who died within 1 year after baseline assessments. There were no interactions between depressive symptoms and SEP.

CONCLUSIONS

Elevated depressive symptoms are associated with a greater risk of all-cause mortality among people LWBC within an 8-year follow-up period. Associations between depressive symptoms and cancer mortality might be due to reverse causality.

Genetic correlation and causal associations between psychiatric disorders and lung cancer risk

BACKGROUND

Patients with certain psychiatric disorders have increased lung cancer incidence. However, establishing a causal relationship through traditional epidemiological methods poses challenges.

METHODS

Available summary statistics of genome-wide association studies of cigarette smoking, lung cancer, and eight psychiatric disorders, including attention deficit/hyperactivity disorder (ADHD), autism, depression, major depressive disorder, bipolar disorder, insomnia, neuroticism, and schizophrenia (range N: 46,350-1,331,010) were leveraged to estimate genetic correlations using Linkage Disequilibrium Score Regression and assess causal effect of each psychiatric disorder on lung cancer using two-sample Mendelian randomization (MR) models, comprising inverse-variance weighted (IVW), weighted median, MR-Egger, pleiotropy residual sum and outlier testing (MR-PRESSO), and a constrained maximum likelihood approach (cML-MR).

RESULTS

Significant positive correlations were observed between each psychiatric disorder and both smoking and lung cancer (all FDR < 0.05), except for the correlation between autism and lung cancer. Both univariable and the cML-MA MR analyses demonstrated that liability to schizophrenia, depression, ADHD, or insomnia was associated with an increased risk of overall lung cancer. Genetic liability to insomnia was linked specifically to squamous cell carcinoma (SCC), while genetic liability to ADHD was associated with an elevated risk of both SCC and small cell lung cancer (all P < 0.05). The later was further supported by multivariable MR analyses, which accounted for smoking.

LIMITATIONS

Participants were constrained to European ancestry populations. Causal estimates from binary psychiatric disorders may be biased.

CONCLUSION

Our findings suggest appropriate management of several psychiatric disorders, particularly ADHD, may potentially reduce the risk of developing lung cancer.

Homotherapy-for-heteropathy of Bupleurum Chinense DC.-Scutellaria baicalensis Georgi in treating depression and colorectal cancer: A network pharmacology and animal model approach

ETHNOPHARMACOLOGICAL RELEVANCE

Bupleurum chinense DC.-Scutellaria baicalensis Georgi (BS) is a classic drug pair that has good clinical effects on depression and many tumors. However, the concurrent targeting mechanism of how the aforementioned drug pair is valid in the two distinct diseases, has not been clarified yet.

AIM OF THE STUDY

The components of BS were detected by LC-MS, combined with network pharmacology to explore the active ingredients and common targeting mechanism of its multi-pathway regulation of BS in treating depression and CRC, and to validate the dual effects of BS using the CUMS mice model and orthotopic transplantation tumor mice model of CRC.

RESULTS

Twenty-nine components were screened, 84 common gene targets were obteined, and the top 5 key targets including STAT3, PIK3R1, PIK3CA, AKT1, IL-6 were identified by PPI network. GO and KEGG analyses revealed that PI3K/AKT and JAK/STAT signaling pathways might play a crucial role of BS in regulating depression and CRC. BS significantly modulated CUMS-induced depressive-like behavior, attenuated neuronal damage, and reduced serum EPI and NE levels in CUMS model mice. BS improved the pathological histological changes of solid tumors and liver tissues and inhibited solid tumors and liver metastases in tumor-bearing mice. BS significantly decreased the proteins' expression of IL-6, p-JAK2, p-STAT3, p-PI3K, p-AKT1 in hippocampal tissues and solid tumors, and regulated the levels of IL-2, IL-6 and IL-10 in serum of two models of mice.

CONCLUSION

BS can exert dual antidepressant and anti-CRC effects by inhibiting the expression of IL-6/JAK2/STAT3 and PI3K/AKT pathway proteins and regulating the release of inflammatory cytokines.

How race and socioeconomic status moderate the association between moderate-to-vigorous physical activity and depressive symptoms: a cross-sectional study with compositional data

OBJECTIVES

This study explored how race and socioeconomic status (SES) moderated the association between moderate-to-vigorous physical activity (MVPA) and depressive symptoms with compositional data.

METHODS

Participants were 2803 US adults from the 2005-2006 cycle of the National Health and Nutrition Examination Survey. Accelerometers were used to measure MVPA, light-intensity physical activity (LPA) and sedentary behaviours (SB). Participants self-reported sleep duration and depressive symptoms. SES was derived by latent class analysis using household income level, education attainment and occupation. The association between the relative time of MVPA and depressive symptoms and the moderating effects of race and SES were investigated through compositional data analysis. Isotemporal substitution analysis was employed to estimate the association of time reallocation from other movement behaviours to MVPA with depressive symptoms.

RESULTS

Increased time spent in MVPA relative to time spent in LPA, SB and sleep was inversely associated with depressive symptoms (OR (95% CI)=0.679 (0.538-0.855)). The relative time of MVPA significantly interacted with race and SES for depressive symptoms (P for interaction <0.05). Reallocating 10-30 min from sleep, SB or LPA to MVPA was associated with lower odds of depressive symptoms solely among non-Hispanic white individuals and those with higher SES.

CONCLUSION

This study used compositional data to reveal a reverse association between MVPA and depressive symptoms among white individuals and those with higher SES. Our results provide evidence of how race and SES moderate the relationship between MVPA and depressive symptoms. Future research is needed to further explore these racial and socioeconomic differences.

Shifting From Best Practice to Standard Practice: Implementing Measurement-Based Care in Health Systems

There is a high prevalence of untreated depression in adults and youth observed at the population level in the United States, and many who would benefit from treatment do not receive it. One proposed effort to increase access to care is the use of measurement-based care (MBC; repeated use of symptom measures for screening and treatment guidance) by primary care physicians to treat non-complex cases of depression. MBC has been shown to improve patient outcomes compared to care as usual, but there are barriers that need to be addressed at the health system level for effective implementation to occur. Herein we provide an overview of MBC and detail benefits and barriers of MBC implementation. Relevant considerations and guidance for implementing MBC are presented, and a case example of a health system implementing MBC is included. Though issues of reimbursement, limited human and technological resources, and resistance to systemic change are barriers to implementing MBC, effective strategies exist to overcome these barriers. In addition to helping health systems align with changes to value-based care models, effective implementation of MBC can likely improve patient outcomes and result in net financial benefits.

Research progress on the psychological burden and intervention measures in cancer patients

In the past 40 years, the gradually increasing incidence and mortality rates of malignant tumors have severely impacted the quality of life of patients, bringing significant physical and psychological burdens and becoming an increasingly serious social issue. With the development of medical standards, new methods for cancer detection and treatment have been continuously proposed. Although it has been proven that cancer is related to increased psychological burden and suicidal behaviors in patients, current research on the psychological burden caused by cancer is insufficient. Clinicians often overlook the psychological health issues of patients while treating their physical diseases. Considering the high incidence of cancer, this review will outline the psychological burdens of cancer patients worldwide in recent years and its high-risk factors. Moreover, this review will summarize the common methods for evaluating psychological burdens, present current predictive models and treatment methods for the psychological burden of cancer patients, aiming to provide a research basis and future direction for the timely and accurate assessment of the psychological burden in cancer patients.

"Let him die. He caused it": A qualitative study on cancer stigma in Tanzania

Cancer stigma presents a critical barrier to care seeking, contributing to delayed presentation and poor cancer outcomes worldwide. The burden of cancer in Tanzania is on the rise, with cancer being the third-leading cause of death in the country. Despite rising incidence and poor outcomes of cancer, cancer-related stigma interventions have received low prioritization. There is a need for sound research that focuses on understanding attitudes driving stigma, its impact on care-seeking and treatment adherence, and intervention models to reduce stigma. We used a cross-sectional qualitative study design. We administered three open-ended qualitative questions to 140 adults newly diagnosed with cancer in Moshi, Tanzania. The questions explored common attitudes toward people with cancer, the perceived impact of cancer-related stigma on care engagement, and ideas for reducing cancer stigma. Patients were recruited during routine appointments at the Cancer Center at Kilimanjaro Christian Medical Center. Data were analyzed using a team-based, applied thematic approach and NVivo 12 software. All participants described stigma as a significant challenge for treatment and receiving support from their social networks. Perceptions of financial burden, misconceptions about cancer, such as the belief that it is contagious, and fear of death, were common attitudes driving cancer stigma. Most participants feared that symptoms would prevent them from being able to work and that the cost of cancer care would drive away loved ones. Stigma was not a ubiquitous response, as some participants reported increased care and social support from family members after a cancer diagnosis. Experiences of stigma contributed to feelings of shame, fear of burdening the family, reduced resources to access treatment, and disengagement from care. Common substitutes to medical therapies included religious interventions and traditional medicine, perceived as less expensive and less stigmatizing. Many participants felt they would benefit from improved financial support, professional counseling, and education for families and communities to reduce stigmatizing attitudes and enhance social support. There is a need for intervention studies focused on improving cancer literacy, community advocacy to reduce cancer stigma, and increasing emotional and practical support for people with cancer and their families. There is also a clear need for policy efforts to make cancer care more affordable and accessible to reduce the financial burden on patients and families.

Tumor-infiltrating nerves functionally alter brain circuits and modulate behavior in a male mouse model of head-and-neck cancer

Cancer patients often experience changes in mental health, prompting an exploration into whether nerves infiltrating tumors contribute to these alterations by impacting brain functions. Using a male mouse model for head and neck cancer, we utilized neuronal tracing techniques and show that tumor-infiltrating nerves indeed connect to distinct brain areas via the ipsilateral trigeminal ganglion. The activation of this neuronal circuitry led to behavioral alterations represented by decreased nest-building, increased latency to eat a cookie, and reduced wheel running. Tumor-infiltrating nociceptor neurons exhibited heightened activity, as indicated by increased calcium mobilization. Correspondingly, the specific brain regions receiving these neural projections showed elevated cFos and delta FosB expression in tumor-bearing mice, alongside markedly intensified calcium responses compared to non-tumor-bearing counterparts. The genetic elimination of nociceptor neurons in tumor-bearing mice led to decreased brain Fos expression and mitigated the behavioral alterations induced by the presence of the tumor. While analgesic treatment successfully restored behaviors involving oral movements to normalcy in tumor-bearing mice, it did not have a similar therapeutic effect on voluntary wheel running. This discrepancy points towards an intricate relationship, where pain is not the exclusive driver of such behavioral shifts. Unraveling the interaction between the tumor, infiltrating nerves, and the brain is pivotal to developing targeted interventions to alleviate the mental health burdens associated with cancer.

The effectiveness of mind-body therapy and physical training in alleviating depressive symptoms in adult cancer patients: a meta-analysis

PURPOSE

The aim of this study was to assess the effectiveness of mind-body therapy (MBT) and/or physical training in alleviating depressive symptoms among adult cancer patients through a meta-analysis.

METHODS

PubMed, Embase, EBSCO, Web of Science, and Cochrane Library databases were searched from up to October 21, 2023. Effect sizes, 95% confidence intervals, and other pertinent values were computed utilizing a random-effects model with Review Manager 5.3 and StataMP 14. The reporting of findings adhered to the guidelines for systematic reviews and meta-analyses. The PROSPERO registration code for this review is 4,203,477,316.

RESULTS

10 randomized controlled trials (11 datasets) involving a total of 620 participants were selected for analysis. The results demonstrated that complementary therapies, encompassing MBT and physical training, were effective in alleviating depressive symptoms in adult cancer patients (SMD= -0.47; 95%CI: -0.87, -0.08; P = 0.02). Subgroup analysis indicate that physical training may effectively alleviate depressive symptoms (SMD= -0.72; 95%CI: -1.31, -0.13; P = 0.02), demonstrating moderate effect sizes. Conversely, MBT does not seem to significantly influence depressive symptoms (P = 0.69).

CONCLUSIONS

Complementary therapy lasting four weeks or more, incorporating physical training and MBT, has been shown to alleviate depressive symptoms in adult cancer patients. And physical training has a significant effect on depressive symptoms, while MBT has no effect. Nevertheless, given the constraints of the included studies, further research is required in the future to provide more robust evidence.

Association between anxiety, depression, and symptom burden in patients with advanced colorectal cancer: A multicenter cross-sectional study

OBJECTIVES

Patients with advanced colorectal cancer (CRC) have multiple concurrent physical and psychological symptoms. This study aimed to explore the relationship between anxiety, depression, and symptom burden in advanced CRC.

METHODS

A multicenter cross-sectional study was conducted in 10 cancer centers from geographically and economically diverse sites in China. A total of 454 patients with advanced CRC completed the Hospital Anxiety and Depression Scale and the MD Anderson Symptom Inventory. Multiple regression analysis was applied to explore the relationship between anxiety, depression and symptom burden.

RESULTS

About one-third of the patients showed symptoms of anxiety or depression. Patients with anxiety or depression reported significantly higher symptom burden than those without (p < 0.001). Patients with anxiety or depression reported a higher proportion of moderate-to-severe (MS) symptom number than those without (p < 0.001). About 52% of the patients with anxiety or depression reported at least three MS symptoms. The prevalence of MS symptoms was ranging from 7.3% (shortness of breath) to 22% (disturbed sleep), and in patients with anxiety or depression was 2-10 times higher than in those without (p < 0.001). Disease stage (β = -2.55, p = 0.003), anxiety (β = 15.33, p < 0.001), and depression (β = 13.63, p < 0.001) were associated with higher symptom burden.

CONCLUSIONS

Anxiety and depression in patients with advanced cancer correlated with higher symptom burden. Findings may lead oncology professionals to pay more attention to unrecognized and untreated psychological symptoms in symptom management for advanced cancer patients.

Humanistic Health Management and Cancer: Associations of Psychology, Nutrition, and Exercise with Cancer Progression and Pathogenesis

The incidence rate of cancer is increasing year by year due to the aging of the population, unhealthy living, and eating habits. At present, surgery and medication are still the main treatments for cancer, without paying attention to the impact of individual differences in health management on cancer. However, increasing evidence suggests that individual psychological status, dietary habits, and exercise frequency are closely related to the risk and prognosis of cancer. The reminder to humanity is that the medical concept of the unified treatment plan is insufficient in cancer treatment, and a personalized treatment plan may become a breakthrough point. On this basis, the concept of "Humanistic Health Management" (HHM) is proposed. This concept is a healthcare plan that focuses on self-health management, providing an accurate and comprehensive evaluation of individual lifestyle habits, psychology, and health status, and developing personalized and targeted comprehensive cancer prevention and treatment plans. This review will provide a detailed explanation of the relationship between psychological status, dietary, and exercise habits, and the regulatory mechanisms of cancer. Intended to emphasize the importance of HHM concept in cancer prevention and better prognostic efficacy, providing new ideas for the new generation of cancer treatment.